David Nette's Story - Part One

[IceMakKneeGrows]

good guy

[whiskeyify]

how do we know she didn't have a pre-existing condition? I asked my chiro about this and that's what she said. No doubt some injuries have happened but they are rare. My chiro went on to say she only pays $4000 a year in malpractice ins. Compare that to MD's that pay quite a bit more. Chiros don't have that many claims against them.

[acousmas]

Just want to say thanks for sharing. I had a left side VAD about 7 days ago and am making a fast recovery. I think we should always let people fight for their life. I was surprised how terrified I was of dying with the sudden onset of symptoms of VAD and/or not being more aware and in control of my mortality. Looking back I couldn't imagine begrudging a loved one allowing me to fight for life, even though I have a living will and advanced directives. PEACE

[RedStateRoy]

You'll make a great clinic director some day;-)

[slants1507]

Also the researchers state they've never really done any testing exactly like this before. "this study represents a novel approach into quantifying the biomechanical effects of SMT." This quote is in the discussion section. They also admit that the study is limited because of the "lack of muscle tone in cadavers." I'm assuming a person with a stiff neck coming in to see a chiropractor has a bit more muscle tone in that region. Continued...

[slants1507]

"[A] study from Canada, based on national health records, found that patients with stroke caused by arterial dissection were five times more likely to have recently visited a chiropractor. "

Leon-Sanchez, Andres; Cuetter, Albert; Ferrer, Gustavo

Cervical Spine Manipulation: An Alternative Medical Procedure with Potentially Fatal Complications.

Southern Medical Journal; Feb2007, Vol. 100 Issue 2, p201-203, 3p

[krzyweplecy2]

Yes, makes sense since chiropractors do see people with stiff necks and headaches..which are symptoms of an arterial dissection. The question still remains: did the adjustment cause the dissection or was the dissection already there. To date there is still no proof that adjustmets DIRECTLY cause the disections.

[krzyweplecy2]

The study is saying something like this: Pedestrians who are hit by cars are 5 times more likely to recently been walking on the street. Well Duh. What it doesnt say is the conditons under which this all happened. Was it dark outside and the pedestian was wearing all black, or was the driver intoxicated. Or was it slippery outside? Unknown. But the stats may be accurate. They still dont tell us anything.

[slants1507]

I completely agree that this is only a correlation. But to say that the correlation is as clear as your example is taking it a little over-board. I mean, why aren't arterial dissections five times more likely to happen to people who were in whiplash type motor collisions? Or why isn't it five times more likely to happen to college football players?

[slants1507]

So, it correlates to chiropractors. Is it because neck pain and headaches are associated with arterial dissections? Possibly, that may be the reason they see a chiropractor. Vertebral arterial dissections rapidly deteriorate, as you can imagine. How many of these people who have an arterial dissection going in to see a chiropractor, are deteriorating in the chiropractor's office? Should be some documented cases, I would think? Otherwise this correlation is directly caused by the visit.

[krzyweplecy2]

Yes my example was a little overboard- but it was the best i could think of at that moment. There have been documented instances where in a chirpractic office the patient is deteriorating, and was sent out to the ER during the initial exam- no adjustments yet. Good thing it was caught early. But in some cases it was not recognized and a thrombus may have been dislodged. But the problem is- that it is hard to detect, while in progress.. COntinued

[krzyweplecy2]

This is why the percentage of patients who see a chiro vs medical doctor and have a stroke following the visit it THE SAME. It is very hard to tell if this is a dissection or just a stiff neck and a headache. MD's cant tell just as well as Chiro's. Those are the statistics. So there is a correlation, but i would not say it is a direct one.

[slants1507]

I'm not saying your lying, but could you give me a reputable source of your statistics? I mean if you are going to make factual statements like the statistics are the same and MD's as well as Chiro's can't tell the difference of an early aortic dissection, all I want is a little objective proof. Or at least the news article you got your info from. Thanks!

[docsrocks]

Here's something exponentially more important.

Internal forces sustained by the vertebral artery during spinal manipulative therapy.Symons BP, Leonard T, Herzog W.

Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Canada.

BACKGROUND: Spinal manipulative therapy (SMT) has been established as a clinically effective modality for the management of several musculoskeletal disorders.

[docsrocks]

One major issue with the use of SMT is its safety, especially with respect to neck manipulation and the risk of stroke in the vertebrobasilar system. OBJECTIVES: Our objectives were to quantify the strains and forces sustained by the vertebral artery (VA) in situ during SMT. Study Design: This was a cadaveric study. METHODS: Six VAs were obtained from 5 unembalmed postrigor cadavers.

