RE: Disc Replacement Surgery

February 1, 2006

Hi Jamey,

Yes, a certain amount of docs have jumped on the disc replacement bandwagon. One of the research sites for this technology was in Eugene with Kitchel MD, an orthopedic spine surgeon formerly with OHSU. will be one of the plenary speakers at the International Whiplash Trauma Congress in June in Portland this year, and his topic will be disc replacement. He is likely the most experienced surgeon in the state for this procedure, and would be a good place to start with a referral for consultation.

My take on this technology is that it hasn't proven any better than fusion and that it's got greater post-surgical issues associated with it - for example, if it has to be removed it's apparently a pretty big deal. It has the potential to decrease next level disease through retained segmental motion, of course, but that benefit has not been proven yet.

IMO, the biggest problem with new technology like this is that invariably someon starts doing it that doesn't know how to do it properly, and then complications increase geometrically. Sort of like how discography was in the 70's and early 80's.

Freeman Disc Replacement Surgery

What's the word on disc replacement surgery? I have a patient who could possibly be a candidate. I wanted some feedback and recommendations from this group before I proceed with referrals. Is there anyone doing it in Oregon? Any feedback is very appreciated.

Jamey Dyson, D.C.

Salem

OregonDCs rules:1. Keep correspondence professional; the purpose of the listserve is to foster communication and collegiality. No personal attacks on listserve members will be tolerated.2. Always sign your e-mails with your first and last name.3. The listserve is not secure; your e-mail could end up anywhere. However, it is against the rules of the listserve to copy, print, forward, or otherwise distribute correspondence written by another member without his or her consent, unless all personal identifiers have been removed.

February 6, 2006

Hello Jamey and OR DCs,

I sit on the Providence MCO Physician

Advisory Committee which has been discussing disc replacement. Opinion is

divided (of course) between some surgeons who are enthusiastic and others who

are more skeptical. Anecdotally, there are surgery centers in CA that

specialize in procedures to remove artificial discs and salvage spines that don’t

work out. I’d agree with that the key is patient selection.

The only problem is the selection criteria are pretty vague at this point.

A. Simpson, DC

Vice President, Medical Director

Complementary Healthcare Plans

6600 SW 105th Avenue, Suite 115

Beaverton, OR 97008

503-619-2041

csimpson@...

From:

[mailto: ] On Behalf Of Dr. Freeman

Sent: Wednesday, February 01, 2006

6:57 AM

Subject: Re: Disc

Replacement Surgery

Hi Jamey,

Yes, a certain amount of docs have jumped on the disc replacement

bandwagon. One of the research sites for this technology was in Eugene with Kitchel

MD, an orthopedic spine surgeon formerly with OHSU. will be one of the

plenary speakers at the International Whiplash Trauma Congress in June in Portland this year, and

his topic will be disc replacement. He is likely the most experienced surgeon

in the state for this procedure, and would be a good place to start with a

referral for consultation.

My take on this technology is that it hasn't proven any better than

fusion and that it's got greater post-surgical issues associated with it - for

example, if it has to be removed it's apparently a pretty big deal. It has the

potential to decrease next level disease through retained segmental motion, of

course, but that benefit has not been proven yet.

IMO, the biggest problem with new technology like this is that

invariably someon starts doing it that doesn't know how to do it properly, and

then complications increase geometrically. Sort of like how discography was in

the 70's and early 80's.

Freeman

Disc Replacement Surgery

What's

the word on disc replacement surgery? I have a patient who could possibly

be a candidate. I wanted some feedback and recommendations from this

group before I proceed with referrals. Is there anyone doing it in Oregon? Any

feedback is very appreciated.

Jamey Dyson, D.C.

Salem

OregonDCs

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February 6, 2006

What I teach my patients in these instances is to use the structural care for 3 weeks to 'see' if it will be effective....that that 3 weeks may not fully resolve the issue but they will at least know if it can be resolved. That instruction or thought seems to counter the surgeon's urgency. And yes, we as a profession need to use the outcome measures and re-exams to a greater degree. I am one of the docs who needs to heed that because I too do a mini-exam at each vist and rankle about taking the time for a full periodic review .....yet, 1) this old dog can learn new tricks'; 2) I would be able to bill more and 3) I need to remember that while the insuarnce cos can read my notes, they often (even with the chart-abreviation sheet that I send) can't make any sense of them so....I am the one who needs to get off of it and get on with it. Wrote it down as one of my goals this year.

Sunny

Sunny Kierstyn, RN DC Fibromyalgia Care Center of Oregon 2677 Willakenzie Road, 7C

Eugene, Oregon, 97401

541- 344- 0509; Fx; 541- 344- 0955

From: "Chuck Simpson, DC" <csimpson@...>"sunny Kierstyn" <skrndc1@...>,<drmfreeman@...>,< >Subject: RE: Disc Replacement SurgeryDate: Mon, 6 Feb 2006 08:53:31 -0800

Sunny,

I couldn’t agree more…

However “these guys” can be pretty picky when the treatment plan recommended by the consulting DC is on the order of “3 times per week for 6 weeks, twice a week for 8 weeks and once a week for…” and with no indication of goals of treatment, expected outcomes and measurable indicators for success. In my experience with referring

A. Simpson, DC

From: sunny Kierstyn [mailto:skrndc1@...] Sent: Monday, February 06, 2006 7:48 AMChuck Simpson, DC; drmfreeman@...; Subject: RE: Disc Replacement Surgery

The other part of concern about surgical repair, Chuck, is that there is too often no 'trial' period of alternative methods of correction or pain control. So many of the failed-back surgery cases are done in a misaligned pelvis-to-spine state, resulting in continued dysfunction. If we can ever get these guys to work with us, it very well might result in increasing their sucess rates....when the surgery is actually needed.

