Carotid Artery Dissection

Jeff Williams - evidence-based chiropractor

Two Surgeries, Two Outcomes & Cervical Artery Dissection and Spinal Manipulative Therapy

September 14, 2023 chiropracticforward Carotid Artery Dissection, Outcomes, Surgery, Vertebral Artery Dissection 0:15:59 0 Comments

CF 295: Two Surgeries, Two Outcomes & Cervical Artery Dissection and Spinal Manipulative Therapy

Today we’re going to talk about Two Surgeries, Two Outcomes & Cervical Artery Dissection and Spinal Manipulative Therapy

But first, here‘s that sweet sweet bumper music

 

Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!

Chiropractic evidence-based products

Integrating Chiropractors

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OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.

We’re the fun kind of research. Not the stuffy, high-brow, look down your nose at people kind of research. We’re research talk over a couple of beers.

I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast. I’m so glad you’re spending your time with us learning together.

Chiropractors – I’m hiring at my personal clinic. I need talent, ambition, drive, smart, and easy to get along with associates. If this is you and Amarillo, TX is your speed, send me an email at creekstonecare@gmail.com

If you haven’t yet I have a few things you should do.

  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s excellent educational resource for you AND your patients. It saves you time putting talks together or just staying current on research. It’s categorized into sections so the information is easy to find and written in a way that is easy to understand for everyone. It’s on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams.
  • Then go Like our Chiropractic Forward Facebook page,
  • Join our private Chiropractic Forward Facebook group, and then
  • Review our podcast on whatever platform you’re listening to
  • Last thing real quick, we also have an evidence-based brochure and poster store at com

You have found yourself smack dab in the middle of Episode 295

Now if you missed last week’s episode, we talked about Kids’ Screen Time & Physical Activity In Older Adults

Make sure you don’t miss that info. Keep up with the class.

On the personal end of things…..

Crazy week of trying to do too many things but one particular thought I will share with you all, there is a group that I have been in negotiations with for quite some time now. We are deciding whether or not we will sell a portion of our clinic to a larger conglomerate.

What if an established group came to you and offered to buy a certain portion of your practice and they were offering you more money for that portion than you think you could get for 100% on the private market?

What if? What would you do?? What would be your parameters? Your absolutely nots with regard to what you would accept and not accept for your salary, your staff, restrictions on your clinic’s spending and overhead?

It’s pretty interesting. There was a time when I was absolutely opposed to selling any portion of something I’ve built with blood, sweat, and tears over 20+ years.

When you’re 51 and getting more and more tired every year, things start to look a little differently don’t they? That’s what we’re doing right now and I can say……I think it’s going to happen but, as usual, you know I’ll be sharing the info with you as I go along the process. Once I know when I’ve made the right decision, if I think it would benefit my listeners, I’ll be happy to connect you with the group as well.

But I’ll be taking the hickey first before I ever share the info on the podcast. I have a good feeling about it so….down the road I go.

Item #1

 

The first on today is called “ Two Surgeries, Two Outcomes” by HBR Editors and published in Harvard Business Review and on March 18, 2019.

Why They Did It

Both Sean and Carla experienced back pain for years, leading them to seek medical intervention. They both had abnormal MRIs, prompting them to explore their respective healthcare options. Sean chose to go through a traditional route with his insurance, while Carla opted for Walmart’s Centers of Excellence (COE) program for spine surgeries. Their decisions were likely influenced by factors such as their previous experiences with healthcare, financial considerations, and recommendations from their healthcare providers.

How They Did It

 

Sean’s Path:

  • Scheduled surgery with a local surgeon through traditional insurance.
  • Utilized traditional insurance coverage for the procedure.

Carla’s Path:

  • Contacted her traditional insurance carrier, which connected her with a third-party administrator (TPA).
  • The TPA team handled her intake and gathered relevant health history.
  • Selected a hospital affiliated with Walmart’s COE program based on her location.
  • Hospital team reviewed her medical records and MRI images, connecting her with a nurse navigator.
  • Flew to the hospital with her sister, received specialized care, and underwent surgery.

