Dr. Jonathan "Sem" Holloway's Blog

"All in your head?" or "Guerrilla Chiropractic"

I was talking about patient referrals to other chiropractors here. This is the story of a patient that didn't accept a referral and became the active patient furthest from my office at 225 miles from my office. He doesn't exactly commute for regular visits, but we do the best we can. Here is his story.

A few years ago he fell from a ladder and hurt his upper thoracic spine. The MDs and PTs said he was just kinda stuck with hyper-mobility and should do certain exercises to actively compensate for the problem. It seemed normal to him and he was wondering if a good DC could help with the situation. I tried to refer him to a great DC near Charleston that would take outstanding care of him. Unfortunately for him, her practice is full at the moment and he was also concerned about going to see someone he didn't know even though I have full confidence in the doctor. So we decided that I would take care of him with portable equipment as often as possible so that he could get his body working better, even if not optimally.

We started with a case history and got the normal info on the fall. After that I started the health talk explaining subluxation and the three causes (physical, chemical, and emotional trauma) during which I mention how it can affect the function of any part of the body that is supplied by a nerve that is interfered with. He then mentioned he was having strange heart, breathing, and anxiety problems when he had a hangover, which was most weekend mornings. He also mentioned that the strange dysfunctions started to happen after the fall, but he didn't think they were related. He mentioned that he thought the problem was all in his head since no other health care provider had addressed the issue with success.

After a thorough exam, we discovered extensive subluxation at C1 (the top bone of the spine) and normal mobility of the upper thoracic spine with no subluxation in that area. I informed him that that subluxation could cause the dysfunction that he was experiencing and that I recommended a C1 adjustment regardless of the symptoms. He was very excited and told his wife that it was nice to know it wasn't in all a mental thing. She works in health care and was interested in the exam procedures and finding. I adjusted him once on a set of couch ottomans pushed together with stack of books for a head rest. I call it "guerrilla chiropractic".

Fast forward about 5-6 weeks.

We were hanging out this past weekend for the first time since that adjustment and I asked how his body was functioning. He mentioned that he hadn't experienced any of the previous dysfunction since and he had had several hangovers that would normally have caused a recurrence. I was beaming, that is until he said "I guess it was just all in my head." I was stunned. We had gone through this already and he has expressed that it wasn't all in his head. He thanked me and walked off before I could mount much of a response. I later talked with him and mentioned again that it wasn't all in his head it was just about a 1/4 inch below it. He just grinned. I think he knows me well enough, and he was just trying to get under my skin. Well, it worked and I got a good story to tell out of the experience. Unfortunately that isn't the first time that has happened, but the patient seemed to genuinely believe that it was all in her head.

I discussed the phenomenon with a pastor; people wanting help and being glad when they find the answer they seek but when they are no longer suffering, they brush off the solution as happenstance. If you have read "Are you the Doctor, Doctor?" by F. H. Barge DC, you would recognize this as part of "The Joys of Motoring."

That was fun, now let's get back to changing the world. You and me both.

Changing the world of patients I will never meet.

I spend a fair amount of time referring people to chiropractors.

When I do a spinal screening and find that an individual is interested in care, but is not willing to drive the distance to my office, I work to find them a good chiropractor in their area. In addition to screenings, on any given weekend I am likely to be off in a field doing medieval re-creation with the Society for Creative Anachronism, riding my motorcycle, or hiking somewhere in the beautiful areas around the upstate. As such, I meet lots of people and I always end up talking chiropractic with them. I support Sherman's mission of bringing straight chiropractic to the world by talking with everyone I can about "The Big Idea". Just because they aren't going to come to my office doesn't mean I don't care about them. Let me give you a few examples.

A spinal screening in Anderson, SC that resulted in a grand total of two visits in my office, but over 20 referrals to other chiropractors.

At least a dozen people I know from motorcycle activities referred to DCs throughout the southeast.

Another handful of folks from the medieval stuff, from Maryland to Georgia.

The friend of a patient who lives in Massachusetts.

A friend from Charleston, more on that here.

And my favorite one: I was on the phone with a customer service rep from AT&T who noticed "Chiropractic" in the billing account information. She said "I wish you were in my area, I need a good chiropractor." Within 24 hours she was referred to Dr. Grostic in Kennesaw, GA. It is unlikely that I will ever meet Tina, but I know to have a slight footnote in her memoirs as the guy who helped her find a chiropractor that changed her life.

