Case Study


An Amish Story
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Case Study
Written by Tedd Koren, D.C.   
Tuesday, 08 March 2011 10:14

amishmarchAmish Patients

Nearly 200 years ago, the Amish emigrated from Switzerland and Southern Germany to the Lancaster, Pennsylvania area. As with many others drawn to the "Golden Land", in America they found freedom from persecution, tolerance for their pacifism and religious beliefs, and opportunity.

With an average number of seven children per household, there just wasn’t enough land for all the children to stay on the family farms in Pennsylvania and the Amish have since spread out to Ohio, Wisconsin, Iowa, Illinois, Indiana and many other states.

They are hardworking, doing mostly manual labor such as carpentry and farming. They live by the Biblical injunction to be a “people apart.” And they live apart from others in time as well as in space.

The Amish home and lifestyle seem frozen in the 18th century - they eschew cars, electricity and telephones and other things.  Their homes and grounds are well kept. I’ve found them to be peaceful, polite, honest and appreciative.

Though they live apart, they interact with us “English” (non-Amish) in their work and for their family health care.  They prefer natural healthcare and gravitate towards herbal medicine, homeopathy, naturopathy and chiropractic.  That’s where I come in.

Every Month

Every month, I go to “Amishland.” Driving around the area, it’s hard not to stop at stands selling vegetables, fruits, berries, root beer, pumpkins, gourds and other products.  And let’s not forget Amish quilts.

The Amish heard about my work and word spreads fast in their community. They would often come to me by taxi (passing over a hundred chiropractors) to my office.  But the taxi was expensive; it was hard taking time off and, after numerous requests, I agreed to come to them.

They like KST (Koren Specific Technique) and, as long as I can hook up a generator or inverter to my ArthroStimTM adjusting instrument I can work on them.  The extra bonus is that I come home with fresh raw milk, cream and butter from grass fed Jersey cows, eggs from free-range chickens and other farm and homegrown products.

I Was Tired

It was a long day seeing patients.  I was tired and looking forward to beginning my 75-minute drive home.  I was going to be late for dinner.  But then one of my patients asked if I’d see her husband who had a stroke a few days prior.  “He’s in a hospital bed in the living room.  Can you come by when you finish here?”

Stroke Victims

Stroke victims need immediate care.  Homeopaths, acupuncturists and others know that you need to work on them as soon as it is safe to do so, before unhealthy patterns set in.

How could I say no?  As the last of my patients drove away in their horse powered buggy, I plopped down into my horseless carriage to drive two or so miles down Route 10 to a large, well kept home surrounded by neatly manicured lawns.

Abner was about 75-years-old with a long white beard.  He was alert and pleasant but, under his smile, I could see his concern.

Dutch or Deutch?

I walked into a scene reminiscent of a Dutch masters painting.  About twenty Amish men and women were sitting around the patient’s bed, all chatting in Dutch (really a middle German, similar to Yiddish).  They are called the Pennsylvania Dutch but Pennsylvania Deutch (German) would be more appropriate.  I think the early Yankees couldn’t pronounce Deutch.

But I digress.  Abner was about 75-years-old with a long white beard.  He was alert and pleasant but, under his smile, I could see his concern.  His right side was paralyzed.  He couldn’t move his arm or leg. He couldn’t walk at all.

Almost everyone excused himself or herself into another part of the house.  The Amish like privacy when they are being doctored.

Surrogate Work

I use a binary biofeedback device to check patients.  The most well known is muscle testing as used by applied kinesiology (AK).  Other such devices include the short leg reflex (Van Rumpt/Truscott) and the sweat reflex (Toftness).  There are many more. I prefer the occipital drop (OD), as discovered by Lowell Ward, D.C., because, unlike AK, there is no muscle fatigue and it can be applied in many creative ways, as we’ll soon see.

Because my patient was lying on his back, I couldn’t use his occipital drop (OD) to get information.  So, what was I to do?

I did surrogate work.  I used my own occipital drop as a binary (“yes-no”) device to quickly locate his subluxations. I was a surrogate for my patient.

Adjusting

So, I’m checking my OD to locate his subluxations. For those who have a hard time understanding this, imagine that you can muscle test yourself.