What They Found

Sean’s Experience:

  • Followed a conventional healthcare path.
  • Paid 50% of his spine surgery costs, which averaged around $15,000 for Walmart associates.
  • Returned to work after 90 days.

 

Carla’s Experience (COE Program):

  • Engaged with a streamlined process via Walmart’s COE program.
  • Received comprehensive care package, including procedures, devices, tests, drugs, services, and travel expenses for both her and her caregiver.
  • Stayed in the hospital for 2.5 days, which was the average for associates using the COE program.
  • Transferred to a local hotel for recovery.
  • Experienced a hassle-free postoperative journey, including postoperative visits and transportation.
  • Returned to work after 75 days.
  • Incurred no personal expenses for the surgery.

Wrap It Up

 

The COE program offered by Walmart provides a more streamlined and comprehensive healthcare experience for associates like Carla. It bypasses traditional insurance companies, negotiating bundled payments that cover all necessary costs associated with the procedure, including travel and lodging. This approach not only reduces financial burden on the patient but also ensures a smoother journey from diagnosis to recovery.

 

Comparatively, Sean’s experience with traditional insurance involved more fragmented steps and cost-sharing, ultimately leading to a longer recovery time and higher out-of-pocket expenses. While the COE program might have a higher upfront cost for Walmart, it proves to be a cost-effective solution in the long run, as it minimizes unnecessary surgeries and leads to better outcomes for the associates involved. This case study highlights the potential benefits of innovative healthcare programs in enhancing both patient experience and overall cost-effectiveness.

 

 

Before getting to the next one,

 

Next thing, go to https://www.tecnobody.com/en/products That’s Tecnobody as in T-E-C-nobody. They literally have the most impressive clinical equipment I’ve ever seen. I own the ISO Free and am looking to add more to my office this year or next. The equipment you’re going to find over there can be marketed in your community like crazy because you’ll be the only one with something that damn cool in your office.

 

When you decide you can‘t live without those products, send me an email and I‘ll give you the hookup. They will 100% differentiate your clinic from your competitors.

I have to tell you, Dr. Chris Howson, the inventor of the Drop Release tool re-activated the code! Use the code HOTSTUFF upon purchase at droprelease.com & get $50 off your purchase. Would you like to spend 5-10 minutes doing pin and stretch and all of that? Or would you rather use a drop release to get the same or similar results in just a handful of seconds. I love it, my patients love it, and I know yours will too. droprelease.com and the discount code is HOTSTUFF. Go do it.

Item #2

Our last one this week is called, “ The association between cervical artery dissection and spinal manipulation among US adults” by James M Whedon, Curtis L Petersen, William J Schoellkopf, Scott Haldeman, Todd A MacKenzie, Jon D Lurie and published in PubMed on  09 July 2023. Hot potato!

Why They Did It

Cervical artery dissection (CeAD), which includes both vertebral artery dissection (VAD) and carotid artery dissection (CAD), is the most serious safety concern associated with cervical spinal manipulation (CSM). We evaluated the association between CSM and CeAD among US adults.

How They Did It

Through analysis of health claims data, we employed a case-control study with matched controls, a case-control design in which controls were diagnosed with ischemic stroke, and a case-crossover design in which recent exposures were compared to exposures in the same case that occurred 6-7 months earlier. We evaluated the association between CeAD and the 3-level exposure, CSM versus office visit for medical evaluation and management (E&M) versus neither, with E&M set as the referent group.

 

 

 

What They Found

  • We identified 2337 VAD cases and 2916 CAD cases. Compared to population controls, VAD cases were 0.17 (95% CI 0.09 to 0.32) times as likely to have received CSM in the previous week as compared to E&M. In other words, E&M was about 5 times more likely than CSM in the previous week in cases, relative to controls.

