By the time this you read this I will be nestled into the welcoming (if slightly damp) bosom of Dublin.
I am lecturing at the Chiropractic Association of Ireland (CAI) this weekend on why vitamin B12 deficiency is creating an epidemic of missed diagnosis and mis-diagnoses.
The three things I want attendees to know when they leave are:
3 Key symptoms of B12 deficiency: Persistent pain/p&n/numbness (unilateral or bilateral), fatigue, mood & behaviour (depression/anxiety).
B12 test: +ve tests (low) are reliable, “normal” tests are (relatively) unreliable: therefore the clinical picture is most important.
If in doubt a months trial of B12 sublingually plus supporting B vitamin complex is warranted.
These are my clinical opinions but they are also partly NHS guidelines.
If you have ever had the misfortune of trying to communicate with a GP about B12 levels and patients neurological symptoms, it’s hard to believe they have ever read them.
This is why for me, it is simply not possible to be a competent Chiropractor without knowledge of the metabolic/nutritional side of health.
It’s all too easy to say “I just want to adjust, I refer out for nutrition”.
But if you don’t understand how the metabolic side of our system affects neuromechanical health, you won’t know the patient needs to be referred out.
Patients [email protected] undiagnosed Lymes disease rarely turn up with a history of being bitten by ticks.
Patients with undiagnosed Coeliac disease rarely have overt gastrointestinal symptoms.
So you just keep adjusting them.
Or throw rehab exercises at them.
Or do whatever you do.
And eventually, they drop out.
They don’t pop in, look you in the eye and say “you really haven’t helped in a significant way, I’m going to try someone else”
They call or email lies about being away with work, or their child being ill.
And you become yet another practitioner in a long line that missed a key piece of their health puzzle.
If your patter is good, and you reassess every 36th visit, your patient visit average (PVA) will still be nice and high (don’t want any ill patients dropping down your key wellness indicator do we?)
You will forget these pesky patients that don’t respond, who sullied your clinic with their annoying repetitive pattern of dysfunction/subluxation and pain.
And move on.
Eat. Sleep. Adjust. Repeat.
I’m being facetious but this stuff is serious.
Check out the 10 minute BBC documentary below.
Imagine the lady with “MS” is a new patient.
If she had come to your clinic and you had accepted the diagnosis of MS.
How would you feel knowing you that you had been part of the failing healthcare system that would have eventually led to her death after a long period of disability?
As a profession we are pretty quick to point of the failures in the NHS/medical system.
We need to hold ourselves to a higher standard.
A spinal adjustment is truly an amazing life changingthing for some.
And for others, they are useless, unless the metabolic system is addressed
Action to take today:
Check out the B12 functional range chart from the ACN Core Concepts course.
Ask the patient to request any GP blood test results and check the “normal” B12 levels against the chart. (remember the lady with “MS” was NHS “normal”, but in the grey zone functionally)
As always, don’t waste those valuable adjustments.