I have a process I go through to find a good referral. First, If I don't already know someone in the area, I check the Sherman College Alumni Directory. I also search chirodirectory.com, which is nice because it is info uploaded by the office itself about technique and schooling. Once I have that list, I call around and talk to them. I ask about philosophy and if they use therapeutic modalities and such. Often I find chiropractors that are friendly and dedicated to providing real chiropractic. Occasionally I run into graduates from other "Health Sciences" schools that barely know what chiropractic is. That is why the school you choose and the opportunities you explore while there matter the most. I don't just refer to Sherman grads or just to upper cervical DCs, but I only refer to those that share our focus and passion.

It is almost over-quoted but I think it fits. B.J. Palmer often said "You never know how far reaching something you think, say or do today will affect the lives of millions tomorrow."

Busting Out.

February was a busy month at the office. I spent more time with more patients than any previous month. It was also a benchmark month thanks to elevating from a financial plateau. With the aid of Dr. Mruz of Eastside Chiropractic in Greenville, SC I increase my web presence and the quality of that presence. The best part is that it only cost time. There were other improvements and milestones.

I have finally finished my first box of 8x10 x-ray film and introduced a pamphlet rack in the reception area. Most of the content was self-generated over the past 6 months but it is supplemented by products from Patient Media. They use all the right language to help a principled chiropractor educate patients. I taught two classes at a local factory on safe lifting, ergonomics, and Chiropractic. The nice part about talking about safe lifting is that you have an attentive audience and get to include the Big Idea in with reason to lift with certain techniques. We ended up spending more time on Chiropractic than lifting and ergonomics.

I was also contacted by a former instructor who inspired me as a student and who continues to inspire with his example. Thanks, Dr. Myron Brown.

Now for the big news….. wait for it……. It is going to be good……..

I FINALLY GOT A B.J. PALMER BUST!

The busts are given to DCs that refer students to Sherman that are accepted and start their first quarter. I have wanted one of these since I was a student and they started the program. I look forward to seeing Matthew grow and become a spectacular DC.

At the lateral aspect of the photo, you will notice some of my favorite books listed here.

And there are plenty of things to be excited about in March. I will participate in a health fair at the aforementioned factory, begin learning Spanish to communicate with more patients, and upgrading the education process in the office with posters like this from Patient Media.

In the immortal words of Backman-Turner Overdrive, you ain't seen nothing yet.

Unusual Questions

Wow! It is difficult to believe what just happened.

An older gentleman limped into my office wearing a dirty baseball cap and a jacket that looked as though it hadn't been washed since Reagan was president. I had just finished posting "The Story of the Wagon" and I was beaming. I greeted the gentleman, "Good afternoon, Welcome to Holloway Family Chiropractic. How can I help you?" He seemed to have mild trouble breathing as he replied, "I have an unusual question to ask. I need money to buy my COPD medication. I was wondering I could sweep the floor or take out the trash to makes some money. I'm not asking for a handout, I want to work for it. See, my medicine costs $140 a month and I have earned all but $10.46 of it." He presented a paper with a list of drugs and totals. Some subtraction from the total left the deficit penned at the bottom of the page in purple ink.

I felt compassion for the man and sympathized with his suffering. I stated, "Well, I just finished vacuuming and taking out the trash. I still need to wash the outside of my windows. Would you be willing to do that?" He looked to see the six large windows that lined the corner of the building where my clinic is located. He glanced at the glass door that he had just limped through. "Well, I guess I could do that." I judged his response to be a little disappointed. Maybe he was just hoping I would hand over a 20 and tell him to keep the change. However, I wasn't finished. You see, I decided early on that every person that walks through that glass door is going to hear about chiropractic one way or the other. That even goes for delivery folks.

"I have an unusual question for you, sir." The gentleman paused and looked at me, unsure. "Why do you need the medicine?" I asked. "For my COPD," he replied. I could tell he was trying to be polite. Hadn't he just told me why he needed it? "Well, why do you have COPD?" He hung his head a little as he softly said, "It's my own fault. I smoked for 40 years?" "Do you think your body is capable of healing from COPD?" He earnestly replied, "Naw, it is just one of those things that once you have it, you've got it." I informed him that his information was incorrect. He was quiet.