[docsrocks]

The cephalad/distal (C0-C1) and caudad/proximal (C6-subclavian artery) loops of the VA were carefully exposed and instrumented with a pair of piezoelectric ultrasonographic crystals. The strains between each crystal pair were recorded during range of motion testing and diagnostic tests and during a variety of SMT procedures. The VA was then dissected free and strained on a materials testing machine until mechanical failure occurred.

[docsrocks]

RESULTS: SMT performed on the contralateral side of the cervical spine resulted in an average strain of 6.2% +/- 1.3% to the distal (C0-C1) loop of the VA and a 2.1% +/- 0.4% strain to the proximal (C6) loop. These values were similar to or lower than the strains recorded during diagnostic and range of motion testing. Failure testing demonstrated that the VAs could be stretched to 139% to 162% of their resting length before mechanical failure occurred.

[docsrocks]

Therefore the strains sustained by the VA during SMT represent approximately one ninth of the strain at mechanical failure. CONCLUSIONS: SMT resulted in strains to the VA that were almost an order of magnitude lower than the strains required to mechanically disrupt it. We conclude that under normal circumstances, a single typical (high-velocity/low-amplitude) SMT thrust is very unlikely to mechanically disrupt the VA.

PMID: 12381972 [PubMed - indexed for MEDLINE]

[krzyweplecy2]

Cassidy JD, Boyle,E, Cote et al(2008)Risk of Vertebrobasilar Stroke and Chiropractic Care:Results of a Population-Based Case-Control and Case-Crossover Study, Spine 33(4S):S176-183

Enjoy

[slants1507]

krzyweplecy2, I need to ask a similar question that I asked docsrocks.  Did you only read the abstract or did you read the entire article? Again, I think the abstract is very misleading. The article states:

"There is an association between vertebrobasilar artery stroke and chiropractic visits in those under 45 years of age." AND "There is also an association between vertebrobasilar artery stroke and use of primary care physician visits in all age groups."

[slants1507]

And although they found no reason for increased risk to go to a chiropractor (why would they find a reason for risk when it was only a statistical study?) They did find a correlation similar to the article I quoted above.

[docsrocks]

And I need to ask you if you read it. There is a statisitcal association. Does that give cause? In no way does it. When looking closer, despite a statisitical association, there is no direct causation. No reliable mechanism of injury. No smoking gun technique. No real proof.  The article you quoted was a play on statistics. That's all. And if you read it, some curious things were in it's conclusion as well.

[slants1507]

Yes sir, I sure did read it. I think you and I are saying similar things. A statistical analysis doesn't provide a reason. Maybe my parenthesis comment wasn't worded correctly I apologize. All I'm saying is these "exponentially more important" Pro-Chiropractor articles you guys are providing, really don't help the chiropractor. In truth, some of the things said in those papers actually support the anti-chiropractor people. I mean I am taking quotes right out of the article.

[slants1507]

I'm not trying to make a big Anti-chiropractor Parade. I just see a couple people on this comments section being super rude and and these scientific abstracts thrown around like they are some kind of Untouchable Proven Law. And to the non-science people out there, they might be misled. I don't think that is right.

[docsrocks]

Anthony Rosner, PhD did a nice, long retort to this correlative 'study'.

-this can be found on chiroweb when you put in the title of this 'study' in the search on the site. It's really not very credible and still allows absolutely no credible mechanism of injury. I guess they ran out of imagination for that part.

[slants1507]

docsrocks, just out of curiosity did you actually read the study or the abstract? There are a lot of holes in the Journal of Manipulative and Physiologic Therapeutics study. First they measure this on cadavers (granted they didn't use embalmed so at least they were smart in that aspect) cadavers don't have a blood pressure. How can they measure the pinching or destruction of an artery without blood flow? I don't think that the blood pressure in a vertebral artery is negligible. Continue....

[slants1507]

Also the researchers state they've never really done any testing exactly like this before. "this study represents a novel approach into quantifying the biomechanical effects of SMT." This quote is in the discussion section. They also admit that the study is limited because of the "lack of muscle tone in cadavers." I'm assuming a person with a stiff neck coming in to see a chiropractor has a bit more muscle tone in that region. Continued...

[slants1507]

There was "a large aneurysm" in one of the cadavers. Nobody knows what kind of effect that would have on their testing, but they tout it as something that would help out the study, although again, no blood pressure in cadavers. They even state that during the dissection, they "render[ed] the environment of the VA [vertebral artery] less stable." I'm in a cadaver anatomy lab right now, and I can tell you that the VA is in a very tight area, and any twisting of such a small area.....