Sunny

Sunny Kierstyn, RN DC Fibromyalgia Care Center of Oregon 2677 Willakenzie Road, 7C

Eugene, Oregon, 97401

541- 344- 0509; Fx; 541- 344- 0955

From: "Chuck Simpson, DC" <csimpson@...>"Dr. Freeman" <drmfreeman@...>,"" < >Subject: RE: Disc Replacement SurgeryDate: Mon, 6 Feb 2006 07:23:59 -0800

Hello Jamey and OR DCs,

I sit on the Providence MCO Physician Advisory Committee which has been discussing disc replacement. Opinion is divided (of course) between some surgeons who are enthusiastic and others who are more skeptical. Anecdotally, there are surgery centers in CA that specialize in procedures to remove artificial discs and salvage spines that don’t work out. I’d agree with that the key is patient selection. The only problem is the selection criteria are pretty vague at this point.

A. Simpson, DC

Vice President, Medical Director

Complementary Healthcare Plans

6600 SW 105th Avenue, Suite 115

Beaverton, OR 97008

503-619-2041

csimpson@...

From: [mailto: ] On Behalf Of Dr. FreemanSent: Wednesday, February 01, 2006 6:57 AMSubject: Re: Disc Replacement Surgery

Hi Jamey,

Yes, a certain amount of docs have jumped on the disc replacement bandwagon. One of the research sites for this technology was in Eugene with Kitchel MD, an orthopedic spine surgeon formerly with OHSU. will be one of the plenary speakers at the International Whiplash Trauma Congress in June in Portland this year, and his topic will be disc replacement. He is likely the most experienced surgeon in the state for this procedure, and would be a good place to start with a referral for consultation.

My take on this technology is that it hasn't proven any better than fusion and that it's got greater post-surgical issues associated with it - for example, if it has to be removed it's apparently a pretty big deal. It has the potential to decrease next level disease through retained segmental motion, of course, but that benefit has not been proven yet.

IMO, the biggest problem with new technology like this is that invariably someon starts doing it that doesn't know how to do it properly, and then complications increase geometrically. Sort of like how discography was in the 70's and early 80's.

Freeman Disc Replacement Surgery

What's the word on disc replacement surgery? I have a patient who could possibly be a candidate. I wanted some feedback and recommendations from this group before I proceed with referrals. Is there anyone doing it in Oregon? Any feedback is very appreciated.

Jamey Dyson, D.C.

Salem

OregonDCs rules:1. Keep correspondence professional; the purpose of the listserve is to foster communication and collegiality. No personal attacks on listserve members will be tolerated.2. Always sign your e-mails with your first and last name.3. The listserve is not secure; your e-mail could end up anywhere. However, it is against the rules of the listserve to copy, print, forward, or otherwise distribute correspondence written by another member without his or her consent, unless all personal identifiers have been removed.

February 6, 2006

Thanks for a very good post, Sunny! You speak for a lot of us here.

Sears

NW Portland

On Feb 6, 2006, at 9:51 AM, sunny Kierstyn wrote:

> What I teach my patients in these instances is to use the structural

> care for 3 weeks to 'see' if it will be effective....that that 3 weeks

> may not fully resolve the issue but they will at least know if it can

> be resolved.Â That instruction or thought seems to counter the

> surgeon's urgency.Â And yes, we as a profession need to use the

> outcome measures and re-exams to a greater degree.Â I am one of the

> docs who needs to heed that because I too do a mini-exam at each vist

> and rankle about taking the time for a full periodic review .....yet,

> 1) this old dog can learn new tricks'; 2) I would be able to bill more

> and 3) I need to remember that while the insuarnce cos can read my

> notes, they often (even with the chart-abreviation sheet that I send)

> can't make any sense of them so....I am the one who needs to get off

> of it and get on with it.Â Wrote it down as one of my goals this

> year.Â

>

> Sunny

>

> Â

>

> Sunny Kierstyn, RN DC

> Fibromyalgia Care Center of Oregon

> 2677 Willakenzie Road, 7C

>

> Eugene, Oregon, 97401

>

> 541- 344- 0509; Fx; 541- 344- 0955

>> From: " Chuck Simpson, DC " <csimpson@...>

>> " sunny Kierstyn "

>> <skrndc1@...>,<drmfreeman@...>,<@...

>> m>

>> Subject: RE: Disc Replacement Surgery

>> Date: Mon, 6 Feb 2006 08:53:31 -0800

>>

>> Sunny,

>> I couldnâ€™t agree moreâ€¦

>> Â

>> However â€œthese guysâ€ can be pretty picky when the treatment plan

>> recommended by the consulting DC is on the order of â€œ3 times per week

>> for 6 weeks, twice a week for 8 weeks and once a week forâ€¦â€ and with

>> no indication of goals of treatment, expected outcomes and measurable

>> indicators for success.Â In my experience with referring

>> Â

>> A. Simpson, DC

>>

>> From: sunny Kierstyn [mailto:skrndc1@...]

>> Sent: Monday, February 06, 2006 7:48 AM

>> Chuck Simpson, DC; drmfreeman@...;

>>

>> Subject: RE: Disc Replacement Surgery

>> Â

>>

>> The other part of concern about surgical repair, Chuck, is that there

>> is too often no 'trial' period of alternative methods of correction

>> or pain control.Â So many of the failed-back surgery cases are done

>> in a misaligned pelvis-to-spine state, resulting in continued

>> dysfunction. If we can ever get these guys to work with us, it very

>> well might result in increasing their sucess rates....when the

>> surgery is actually needed.