I followed, "What if I could offer you something that might allow your body to heal from COPD and then you might not need those drugs anymore?" [1][2][3] "O-Okay," he stammered and stepped closer to the counter in the reception area. "I can offer you chiropractic care," I grinned. He stood straight and shook his head. "But I don't have any money." Ignoring the math on the sheet which indicated he had $129.54, I said "Well, how about you clean the windows instead?" He balked, "I came in to offer to work for money for my medicine, not to trade services." He broke eye contact. "And I am offing you a way to, maybe, not need those drugs anymore," I said with a hopeful smile.

He slouched and hung his head again. The dirty edge of his red hat covered his eyes. "I'll think about it," he mumbled as he limped toward the door. I said, "Here, take my card and call me if you change your mind." He accepted the card and murmured "Thank you" to the floor before he opened my dusty glass door.

I was stunned. I had offered to care for him in exchange for a service he valued at $10.46. That might just change his entire life and he declined in favor of taking expensive drugs for the rest of his life. Drugs, might I point out, that he couldn't afford.

So I decided to ask myself an unusual question.

How can I create a large number of patients dedicated to ADIO thinking and chiropractic care? So dedicated that they are willing to go to other health care providers and ask for charity to come see me?

I might add that it would cost less than the drugs.

[1] Amalu WC. Chiropractic Management of 47 Asthma Cases. Today's Chiropractic, 2000; 29(6): 94-101.

[2] Kessinger R. Changes in Pulmonary Function Associated with Upper Cervical Specific Chiropractic Care. Journal of Vertebral Subluxation Research, 1997; 1(3):43-49.

[3]Peet JB, Marko SK, Piekarczyk W. Chiropractic Response in the Pediatric Patient with Asthma: A Pilot Study. Chiropractic Pediatrics, 1995; 1(4):9-13.

Dr. Simpson maskes opinion as sociological research.

J. Keith Simpson, DC Ph.D wrote an op-ed and published in the journal Chiropractic and Manual Therapies. The full article can be found here. It starts out as a very comprehensive chiropractic history lesson but continues into a rant about "subluxation-based" chiropractors. I found his approach unprofessional and unscientific. I am dissappointed in CMT for publishishing this opinion piece. Unfortunatley, I have come to expect such "research" from CMT. Simpson has full right to his opinon but a research journal is not the appropriate form for condemnation.

My email to Dr. Simpson is below.

Dear Dr. Simpson,

I read your article in ChiroMT. I would like to thank you for the comprehensive historical presentation of chiropractic and the challenges it has faced. I would also like to express my perspective of the problem in our profession. You have stated that the division is between "evidence-based" and "subluxation-based." You asserted that the "evidence-based" side espouses science and progress while the "subluxation-based" side espouses dogma and mythological constructs. In effect your division separates your perspective into good and bad, right and wrong, sane and less than sane.

My perspective is that the division is between therapeutic providers and non-therapeutic providers. The therapeutic side tends to be more medical in the approach of treating musculoskeletal symptoms and conditions while the non-therapeutic side uses other objective criteria to determine the need for and adjustment that is not intended to treat a negative but to improve a positive. Both sides of this division use scientific analysis and both sides have dogmatic practitioners. The distinction I make is one of intent, not condemnation. To ignore the scientific approach that "subluxation-based" chiropractors take would be deluding yourself and your profession. It is the intent and application of the science that differentiates, not the use or non-use of scientific understanding.

I also believe you have omitted other options from your list of three, but that is of little concern since your division of the profession is not congruent with the reality of modern practitioners.

I invite you to reconsider your perspective and consider the situation objectively and scientifically without condemnation. I think you will discover that there is a more accurate way to differentiate chiropractic professionals.

I suggest that the profession take a path similar to the third option you proposed. I think it would benefit the therapeutic side to join the therapeutic professions like medicine, physiotherapy, osteopathy, and orthopedists under whatever other title would be appropriate and acceptable. This would allow you to practice the way you want without the "checkered past" of chiropractic. The non-therapeutic side would maintain the term "chiropractic" since the profession was developed as non-therapeutic after D. D. Palmer's initial experiences.

I will appreciate reading your response as soon as it is available.