  • CSM was 2.53 (95% CI 1.71 to 3.68) times as likely as E&M in the previous week among individuals with VAD than among individuals experiencing a stroke without CeAD. In the case-crossover study, CSM was 0.38 (95% CI 0.15 to 0.91) times as likely as E&M in the week before a VAD, relative to 6 months earlier. In other words, E&M was approximately 3 times more likely than CSM in the previous week in cases, relative to controls. Results for the 14-day and 30-day timeframes were similar to those at one week.

Wrap It Up

Among privately insured US adults, the overall risk of CeAD is very low. Prior receipt of CSM was more likely than E&M among VAD patients as compared to stroke patients. However, for CAD patients as compared to stroke patients, as well as for both VAD and CAD patients in comparison with population controls and in case-crossover analysis, prior receipt of E&M was more likely than CSM.

Let’s get to the message. Same as it is every week.

 

Store

Remember the evidence-informed brochures and posters at chiropracticforward.com.

 

 

Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!

Chiropractic evidence-based products

Integrating Chiropractors

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The Message

I want you to know with absolute certainty that when Chiropractic is at its best, you can‘t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots.

When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few.

It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient.

And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health!

 

 

 

Key Point:

At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints….

That‘s Chiropractic!

Contact

Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes.

Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms.

We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference.

Connect

We can‘t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.

Website

Social Media Links

https://www.facebook.com/chiropracticforward/

Chiropractic Forward Podcast Facebook GROUP

https://www.facebook.com/groups/1938461399501889/

Twitter

YouTube

https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q

iTunes

https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2

Player FM Link

https://player.fm/series/2291021

Stitcher:

https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through

TuneIn

https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/

About the Author & Host

Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine (FIANM) and Board Certified Diplomate of the American Board of Forensic Professionals (DABFP) – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger

     
Jeff Williams - evidence-based chiropractor

Postpartum VAD and Pregnancy CAD

March 22, 2023 chiropracticforward Carotid Artery Dissection, Cervical Artery Dissection, Pregnancy, Vertebral Artery Dissection 00:18:25 0 Comments

CF 272: Postpartum VAD and Pregnancy CAD

 

Today we’re going to talk about postpartum VAD and pregnancy CAD.

 

But first, here’s that sweet sweet bumper music

 

Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!

Chiropractic evidence-based products

Integrating Chiropractors

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This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.09-AM-150x55.jpg

  OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.   We’re the fun kind of research. Not the stuffy, high-brow, look down your nose at people kind of research. We’re research talk over a couple of beers.  

I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  I’m so glad you’re spending your time with us learning together.   Chiropractors – I’m hiring at my personal clinic. I need talent, ambition, drive, smart, and easy to get along with associates. If this is you and Amarillo, TX is your speed, send me an email at creekstonecare@gmail.com   If you haven’t yet I have a few things you should do.

  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s excellent educational resource for you AND your patients. It saves you time putting talks together or just staying current on research. It’s categorized into sections so the information is easy to find and written in a way that is easy to understand for everyone. It’s on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams.
  • Then go Like our Chiropractic Forward Facebook page,
  • Join our private Chiropractic Forward Facebook group, and then
  • Review our podcast on whatever platform you’re listening to
  • Last thing real quick, we also have an evidence-based brochure and poster store at com

  You have found yourself smack dab in the middle of Episode #272   Now if you missed last week’s episode , we talked about outdoor play, screen time, and the impact of exercise. Make sure you don’t miss that info. Keep up with the class.  

On the personal end of things…..

Last week was Spring Break so we were a little slower than I like last week but understandable. Everyone is enjoying their kiddos being out of school and taking them on trips. I guess I’ll just move on and get over it.   It’s a big week for me. I’m headed to Atlanta on Thursday for a big voiceover conference called VOAtlanta. It’s actually the largest voice conference in the US from what I’m told.   If you’ve been to a chiropractic conference, then I can tell you, it’s very similar but big. You go keynote speeches. You sit in classes and do all that good stuff. Meet, mix, network. But they have X-sessions, which are really interesting.   An x-session is taught by an expert in whatever that session has to do with. It’s a 3-hour intensive where you really dial down into that subject.

