carotid artery dissection

The Stroke Issue – New Information

CF 261: The Stroke Issue – New Information   Today we’re going to talk about the age-old issue chiropractors continue to be burdened by. The weird myth that our adjustments cause strokes. We have some newer info I’m going to share with you on it in this week’s episode.    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!

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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 chiropracticforward.com   You have found yourself smack dab in the middle of Episode 261  

Now if you missed last week’s episode, we had our 5th year roundup and got ready for our 6th Season!! Hard to believe honestly. I continue to be blessed by you all.  Make sure you don’t miss that info. Keep up with the class.   

On the personal end of things…..

You probably remember me talking about Darcy Sullivan and Propel and the work they’re doing on my website. If you don’t recall or haven’t listened lately, I’m usually so busy with patients that I can’t see straight but, ever since September, I’ve been slow as hell. There are lots of factors I’m sure, but I believe website SEO and my Google ranking plays a part in it. So, I decided to act. Darcy and Propel was my first call.    They’re still in the building it out mode so no big results yet. It’s a six-month process and I’m literally only about 2 weeks into it so there’s not supposed to be a bit wow yet.   

But I did like that they had me on an intro Zoom where Darcy talked with me and we went over my site, metrics, where I could make improvements, where they could help. She gave me several options on what they could do to help. Options like they could do a little bit and teach me to do the rest all of the way up to they could do all of it for me.    If you know me, I don’t have time to learn current SEO, so I went all in. Do it all for me please and I’m happy to pay for it. Then, after I was all signed up, we had another Zoom where Darcy went over every single thing we wanted to work on and what that would look like. It really helped me see the light at the end of the tunnel and gave Propel good info on where we needed to go and how to get there.   

Now, they are making it happen. So, let’s sit back and see what happens. I’ll keep you updated.   

After the last mastermind meeting in November in the gorgeous Florida Keys, I decided that I needed to delegate more of my day. So, I started considering how I spend the majority of my day and what parts of that work can be farmed out to more virtual assistants.   

As a result, lots of the content I produce will be farmed out a little bit. I’m still in the middle of it all as oversight but my weekly blog in particular…..I’m going to farm out the meat of the content to a writer, then come in, make my edits, add anything I feel is important that was missed, make it mine, and then get it posted.    What do you spend the majority of your days and weeks doing outside of patient care? What duties can you identify that can be farmed out reasonably so that you free up your time and your brain?   Work on it and consider it.     

Item #1  

The first one today is called “Association between cervical artery dissection and spinal manipulative therapy” by Whedon, J.M., Petersen, C.L., Li, Z. et al. (Whedon 2022) and published in Journal of BMC Geriatrics on November 29, 2022. Dayum. That’s hot.    

Why They Did It   ·     

Cervical artery dissection (CAD) is a potentially serious condition that occurs when weakening and disruption of the arterial lining allow blood to get in between and separate the layers of the arterial wall.    ·     

Patients with CAD often present with neck pain or headache, may be asymptomatic or present as a stroke in progress. The blood that accumulates within the arterial wall can occlude the artery or cause a blood clot that in turn can be dislodged, leading to an ischemic stroke.   ·     They had to figure out what the associations or dangers might be. Even thought it’s already been done a ton of times. But that’s OK. A pile of research in your favor is better than just a couple of papers. So let’s do it!      

How They Did It   ·     

  • They evaluated the association between cervical spinal manipulation and CAD among older Medicare beneficiaries in the United States.  ·      It was a case-control and case-crossover design  ·     
  • It was an analysis of claims data for individuals aged 65+, continuously enrolled in Medicare Part A (covering hospitalizations) and Part B (covering outpatient encounters) for at least two consecutive years during 2007–2015. ·     
  • They created a 3-level categorical variable, (1) any cervical spinal manipulation, 2) evaluation and management but no cervical spinal manipulation and (3) neither cervical spinal manipulation nor evaluation and management.  

What They Found   ·     

The primary outcomes were occurrence of cervical artery dissection, either (1) vertebral artery dissection or (2) carotid artery dissection.  ·      The cases had a new primary diagnosis on at least one inpatient hospital claim or primary/secondary diagnosis for outpatient claims on at least two separate days. ·     

The odds of cervical spinal manipulation versus evaluation and management did not significantly differ between vertebral artery dissection cases and any of the control groups at any of the timepoints.  ·     

Results for carotid artery dissection cases were similar

Wrap It Up

Among Medicare beneficiaries aged 65 and older who received cervical spine manipulation, the association with cervical artery dissection is no greater than that among the control groups, and cervical spinal manipulation does not appear to be a significant risk factor for cervical artery dissection in this population group. If you want a complete breakdown, and shut your pie holes once and for all, summary of the research and related topice, including risk vs. benifts analysis, go to my blog at chiropracticforward.com, click on the blog link, and read the blog called Debunked: the Odd Myth That Chiropractors Cause Strokes.

You’ll have everything you need to debunk the junk. 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, “Oral Contraceptives and Ischemic Stroke Risk” by Caitlin Carlton, Matthew Banks and Sophia Sundararajan (Carlton C 2018) and published in ahajournals on March 16, 2018.  

Why They Did It   ·     

They wanted to know if there is a link in increased ischemic stroke when using oral contraceptives containing high-dose estrogens. Several meta-analyses of case–control and cohort studies attempt to clarify the relationship between modern low-dose combination estrogen–progestin oral contraceptives and stroke.   ·     

Data linking oral contraceptives to stroke is mixed, but most physicians err on the side of caution and discontinue oral contraceptives. They decided to focus on the potential role of oral contraceptives in stroke and the management of patients with stroke who use oral contraceptives.  

How They Did It   ·     

They looked at the first meta-analysis addressing ischemic stroke risk in high-dose estrogen-containing oral contraceptives users evaluated 16 studies from 1960 to 1999 and found an increased relative risk of stroke of 2.75 across estrogen dose, blood pressure, smoking status, and age.   ·      They also looked at the meta-analysis including studies from 1980 to 2002 evaluated only low-dose combination oral contraceptives and found a lower odds ratio of 2.12 for ischemic stroke. 

More recently, a study from 1995 to 2009 failed to find any increased relative risk for low-dose ethinyl estradiol formulations, estrogen-containing hormonal contraceptive patches, or vaginal rings.    

What They Found   ·     

  • Combination oral contraceptives have a lower risk of stroke than earlier formulations containing high-dose estrogens. Stroke risk in oral contraceptives users is impacted by several confounding issues, including oral contraceptives formulation, age, hypertension, smoking, and the presence of migraine with aura.  ·     
  • It is important to consider the constellation of stroke risk factors in concert with oral contraceptives formulation to determine individual stroke risk and the best contraceptive to reduce that risk in an individual woman.     
  • Wrap It Up   ·     
  • Modern combined oral contraceptive pills have a lower dose of estrogens and less risk of stroke than older contraceptive formulations   ·     
  • The risk of ischemic stroke in patients using combined oral contraceptives is increased in patients with additional stroke risk factors, including smoking, hypertension, and migraine with aura.   ·     
  • The risk of ischemic stroke because of combined oral contraceptive pills is less than the risk associated with pregnancy.    

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

  1. Carlton C, B. M., Sundarararajan S, (2018). “Oral Contraceptives and Ischemic Stroke Risk.” Stroke 49(4).  
  2. Whedon, J. M., Petersen, C.L., Li, Z, (2022). “Association between cervical artery dissection and spinal manipulative therapy –a medicare claims analysis.” BMC Geriatr 22(917).