Regards,

Jonathan Holloway, DC

Holloway Family Chiropractic

1738 East Main St. Easley, South Carolina, USA

864-855-1380

HollowayFamilyChiropractic.com

The Story of a Wagon

The Story of a Wagon

By L. H. (Uncle Howard) Nutting

(THE CHIROPRACTOR, A Monthly Journal, Vol. 1, No. 2, January,1905 (107 years ago). Published by
The Palmer School of Chiropractic.)

Last Saturday,the writer saw an incident on Main street, Davenport, Iowa, which caused much ill humor, amusement, and some instruction to the crowd that witnessed it. Human nature, the quality of which depends upon education, was shown by each one presenting his peculiar idea of the situation and his suggestions. Main street is paved with brick and is quite steep between Sixth and Eighth. A crowd of idle men had gathered on this street to watch a stalled team. I, of course, joined them. The horses were once full of life and vigor, but now they are thin of flesh, showing want of care and lack of ambition. They were hitched to a good wagon, which contained a heavy load. They had gotten half way up the hill, but could go no farther. The driver did not know what course to pursue. Several of the bystanders were eager to assist him with their counsel. Their varied suggestions only served to confuse him. The reader will notice closely the advice given, for it will be made use of hereafter.

The first instruction was to apply the whip, which was used unsparingly. It excited and aroused what little energy they had left, but only worried them without any gain. The next order given and acted upon was to back them down the hill so as to give them a new start. This was tried, with the result that they were not able to make as far up the grade as before. A professional looking man then said, “Blindfold the horses, shake the wagon, throw something heavy on the pavement, make them believe that you have unloaded. If they think the wagon is empty, they will pull it up the hill easily.” But try as hard as they might, they could not pull the load.

The next man to offer advice was a clerk from a nearby drug store. He thought that the axles and heels were tired instead of the horses. A supply of oil was secured and applied to the axles and heels plentifully, which seemed to make the wagon more inclined to slide down the hill.

Then there appeared in the front of the crowd a seemingly wise fellow. He looked as though he was a graduate from some college or a president of some hospital board. He argued the case as follows: “No team on earth can pull that load, there is too much wagon; make it as light as possible, take off the spring seat, take out the end gate and all the loose rods, saw out half the spokes for they are crowding each other, take off the tires, for they only serve to make extra weight; the fewer pieces you have in the wagon the more easily it will move.”

But fortunately, before the well-dressed man’s advice was put in force, there appeared a practical farmer who took in the situation at a glance. He spoke in a mild tone, but what he said carried force and was convincing. He said, “Let that wagon remain whole, not one piece of it can be spared at this time when it is so loaded. Wipe off that surplus oil, throw the whip in the gutter, cease to blindfold the horses.” When this was done, he calmly said to the driver, “NOW TAKE OFF THE BRAKE.” It was released. The team made the top of the hill with the usual speed and ease. The farmer was heard to say, “That is easy to do when you know how.” The crowd dispersed, being benefitted more or less by the experience.

Author's note: This story was originally titled "The Story of Take off the Brake" which is found in the Green Books Vol. 27 "History Repeats." I thought the title was a bit too much forshadowing and didn't engage the reader as much. I have to say tho (sp), I spent the whole story a bit frustrated knowing how it was going to go. Go back and re-read it and see if you feel the same way.

When I talk to people about their health I occationaly feel like screaming "Take off the brake!" I usually opt for something more professional like "I think we can agree that you body is designed to be healthy and the way your body coordinates health is throught the nervous system. We, at Holloway Family Chiropractic, work to remove the intereference with the expression of health." I often get a blank look and a short pause followed by further explaination of how they tried "everything" and they "haven't figured it out yet". Total face-palm.

**As I finished writing this post an elderly gentleman limped into my office. Read about it here**

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Top 10 most useful books for a first year DC: Part 2

Continued from Part 1

4 What Time Tuesday? By James Tomasi

Like “Chiropractic First” I have this in the reception area. I have had the true pleasure of meeting Rev. Tomasi on several occasions and I am always encouraged by his smile and warm disposition. This text chronicles James’s experience with Trigeminal Neuralgia which is known as “the suicide disease.” It is considered virtually untreatable in many cases and the extreme and constant pain influence sufferers to take their own life rather than live with the condition. It is no spoiler to say that James experiences a full recovery after experiencing specific upper cervical chiropractic care. His appointment with destiny was thankfully early enough in the day on that fateful Tuesday than the time he had choose to reinforce the “suicide disease” part. If you don’t believe chiropractic care can save lives, read this book. Hell, read this book anyway. It will also be a part of my new patient packet eventually.