[slants1507]

I could imagine would lead to damage. But in this study the researchers made it sound like they increased the space for the VA to move. How is that going to make the study reliable? And finally the most telling quote of the whole paper. "The clinical relevance of these results is equivocal, mainly because these were single, manipulative thrusts in a

non-living subject." So your abstract you provided was a bit misleading.

[docsrocks]

Um, only in that it wasn't a perfect model. This study was, by far, more substantial than the one you provided. This may have been off by some margin, but even if it estimates half of what it would on a live subject, that means we've hit 2/9ths of the limit. And that would be the so-called 'worst case' scenario. There are many menipulation techniques that use less force than that. And if the VA was that delicate, many other forces would be causing strokes far more often.

[docsrocks]

And I doubt it would make up for the 8/9ths difference.

[slants1507]

docrocks, the 2/9ths limits and numbers you reference to are a theoretical number based on a longitudinal rip from a study that they state is a novel study. How does this predict a dissection in a person with a pulse, possible arteriosclerosis, or any thing else that creates problems in the living? I'm not saying they didn't try to make their results correlate, I'm just saying that using this study as the BIG reason why chiropractors don't cause VA dissections is hardly good enough.

[slants1507]

But do they cause VA dissections? Jury is still out, and i think that's the big thing. Chiro haters think they've proved it and chrio lovers think it's been disproven. I don't think either. More studies need to be done and someone needs to come up with a clever way to measure if this is actually possible. What if it is possible? So what? The likelihood is low, but then patients would just need to be warned of the possible complication.

[slants1507]

It would be like anesthesia having patients sign the "you could die from this you know?" paper before any general anesthesia procedure. Are people who get a benefit from chiros really gonna be scared of a paper like that? If not, then what's the worry? If so, then why? Just makes more questions.

[slants1507]

Just out of curiosity docrocks. How much medical background do you have? Also, have you done any laboratory research?

[docsrocks]

DC. Yes, I did in undergrad my senior year. No, I don't get paid to do it.

[docsrocks]

Most of us do use one. A general waiver, that is. And no, I haven't had anyone say, "really? This isn't 100% safe? I'm not going through with it..". While this is an extremely safe profession, it's certainly not 100% safe. The stroke issue, however, is being vastly overblown and there is still nothing that points to anything we do specifically that can do anything harmful to a healthy VA.

[docsrocks]

No. Because what seems to happen is that, via a genetic/malformation weakness, the artery will dissect on it's own and wait for a very light and benign occurance (birdwatching, looking back, etc) that induces a thrombus. As this study points out, exam procedures are more stressful to the VA than every technique used. As pointed out already, these people are already in the early stages of stroking out.

[docsrocks]

What study on this is better?

[highch]

It is truely awful what has happend here. Reading some of the comments there does appear to be somewhat of a witchhunt against chiropractors. As far as neck manipulation goes no-one knows if there is an increased risk following manipulation of the neck but it certainly does happen. I am a chiropractor and I dont know whether there is any more risk than associated with normal neck movement continued next comment.

[highch]

One study comes concludes you are 7 times more likely to see a chiropractor 1 week before vertebral artery dissection, the next study shows you are also 7 times more likely to see your Medical doctor prior to dissection (Cassidy et al 2008). Cardiff 2007 a patient is referred to hospital from the Chiropractic College as she was suspected of being in the process of a dissection on initial history taking, confirmed by the hospital. I examined a new patients ankle and he took a stroke.

[highch]

3rd comment. Why are there no increased rates of VBA dissection with increased use of chiropractic? While the risk is unkown we can only look at the risk benefit ratio. Reduce the the risk. history taking, Contraceptive pill, hypermobilty, neuro signs, BP, Smoker, etc and only manipulate when benefit is demonstrable. To perform this just to "improve health" is not on, there is no evidence. But for neck pain and headaches there is evidence.

[highch]

4th and last post. Given that it has not been shown that manipulation is any more dangerous than normal exercise phystherapy mobilistion or osteopathic manipulation there is no indication to stop the procedure for these cases.

I am not saying manipulation is completely safe, clearly strokes happen, but nobody has shown that it carrys more risk (or indeed and greater benefit) than other manual therapies of the neck or indeed exercise, its certainly safer than antinflamm's.

[trulyheaven777]

I still find the fact that football collisions don't markedly increase the risk of stroke, but some of these people think a well performed adjustment will. Silliness.

