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Dealing with BLATANT Chiro misinformation 101

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  • #16
    Originally posted by Pooka1 View Post
    Stitzel (chiro) writes:



    How would he know one way one way or the other what surgeons do or don't do? I have been tangentially related to two fusions, one for each of my kids and I am very sure the surgeon shared with me only what I needed to know which wouldn't fill a thimble compared to the actual expertise he brought to those two cases. And even with that small amount of knowledge I have, as a parent who helped two daughters, I know far more than a chiro knows about surgery.



    So what? Lateral angels aren't going to measure themselves. It just comes off as yet another point of ignorance from a purveyor of an alternative treatment. My advice is stick with accepted terminology if you don't want to be ignored out of hand. And it is no coincidence that you can publish "Cobb's angle" in a chiro publication; Try publishing that in a medical journal.



    How would he know what surgeons do and don't do? This is beyond absurd. Chiro is not a surgical specialty.



    He is suggesting that chiros can make surgical decisions on firmer ground than surgeons. Maybe they use (imaginary) subluxations.



    He is second guessing them on THEIR field (surgery) which is not his field by a MILE. If chiro is going to have a seat at the big table of scoliosis, they need to understand where their training ends and where the training of orthopedic surgeons starts.
    NSF was mentioned because - eh hem - some seem concerned with putting this particular man under an electron microscope.

    I went back over this thread today with morning coffee.

    I find a good conversation between two people (Dr. Stizel and Goldfinch who is a surgical nurse at a very large hospital in the UK); one that at the end of the day, finds some enlightening concepts exchanged.

    I think maybe - we make too much of this?

    That's all I know :-)

    Comment


    • #17
      Is it seemly or unseemly for a person not trained in surgery to suggests surgeons may not be taking the right approach to making surgical decisions?
      Sharon, mother of identical twin girls with scoliosis

      No island of sanity.

      Question: What do you call alternative medicine that works?
      Answer: Medicine


      "We are all African."

      Comment


      • #18
        Originally posted by Pooka1 View Post
        Is it seemly or unseemly for a person not trained in surgery to suggests surgeons may not be taking the right approach to making surgical decisions?
        I think that ...

        If we all restricted our conversations to only things we were truly knowledgeable about - we would have very few conversations - and learn very little :-)

        I see the conversation between Stitzel and Goldfinch (or the chiropractor and the surgical nurse) as both a good exchange, and learning experience - along with good form within forum.

        Comment


        • #19
          Originally posted by mamamax View Post
          I think that ...

          If we all restricted our conversations to only things we were truly knowledgeable about - we would have very few conversations - and learn very little :-)
          Back and forth between lay people on fora is not on the table.

          The central question on the table is should people ignorant of how surgical decisions are made be PUBLISHING that in a blind leading the blind leading the naked fashion and maligning surgeons?
          Sharon, mother of identical twin girls with scoliosis

          No island of sanity.

          Question: What do you call alternative medicine that works?
          Answer: Medicine


          "We are all African."

          Comment


          • #20
            Originally posted by Pooka1 View Post
            Back and forth between lay people on fora is not on the table.

            The central question on the table is should people ignorant of how surgical decisions are made be PUBLISHING that in a blind leading the blind leading the naked fashion and maligning surgeons?
            Well, that narrows down the question :-)

            Strictly in regards to publishing: I would generally speaking, say no. However, I do not see a forum conversation as publishing. I see a forum conversation as just that - a forum conversation.

            Comment


            • #21
              Originally posted by mamamax View Post
              However, I do not see a forum conversation as publishing.
              Nobody said it was. But we can have a forum conversation about what a person is publishing in a chiro journal to other chiros, yes? It's a metadiscussion on that.
              Sharon, mother of identical twin girls with scoliosis

              No island of sanity.

              Question: What do you call alternative medicine that works?
              Answer: Medicine


              "We are all African."

              Comment


              • #22
                I'm not certain I have a problem with someone outside a field publicly (or, even, publishly) criticizing the methodology of a field. All it would require was good knowledge of what you were criticizing. If they have this knowledge, then it's OK to publish. If they don't, then it's not.

                So, in this case, if they'd talked to lots of doctors about how the doctors make their decision to operate, then they have every right to examine that decision-making process.

                I do have to say, as a complete outsider, that is does seem as if the decision to operate on immature scoliosis patients coincides 100% with a cobb angle cutoff (although the actual cutoff varies between doctors). I don't know if the additional considered factors just happen to coincide exactly with the angle, or if the angle alone is considered. But it *appears* that any curve that passes a certain agreed-upon angle is always operated on.

                Comment


                • #23
                  Originally posted by hdugger View Post
                  I do have to say, as a complete outsider, that is does seem as if the decision to operate on immature scoliosis patients coincides 100% with a cobb angle cutoff (although the actual cutoff varies between doctors). I don't know if the additional considered factors just happen to coincide exactly with the angle, or if the angle alone is considered. But it *appears* that any curve that passes a certain agreed-upon angle is always operated on.
                  But it's been established that they use more than that. Proven progression is one important factor. If Pam wasn't having pain, with documented non-progression of her ~50* for about two decades, I highly doubt she could find a surgeon who would operate. But I don't know that. Also, the surgical decision on my one daughter was made before she reached the trigger angle. That decision rested on the documented progression rate and the time to surgery. Indeed she was well into the surgical window on the day of surgery. Both these cases show that surgeons are using much more than Cobb angle to make surgical decisions. Further I suggest not just these two cases but EVERY case is evaluated for far more than Cobb angle. Goldfinch mentions some of these other criteria.