3 Inspirations by Thomas A. Gelardi, DC

Dr. Gelardi is known as the “Defender of Chiropractic” for many reasons including the founding of Sherman College of Chiropractic. In “Inspirations” he compiled quotes and short anecdotes of encouragement that helped him become one of the most respected DCs still living. Gelardi has always been staunch and vocal but you can’t change the world without making some people angry. This text is in continual use in my office. I have repeatedly handed it to a patient who was stressed or depressed and it is consistently returned with a thankful smile. It is available in the Sherman College bookstore. A big thank you to Dr. Myron Brown for gifting me his copy with his own personal encouragement.

2 The Big Idea: 10 Innate Principles to Becoming a Successful Chiropractor by James M. Brown, DC

This book was the first chiropractic book I ever read. I interviewed Dr. Brown for a paper during my undergraduate studies and found him to be one of the most compassionate people I have ever spoken with. In his later years, he wrote this text in hopes of furthering his dream of seeing wildly successful and compassionate DCs across the world. His definition of success was inclusive of clinical results and a healthy business model. He did not separate the two. This is a very rare book and I have one of the few copies I have seen. Dr. Brown’s first edition is in need of editing and I have undertaken part of that task. I hope to see a 2^nd edition published in the next two years. There are still a few copies in the Sherman bookstore.

Honorable Mentions

Starting a Practice by Reggie Gold, DC

This book missed the list due to it being an audiobook, but is the single most useful information on building a practice that I have. It is available for purchase and from the Sherman College library. Also check out his commencement speech “The Valley of the Blind.”

Differential Diagnosis and Management for the Chiropractor by Souza, DC, DACBSP

Though written by a DC, this book missed the list because it concerns medical practices that fall within the potential scope of practice of chiropractors. It is useful to see how conditions are approached from a medical standpoint and I use it most to inform patients as to what an “outside-in” approach would be to their health and to answer questions they have about what a “sickness care” provider has told them. Good information, just not chiropractic.

Number 1!

Are You the Doctor, Doctor? By Fred H. Barge DC, Ph. C, FICA, FPAC, SCS

I don’t remember how I found this book. I think it was next to the “Green Books” in the library and it being much smaller, thought it would be good for out-of-class reading. This book has been vital to my professional mindset, office setup, and table-side manner. I grew up with mechanics and factory workers at carnivals and trailer parks. While I learned how to work on vehicles and handle myself in a fight, no one ever taught me how to be a doctor. We didn’t go to MDs often as kids and when we did it was often a bad experience. It was a DC who first made me feel respected as a patient.

I learned a lot at Sherman and there are many shining examples of successful and professional DCs to model but I could only learn what they did and didn’t do. “Are you the Doctor, Doctor?” answered questions that kept me up at night during school and sometimes after graduation. I modeled my professional self with the guidance of this invaluable text. The most important aspect of this book is that it does tell you exactly what to do; it guides you to make the best decision for yourself and your patients. That is the difference between being a technician and a professional.

In your first year out you will need guidance and these books have been a large part of the map I use. I know they will help you too.

Top 10 most useful books for a first year DC: Part 1

Hello everyone. My name is Jonathan and I am a bibliophile. That’s right, I love books. My personal collection numbers in the thousands. While my professional collection is significantly smaller; I actually spend more time with it. The only piece of office furniture I purchased new was a very nice bookshelf that I found on sale at an office supply store. Good used bookshelves are hard to come by. Back to the point.

I have found use in all of the books in my professional collection so I figured (southern dialect for “reasoned”) I would compile this list for future and current DCs who are willing to avail themselves of the library of knowledge (pun intended) we have access to.

10 Clinically Oriented Anatomy; 5^th Edition by Moore and Dalley

The first title on the list is the textbook for graduate level anatomical study at many universities for its modern, accessible, and memorable approach to learning anatomy. Grey’s Anatomy is more complete but is difficult to read and learn from. COA is updated with colorful illustrations and photos and associated clinical examples of why knowing this information is useful. It was essential for my study of anatomy while at Sherman and I continue to use it for reference at least weekly.