[drjag10]

I'm sorry. As a chiropractor, cervical HVRA are overpracticed. It is not necessary in order to gain musculo-skeletal relief - there are plenty of other options that work better long term. High Velocity Rotatory Ajustments in the cervicals (and Lumbar region) should not be taught in Chiropractic Schools.

[docsrocks]

Are they? I'm not sure where you went, but at PCC there was nothing taught like that. Gonstead, MRB and even RB do not use much movement at all when performed correctly. Which is usually the main problem-when performed correctly.I've been adjusted by almost least a hundred chiros and only three or four where truly bad at it, but those few absolutely needed to either work harder or use SOT or activator. As for HVRA-McKenzie technique exemplifies that and is a PT maneuver.

[krzyweplecy2]

Im sorry but drjag10, you should quit practicing because you are not a chiropractor!

If you want to be a Physical therapist and practic supervised exercise you should have go to school for that. Chiropractors adjust the spine to improve the overall function of the individual, and the nervous system. That includes HVLA( low amplitude) not much rotation there at all, to all segments of the spine that need the adjustment.

[christaheck]

drjag10..you are a true professional and health care provider. I know there are many quality chiropractors out there who share your point of view on this subject. It is my hope that they will come forward. I will be launching a website very soon. It will encourage stroke victims, families, conscientious chiropractors,physicians, concerned citizens to raise awareness about this risk. Our ultimate goal is to ensure that all chiropractic patients receive safe care from providers like you.Thank you.

[docsrocks]

Please stop lying christa. And talking out both sides of your face.

As for your website, there are already a couple of chiro-hate sites. I doubt yours will be any improvement whatsoever over those trash sites.

Too bad drjag couldn't come back and enlighten us more with that 'wisdom'.

[RedStateRoy]

Next time you have a thought doc...let it pass. Sounds like you need to go to the Mountain Top for another philospy injection! ;-)

[drjag10]

LOL. I certainly don't need to have my "power turned on" by a subluxation chaser. Chiropractic is safe and effective in treating myo-skeletal dysfunction. I have my niche, you have your's. I hope my views are mainstream. Based on experience, I have learned that HVRA, when done incorrectly and without full disclosure and history can cause injury. Just do your homework and try and get through school or call David Singer for another scripted prepay cd.

[interested777]

These are severe cases,but what about the cases that go unreported like people that get headaches shoulder pain, numbness and god knows what else.Our joints are not meant to be popped and cracked.Sometimes the body will pop the crack the joint itself the natural way the joint will only go where the muscle pushes it.

[krzyweplecy2]

Interested777, you really know nothing of the human body. How it functions, how it was designed, and what it is capable of doing.

[prettysailorstar]

this is so sad...i have always been iffy towards chiropractors. But i had no idea, sometimes my mom leaves with a very sore neck, then she is great, maybe it all depends on who you see, she sees a very very well trained and well known one. So...i dunno, but i definetly feel for you, ya

[trulyheaven777]

This is a story. The evidence to back up claims against the chiropractor specifically are? Not much. The tie to chiro adjustments and strokes are jack and shit. There is scant evidence, at best. This is very unfortunate, but as a malpractice suit-iffy. As a class action suit-ridiculous.

[paultmckay]

In 1992, researchers at the Stanford Stroke Center asked 486 California members of the American Academy of Neurology how many patients they had seen during the previous two years who had suffered a stroke within 24 hours of neck manipulation by a chiropractor. The survey was sponsored by the American Heart Association. 177 neurologists reported treating 55 such patients, all of whom were between the ages of 21 and 60. One patient had died, and 48 were left with permanent neurologic deficits.

[trulyheaven777]

1) This is a 'survey', not research.

2) At best (for you) it implies a temporal relationship.

3) No causal mechanism is even implied.

[paultmckay]

A recent review of 116 articles published between 1925 and 1997 found 177 cases of neck injury associated with neck manipulation, at least 60% of which was done by chiropractors.

[trulyheaven777]

Again, this implies a temporal relationship, not causal.

[trulyheaven777]

Risk of Vertebrobasilar Stroke and Chiropractic Care: Results of a Population-Based, Case-Control and Case-Crossover Study

Cassidy JD, et al. Spine. Vol. 33, No. 4S, pp. S176-S183

[calrico]

Thousands of people are adjusted every day in Alberta. Why doesn't this happen more often? Why do people continue to see Chiropractors? This doesn't happen all the time because chiropractic IS safe. Chiropractic adjustments (given properally) are very benificial. This is a misfortune to see and hear about. Our prayers go out to the Nette's. Juest remember more people die at hospitals every day because of mis diagnosis, and medical mistakes and many people get relief from chiropractic.