>>

>> Sunny

>> Â

>>> Â

>>>

>>> Sunny Kierstyn, RN DC

>>> Fibromyalgia Care Center of Oregon

>>> 2677 Willakenzie Road, 7C

>>>

>>> Eugene, Oregon, 97401

>>>

>>> 541- 344- 0509; Fx; 541- 344- 0955

>>>>

>>>> From: " Chuck Simpson, DC " <csimpson@...>

>>>> " Dr. Freeman " <drmfreeman@...>, " "

>>>> < >

>>>> Subject: RE: Disc Replacement Surgery

>>>> Date: Mon, 6 Feb 2006 07:23:59 -0800

>>>> Hello Jamey and OR DCs,

>>>> Â

>>>> I sit on the Providence MCO Physician Advisory Committee which has

>>>> been discussing disc replacement. Â Opinion is divided (of course)

>>>> between some surgeons who are enthusiastic and others who are more

>>>> skeptical. Â Anecdotally, there are surgery centers in CA that

>>>> specialize in procedures to remove artificial discs and salvage

>>>> spines that donâ€™t work out.Â Iâ€™d agree with that the key is

>>>> patient selection.Â The only problem is the selection criteria are

>>>> pretty vague at this point.

>>>> Â

>>>> A. Simpson, DC

>>>> Vice President, Medical Director

>>>> Complementary Healthcare Plans

>>>> 6600 SW 105th Avenue, Suite 115

>>>> Beaverton, ORÂ 97008

>>>> 503-619-2041

>>>> csimpson@...

>>>>

>>>> From: [mailto: ]

>>>> On Behalf Of Dr. Freeman

>>>> Sent: Wednesday, February 01, 2006 6:57 AM

>>>>

>>>> Subject: Re: Disc Replacement Surgery

>>>> Â

>>>> Hi Jamey,

>>>> Yes,Â a certain amount of docs have jumped on the disc replacement

>>>> bandwagon. One of the research sites for this technology was in

>>>> Eugene with Kitchel MD, an orthopedic spine surgeon formerly

>>>> with OHSU. will be one of the plenary speakers at the

>>>> International Whiplash Trauma Congress in June in Portland this

>>>> year, and his topic will be disc replacement. He is likely the most

>>>> experienced surgeon in the state for this procedure, and would be a

>>>> good place to start with a referral for consultation.

>>>> My take on this technology is that it hasn't proven any better than

>>>> fusion and that it's got greater post-surgical issues associated

>>>> with it - for example, if it has to be removed it's apparently a

>>>> pretty big deal. It has the potential to decrease next level

>>>> disease through retained segmental motion, of course, but that

>>>> benefit has not been proven yet.

>>>> IMO, the biggest problem with new technology like this is that

>>>> invariably someon starts doing it that doesn't know how to do it

>>>> properly, and then complications increase geometrically. Sort of

>>>> like how discography was in the 70's and early 80's.

>>>> Â

>>>>

>>>> Freeman

>>>>

>>>> Disc Replacement Surgery

>>>> What's the word on disc replacement surgery?Â I have a patient who

>>>> could possibly be a candidate.Â Â I wanted some feedback and

>>>> recommendations from this group before I proceed with referrals.Â

>>>> Is there anyone doing it in Oregon?Â Any feedback is very

>>>> appreciated.

>>>> Â

>>>> Jamey Dyson, D.C.

>>>> Salem

>>>>

>>>> OregonDCs rules:

>>>> 1. Keep correspondence professional; the purpose of the listserve

>>>> is to foster communication and collegiality. No personal attacks on

>>>> listserve members will be tolerated.

>>>> 2. Always sign your e-mails with your first and last name.

>>>> 3. The listserve is not secure; your e-mail could end up anywhere.

>>>> However, it is against the rules of the listserve to copy, print,

>>>> forward, or otherwise distribute correspondence written by another

>>>> member without his or her consent, unless all personal identifiers

>>>> have been removed.

>>>>

February 7, 2006

Doesn't it come down to the progress that the patient has made? If the patient's symptoms are relieved by conservative chiropractic care, then surgery is unnecessary no? Why would they be picky about another physician's plan if it concludes effectively? Most surgeons will require some conservative therapy in order to guage the surgical need. It should be up to the patient. I for one, after treating a possible surgical candidate for 2 months without relief, would suggest surgical intervention. However, if the patient was satisfied with the outcomes, then they have avoided the cut of the knife.

Dr. ph Medlin D.C.Spine Tree Chiropractic1627 NE Alberta St. #6Portland, OR 97211Ph: 503-788-6800c: 503-889-6204

Disc Replacement Surgery

What's the word on disc replacement surgery? I have a patient who could possibly be a candidate. I wanted some feedback and recommendations from this group before I proceed with referrals. Is there anyone doing it in Oregon? Any feedback is very appreciated.

Jamey Dyson, D.C.

Salem

OregonDCs rules:1. Keep correspondence professional; the purpose of the listserve is to foster communication and collegiality. No personal attacks on listserve members will be tolerated.2. Always sign your e-mails with your first and last name.3. The listserve is not secure; your e-mail could end up anywhere. However, it is against the rules of the listserve to copy, print, forward, or otherwise distribute correspondence written by another member without his or her consent, unless all personal identifiers have been removed.

February 7, 2006

It does come down to the progress the patient has made ... but you have to get them into your/our office(s) in order to make that progress. The referrals our direction are a pittance of what the surgeons turn away. We are taught via many hours of how/when we need to make a referral to an MD .... they have no clue as to when to make a referral to us. ...or even that they should.

Sunny

Sunny Kierstyn, RN DC Fibromyalgia Care Center of Oregon 2677 Willakenzie Road, 7C

Eugene, Oregon, 97401

541- 344- 0509; Fx; 541- 344- 0955

From: "deadmed" <deadmed@...><csimpson@...>,<drmfreeman@...>,< >,"sunny Kierstyn" <skrndc1@...>Subject: Re: Disc Replacement SurgeryDate: Tue, 7 Feb 2006 10:24:46 -0800

Doesn't it come down to the progress that the patient has made? If the patient's symptoms are relieved by conservative chiropractic care, then surgery is unnecessary no? Why would they be picky about another physician's plan if it concludes effectively? Most surgeons will require some conservative therapy in order to guage the surgical need. It should be up to the patient. I for one, after treating a possible surgical candidate for 2 months without relief, would suggest surgical intervention. However, if the patient was satisfied with the outcomes, then they have avoided the cut of the knife.