So one may be eLearning, one may be commercial reads, or one may be the best way to win auditions.   That’s what’s on tap for this weekend. It seems more and more voiceover stuff is taking over my weekends and, to be honest, my weekly lunches.   I have too many side gigs and too many interests. I want to be the highest level at everything I do. Of course, that’s not possible is it? Nobody can be an expert at everything.   I’ll never be the smartest, most capable chiropractor. I’ll never be the busiest vo, or the best real estate investor, or the best painter or sculptor or musician or whatever else I have my fingers in.   So we have to be OK with be pretty darn good, don’t we? My point is, we are hard on ourselves many times.

With imposter syndrome and all of the things that go into business and our psyches, it’s difficult to believe that we are where we are and we are on a level that lots of people with they were on. We doubt ourselves instead of lifting ourselves up. I’m the worst.   I’m a tweener right now. Lol. I just made that word up by the way. I’m between. I have a successful clinic, thank the good Lord. And I have a successful voiceover career that is starting up. So, I’m between. I’m a tweener. That’s where I’m busy as hell at the one thing that I want to transition out of.   Don’t get me wrong. I love being a chiropractor and I love solving the puzzles of my patients. But I’m past the every day, day to day, hands on treatment part of it. It’s time for a younger and hungrier associate or two to come in and rock that part out.   At the same time here, I’m building for my future.

How do you retire from day to day patient care and transition into having more freedom of time, freedom of money, and freedom of place? For me, that’s voice over and real estate investing.

These can be done from anywhere at any time. But those have to mature to be able to take over my healthcare provider income. Or at least supplement it once I withdraw from daily care.   In the meantime, one is already built and busy. The other two are building and getting busy. So when both are combined and considered, well I’m busier than a one legged man in an ass kicking contest.   I think where I’m going with all of this is to make sure you have your plan. I’m 50. Some say that’s young. Especially when I spent the first 8 years or so of having my chiro license being a full-time musician. I gave everyone else a head start on me.

But I feel I’m running behind. I see chiros, many in my mastermind group, ahead of me in being able to withdraw from daily patient care and being able to have multiple locations and things like that.   So, what’s your plan? Just work like a mule your whole life and die in your clinic seeing patients at 80 years old? There’s nothing wrong with that by the way. Some love that idea. I have other things I really want to do and accomplish.

How do I get there?

How do you get there?  

Start thinking big and beyond your current positions. Start at the end and work backwards. What is your ultimate goal and what’s it going to take to get there financially, emotionally, risk-wise, etc.? Also, like voiceover and real estate is for me, what are your fail safes in case things don’t unfold perfectly. Because you know they rarely do.   Just start thinking about it regardless of your age. It’s never too early to plan it out and go down that path. Does it take 5 clinics and you just started your first one? Not too early to start considering what it’ll take to get another up and running in the next 3-5 years, and then on and on.   Start thinking, planning, and using some strategery.   Alright, lets get into the research.        

Item #1   The first on today is called, “Postpartum vertebral artery dissection: case report and review of the literature” by Nicholas T. Manasewitsch and published in Thrombosis Journal on 29 October 2020.    

Why They Did It   To determine the hypertensive disorders of pregnancy associated with vascular complications, including ischemic stroke and cervical artery dissection and vertebral artery dissection (VAD).  

How They Did It   A 31-year-old Hispanic woman presented 10 days postpartum with a one-day history of vertigo, nausea, vomiting, and frontal headache. The patient’s pregnancy course had been complicated by preeclampsia, chorioamnionitis, and iron-deficiency anemia, and her delivery was complicated by acute hemorrhage. Physical examination was significant for left leg ataxia.    

What They Found  

  • Laboratory studies showed marked thrombocytosis. Emergent computed tomography (CT) scan of the head was obtained and revealed a left cerebellar ischemic large vessel stroke. Subsequent CT angiography of the head and neck showed a left VAD.
  • Based on correlation of the clinical history and laboratory and imaging findings, a diagnosis of vertebral artery dissection secondary to reactive (secondary) thrombocytosis from overlapping iron-deficiency anemia and acute hemorrhage was established. The patient was started on a heparin infusion and experienced significant improvement after a four-day hospitalization.

