Dr Merri's Blog

A study published in the Journal of Evaluation in Clinical Practice on April 4, 2017, found that more than 20 percent of medical patients are misdiagnosed. The study titled "Extent of Diagnostic Agreement Among Medical Referrals" looked at the diagnosis originally given to patients and compared that to the diagnosis later given upon the patient seeking a second opinion.

The study reviewed the records of 286 patients who were referred by their primary care doctor to the Mayo Clinic's General Internal Medicine Division in Rochester, Minnesota, over a two-year period from Jan. 1, 2009 to Dec. 31, 2010.

Overall, the results showed only 12 percent of those seeking a second opinion at the Mayo Clinic had their diagnoses confirmed. However, 21 percent of the patients had their diagnosis completely changed, while 66 percent of those patients received a refined or redefined diagnosis. Overall, the study showed that almost 88 percent of patients seeking a second opinion at the Mayo Clinic receive a new or refined diagnosis.

Previous research cited in the new study showed that errors in diagnosis "...contribute to approximately 10 percent of patient deaths." Additionally they "account for 6 to 17 percent of adverse events in hospitals."

"Effective and efficient treatment depends on the right diagnosis," said study co-author James Naessens, a health care policy researcher at the Mayo Clinic, in an April 4th press release in Science Daily. "Knowing that more than 1 out of every 5 referral patients may be completely [and] incorrectly diagnosed is troubling -- not only because of the safety risks for these patients prior to correct diagnosis, but also because of the patients we assume are not being referred at all."

In a Washington Post article, Mark L. Graber, a senior fellow at the research institute RTI International and founder of the Society to Improve Diagnosis in Medicine, who was not involved with the study noted, "Diagnosis is extremely hard. There are 10,000 diseases and only 200 to 300 symptoms." He added, "Doctors are humans, and they make the same cognitive mistakes we all make. If you are given a serious diagnosis, or you’re not responding the way you should [to medication], a second opinion is a very good idea. Fresh eyes catch mistakes."

Second opinions are still encouraged, but the concern is that they may be limited due to in-network insurance issues preventing patients from seeking second opinions. In response to the problem of diagnosis error, the National Academy of Medicine has called for dedicated federal funding for improved diagnostic processes and error reduction.

It is obvious that there is an increase in cost both in diagnosis and medical treatment if the first diagnosis is not confirmed by the second opinion. However, Naessens sums up the concerns if a second opinion is not sought saying, "Total diagnostic costs for cases resulting in a different final diagnosis were significantly higher than those for confirmed or refined diagnoses, but the alternative could be deadly."

A long-term case study published on February 9, 2017, in the Annals of Vertebral Subluxation Research followed the improvement received from chiropractic care of an elderly man with a long list of health issues including difficulty in walking, balance, standing and overall mobility. Mobility, musculoskelital pain, and balance are of key concern to the geriatric population and have a significant impact on the quality of life.

Pain plays a key role in the abilities of a senior to function normally. According to a 2014 study in the Journal of Physical Therapy Science. "Spinal pain is the most common of all chronic pain disorders. In a previous study, 24.6% of older adults with chronic pain reported back pain."

In this case, an 85-year-old man presented himself to the chiropractor for a variety of health concerns. His chief complaints for which he went to the chiropractor were difficulty walking and poor posture. In addition to the issues he sought chiropractic for, he also had a number of prior medical diagnoses that included benign prostatic hypertrophy, osteoporosis, heart valve insufficiency, high cholesterol, high blood pressure, angina, and other assorted problems. Most of his issues were being treated medically. As a result, the man had been prescribed eighteen different medications that were being taken on a daily basis.

A chiropractic examination was performed. This included a range of motion study, paraspinal thermography, a postural analysis, spinal motion palpation and spinal x-rays. As expected, the man's range of motion in all areas was significantly reduced. His head was carried in a forward position causing a roundness of his shoulders. The spinal x-rays on this patient showed considerable calcium buildup indicative of intervertebral degenerative joint disease, spinal arthritis, and old compression fractures of several of his vertebrae.

Based on the findings of all the examination procedures, the diagnosis for this man was healed compression fractures, calcification of the abdominal aortic, atherosclerosis, abnormal postural and vertebral subluxations in the cervical, thoracic and lumbar regions of the spine. With this diagnosis, chiropractic care was rendered.

This study recorded the chiropractic care and progress for this man over an eight year period. Over that time, a variety of chiropractic techniques were utilized. The study records that, over time, the man's overall health improved and he experienced improvement in gait, balance stability, coordination, posture and reported an increase in strength in the lower extremities. The man's medical doctor also noticed the changes and commented that the patient was healthier while under chiropractic care. In addition, he was able to get himself in and out of a chair, and was able to reduce the amount of prescription and over the counter medication he was taking.