Dr. ph Medlin D.C.Spine Tree Chiropractic1627 NE Alberta St. #6Portland, OR 97211Ph: 503-788-6800c: 503-889-6204

Disc Replacement Surgery

What's the word on disc replacement surgery? I have a patient who could possibly be a candidate. I wanted some feedback and recommendations from this group before I proceed with referrals. Is there anyone doing it in Oregon? Any feedback is very appreciated.

Jamey Dyson, D.C.

Salem

OregonDCs rules:1. Keep correspondence professional; the purpose of the listserve is to foster communication and collegiality. No personal attacks on listserve members will be tolerated.2. Always sign your e-mails with your first and last name.3. The listserve is not secure; your e-mail could end up anywhere. However, it is against the rules of the listserve to copy, print, forward, or otherwise distribute correspondence written by another member without his or her consent, unless all personal identifiers have been removed.

February 7, 2006

Good post...

But, this is exactly why a lot of surgeons (in my experience orthopedic more than neuro) tell their patients NOT to go to Chiropractors.

In our area, the Orthos tell disc herniation patients that they will try a period of conservative care with a PT...but if that fails, then they will have to have surgery.

Well....this becomes a "self-fulfilling" prophecy. The PT does a little back rub, a little ultra-sound, maybe some exercises, and when patient doesn't improve, they go back to the Ortho and he says, "Well, we tried 'everything,' you didn't get better, so we need to do surgery."

Well...they DIDN'T try everything! They didn't try Chiropractic, licensed massage, acupuncture, "effective" back exercises, swimming, yoga, or any nutritional supplements!

If every potential disc surgery patient went through the 2-month Chiropractic trial you suggest...I think a significant % would be happy with the outcomes, and thus avoid going under the knife...(but we know patient satisfaction and avoidance of expensive medical procedures (and I'll be nice here...) isn't "always" the goal). (Wow...imagine "me" trying to be "politically correct"!) (:-)

M. s, D.C.

Disc Replacement Surgery

What's the word on disc replacement surgery? I have a patient who could possibly be a candidate. I wanted some feedback and recommendations from this group before I proceed with referrals. Is there anyone doing it in Oregon? Any feedback is very appreciated.

Jamey Dyson, D.C.

Salem

OregonDCs rules:1. Keep correspondence professional; the purpose of the listserve is to foster communication and collegiality. No personal attacks on listserve members will be tolerated.2. Always sign your e-mails with your first and last name.3. The listserve is not secure; your e-mail could end up anywhere. However, it is against the rules of the listserve to copy, print, forward, or otherwise distribute correspondence written by another member without his or her consent, unless all personal identifiers have been removed.

February 7, 2006

In the not-too-distant future I can foresee a scenario wherein the only patients who get referred to the spine surgeon for fusion/ disc replacement etc surgery have been referred by a chiropractor who has served as a primary care physician for the spine. The DC will make certain that the patient's condition is truly refractory to conservative means, and that the next appropriate referral is to a spine surgeon. This will be a highly effective method of keeping costs down AND improving the odds of successful surgery.

Some bright bulb in the insurance industry will come up with this idea, and it will take off. Chiropractic's future will be guaranteed by accountants, as well as patients.

D Freeman

Mailing address: 205 Liberty Street NE, Suite B Salem, OR 97301 503 586-0127 fax 503 586-0192 cell 503 871-0715 drmfreeman@...

Re: Disc Replacement SurgeryDate: Tue, 7 Feb 2006 10:24:46 -0800

Doesn't it come down to the progress that the patient has made? If the patient's symptoms are relieved by conservative chiropractic care, then surgery is unnecessary no? Why would they be picky about another physician's plan if it concludes effectively? Most surgeons will require some conservative therapy in order to guage the surgical need. It should be up to the patient. I for one, after treating a possible surgical candidate for 2 months without relief, would suggest surgical intervention. However, if the patient was satisfied with the outcomes, then they have avoided the cut of the knife.

Dr. ph Medlin D.C.Spine Tree Chiropractic1627 NE Alberta St. #6Portland, OR 97211Ph: 503-788-6800c: 503-889-6204

Disc Replacement Surgery

What's the word on disc replacement surgery? I have a patient who could possibly be a candidate. I wanted some feedback and recommendations from this group before I proceed with referrals. Is there anyone doing it in Oregon? Any feedback is very appreciated.

Jamey Dyson, D.C.

Salem

OregonDCs rules:1. Keep correspondence professional; the purpose of the listserve is to foster communication and collegiality. No personal attacks on listserve members will be tolerated.2. Always sign your e-mails with your first and last name.3. The listserve is not secure; your e-mail could end up anywhere. However, it is against the rules of the listserve to copy, print, forward, or otherwise distribute correspondence written by another member without his or her consent, unless all personal identifiers have been removed.

February 7, 2006

I guess you're right, and thats what it comes down to. One would think that a chiropractic physician would be a no brainer for conservative back treatment (who knows the spine better?). They should be referring to us as a fellow physician, and let us refer to a PT if we deem it necessary. As you say, they should be responsible in making that referral to us. I would add that they should also suffer the consequences if they haven't at least mentioned chiropractic as a conservative therapeutic option. Now that would be a tasty piece of legislation. Because ignoring the option is detrimental to the patient's well being and health. It seems that they will only do that if the patient requests it. How irresponsible. How can they singularily decide we are a non entity when the state and federal government recognizes us? How can they in this day and age actually know more about these useless run of the mill fad drugs etc. than a health profession that has been around for 100yrs. uuuuuggghhh

Dr. ph Medlin D.C.Spine Tree Chiropractic1627 NE Alberta St. #6Portland, OR 97211Ph: 503-788-6800c: 503-889-6204

Disc Replacement Surgery

What's the word on disc replacement surgery? I have a patient who could possibly be a candidate. I wanted some feedback and recommendations from this group before I proceed with referrals. Is there anyone doing it in Oregon? Any feedback is very appreciated.