 

Wrap It Up   VAD is a rare but important cause of neurologic symptoms in the postpartum period and should be considered in the differential diagnosis for women who present with headache and/or vertigo. Women aged 30 years or older and those with a history of a hypertensive disorder of pregnancy are at particularly high risk. Prompt diagnosis and management of VAD is essential to ensure favorable outcomes.   Before getting to the next one,

  Next thing, go to https://www.tecnobody.com/en/products That’s Tecnobody as in T-E-C-nobody. They literally have the most impressive clinical equipment I’ve ever seen. I own the ISO Free and am looking to add more to my office this year or next. The equipment you’re going to find over there can be marketed in your community like crazy because you’ll be the only one with something that damn cool in your office.   When you decide you can’t live without those products, send me an email and I’ll give you the hookup. They will 100% differentiate your clinic from your competitors.     I have to tell you, Dr. Chris Howson, the inventor of the Drop Release tool re-activated the code! Use the code HOTSTUFF upon purchase at droprelease.com & get $50 off your purchase. Would you like to spend 5-10 minutes doing pin and stretch and all of that? Or would you rather use a drop release to get the same or similar results in just a handful of seconds. I love it, my patients love it, and I know yours will too. droprelease.com and the discount code is HOTSTUFF. Go do it.  

Item #2   Our last one this week is called, “Pregnancy Linked to Risk of Postpartum Cervical Artery Dissection” by Kurt Samson, MS and published in American Academy of Neurology on August 20, 2020.    

Why They Did It   To provide a possible explanation for why pregnancy is a risk factor for stroke.    

How They Did It  

  • The researchers analyzed data from emergency departments and acute care hospitals in New York and Florida between 2005-2015 and identified 826 women with cervical artery dissection and 826 matched controls, between the ages of 12 and 42 years, who had been hospitalized for renal colic.
  • The subjects were matched for age, race, insurance, income, and state of residence, with pregnancy defined as labor and delivery within 90 days before or six months after the index visit. The researchers then compared the risk of cervical artery dissection during pregnancy versus the same time period one year later.

 

What They Found   Pregnancy was twice as common among 826 women with cervical artery dissection compared with the controls, with heightened risk limited to the postpartum period. Postpartum events occurred an average of 21 days after hospital discharge, and 45 percent of women with postpartum cervical artery dissection had hypertensive disorders of pregnancy at the time of their dissection diagnosis.      

Wrap It Up   New types of headaches, including face or neck pain, should be taken seriously, especially in the weeks just after pregnancy. While migraines, especially if similar to prior migraines, are the most common causes of headaches, new headaches or new types of headaches require prompt medical attention to be considered treatable issues.    

Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen.   Let’s get to the message. Same as it is every week.  

Store Remember the evidence-informed brochures and posters at chiropracticforward.com.        

Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!

Chiropractic evidence-based products

Integrating Chiropractors

This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.22-AM-150x55.jpg

This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.33-AM-150x55.jpg

This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.09-AM-150x55.jpg

 

The Message

I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots.

 

When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few.

 

It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient.

 

And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health!

 

Key Point:

At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints….

 

That’s Chiropractic!

 

Contact

Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes.

 

Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms.

 

We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference.

 

Connect

We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.

 

Website

 

Social Media Links

https://www.facebook.com/chiropracticforward/

 

Chiropractic Forward Podcast Facebook GROUP

https://www.facebook.com/groups/1938461399501889/

 

Twitter

 

YouTube

https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q

 

iTunes

https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2

 

Player FM Link

https://player.fm/series/2291021

 

Stitcher:

https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through

 

TuneIn

https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/

 

About the Author & Host

Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine (FIANM) and Board Certified Diplomate of the American Board of Forensic Professionals (DABFP) – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger

 

 

Jeff Williams - evidence-based chiropractor

Recognizing Cervical Artery Dissection

September 1, 2022 chiropracticforward Carotid Artery Dissection, Cervical Artery Dissection, Risk Management, Stroke, Vertebral Artery Dissection 00:16:05 0 Comments

 CF 244: Recognizing Cervical Artery Dissection Today we’re going to talk about Recognizing Cervical Artery Dissection But first, here’s that sweet sweet bumper music  

Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!