You may be thinking, “Are patients OK with this?”  My answer is that, as long as you are OK with it, the patient is OK with it.

Is surrogate adjusting weird? It’s a lot less weird than making a person lie unconscious on a table, cutting them open and doing things to their insides, yet that goes on all the time without question.  How we deal with healing is cultural.

I remember once a surgeon brought in her infant for care. I didn’t want to wake the child while checking his OD, so I casually said, “It’d be easier if you held the baby and I checked him through you.”

She said, “OK.”  It was no big deal.  But I digress (again).craniummarch1

Back to Abner.  As expected, his cranial bones were subluxated.  More specifically, his left and right sphenoid wings were anterior, his occiput was inferior and right lateral, his frontal was right lateral and his right temporal bone was anterior and superior.  His left and right zygomatic arches and points around his orbit were also involved.  His Atlas (C-1) had a Blair listing and his hyoid (which can affect speech and swallowing) was anterior.

Most interesting was that his head “bumps” needed adjusting.  No head is perfectly smooth and sometimes cranial bumps and ridges need correcting.  I’ve especially noticed this in trauma victims, in those suffering from depression, and among those with learning disorders, but was not surprised to find it in a stroke victim.  In addition, his sternum was superior, in a panic (fight or flight) pattern, which should come as no surprise.

The adjustments were performed quickly and easily.  There was no twisting or cracking, I just gently touched the ArthroStim (you can use any adjusting instrument, although I prefer the ArthroStim) to the segments in question at the proper line of drive and pressed the button for a fraction of a second. It’s so gentle that sleeping children can be adjusted without awakening them.  Abner’s post check revealed the subluxations were corrected and his body wanted no more.  We should never over-adjust.

After the adjustments, he made an announcement to all of us. “Look, I can now lift my right leg.”

The Dental Connection

As I’m checking and adjusting, I find a dental problem.  “Where is the dental problem?”  I ask the body. “Upper jaw?  Lower jaw?  Right quadrant? Left quadrant?”  I get the quadrant and locate a bad tooth.

It is always important to check for dental issues, especially when someone has a serious, sudden illness.  I asked Abner, “Did you have any recent dental work, especially any extractions or root canals.”

“Yes, I did,” he said.  “A few months ago, I had a root canal done.  I never had one before.  The dentist said there was an infection.”

Abner continued, “I asked him if he was going to clean out the infection under the tooth before he did the root canal and he said, ‘No, it doesn’t matter.’  I had a bad feeling about that.”

Sometimes, it’s best to go with your feelings.rootcanalxray

Infected root canals have been linked to stroke, cancer (especially breast cancer, lymphoma and leukemia), heart attacks, multiple sclerosis (MS), Lou Gehrig’s Disease (ALS), depression, rheumatoid arthritis and many other conditions.  It usually takes a few months for the effects to be noticed, but they can be devastating.  People can go from robust health to severe incapacity a few weeks or months after a root canal.

In fact, the only case of MS I ever saw in an Amish occurred a few months after she had a root canal.  Good books on this subject are The Root Canal Cover-up by George Meinig and books by Hal Huggins on dentistry.

I recommended that Abner get that tooth pulled.  Bad root canals need to be pulled and replaced with a bridge or an implant. Research indicates that in time the majority of root canals become infected.

Bridges are less invasive but, recently, a new material was approved for implants that is apparently safer than what had been used.

Amish e-mail

Amish e-mail does not exist. The closest I’ve come to it is an Amish farmer named Enoch who likes to gossip a lot.  The Amish don’t have computers.  They may have a phone in the barn or the shop, so it’s a little tricky hearing from them.  However, I did receive a phone message two days later: “Dr. Koren, this is Sadie, Abner’s wife. Thank you so much for coming over. Abner is improving.  He felt so much better the next morning after you were here.  He took a couple of steps this morning. His right hand is doing really good, his hand and arm.  If you can come over again and give him another adjustment, we’d be really, really glad; it’d do him a lot of good.  Thanks again for coming.”

I hope to return soon.

Why did I write this?

This little story has a lot of different elements I’ve wanted to write about for a while: my visits to the Amish using KST, binary biofeedback devices, working on a stroke victim, surrogate adjusting and dental information.  My experience a few nights ago put it all together.

