What is a Chiropractic Internist?
Historically chiropractic has been well known for its beneficial role in alleviating back pain and headaches, as well as improving athletic performance. Little attention is given to the holistic approach of chiropractic care. This is most likely due to the introduction of third party reimbursement (insurance) in the 1980’s. This era of medicine was cleverly termed the “Mercedes 80s.” The chiropractic board fought for recognition in “modern” medicine and validation was given through acceptance into the insurance game. Unfortunately, many doctors of chiropractic (D.C.) (and other medical specialties even to this day) fell into the rabbit hole of only performing those services to which the patient had coverage, i.e. the spinal adjustment. This led to the abandonment of, what we know of as today, as natural medicine or functional medicine. Concentration on spinal pain was now mainstream marketing for chiropractors.
Currently there are many different facets in the Chiropractic field with over 100 different techniques all with the same goal in mind; restoration of human health.
Personally, I was always intrigued with natural medicine. The idea of actually fixing something versus alleviating symptoms was something I gravitated towards even in everyday life. Even from a very early age I liked to tinker on cars. I knew a good solid exhaust weld beat some tin foil and a band clamp for an exhaust leak and replacing a section of roof shingles was far superior to slapping some tar on old ones.
Creating this article came to me the other night when I found myself covered in lint from our dryer. We just moved into a new place and the dryer vent was caked with lint leading to poor performance of the dryer. Our landlord offered us numerous options to help with the drying capacity: put in less clothes, spin them an extra time in the washer or get one of those indoor dryer vent kits; none of these options appeared to solve the problem. Unknown to him (landlord) there are special dryer hose brush kits that are curative to the problem. They allow you to snake a round brush all the way through the ductwork and clean the inside. These kits are inexpensive and the results are long lasting not to mention the hot exhaust continues to pump outside the home, rather than an indoor solution. This scenario mirrors what often happens in medicine and patients knowledge of what is available to them. Patients are unaware that there may be safer and more effective strategies that provide long lasting results even once the therapy is removed. Sometimes these therapies add an additional layer of benefit, as they can be more cost effective than their medical counterparts.
Advancements in the field of medicine have been tremendous in the past 10 years; advanced testing for cardiovascular disease to molecular and genetic testing for more efficient and safer administration of therapies. There are even labs looking into microchip technologies which claim to increase accuracy of testing results while utilizing smaller sample sizes (i.e. having to draw less blood).
Now back to the question at hand…what is a chiropractic internist? First, a chiropractic internist is a doctor of chiropractic that has gone through a comprehensive postgraduate course and testing to achieve board certification from the American Board of Chiropractic Internists. And that means? The chiropractic internist program was created to marry the original paradigm of chiropractic, that the body is one complete entity and each and every organ is interconnected, with today’s modern advancements in diagnoses and treatment. Utilizing blood work, physical exam, stool analysis, urine testing and many more diagnostics modalities a chiropractic internist will formulate a plan based off of clinical symptoms and hard evidence from such modalities. This allows he/she to formulate the most comprehensive treatment plan possible. Treatments come in the form of natural therapies such as herbs, homeopathics, vitamins, and minerals. Often, lifestyle changes such as exercise and dietary alterations are put into motion, along with stress management techniques. We truly try and hit every aspect of a patient’s life. Our goal is not to get patients on remedies or supplements, but to get them off all their treatments and rely on those positive lifestyle changes, long term. We use those remedies to jump-start a particular biochemical pathway or support detoxification, for instance, while patients work with lifestyle modifications. By performing in this way we are gearing up to “maintain the gain” in hopes that one day we can completely remove our therapy and the patient remain healthy and resistant to future complications or re-infections. Many chiropractic internists still perform spinal and extremity joint adjustments as well as soft tissue therapies and rehabilitation. This truly builds a holistic platform to which the patient is given the greatest chance of long-term success.
As natural practitioners we are often seen as early adopters or even inventors of therapies and diagnostics; often times taking recent theories or research and applying them into clinical practice right away. This is not to say that we are reckless in our approach, quite the contrary. We try to develop treatment methods when traditional medicine has had no benefit. Many times this leads us back to a fundamental flaw in a specific pathway that we learn to recognize even before its manifestation as “disease.” I feel we assume this authority of early adoption due to our relatively safe, non-toxic treatment approaches. A properly trained doctor in natural medicine is well aware of the cost-benefit ratios to his or her therapies as well as interactions it may have with pre-existing treatments. If there is a therapy that we feel carries a greater risk to the patient, we most surely postpone the adoption of a new technique or theory until stronger data is available.