The author of this study summed up the implications of this study by noting, "Age related musculoskeletal problems can cause impairment in a patient's balance and gait. An unstable person on their feet puts them at a higher risk of falling and as age increases so does the risk of falling." She continued to explain how this can help by saying, "Individuals over the age of 65 years of age that suffer from musculoskeletal dysfunctions may benefit from chiropractic care. Chiropractic care focuses on the vertebral subluxation complex (VSC)."

A case study published in the Annals of Vertebral Subluxation Research on August 18, 2016, showed how chiropractic helped improve the quality of life for a patient with Multiple Sclerosis (MS) by showing improvement in breathing and muscle strength.

The study begins by defining MS by saying, "Multiple sclerosis (MS) is a chronic, degenerative disease of the nervous system that is demyelinating and inflammatory in nature and is characterized by patchy sclerosis of the central nervous system (CNS)." They note that MS affects 400,000 people in the United States and over 2 million people worldwide. Half of those with MS also experience depression, and almost all patients with MS have a shortened life expectancy.

Some of the symptoms associated with MS can include numbness in the extremities, fatigue, muscle spasms, muscle weakness, vision loss, blurred vision, loss of coordination, gait alteration, seizures, mood swings, depression, tremors, impaired bladder control, and loss of sphincter control. Medical care for MS is geared around helping patients with the symptoms, as there is no known medical care available for the condition itself.

In this case, a 58-year-old woman presented herself for chiropractic care. She was confined to a wheelchair and had been diagnosed with MS. Her history shows that she was suffering with constant, severe, throbbing pain in her left hip for 6 years. Additionally she reported suffering from neck pain, neck stiffness, wrist pain, irritability, constipation, sinus problems, cold feet, cold hands, tension, dry skin, heat and cold intolerances, tingling sensation in her arms, shoulder pain, shortness of breath, depression, and difficulty urinating.

A chiropractic examination was performed which included a visual and postural inspection, spinal x-rays, and thermographic studies to check for heat variations. In addition her respiratory volume levels were checked and her hand grip strength was measured.

Specific chiropractic care was begun to address the subluxations determined to be present in the woman's spine. Care was rendered over a 10 week period consisting of 30 total visits. After this period, a re-evaluation was performed.

The re-evaluation x-rays showed a notable spinal improvement. Additionally, the woman's respiratory volume had measurably improved. Her grip strength also improved, with her left-hand grip strength improving from 2.8 lbs to 12 lbs, and her right-hand grip strength improved from 3.0 lbs to 8.0 lbs.

The results of this study were consistent with other studies of MS patients under chiropractic care. The authors cited several other studies showing chiropractic helping patients with MS. In one reported study, researchers found that 90.9% of MS patients in that study showed symptomatic improvement and no further progression in the MS disease process while under chiropractic care.

In explaining a possible mechanism for why MS patients can be helped by chiropractic, the authors stated, "A properly functioning immune system will prevent MS development or can even initiate healing within the nervous system. Chiropractic adjustments have been shown to restore immune system integrity to a normal state."

On February 27, 2017, the Annals of Vertebral Subluxation Research published a case study documenting a patient suffering a loss of the sense of smell (Anosmia), which was corrected with chiropractic care. According to the Anosmia Foundation, between 2 and 5 million American adults suffer from some form of this condition.

The study reports that a loss of smell can be either partial or complete, and can be temporary or permanent. A complete loss of smell is rarer. The condition is more common in the elderly population. Some of the associated causes can include head trauma, sinus or nasal diseases, pathologies, toxic exposures such as cocaine abuse, and some very rare congenital anomalies. Several medical conditions have also been associated with a loss of the sense of smell. These include: Alzheimer's disease, Multiple Sclerosis, Parkinson's disease, and depression.

In this case, a 58-year-old woman came to the chiropractor for care related to her high blood pressure as well as symptoms from a recent car accident a month earlier. Her blood pressure condition had been present for 20 years since the birth of her son, and she was taking medication since that time. Since her car accident, she had been suffering with right shoulder and mid-back pain.

The woman reported that she had been involved in another car accident 9 years prior. It was immediately after this accident that she had lost her sense of smell. Her ability to smell had not returned since that time.

A chiropractic examination was performed which included palpation, a posture assessment, paraspinal surface EMG, and x-rays. Based on the findings, specific forms of chiropractic care were initiated.

The results of the care were objectively documented by improvements in the paraspinal surface EMG, the spinal x-rays and the other examination procedures that were performed.