Chiropractic evidence-based products

Integrating Chiropractors

This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.22-AM-150x55.jpg

This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.33-AM-150x55.jpg

This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.09-AM-150x55.jpg

OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.  We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.   If you haven’t yet I have a few things you should do. 

  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s excellent education for you AND your patients. It saves you time in putting talks together or just staying current on research. It’s categorized into sections so the information is easy to find and written in a way that is easy to understand for everyone. It’s on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams. 
  • Then go Like our Chiropractic Forward Facebook page, 
  • Join our private Chiropractic Forward Facebook group, and then 
  • Review our podcast on whatever platform you’re listening to 
  • Last thing real quick, we also have an evidence-based brochure and poster store at chiropracticforward.com

You have found yourself smack dab in the middle of Episode #244 Now if you missed last week’s episode , we talked about Chiropractic Adjustments To Avoid Other Procedures & we talked about Male Vets With Chronic Pain. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

Well, I just turned the big 50 people. It hurt a little. I’m not going to lie. I’ve always been one to really value and enjoy being young. I didn’t just go through it without appreciating my abilities and what I could do and accomplish.  I loved being an athlete and running and all of that good stuff. They say it’s just a number but that number is engrained in my joints and I feel it. Part of it is a weight thing.

Being 6’ 4” and 275 or so isn’t great for joints of the body so I’m on it. We’ll get that down. I’m determined.  So, 50 is blah for me but it’s over and it’s onward ho. I have too many irons in the file to be worrying about birthdays and all of that stuff. 

Business is pretty solid for back-to-school. It’s pretty steady. Which is surprising. I’m changing up some marketing in the near future and will share some of my experience on that. I’m a little nervous to dive more into marketing because if I’m honest, I’m at capacity as it is.  I saw 27 new patients last week. Just me. We had a total of about 180 visits and that’s just about as much as I can do. But with the type of marketing, we’re going to be trying, we’ll be more likely to only get the patients in here that we want to work with that are already fully committed and motivated.  We shall see. But for now, let’s get on with the research. We have some fun ones this week. 

Before I do that though, I have to tell you, that Dr. Chris Howson, the inventor of the Drop Release tool re-activated the code! It’s live again. Use the code HOTSTUFF upon purchase at droprelease.com to get $50 off your purchase. Y’all, it makes a world of difference. Would you like to spend 5-10 minutes doing pin and stretch and all of that? Or would you rather use a drop release to get the same or similar results in just a handful of seconds. My patients love it and I know yours will too. droprelease.com and the discount code is HOTSTUFF. Go do it. Hear me now and believe me later.

Item #1

This first and only one this week is getting some attention due to a recent artery dissection suffered by a woman in Georgia. Unfortunate for sure. I don’t know the particulars so we won’t go into that specifically but, when things like this happen, we start seeing more and more about the chiropractors cause stroke thing.  Typically, this isn’t true and there is a lot of research backing that up. I want to cover an article today that just came out called, “How to Recognize A Cervical Artery Dissection’ by James Demetrious, DC, DABCO (DABCO 2022) and published in PostGrad DC on July 18, 2022. Kaplowy! 

That’s hot!

Since this is an article, we’ll dispense with the traditional format and hit the high notes.  The arrticle highlights an excellent paper that came out not long ago that we covered here on the podcast. It’s by Chaibi et al (Chaibi A 2018) and was in the Annals of Medicine in 2019. In their paper, they cited high-quality research that affirms 

  • Manual therapy doesn’t no result in an increased risk of CAD
  • There is no strong evidence that manual therapy provokes CAD. 