Jamey Dyson, D.C.

Salem

OregonDCs rules:1. Keep correspondence professional; the purpose of the listserve is to foster communication and collegiality. No personal attacks on listserve members will be tolerated.2. Always sign your e-mails with your first and last name.3. The listserve is not secure; your e-mail could end up anywhere. However, it is against the rules of the listserve to copy, print, forward, or otherwise distribute correspondence written by another member without his or her consent, unless all personal identifiers have been removed.

February 7, 2006

In a message dated 2/7/2006 5:18:01 PM US Mountain Standard Time, sharronf@... writes:

how Chiropractic care does fit in to the conservative care option in the PARQ and a list of the DC's to refer to in their area and send it to a swath of MD's about 4x per year

I think this is a great idea. During a pain management rotation, I was able to help the MD understand alot about chiropractic : that it is not all high velocity, type 2 mechanoreceptors etc. Within a few weeks he was very excited about what a DC could do potentially. He was referring out about half his new patients (he gets about 20 NP a week) to PT before trying epidurals/transforaminals/RF/etc on them in his office. I brought in some of my DC friends to meet him, see what he does, etc - I thought it was mutually beneficial - they could have an MD who would not snake their patients - whom they could send for pain care that is less invasive than surgery and he had someone to refer patients he felt could benefit from that work. Some of my DC friends came in and met him, watched him do some radiographically guided epidurals - and now he refers them a few patients each week. The DC's are doing a great job - getting roughly 80% pain relief within a few visits etc. I know there are many other MD's that also would refer if the doors were opened a bit and a conversation started. It benefits everyone.

Anglen

February 7, 2006

In a message dated 2/7/2006 4:34:56 PM US Mountain Standard Time, rjacksondc@... writes:

But, how many MD's actually know what we do, how we do it and what our results can be? Medical school does not have Chiro 101.

This is so true. Many MD's think DC's do 3 things : treat low back pain, cause strokes and make an inordinate amount of money with no liability. I wonder how it would work if you had a DC who was a good speaker with good presence, who could contact a few MD's and just say " I would like to see what you do - see if I would like to refer to you - can I shadow you - be quiet and see what you do?" Probably half would say no and half would say yes, its just a numbers thing - many of them would love to have a good referrel source. Spend the afternoon - comment non-threateningly on what you like about their practice, ask some 'what if' questions, let them know what you do etc. Get some of their cards give them some of yours. Maybe share a study or two.

Anglen

February 7, 2006

In a message dated 2/7/2006 3:52:52 PM US Mountain Standard Time, drmfreeman@... writes:

In the not-too-distant future I can foresee a scenario wherein the only patients who get referred to the spine surgeon for fusion/ disc replacement etc surgery have been referred by a chiropractor

I hope that is true, but unless chiropractors integrate themselves more I fear it may be an MD that is trained in spinal manipulation. Half the family medicine residencies I interviewed at had just installed adjusting tables and were teaching it to residents - talking to the residents the redeeming thing is that most find the reimbursement too low to spend time on. For example, freezing a precancerous skin lesion (takes 2 minutes to diagnose and freeze) and can reimburse $110 from Medicare for an established patient - so why spend twice that long and get $25 for adjusting a patient????? But they could be in charge of the brief lay over on the way to the surgeons.

Anglen

February 7, 2006

Great points Sunny...

Ya know....maybe it's EVERYONE ELSE in the health care profession who needs Outcome Assessments, and Clinical Justification/Rational language in their OAR's... (ok, so I couldn't be politically correct ALL DAY!!!). (:-)

M s, D.C.

Disc Replacement Surgery

What's the word on disc replacement surgery? I have a patient who could possibly be a candidate. I wanted some feedback and recommendations from this group before I proceed with referrals. Is there anyone doing it in Oregon? Any feedback is very appreciated.

Jamey Dyson, D.C.

Salem

OregonDCs rules:1. Keep correspondence professional; the purpose of the listserve is to foster communication and collegiality. No personal attacks on listserve members will be tolerated.2. Always sign your e-mails with your first and last name.3. The listserve is not secure; your e-mail could end up anywhere. However, it is against the rules of the listserve to copy, print, forward, or otherwise distribute correspondence written by another member without his or her consent, unless all personal identifiers have been removed.

February 7, 2006

But, how many MD's actually know what we do, how we do it and what our results can be? Medical school does not have Chiro 101. We had some pharmacology, minor surgery, proctology and OB/GYN. We know what MD's do, kind of how they do it and probably have a pretty good idea of what their results can be, but until we actually tell them - in scientific language - what, how, when and why we do what we do, they will crack their knuckles and say "how could that possibly do ANYTHING?!?".

We can't rely on our patients talking to their MD's to get the message across and the MD's are probably not going to ask us out to lunch to discuss chiropractic. If we want our allies (yes, I think of my local MD's as allies.....I am sure glad they are here to help with the things I can't treat) to understand what we do, we gotta teach 'em!

Wouldn't it be cool to have an eloquent chiropractic luminary give a lecture to a roomful of medical doctors at one of their CE extravaganzas? We have had them lecturing at WSCC for years.....

Rod , DC

Tillamook, OR

Disc Replacement Surgery

What's the word on disc replacement surgery? I have a patient who could possibly be a candidate. I wanted some feedback and recommendations from this group before I proceed with referrals. Is there anyone doing it in Oregon? Any feedback is very appreciated.

Jamey Dyson, D.C.

Salem

OregonDCs rules:1. Keep correspondence professional; the purpose of the listserve is to foster communication and collegiality. No personal attacks on listserve members will be tolerated.2. Always sign your e-mails with your first and last name.3. The listserve is not secure; your e-mail could end up anywhere. However, it is against the rules of the listserve to copy, print, forward, or otherwise distribute correspondence written by another member without his or her consent, unless all personal identifiers have been removed.