Over the course of care, the woman reported that the pain from her most recent accident was dramatically reduced. Additionally, she noted that her sense of smell had completely returned.

The study authors noted that there is no standard medical care for anosmia. Many times, this condition is overlooked because of the concern of more severe injuries in post-traumatic accidents. A common medical treatment for this condition is the use of oral steroids. However, published studies on this type of treatment has shown that the use of steroids is just as effective as spontaneous recovery, but carries significant risk of side effects.

Because of the lack of successful medical treatment, and the increased risk due to steroid usage, the authors believe that additional studies into chiropractic for people with a loss of their sense of smell is warranted.

All 32 NFL teams include the professional services of a DC as part of their integrated health care team approach, according to a February 1, 2017, release by the Foundation for Chiropractic Progress. Both the Super Bowl participants, the Atlanta Falcons and the Champion New England Patriots had team chiropractors available to adjust their players for optimal performance and reduce the risk of injuries.

The release notes that the New England Patriots have had the same team chiropractor for 35 years. Dr. Michael Miller, who attended his ninth Super Bowl this year stated, "During the NFL season, I regularly visit the stadium on my afternoon off from my office, as well as on game days both at home and away. Chiropractic care is emphasized by the head coach, trainers and medical staff as a proactive regimen to prevent injuries, with most of the players receiving adjustments roughly 1-2 times per week."

Chiropractic has two functions when it comes to care for athletes. They seek care to maximize their performance, and to prevent and manage injuries. Dr Miller explains, "We've also earned the respect of other team physicians as a necessary protocol, and are all committed to one goal: keeping the athletes performing at their maximum potential and preventing and managing injuries as they occur." He continued, "The players are educated about the principles of chiropractic and that it is designed to eliminate the cause of their problem rather than just masking their symptoms."

The Atlanta Falcons team chiropractor, Dr. Joseph Krzemien, points out that players who receive regular chiropractic care are less prone to injury. "During the six seasons I've spent with the Atlanta Falcons, my goal has always been to prepare each player's body to better resist trauma and to speed its natural recovery time," he says. "This season, the Falcons have been successful for a lot of reasons, but I firmly believe that regular chiropractic care has played an important role in helping us stay healthy and get to Super Bowl LI – I am proud of the role I've played in their success."

The Green Bay Packers chiropractor, Dr. Michael Zoelle, added, "Ensuring that the joints are functioning properly is critical in the healing process, as well as for injury prevention and optimal performance," says Dr. Zoelle. "The players recognize that chiropractic care helps them to perform better and heal faster, ultimately leading to better team success."

Dr. Lucas Matlock, President of the Florida Chiropractic Society and chiropractor for many professional athletes, explains how important chiropractic is for the success of a professional athlete. "Chiropractic detects and removes interference to the nervous system at the spine, called subluxations. When an athlete's nervous system is free from interference, he or she can perform at a maximum level. For some athletes this could be the difference between making the team and the Hall of Fame."

Published on December 5, 2016, in the journal Annals of Vertebral Subluxation Research is a case study of a man who was suffering from lower back pain and erectile dysfunction being helped by chiropractic.

According to the study authors, erectile dysfunction (ED) is defined as a man's inability to attain or sustain an erection satisfactory for sexual intercourse. They report that there are two classifications of ED, primary and secondary. Primary ED is a man who has never been able to have an erection, while secondary is the case where a man used to be able to have an erection but is currently unable to.

According to the University of Wisconsin School of Medicine and Public Health website, "About 5 percent of men that are 40 years old have complete erectile dysfunction, and that number increases to about 15 percent of men at age 70. Mild and moderate erectile dysfunction affects approximately 10 percent of men per decade of life (i.e., 50 percent of men in their 50s, 60 percent of men in their 60s)."

In this case, a 47-year-old man went to the chiropractor on three separate occasions for the complaints of lower back problems and neck pain. At those times, he did not report that he had also been suffering from ED since the age of 22 years. He did have a history of spinal trauma at the ages of 16 and 20 years.

An examination performed on this first set of visits to this chiropractor yielded the conclusion that subluxations were present in the man’s spine. Care was given in the form of specific adjustments and the man reported a significant recovery. He thereafter decided not to continue with chiropractic wellness and he discontinue his care.

Several years later, the man returned to the chiropractor again suffering from lower back pain. Once again care was given and the man experienced a significant recovery. This time he was able to resume sports and activities fairly quickly which led to him suffering a neck injury several months later.