Chaibi and Russell cite high-quality research to support these conclusions:

  • The rarity of CAD also makes the provision of epidemiological evidence challenging.
  • However, several extensive cohort studies and meta-analyses have found no excess risk of CAD resulting in secondary ischaemic stroke for chiropractic SMT compared to primary care. [2, 3, 4]
  • Similarly, retrospective cohort studies have reported no association with traumatic injury to the head or neck after SMT for neuromusculoskeletal pain.
  • Studies have disproven any misconception about whether SMT strains exceed failure strains.
  • No changes in blood flow or velocity in the VA of healthy young male adults were found in various head positions and during a cervical SMT.
  • Thus, these studies support the evidence of spontaneous causality or minimally suggest very low risk for serious AEs following SMT.

For my office, I try my best to minimize the risk to as close to zero as possible. If there is a young person in the office with unilateral neck pain for no reason, especially combined with a severe headache, they’re getting the inquisition, folks. I’m a research nerd and through my years of doing this podcast, I have compiled 19 questions that I feel can give us the best possible screen for CAD. Feel free to use them for yourself. They are as follows:

  • Is there any difference in upper arm strength from side to side?
  • Is there pain or numbness in one side of the face?
  • Can the patient raise both eyebrows equally?
  • Is there any difference in the size of the pupils?
  • Does the patient have an even smile?
  • Is the tongue straight when you have the patient stick it out?
  • Do they have a mostly even grip bilaterally?
  • Can they perform a resisted shoulder shrug evenly bilaterally?
  • Do you have a head pain or headache that developed suddenly and can be sharp or throbbing?
  • Do you have a headache that is worse when laying down?
  • Do you have difficulty speaking or swallowing?
  • Do you have any visual abnormalities?
  • Do you have unsteadiness or lack of coordination beyond what you consider normal?
  • Are you having any recent onset hiccups?
  • Are you having any hearing loss or pulsing tinnitus?
  • Are you having any nausea or vomiting?
  • Signs of nystagmus?
  • Any other neurological symptoms?
  • Do they have any light-headedness or fainting, disorientation, unexplained anxiety, disturbances in the ears, tremors, or sweating?

Now, if after all of those questions, you have accurately documented this complaint and should have a good direction forward. Most of the time, after the screen, I’m comfortable moving on. I’ve done my due diligence. However, I’m sure I’ve lost some patients over the years because if some of these are answered yes with no clear explanation for them, they’re getting an MR-A or a CT-A or I’m not working on them. Plain and simple.  I tell them my first job is to do no harm. My second job is to make them better.  Most appreciate it and are happy to do the imaging. 

So, there you go. If you’d like more information on why chiropractors are almost never solely responsible for CAD, I put together a very comprehensive and, I think, entertaining rundown of the information and I did it in various forms so that you could get the info however you like.  I put it in a blog on my website at chiropracticforward.com. The blog is called Debunked; The Odd Myth That Chiropractors Cause Strokes. The link can be found in the show notes right here at this point in the episode.  https://www.chiropracticforward.com/blog-post/debunked-the-odd-myth-that-chiropractors-cause-strokes-revisited/

I also have it in video form on YouTube with the same title   And just to be sure you could get the information in your preferred format, I made podcast episodes covering the same information in depth. The episodes of this podcast are Episodes 13, 14, and 15

I invite you to dive in a bit so you can be on top of it all. 

Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week.  Store Remember the evidence-informed brochures and posters at chiropracticforward.com.   

Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!

Chiropractic evidence-based products

Integrating Chiropractors

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The Message

I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health!

Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic!

Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes.  Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms.  We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference. 

Connect We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.

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About the Author & Host Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine (FIANM) and Board Certified Diplomate of the American Board of Forensic Professionals (DABFP) – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger  

Bibliography

  • Chaibi A, R. M. (2018). “A risk-benefit assessment strategy to exclude cervical artery dissection in spinal manual-therapy: A comprehensive review.” Annals of Medicine.
  • DABCO, J. D. D. (2022). “How to Recognize a Cervical Artery Dissection?” PostGradDC.