 

Tedd Koren, D.C., is the developer of Koren Specific Technique.  For information, go to www.korenspecifictechnique.com. Dr. Koren also writes patient education materials.  Go to www.korenpublications.com. Dr. Koren can be reached at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

To locate a holistic or biological dentist in your area: http://mercuryfreedentists.com

http://www.iaomt.org


 
Strained Lower Extremities Needed a Lift
Case Study
Written by John Danchik, D.C., F.I.C.C., F.A.C.C.   
Monday, 21 February 2011 17:21

leftlowerbackpainHistory and Presenting Symptoms

A 44-year-old female reports occasional episodes of pain in her lower back, primarily on the left.  Her low back pain seems to be randomly intermittent, but is worse when she’s been on her feet for a while.  Currently it takes about one hour of walking or standing for her to notice tension building in her low back.  She localizes her pain to the left lower back and upper pelvis; she has not noticed any pain extending into her leg.  On a 100mm Visual Analog Scale, she rates her low back pain at about 20mm, with an occasional 50mm.  She takes non-prescription anti-inflammatory tablets when the pain in her lower back interferes with her daily or work activities.  Now that her three children are grown, she works about 30 hours a week for a local non-profit organization, primarily at a desk.

 

Exam Findings

Vitals. This is a large woman who weighs 171 lbs. which, at 5’11’’, results in a BMI of 24; she is not overweight, but is close.  She is a non-smoker, drinks beer moderately, and her blood pressure and pulse rate are within normal ranges.

Posture and gait. Standing postural evaluation finds a lower iliac crest on the right, and a low right greater trochanter.  The left shoulder is somewhat lower than the right, with no history of fracture or surgery.  Her knees are well aligned and her lower extremities are symmetrical, with no significant calcaneal eversion, foot flare, or low medial arch.  Inspection of her shoes finds minor wearing at the lateral aspect of both heels.

Chiropractic evaluation. Motion palpation identifies several limitations in spinal motion: the left SI joint, the lumbosacral junction, L2/3, and at the cervicothoracic junction.  Except for the left SI joint and the left piriformis muscle, palpation elicits no significant tenderness in these regions, and all active spinal ranges of motion are full and pain free.  Hip ranges of motion are also full and pain free.  All provocative orthopedic and neurological tests for nerve root impingement and/or disc involvement are negative.

 

Imaging

A-P and lateral lumbopelvic X-rays in the upright, standing position are taken with the patient weight-bearing, heels aligned directly under the femur heads, and both knees extended.  A substantial discrepancy in femur head heights is noted, with a measured difference of 8mm (right side lower).  A moderate lumbar curvature (6°) is noted, convex to the right side, and both the sacral base and the iliac crest are lower on the right side.  The sacral base angle and measured lumbar lordosis are within normal limits.

 

Clinical Impression

Multiple lumbopelvic fixations, with anatomical leg length discrepancy (right short leg) and associated pelvic tilt and lumbar curvature.

 

Treatment Plan

orthoticblueAdjustments.  Specific adjustments for the lumbosacral and sacroiliac joints were provided, and other regions received adjustment as needed.  Side-posture adjustments were well tolerated and resulted in very good articular releases.

Support. Flexible, custom-made stabilizing orthotics were fitted, based on foot imaging in mid-stance (weightbearing).  A 6mm heel lift was permanently built onto the left side.  These were introduced after the first week of regular adjustments.  She reported no difficulty in adapting to the orthotics or the heel lift.

Rehabilitation. She was instructed in a daily core strengthening program (the “easy eight” exercises) at home, using elastic exercise tubing.  The focus was on activation of the patient’s transverse abdominis musculature, to improve spinal-pelvic stability.

 

Response to Care

This patient responded well to her adjustments, and adapted well to her orthotics with the heel lift.  After 6 weeks of adjustments (8 visits) and daily home exercises, she was released to a self-directed home stretching program.

 

Discussion

This patient had developed a chronic lumbopelvic fixation, caused by her anatomical discrepancy in leg length.  By necessity, her chiropractic treatment plan included orthotics with a permanent heel lift on the right side to support her strained lower extremities.  I have found that, when a heel lift is needed, it is tolerated best when the entire foot and both lower extremities are supported with custom-made orthotics.


 
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