Although the man did not share his history of having ED with the chiropractor initially, upon returning for chiropractic care related to his neck injury, the man noticed the correlation between the correction of his ED and the time he was under chiropractic care. Because of this connection, the man continued his chiropractic on a wellness basis and was able to report to the chiropractor that his ED was effectively eliminated while under chiropractic care.

The man commented about his ED improvement by saying, "For a short time after receiving an adjustment it is much easier and highly more likely that (he) will attain and maintain a strong erection." When asked by the doctor if he will be maintaining his chiropractic care since he has made the connection between that and the improvement in his ED, he commented, "Of course!"

The Journal of Pediatric, Maternal & Family Health published a study on October 10, 2016, reporting on the case of a toddler suffering with developmental delays in speech and coordination being helped through chiropractic care.

The study begins by discussing the increased usage of complementary alternative medicine (CAM) by children. CAM consists of a wide variety of non-medical forms of health care. While some classify chiropractic as a separate and distinct form of healthcare, many classify it within the umbrella of CAM professions. The authors note that several studies have shown that chiropractic is the most popular form of CAM for children in the U.S. since an initial study in 2007. They report that one in four children with common neurological conditions use some form of CAM.

In this case, a 2-year-old boy was brought to a chiropractic clinical training center for evaluation. The toddler had developmental delays in speech and coordination. According to his mother, her son was delayed and had consistently failed to meet developmental milestones. His symptoms included below average locomotion skill, delayed hearing comprehension and expressive communication, and difficulty swallowing certain food textures. The boy was born several weeks pre-mature and had suffered one seizure when he was three months old.

The boy had been receiving speech and physical therapy for one year prior to any chiropractic care. The therapy did show some signs of improvement. The therapy consisted of 30-minute sessions twice a month for six months designed to increase the child's motor skills through the use of therapeutic play, gait training, ball skills and a home program. The boy's physical therapist performed several standardized tests prior to chiropractic care that measured and confirmed the boy was developmentally delayed.

An examination was performed which included a visual inspection, palpation, and a postural analysis. Based upon the history and the examination, subluxations were determined to be present affecting the child's spine and nervous system. Specific chiropractic adjustments were given to address the subluxations.

The study records that the boy responded well to care with a steady improvement in his speech and coordination. His mother also reported that his "outbreaks" had decreased to only occurring rarely, late at night, if her son was tired. In a follow up examination performed by the physical therapist after starting chiropractic care, there was a continual improvement in the boy's developmental issues.

In their conclusion the authors wrote, "This case report informs clinical practice and research on the possible benefits of chiropractic care in children with developmental delays through chiropractic adjustments to address the presence of subluxations."

The Journal of Pediatric, Maternal & Family Health published a case study on April 3, 2017, documenting the case of a woman who experienced a shorter and easier birth due to chiropractic care. This improvement was compared to her first pregnancy and delivery where she did not receive any chiropractic care.

The study begins by noting that chiropractic care has been involved in the care of pregnant women since the early days of the profession over a century ago. The authors note that over 76% of practicing chiropractors report that the care of pregnant women is a part of their practices. This care is rendered for both musculoskeletal issues related to pregnancy as well as care for overall wellness during pregnancy.

In this study, a 28-year-old woman went to the chiropractor for evaluation and possible care. She sought chiropractic for a pain in her tailbone area as well as for wellness care. The woman believed that her pelvis had shifted due to her first pregnancy. She reported that after the delivery of her firstborn, she experienced pain and discomfort at her tailbone any time she sat on a hard surface. The woman reported that her first pregnancy went well, but that her delivery was very long and difficult. This was one of the factors in her desire to receive chiropractic care in anticipation of her second pregnancy. 

Her history revealed that between the ages of eight and sixteen, she was a competitive gymnast and was receiving chiropractic intermittently during that time. She also noted that she did not receive any chiropractic care during her first pregnancy. Prior to her first pregnancy, she did not have tailbone pain. She later attributed her long and difficult labor and delivery as being the cause of the tailbone pain.

A chiropractic examination was performed and it was determined that multiple vertebral subluxations were present. Care was started to address the subluxations through a series of adjustments to the areas involved. After a number of adjustments, the woman reported a 50% reduction in the tail bone pain. She then became pregnant for the second time. The chiropractic care was continued to, hopefully, facilitate an easier delivery process.

As with her first birth, the woman decided to have her second child at home. She was supervised by the same Certified Professional Midwife (CPM) that attended her first home birth. According to the midwife, the woman’s first labor and delivery time combined was 32 hours and 25 minutes. After chiropractic care, the midwife reported that the woman’s labor and delivery times for her second child was only two hours and 45 minutes combined.