9 Sinnott’s Textbook of Chiropractic Philosophy; 1^st Edition by Rob Sinnott, DC, DPhCS

Aside from being a stalwart and vigilant defender of chiropractic’s unique and exceptional philosophy of health, Dr. Sinnott authors this text that provides the solid foundation for logical and complete understanding of why doctors of chiropractic do what we do. It is complete but not dry. It is also structured to be assimilated into classroom education for DC students. While I do not bend the book’s spine that often lately, I use the information therein with every patient. I think it should be required reading for every chiropractic school and for all practitioners. It probably wouldn’t hurt to donate a few copies to medical schools as well.

8 Upper Cervical Subluxation Complex: A Review of the Chiropractic and Medical Literature by Kirk Eriksen, DC

This book is wonderful. It is a well-organized literature review of research that I don’t have to pay a subscription or have an internet connection to access. Not only is this book full of thousands of peer reviewed articles, it is organized so that that it doesn’t take a week and a half to find it. If you are asking why you need a research book in your clinic, then you need two copies of this book.

7 Chiropractic First by Terry A. Rondberg, DC

This book sits in my reception area for patients to read while I am developing x-rays or with another patient. Its goal is to change health thinking to bring chiropractic to the forefront of patient’s minds when considering health choices. It is much too long for a patient to complete while in the office but I use examples from the text on my patient education board. The story of Winifred Gardella alone is worth the price. Eventually I will include the book in the packet a patient receives when they start up care.

6 The Subluxation Specific The Adjustment Specific (Vol. 18) by B. J. Palmer, DC, Ph. C

The most famous “Green Book” in chiropractic is philosophy, research, technique, and encouragement all in one tome. I use "tome" because you could hammer tent pegs with this thing. In the early years of the profession Palmer College of Chiropractic was the fountain head for all chiropractic research and publication. Published in 1934, this book needed to apprise the profession across the country with the most up-do-date information available. Nearly 80 years later this book still serves DCs who care even the slightest about specific care for their patients. Though it advocates and upper cervical approach to care, it is useful for any specific adjuster.

5 How to Start a Practice from Scratch by Peter G. Fernandez, DC

This is an interested double book that was published with the additional text of “How to Buy and Sell a Practice.” The book is a bit dated in its checklists and ways to research a location but it still covers the basic concept of one of the hardest things to teach students. This book cost me 50 cents at the Sherman Library books-for-sale pile and it has been the best investment I have made in terms of monetary return. I do have some issues with some of the equipment Dr. Fernandez suggests you purchase, but for the business side, it is excellent and frugal without being cheap.

Continued in Part 2

Ebb and Flow, Ups and Downs

Things have been going well for the practice. We broke even the first and second month which is awesome. The average small business takes years to do that. Good progress being stated, I was not surprised when the number of new patients started to decrease a couple of weeks ago. I believe it is due to the holidays and was told by fellow DCs to expect it. I am working on a way to turn that around. Get the tide to start rolling back in so to speak. But what I have not received in new patient flow I have gained in support.

Today a fellow DC in town dropped by to get checked and to play Santa. He is an experienced practicioner and had an old Neurocalorometer aka "Kale Thermeter" and he gave it to me. Just handed it to me. I have been hoping to do thermography in the clinic but it has been cost prohibitive. He just eliminated that problem.

The moral of the story is that we should not be competing with other chiropractors. Our competitors are those that promote the "outside-in" health care thinking. We have to educate the public not put down our fellows. I am proud to be in a community and profession with the camaraderie and compassion that I experienced today.

Sherman Pride Day 2011

Monday, October 24th was Sherman Pride Day 2011. The announcement email suggested a few different ways to celebrate. I chose several of those options. I :

Wore a Sherman Shirt.

Offered a prospective student a chance to shadow me in the office.

Spoke with two classes of students from the Donaldson Career Center about Chiropractic.

Set up a visit for those students to visit my clinic.

Talked with a two classmates.

Played a classmate's CD during office hours (The Micah Dunn at DunnsMusic.com).

 

So, what did you do to celebrate your pride in Sherman?