Perhaps one of the greatest benefits of natural medicine is its ability to, or at the very least, gives an honest attempt at being curative for a particular disease process. Let’s look at one of the hottest disease trends in our society, autoimmunity (lupus, rheumatoid arthritis, fibromyalgia, diabetes etc.). Traditional medical treatment has failed in the treatment of autoimmune disease. This statement is not intended to be demeaning; it is simply fact. Below is an excerpt from The Cochrane Library with commentary by Dr. Fred Wolfe, M.D. of the National Data Bank for Rheumatic Diseases:
“Among fibromyalgia patients taking either of two commonly prescribed drugs to reduce pain, 22 percent report substantial improvement while 21 percent had to quit the regimen due to unpleasant side effects, according to a new review”
Dr. Fred Wolfe, M.D., commented to these results: “This is a very important study,” and he continued “There’s an enormous amount of advertising suggesting that these drugs really help, whereas the research data show that the improvement is really minimal.”
The cause of fibromyalgia, and many other autoimmune diseases, is now well recognized as being a microbe-induced disease (more on this in another article). This theory is supported in the research and the results speak for themselves in clinical practice. Specific numbers have not been calculated but in our office we have over 90% success with the resolution of symptoms even after treatment is removed. Clearly these drugs produce a poor success rate and can be more harmful than the disease process itself.
“The medical field does poorly with the treatment of fibromyalgia in general,” says Brian Walitt, M.D., M.P.H., a co-author of the review and an expert in pain syndromes at Washington Hospital Center in Washington, D.C. “Chasing [a cure] with medicine doesn’t seem to work. The people who seem to me to do best sort of figure it out on their own by thinking about things, getting to know themselves, and making changes in their lives to accommodate who they’ve become,” concludes Walitt.http://www.cfah.org/hbns/2013/drugs-to-treat-fibromyalgia-just-as-likely-to-harm-as-help-
Natural medicine carries great benefits with a relatively low risk. This does not mean that just anyone is trained in the safe and effective administration of these therapies, which is often how it is perceived. There are countless weekend seminars, certifications and “degrees” that are awarded to individuals with minimal training. This is not to say that just because someone isn’t a doctor that they are not intelligent. I have many patients that have taken the time to teach themselves about their bodies and conditions because their previous doctors have failed to do so. What I am saying is you need to do your research about the practitioner that you trust with the health of you and your family. As mentioned previously, a lot of the natural therapies do not pose a direct negative effect, but if given improperly their ineffectiveness can be just as dangerous as negative side effects. Improper administration of natural therapies may allow a disease process to continue with the false confidence of proper treatment, and alluding to a cure of a disease with no results that leaves a patient emotionally frustrated and financially inconvenienced. This gives a very poor perception of natural medicine that may dissuade the patient from attempting it again with a different practitioner that carries higher knowledge or a different perspective and can truly help them.
In my opinion, chiropractic internists are some of the most well equipped medical practitioners that are trained and have the ability to recognize and treat chronic complex conditions. Although a rare breed with less than 300* active chiropractic internists across the country, you will find that they often spend 60-90 minutes on the initial visit taking a detailed history, and follow-up visits are not uncommon to last nearly an hour! Their recommendations are based off of sound scientific diagnostic labs such as LabCorp, Quest and others that are popular and rooted in functional medicine. Their treatments are relatively safe and extremely effective with a patient-centered approach. So if you were curious about the specialty of a chiropractic internist, I would have to say that we specialize in people and listening to our patients. Both of those qualities seem simple enough yet have been dismissed from traditional medicine for one reason or another.
*Figure accurate at the time of writing this article
HäuserW, Urrútia G, Tort S, ÜçeylerN,Walitt B. Serotonin and noradrenaline reuptake inhibitors (SNRIs) for fibromyalgia syndrome. Cochrane Database of Systematic Reviews 2013, Issue 1. Art. No.: CD010292. DOI: 10.1002/14651858.CD010292.