In their conclusion, the study authors note that chiropractic care during pregnancy is far more valuable than just symptomatic relief of musculoskeletal pains, and should be considered for the overall wellness and process of pregnancy. They stated, "This case report provides supporting evidence that subluxation centered chiropractic care on pregnant patients can have beneficial effects on the birthing process."

The Journal of Pediatric, Maternal & Family Health published a case study on April 14, 2016, documenting the case of a baby girl who was suffering with a variety of digestive and neurological problems being helped by chiropractic. The baby had been diagnosed medically with Sandifer syndrome since birth.

The study reports that Sandifer syndrome is when a baby exhibits contortions of the head and neck, sometimes the chest, and abnormal postures, in an effort to relieve their symptoms from severe gastro-esophageal reflux with or without hiatal hernia. It is believed that these spasms may actually be seizures and appear as sudden extensions of the head and neck where the head may be twisted from side to side and the upper part of the trunk bent from side to side.

In this case, a 12-pound, 11-week-old baby girl suffering from reflux and digestive problems, possible seizures, and possible colic, was brought to the chiropractor. She had been diagnosed by a pediatric neurologist and pediatric GI specialist with Sandifer syndrome. Her symptoms included explosive bowel movements since birth, but she started to become constipated, going 3-5 days without a bowel movement. It was reported that the infant screamed uncontrollably during her first week of life.

The infant girl also experienced regular hiccups, vomiting, and difficulty lying flat which would cause her hands to shake, eyes bounce, face to become red, and she would scream. Due to the severity of her suffering, the baby was placed on the powerful medication Zantac twice per day.

A chiropractic examination with spinal palpation was performed. Vertebral subluxations were found and specific adjustments were done as needed. By the seventh visit, the study reports that the baby showed more frequent bowel movements, decreased reflux, decreased gagging, decreased spitting up, and was able to lay flat again.

As care continued, by the 10th visit it was noted that the patient began sleeping in her crib for six hours a night and was having bowel movements daily. On the 12th visit, the baby's mother was asked to fill out an evaluation, form to report on the progress of her baby girl. In the evaluation, she noted that her daughter was less congested, had no more episodes of shaking, was better during tummy time, showed less fighting when eating, had better sleeping, and more frequent bowel movements. The baby girl also exhibited more energy, and an overall increase in playfulness.

The Journal of Pediatric, Maternal & Family Health published a follow-up study on February 2, 2017, showing the long-term improvement of scoliosis with chiropractic. This study was the second of two studies that tracked the long-term progress of patients who had participated in an earlier scoliosis study.

The original study looked at 36 subjects with scoliosis and followed their initial progress of correction with chiropractic care. This study reviewed those cases and looked long-term to see how the chiropractic care had an effect over a longer period of time.

The researchers noted that adolescent idiopathic scoliosis (AIS) affects 2-4% of children between the ages of 10-16 years. Idiopathic scoliosis is the largest category of scoliosis. The medical treatment for this condition is usually bracing, or in more severe cases surgery.

In prior studies, bracing was shown to be of limited benefit with several major studies showing that, over the long-term, the patient's scoliosis continued to get worse. Surgery for scoliosis is a severe risky process with results being mixed. The cases where the surgery is unsuccessful leave the patients with significant health issues. In the opinion of many, surgery should be only considered in the most extreme cases and as a last resort.

A number of chiropractic studies have shown variable degrees of correction of scoliosis from the care. In most all cases, there was minimal risk of harm with the worst case scenario being that the scoliosis continued to progress over time.

This study looked at two groups of subjects. One was a group with scoliosis and one group was less severe and categorized as sub-scoliosis. The ranges of age for the scoliosis group was 7-16 years of age, with the sub-scoliosis group ranging from 4-17 years of age.

The results showed that of the 36 subjects included in the original study, 24 continued care. Of those, only 20 had an additional spinal x-rays taken and therefore could be included in this study review. During the time between the first follow-up x-rays and the final follow-up x-rays, there was a 7.6% reduction on average for those subjects with scoliotic curves, and a further 18% decrease for those who were classified as having sub-scoliotic curves.

The initial study had shown an improvement in the curvatures of most all subjects in the original study. When 20 of those were x-rayed again sometime later, most showed additional long-term correction of their curvatures. The subjects had received care from between one and four years.

On average, the additional correction of curvature for the entire group showed a 12.9% decrease in curvature following the initial care. This change added to the initial change resulted in a 46.8% mean average decrease of the curvatures over the course of care for the entire group. When looked at individually, the researchers noted that the 10 subjects in the scoliosis group had an average correction of 31.5%, while the 10 subjects in the sub-scoliosis group had a average correction of 62.1%.