[trulyheaven777]

Yes. Chiropractic is the safest helathcare. This is a specific claim and should never ever be seen in a 'class action' case.

[jemisis]

PREVIOUS comment was to 'greatotis'

[greatotis]

There is no way after seven years of chiropractic care that you can blame the chiropractor for a stroke. Convenient yes. Lucrative yes. The statistical probability is greater at the hairdresser!

[rabbletv]

That is a old saw that doesn't cut it anymore. Neurologists in Edmonton alone are seeing one to two cases of stroke after chiropractic neck manipulation per month. Besides, the adjustments have no value, so any risk is too high.

[greatotis]

You should check your facts. You are probably listening to the rogue neurologist in Edmonton who likes to link two sentences together that have no relation just for effect. He was clamped by the judge for saying just what you have said which is entirely untrue. What he said was the following, "Chiropractic is dangerous, we see at least two stroke victims in our office every month". Of course when pressed he said that he did not say that the stroke victims had ever received chiroparactic care.

[firstblob]

I have no respect for your comment. You can sound smug and like a know it all, but you simply don't know what you're talking about here. Simple as that.

[trulyheaven777]

Who are you talking to?

[christaheck]

Amazing!...just keep your head buried in the sand greatotis...statistical probability?...hmm, how would that apply if YOU were the one who suffered this (even if it was after 17 years)? This has been happening for YEARS, but it won't be kept a secret any longer. You can stick to your ridiculous philosphies and comments...we victims WILL stop chiropractors from hurting and killing people...mark the day!

[greatotis]

Not amazing at all, it is a statistical fact that you are more likely to suffer a stroke at the hairdresser, or backing your car out of the driveway, or at the dentist, than at the chiropractor. Learn to read before you pretend to know what you are talking about. Sorry you feel like a victim, looking for someone to blame.

[trulyheaven777]

It's sad that the pathetic little youtards bother clicking on the negative comments but won't pony up to a real comment.

greatotis-good call. These people are all excited and ready to go on a witch hunt. And here I thought this was 2008....

[trulyheaven777]

So the fact alone that someone suffers a stroke means that someone else is at fault? They never hapen on their own? That's usually the nonsense that backs the chirohaters. Kook.

[LarBall29]

your ignorance is obvious, your lack of compassion even more so. my brother-in-law, 40 years old with two young sons just had both of his arteries snapped by a chiropractor. The Neurosurgeons said they only see this happen in severe car accidents and chiropractic adjustments. He was adjusted days before and is now on life support. This doesn't just happen nor is it coincidence.

[wwfanclub]

Our heartfelt compassion goes out to you. We share your pain.

Keep up the good fight. The facts are adding up. The wheels of justice move slow but they grind very fine. Truth will have it's day.

Dave&Sandy

[trulyheaven777]

Then there should be scientific backing for it rather than just anecdeote. but I'm ignorant, correct? I don't cave in and agree based on emotional responses that aren't corroborated with actual data. Your story smells of....BS. Both arteries? That's not just a reach, it's science fiction. How could the chiro have done that? It's a ridiculous assumption. But I'm not compassionate for not believing your story..oh well.

[wwfanclub]

Hello Christa,

I believe you have said it all.

Mark the day indeed.

Dave & Sandy

[ar1411]

Hello Mr. Nette,

I am Graham McMillan's sister, Sheree Weisenberger. We live in Beaumont, south of Edmonton. He has kept us apprised of your difficult situation. I used to go to the chiropractor all the time for adjustments, but have been noticing more and more neck pain, and have stopped taking treatment since hearing your story.

We're praying for you!

- Sheree

[wwfanclub]

Thank you Sheree,

Graham and Susan are wonderful people! We feel as though we have known them forever! Spending time with the was the last trip Sandy and I took together. Many happy memories indeed!

We treasure their friendship and look forward to perhaps meeting you also some day.

Many sincere thanks for your prayers and good wishes.This is what keeps us going!

Be Well,

Dave & Sandy

[erbourne]

Thanks goodness Sandy has such wonderful support! Hang in there!! I think what you are doing is a wonderful thing. I've agreed that no neck manipulations is key for a long time! Good luck!

[wwfanclub]

Thank you so much for your encouragement. We are getting emails from all over the world.

The message is finaly getting out there.

Be well,

Dave & Sandy