Musings of a Dinosaur

A Family Doctor in solo private practice; I may be going the way of the dinosaur, but I'm not dead yet.

Friday, January 16, 2009

Chiropractor Rant; or Time to Split

Got a call this afternoon from a lovely little old lady who had just been to the chiropractor. He was doing a manipulation on her hands (presumably for arthritis in her fingers) and had split the skin on the back of her hand. He was worried because it was "pretty close to a vein," and had asked her to get it checked out.


She came over to let me see the wound. Sure enough, there was a 3.5 cm (that's 1 and 3/8 inches to y'all you haven't gotten metric into your head) laceration of the skin on the back of her left hand. It went all the way through the skin, gaping wide open, leaving the subcutaneous tissues clearly visible. The thing is, the skin on the back of the hand is pretty thin, especially in little old ladies. There isn't any subcutaneous fat to speak of. The wound did come close to a superficial blood vessel at one end, but the vein was intact. By the time I saw her, the bleeding had stopped. There was some old dried blood under the skin, but the wound was clean. She said it didn't hurt at all.

I used steri-strips to approximate the skin edges, and they came together beautifully. (The last thing I'd want to do would be try to numb it up and stitch it.) I put a large band-aid over it to keep it clean and asked her to come back in a week so I could be sure it was healing.

I asked her why she went to a chiropractor. She said he made her back feel soooo good, and I believe her; she's got a significant rounding forward of the upper back, common in little old ladies. I have no problem with a chiropractor acting like a glorified massage therapist, at least for the axial musculature (ie, neck and back.) But what on earth would possess him to think he could do anything for arthritis by "manipulating" her hands!

So for those who believe chiropractors are mostly harmless back-crackers, beware of dangers that go beyond anti-vaccination rhetoric and the occasional stroke from cervical manipulation in patients with vascular disease in the neck. This guy actually split the patient's skin with his hands.

If you happen to be reading this in a chiropractor's office, my advice to you is: SPLIT, before he does it to you.


At Fri Jan 16, 06:48:00 AM, Blogger ariel said...

I had a patient once whose chiro broke her neck, leaving her completely and permanently paralyzed. no joke.

I went to one when I was a teenager, though, and the way he taped the arches of my feet felt really good.

At Fri Jan 16, 08:19:00 AM, Blogger Beach Bum said...

I went to one who massaged my forearms and hands. I'd had really bad tendonitis a couple years prior (which had ended my university piano studies), and what this chiro did for me really released my fingers and allowed me to play better and (more importantly for me) pain-free. I assume that he got rid of some adhesions.

So, while I don't buy all the snake oil in a chiropracter's dispensary, some of it can be helpful for the right patient.

But vigorous massage on a LOL? That's just stupid.

At Fri Jan 16, 06:05:00 PM, Anonymous Anonymous said...

So Doctor Dinosaur,

Do you believe a chiropractor has any therapeutic value? How about acupuncture? Osteopathy?


At Fri Jan 16, 07:39:00 PM, Anonymous Anonymous said...

I'm curious as well, what are your thoughts on the osteopathic manipulations practiced by some DOs?

At Fri Jan 16, 08:32:00 PM, Anonymous Anonymous said...

Great glory. I remember hearing about a chiro in our old town who manipulated a LOL for back pain. Alas, he mostly succeeded in increasing the number of pathologic fractures from her myeloma.

At Sat Jan 17, 08:47:00 AM, Blogger Vitriolic Virchow said...

The first chiropractor went to DO school, figured he'd learned enough in two years, and went out on his own. You do gotta be careful with manipulation, as bad things can happen. I've heard they'd be useful as gatekeepers for people with chronic back pain, because, well, there's nothing really else to be done with those patients anyway.

At Wed Jan 21, 02:49:00 PM, Anonymous Anonymous said...

Dino, anyidea what the differences in fees might have been? I be the LOL paid out of pocket (gladly "it feels ..good") more than you were paid.

When are you going cash?

At Mon Jan 26, 04:41:00 PM, Anonymous Anonymous said...

Hi let me first start off by saying I am a chiropractor.

This doctor should have been competent enough to realize manipulation in this case is a very poor choice. To be clear we are trained NOT to manipulate in the cause of RA. If this patient had OA then perhaps a paraffin bath or simply some ROM exercises may be an option. I agree he made a poor clinical decision and you were left to clean up his mess so to speak which if I were in your shoes would probably have posted an angry rant as well:)

I do however disagree with you on a few points. 1) Chiropractors are not "glorified massage therapists". The classroom hours are very similar to that of a medical student even surpassing them in certain areas such as A&P and radiology but obviously less in other areas such as pathology and obstetrics & gynecology. We are required to pass national and state board exams just like you guys. I agree that the lack of clinical rotations is a serious issue and that the knowledge and experience lost by not undertaking these is significant and something the profession needs to take a serious look at. 2) Not all chiropractors are anti-vaccination....Only the ones that choose to believe the dogma that some schools spout instead looking at the research:) Again I understand and agree with my MD friends in the area that the lack of consistency in the profession is a problem and needs to be addressed. Not all of us are anti-drug/anti-vaccination, in fact I'd say that is the minority.

I'm glad the MDs in the area know this as I do not advertise or even have anything more that my number in the phone book. I'd estimate 80% of my business are MD referrals while 20% are patient referrals.

I can understand that you and perhaps others have less that positive views concerning DCs. Some of the points out there are valid and do need addressed. But to be fair some of the information is out of date, inaccurate, or no longer being taught. Sure I am sure you there may be a knucklehead or two in your area but I am also willing to be there are some darn good DCs nearby too that when used in a combination with the vicodins, darvocets, motrins , diclofenacs, piroxicams, medrol dose packs, flexerils, somas, baclofens, skelaxin (or whatever route you choose to go) can do a lot of good and help your back and neck pain patients recover much faster.

In any event I enjoying reading your blog and will continue to do so!

Thanks... J.K. DC


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