February 7, 2006

Why don't groups of DC's get together a summary of relevant medical lit. , a short sheet discussing how Chiropractic care does fit in to the conservative care option in the PARQ and a list of the DC's to refer to in their area and send it to a swath of MD's about 4x per year ? It would cost very little.

Do this with DC's who may practice similar to you or whose differing techniques may complement yours ? I don't see you in competition with each other - business attracts business.

I appreciated seeing the one doctors insert in the paper. It was very informative. If only there were 4-5 doctors names at the bottom....

sharron fuchs dc

From: [mailto: ] On Behalf Of Dr. FreemanSent: Tuesday, February 07, 2006 12:12 PM Subject: RE: Disc Replacement Surgery

In the not-too-distant future I can foresee a scenario wherein the only patients who get referred to the spine surgeon for fusion/ disc replacement etc surgery have been referred by a chiropractor who has served as a primary care physician for the spine. The DC will make certain that the patient's condition is truly refractory to conservative means, and that the next appropriate referral is to a spine surgeon. This will be a highly effective method of keeping costs down AND improving the odds of successful surgery.

Some bright bulb in the insurance industry will come up with this idea, and it will take off. Chiropractic's future will be guaranteed by accountants, as well as patients.

D Freeman

Mailing address: 205 Liberty Street NE, Suite B Salem, OR 97301 503 586-0127 fax 503 586-0192 cell 503 871-0715 drmfreeman@...

Re: Disc Replacement SurgeryDate: Tue, 7 Feb 2006 10:24:46 -0800

Doesn't it come down to the progress that the patient has made? If the patient's symptoms are relieved by conservative chiropractic care, then surgery is unnecessary no? Why would they be picky about another physician's plan if it concludes effectively? Most surgeons will require some conservative therapy in order to guage the surgical need. It should be up to the patient. I for one, after treating a possible surgical candidate for 2 months without relief, would suggest surgical intervention. However, if the patient was satisfied with the outcomes, then they have avoided the cut of the knife.

Dr. ph Medlin D.C.Spine Tree Chiropractic1627 NE Alberta St. #6Portland, OR 97211Ph: 503-788-6800c: 503-889-6204

Disc Replacement Surgery

What's the word on disc replacement surgery? I have a patient who could possibly be a candidate. I wanted some feedback and recommendations from this group before I proceed with referrals. Is there anyone doing it in Oregon? Any feedback is very appreciated.

Jamey Dyson, D.C.

Salem

OregonDCs rules:1. Keep correspondence professional; the purpose of the listserve is to foster communication and collegiality. No personal attacks on listserve members will be tolerated.2. Always sign your e-mails with your first and last name.3. The listserve is not secure; your e-mail could end up anywhere. However, it is against the rules of the listserve to copy, print, forward, or otherwise distribute correspondence written by another member without his or her consent, unless all personal identifiers have been removed.

February 7, 2006

Ron, After laying a foundation for Chiropractic care to be one of the conservative care options in the PARQ then perhaps, in the future, a case for negligence could be made. I work in the medical malpractice field and I don't think this is yet ready to fly as an allegation of negligence. If it does become negligence not to refer for Chiropractic care prior to other less conservative care it will most certainly be for NMS diagnosis and not for anything else.

sharron fuchs dc

From: [mailto: ] On Behalf Of rongrice01Sent: Tuesday, February 07, 2006 12:45 PM Subject: Disc Replacement Surgery

To the attorneys on list:During the surgical par conference, wouldn't the surgeons be negligent if they did not mention a trial of chiropractic care, since a plethora of studies show its tremendous benefit? To the rest of us:If the PR campaign underway across the country undertook this message, directing it to people who are contemplating surgery, it should direct a large number of new patients to our doors. Doing it in the right way would not alienate our friends in the orthopedic field, and may just pave the way for greater cooperation from the medical field. Just like the pharmaceutical industry inundating us with drugs to suggest to our mds, this message just may cause the surgical patient to ask about chiropractic care. If the surgeon was a bit nervous about advising against safe and effective alternatives this message would work.In the latest issue of DC, the director of this nationwide PR campaign is asking for just $25.00 per month from all of us. That is really not much to spend, and if we suggested this message, it could return on it's investment many times.What do you all think? Grice, DCAlbany, OR

February 7, 2006

That would be a start. Sunny

Sunny Kierstyn, RN DC Fibromyalgia Care Center of Oregon 2677 Willakenzie Road, 7C

Eugene, Oregon, 97401

541- 344- 0509; Fx; 541- 344- 0955

From: "Sharron Fuchs" <sharronf@...>< >Subject: RE: Disc Replacement SurgeryDate: Tue, 7 Feb 2006 16:10:45 -0800

Ron, After laying a foundation for Chiropractic care to be one of the conservative care options in the PARQ then perhaps, in the future, a case for negligence could be made. I work in the medical malpractice field and I don't think this is yet ready to fly as an allegation of negligence. If it does become negligence not to refer for Chiropractic care prior to other less conservative care it will most certainly be for NMS diagnosis and not for anything else.

sharron fuchs dc

From: [mailto: ] On Behalf Of rongrice01Sent: Tuesday, February 07, 2006 12:45 PM Subject: Disc Replacement Surgery

To the attorneys on list:During the surgical par conference, wouldn't the surgeons be negligent if they did not mention a trial of chiropractic care, since a plethora of studies show its tremendous benefit? To the rest of us:If the PR campaign underway across the country undertook this message, directing it to people who are contemplating surgery, it should direct a large number of new patients to our doors. Doing it in the right way would not alienate our friends in the orthopedic field, and may just pave the way for greater cooperation from the medical field. Just like the pharmaceutical industry inundating us with drugs to suggest to our mds, this message just may cause the surgical patient to ask about chiropractic care. If the surgeon was a bit nervous about advising against safe and effective alternatives this message would work.In the latest issue of DC, the director of this nationwide PR campaign is asking for just $25.00 per month from all of us. That is really not much to spend, and if we suggested this message, it could return on it's investment many times.What do you all think? Grice, DCAlbany, OROregonDCs rules:1. Keep correspondence professional; the purpose of the listserve is to foster communication and collegiality. No personal attacks on listserve members will be tolerated.2. Always sign your e-mails with your first and last name.3. The listserve is not secure; your e-mail could end up anywhere. However, it is against the rules of the listserve to copy, print, forward, or otherwise distribute correspondence written by another member without his or her consent, unless all personal identifiers have been removed.