                  What is the evidence that the surgeons are doing anything in a non-optimal manner?

                  What training do chiros have to weigh in on surgical criteria?

                  What can chiros credibly add to the discussion on optimizing surgical decisions criteria given they have no training in surgery?
                  Last edited by Pooka1; 01-23-2010, 12:25 PM.
                  Sharon, mother of identical twin girls with scoliosis

                  No island of sanity.

                  Question: What do you call alternative medicine that works?
                  Answer: Medicine


                  "We are all African."

                  Comment


                  • #24
                    Originally posted by hdugger View Post
                    So, in this case, if they'd talked to lots of doctors about how the doctors make their decision to operate, then they have every right to examine that decision-making process.
                    They didn't do that nor did they claim to have done that.
                    Sharon, mother of identical twin girls with scoliosis

                    No island of sanity.

                    Question: What do you call alternative medicine that works?
                    Answer: Medicine


                    "We are all African."

                    Comment


                    • #25
                      Surgical decisions on adults are multi-faceted. My son's doctor is holding off on operating on a possibly over 60 degree curve. But, on children, if you reach a certain cobb angle before you are skeletally mature, you are going to be operated on 100% of the time by any knowledgeable doctor.

                      To disprove this, you'd have to show a case in an immature and still-growing patient with a well-regarded doctor (or, at least, someone who was widely assumed to know what they were doing), where the doctor decided against operating on a growing child with a cobb angle over the cutoff (let's say 60 degrees, to be safe) because of other measurements. Not because of some additional risk to the child, but because the other measurement gave them information which they somehow regarded as more important in indicating progression than the cobb angle.

                      Comment


                      • #26
                        Originally posted by hdugger View Post
                        But, on children, if you reach a certain cobb angle before you are skeletally mature, you are going to be operated on 100% of the time by any knowledgeable doctor.
                        That is simply not true. Surgeons tend to hold off on definitive surgery when the child has a lot of growth remaining.

                        But i cases where little or no growth remains, then that surgical decision is driven by evidence in hand that virtually all of those kids will be worse off absent fusion. So where is there room for a chiro to criticize using Cobb angle if that is true?
                        Sharon, mother of identical twin girls with scoliosis

                        No island of sanity.

                        Question: What do you call alternative medicine that works?
                        Answer: Medicine


                        "We are all African."

                        Comment


                        • #27
                          Originally posted by Pooka1 View Post
                          But i cases where little or no growth remains, then that surgical decision is driven by evidence in hand that virtually all of those kids will be worse off absent fusion. So where is there room for a chiro to criticize using Cobb angle if that is true?
                          I'm not arguing that doctors are wrong. I'd be very wary of a doctor who didn't want to stop the curve progression in a growing child once it reached 60 degrees (exception for younger children noted). I'm just saying that it is the Cobb angle, and not some other measurement, that drives that decision. At least, I haven't heard of a case where they decided not to operate because they thought some other measurement was more important than an over-60-degree angle.

                          My concern about this reliance on Cobb angles (although I have nothing better to offer) is that they certainly do seem to be fluid! My son's angle is just all over the map, even with the same doctor looking at the same xray (a reading which varied by 12 degrees with one of my doctors). For children on the cusp, they could have surgery or not have surgery, presumably, because of the time of day at which they got their xray. That's an awfully big decision to make based on such a fluid measure. Again, I don't have anything better to offer, but it is worrisome.

                          Comment


                          • #28
                            Originally posted by hdugger View Post
                            My concern about this reliance on Cobb angles (although I have nothing better to offer) is that they certainly do seem to be fluid! My son's angle is just all over the map, even with the same doctor looking at the same xray (a reading which varied by 12 degrees with one of my doctors). For children on the cusp, they could have surgery or not have surgery, presumably, because of the time of day at which they got their xray. That's an awfully big decision to make based on such a fluid measure. Again, I don't have anything better to offer, but it is worrisome.
                            I doubt a surgical decision ever rests on something like that. In kids who are mostly grown it seems to be driven at least by Cobb angle and documented progression rate. If the data are "noisy" in a certain case, if the data bounce around, have periods of quasi-stability, aren't unidirectional, etc., I suspect the decision to fuse would be put off until the data are clear one way or the other. But I don't know that.

                            There remains no evidence that any surgical decision has been precipitous. So any second guessing of the decision approach, especially from camps with no surgical training, should be very circumspect in my opinion.
                            Sharon, mother of identical twin girls with scoliosis

                            No island of sanity.

                            Question: What do you call alternative medicine that works?
                            Answer: Medicine


                            "We are all African."

                            Comment

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