February 8, 2006

I'm sorry, but BS!!!

This should be THEIR RESPONSIBILITY. Why do i have to run around educating people that may or may not even want to know what i have to say. The thing is, is that they refuse to consider it. You can't tell me that they don't know what its about, they do. If they need further education, take a GD CE course or teach it in their shcools like they do ours. come on.

Dr. ph Medlin D.C.Spine Tree Chiropractic1627 NE Alberta St. #6Portland, OR 97211Ph: 503-788-6800c: 503-889-6204

Disc Replacement Surgery

What's the word on disc replacement surgery? I have a patient who could possibly be a candidate. I wanted some feedback and recommendations from this group before I proceed with referrals. Is there anyone doing it in Oregon? Any feedback is very appreciated.

Jamey Dyson, D.C.

Salem

OregonDCs rules:1. Keep correspondence professional; the purpose of the listserve is to foster communication and collegiality. No personal attacks on listserve members will be tolerated.2. Always sign your e-mails with your first and last name.3. The listserve is not secure; your e-mail could end up anywhere. However, it is against the rules of the listserve to copy, print, forward, or otherwise distribute correspondence written by another member without his or her consent, unless all personal identifiers have been removed.

February 8, 2006

" If it does become negligence not to refer for Chiropractic care prior to other less conservative care it will most certainly be for NMS diagnosis and not for anything else."

That would include the vertebrae and discs though right? It would be a good start. Not to mention, we deal primarily with NMS anyway.

Dr. ph Medlin D.C.Spine Tree Chiropractic1627 NE Alberta St. #6Portland, OR 97211Ph: 503-788-6800c: 503-889-6204

RE: Disc Replacement Surgery

Ron, After laying a foundation for Chiropractic care to be one of the conservative care options in the PARQ then perhaps, in the future, a case for negligence could be made. I work in the medical malpractice field and I don't think this is yet ready to fly as an allegation of negligence. If it does become negligence not to refer for Chiropractic care prior to other less conservative care it will most certainly be for NMS diagnosis and not for anything else.

sharron fuchs dc

From: [mailto: ] On Behalf Of rongrice01Sent: Tuesday, February 07, 2006 12:45 PM Subject: Disc Replacement Surgery

To the attorneys on list:During the surgical par conference, wouldn't the surgeons be negligent if they did not mention a trial of chiropractic care, since a plethora of studies show its tremendous benefit? To the rest of us:If the PR campaign underway across the country undertook this message, directing it to people who are contemplating surgery, it should direct a large number of new patients to our doors. Doing it in the right way would not alienate our friends in the orthopedic field, and may just pave the way for greater cooperation from the medical field. Just like the pharmaceutical industry inundating us with drugs to suggest to our mds, this message just may cause the surgical patient to ask about chiropractic care. If the surgeon was a bit nervous about advising against safe and effective alternatives this message would work.In the latest issue of DC, the director of this nationwide PR campaign is asking for just $25.00 per month from all of us. That is really not much to spend, and if we suggested this message, it could return on it's investment many times.What do you all think? Grice, DCAlbany, OR

February 8, 2006

Perhaps little by little the tides are changing. Here's one example.

My son's fiance is a second year medical student at the University of

Rochester Medical School, in her Neurology class, yes taught by a

neurologist, they had a lengthy discussion about Chiropractic. The

pros and cons and the statistics regarding stroke, what we do, a few

different techniques etc...... He challenged them, a few students were

sent off to research the stats etc. She called me and we went over

some of her information she was reporting on. In the end the bottom

line message that was sent out to the students (over 100 in her class)

that Chiropractic care was a good alternative for necks and low backs,

a good option PRIOR to surgery. This neurologist's only concern was

manually adjusting a senior's neck. He noted that seniors have strokes

with everyday events, turning their head backing out of the driveway,

and therefore in his opinion, it was not appropriate to adjust a

seniors neck.

Inch by inch, of course, a Chiropractor was never present in that

conversation, but I think it's a positive sign. It also helps that my

future daughter-in-law has been adjusted by me a number of times and

when they come home to OR on their breaks she and my son come in

everyday for adjustments. I have educated her well. My next step is

to see if I can visit with him (the neurologist that taught the class)

face-to-face when I go back this summer to visit.

I personally think we need to take it upon ourselves to continue to not

just educate our patients, but their doctors as well. (feels like a

big up hill trudge but someone's got to do it)

Judith E. Allan, DC

Lake Oswego

On Feb 8, 2006, at 9:09 AM, deadmed wrote:

> I'm sorry, but BS!!!

> Â

> This should be THEIR RESPONSIBILITY. Why do i have to run around

> educating people that may or may not even want to know what i have to

> say. The thing is, is Â that they refuse to consider it. You can't tell

> me that they don't know what its about, they do. If they need further

> education, take a GD CE course or teach it in their shcools like they

> do ours. come on.

> Â

> Dr. ph Medlin D.C.

> Spine Tree Chiropractic

> 1627 NE Alberta St. #6

> Portland, OR 97211

> Ph: 503-788-6800

> c:Â 503-889-6204

>> Disc Replacement Surgery

>>>>>>>>> What's the word on disc replacement surgery?Â I have a patient

>>>>>>>>> who could possibly be a candidate.Â Â I wanted some feedback and

>>>>>>>>> recommendations from this group before I proceed with

>>>>>>>>> referrals.Â Is there anyone doing it in Oregon?Â Any feedback

>>>>>>>>> is very appreciated.

>>>>>>>>> Â

>>>>>>>>> Jamey Dyson, D.C.

>>>>>>>>> Salem

>>>>>>>>>

>>>>>>>>> OregonDCs rules:

>>>>>>>>> 1. Keep correspondence professional; the purpose of the

>>>>>>>>> listserve is to foster communication and collegiality. No

>>>>>>>>> personal attacks on listserve members will be tolerated.

>>>>>>>>> 2. Always sign your e-mails with your first and last name.

>>>>>>>>> 3. The listserve is not secure; your e-mail could end up

>>>>>>>>> anywhere. However, it is against the rules of the listserve to

>>>>>>>>> copy, print, forward, or otherwise distribute correspondence

>>>>>>>>> written by another member without his or her consent, unless

>>>>>>>>> all personal identifiers have been removed.

>>>>>>>>>

February 8, 2006

There are DC's who lecture to MD's and DO's at the Spine Institute seminars... (:-)

M. s, D.C.

Re: Disc Replacement Surgery

In a message dated 2/7/2006 4:34:56 PM US Mountain Standard Time, rjacksondc@... writes:

But, how many MD's actually know what we do, how we do it and what our results can be? Medical school does not have Chiro 101.This is so true. Many MD's think DC's do 3 things : treat low back pain, cause strokes and make an inordinate amount of money with no liability. I wonder how it would work if you had a DC who was a good speaker with good presence, who could contact a few MD's and just say " I would like to see what you do - see if I would like to refer to you - can I shadow you - be quiet and see what you do?" Probably half would say no and half would say yes, its just a numbers thing - many of them would love to have a good referrel source. Spend the afternoon - comment non-threateningly on what you like about their practice, ask some 'what if' questions, let them know what you do etc. Get some of their cards give them some of yours. Maybe share a study or two. Anglen

February 8, 2006

Exactly.

sharron fuchs dc

From: deadmed [mailto:deadmed@...] Sent: Wednesday, February 08, 2006 9:14 AM ; Sharron FuchsSubject: Re: Disc Replacement Surgery

" If it does become negligence not to refer for Chiropractic care prior to other less conservative care it will most certainly be for NMS diagnosis and not for anything else."

That would include the vertebrae and discs though right? It would be a good start. Not to mention, we deal primarily with NMS anyway.

Dr. ph Medlin D.C.Spine Tree Chiropractic1627 NE Alberta St. #6Portland, OR 97211Ph: 503-788-6800c: 503-889-6204

RE: Disc Replacement Surgery

Ron, After laying a foundation for Chiropractic care to be one of the conservative care options in the PARQ then perhaps, in the future, a case for negligence could be made. I work in the medical malpractice field and I don't think this is yet ready to fly as an allegation of negligence. If it does become negligence not to refer for Chiropractic care prior to other less conservative care it will most certainly be for NMS diagnosis and not for anything else.

sharron fuchs dc

From: [mailto: ] On Behalf Of rongrice01Sent: Tuesday, February 07, 2006 12:45 PM Subject: Disc Replacement Surgery

To the attorneys on list:During the surgical par conference, wouldn't the surgeons be negligent if they did not mention a trial of chiropractic care, since a plethora of studies show its tremendous benefit? To the rest of us:If the PR campaign underway across the country undertook this message, directing it to people who are contemplating surgery, it should direct a large number of new patients to our doors. Doing it in the right way would not alienate our friends in the orthopedic field, and may just pave the way for greater cooperation from the medical field. Just like the pharmaceutical industry inundating us with drugs to suggest to our mds, this message just may cause the surgical patient to ask about chiropractic care. If the surgeon was a bit nervous about advising against safe and effective alternatives this message would work.In the latest issue of DC, the director of this nationwide PR campaign is asking for just $25.00 per month from all of us. That is really not much to spend, and if we suggested this message, it could return on it's investment many times.What do you all think? Grice, DCAlbany, OR

February 8, 2006

I know Dr. s and I hope my tone wasn't taken to be directed at you for suggesting such a thing.

It's great that DC"s are doing this, but it shouldn't be necessary. They (MD's) simply can't be left off the hook cuz "they didnt' know what we do." There needs to be more education undoubtedly, but perhaps knowing when to refer to us etc. should be done in school (like a prior post mentioned in med. school) and not by us. We should be educating them further, but there MUST be a basic principle of understanding as to what we do. We don't necessarily know the ins and outs of Neuro Surgery etc., but we know enough to know when the patient would benefit from their consultation.

They cannot deny our existence for very much longer lets hope.

Dr. ph Medlin D.C.Spine Tree Chiropractic1627 NE Alberta St. #6Portland, OR 97211Ph: 503-788-6800c: 503-889-6204

Re: Disc Replacement Surgery

In a message dated 2/7/2006 4:34:56 PM US Mountain Standard Time, rjacksondc@... writes:

But, how many MD's actually know what we do, how we do it and what our results can be? Medical school does not have Chiro 101.This is so true. Many MD's think DC's do 3 things : treat low back pain, cause strokes and make an inordinate amount of money with no liability. I wonder how it would work if you had a DC who was a good speaker with good presence, who could contact a few MD's and just say " I would like to see what you do - see if I would like to refer to you - can I shadow you - be quiet and see what you do?" Probably half would say no and half would say yes, its just a numbers thing - many of them would love to have a good referrel source. Spend the afternoon - comment non-threateningly on what you like about their practice, ask some 'what if' questions, let them know what you do etc. Get some of their cards give them some of yours. Maybe share a study or two. Anglen

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