Where other chiropractors were eager to open up their practice, Dr. Postlethwaite had different plans...
Dr. John Postlethwaite, the big man with the big idea.
Dr. John, as he’s known in the profession, graduated from Palmer Chiropractic College in 1987. He moved to the Tampa Bay area of Florida and received his Florida License in 1989. He also holds a license to practice in Michigan.
Where other chiropractors were eager to open up their practice, Dr. Postlethwaite had different plans. He’s not one to think small. He had a vision of introducing to the chiropractic profession a tool that, when understood, could revolutionize the practice of chiropractic by providing a deeper understanding of the mechanics of ligamentous injuries, especially to the cervical spine.
He is the inventor and developer of the Digital Motion X-Ray system, the system that clearly shows the extent of ligament damage following an accident. Not satisfied with the typical fluoroscopic technology available at the time, which was not easy to read and often blurry when the patient moved, he set out to provide a tool that would demonstrate injuries that otherwise would remain undetected.
By virtue of performing over ten thousand studies, he now stands apart from the rest in his ability to pass his acquired knowledge to those chiropractors who are interested.
TAC: What inspired you to become a chiropractor? Do you have a specific story?
POSTLETHWAITE: My mother had polio as a teenager. In that period of world history, the word "polio" struck fear into the hearts of parents everywhere. Her parents took her to a chiropractor, and she got well. As a result, I had regular chiropractic care all my life.
After graduating from high school, I went to Michigan State University for mechanical and electrical engineering because I love creating things and fixing things. One day I was having a conversation with my chiropractor and he was amazed at how I could take beat-up cars and straighten them out with my bare hands, and how I could feel things with my hands that others couldn’t. Then he suggested that I put my talent to better use and become a chiropractor. That way, I could still "straighten out" bodies, only they would be human, not auto.
I thought about it, then quit engineering and transferred to Palmer College of Chiropractic in Davenport, Iowa, where I graduated in December of 1987.
TAC: Can you tell us how you got involved with (or discovered) motion X-ray?
POSTLETHWAITE: It was during a technique class that I was introduced to Vernon Pierce, DC, who demonstrated to the class the "old school" use of fluoroscopy and how it demonstrates loss of structural integrity and abnormal motion. This was back in 1985.
I remember wondering at the time, "Why aren’t we doing a motion study on everyone to see what’s wrong; why are we guessing and just taking these static images?" That’s when I became both intrigued and fascinated with X-ray.
This became even clearer to me when I noticed, in clinic, that most of my patients were complaining of pain when they moved. I couldn’t help wondering why we were only taking static X-rays when they often read as negative. I figured that, if patients hurt more when they moved, then it only made sense to study the area in motion.
The drawback was that this earlier technology, although great for its time, appeared blurry with motion, so a lot of the details were lost. I became obsessed with the idea of motion X-ray that was clear and detailed enough to see subtleties.
Once I graduated from Palmer College, I then moved from Michigan to Florida and, while I was waiting to get my Florida license, I went to the library and looked up on microfiche everything I could about fluoroscopy units. Then I started creating my own unit from that point. This allowed me to combine my knowledge and ability as an electrical and mechanical engineer with my knowledge and training in X-ray and chiropractic.
In the early 90’s, I applied for all my patents and trademarks and, in December 1994, I was granted my FDA clearance to start manufacturing these motion X-ray systems.
TAC: What are your goals for the chiropractic profession?
POSTLETHWAITE: Well, I would love to see chiropractic as the world’s number one choice for health care. To be instrumental in introducing to the profession another technology and tool that can bring unity to the profession would be deeply satisfying. With unity comes strength, and using the DMX system helps objectify patients’ complaints and brings the injuries to life. It would bring us together as a group and would bring about a consistency in our treatments and services. It is a tool to demonstrate and prove to the patient and the public what we do as chiropractors. There is no other imaging procedure that shows functional motion, movement or fixations as Digital Motion X-Ray.
As I said before, if patients hurt more when they move, the Digital Motion X-Ray lets the chiropractor see the spinal dynamics at the actual time that the pain occurs. This gives the chiropractor much greater understanding concerning the cause of the patients’ complaints.
You see, the whole purpose of this technology is to educate the public about what we do as chiropractors. For the first time, we can show them where and why they need chiropractic care.
I understand B. J. Palmer wanted a technology like this that added to the profession back in the early 60’s, a way to clearly see the dynamics of the spine and the effects of the vertebral subluxation. Today, I believe that the DMX fulfills his vision.
TAC: What are some of the most common questions asked when people are learning about the Motion X-Ray Technology?
POSTLETHWAITE: People want to know how this differs from an MRI, CT scan, or static X-rays as far as offering any unique or useful information. The truth is that each has its purpose. However, all these tests have one common limitation. One of the top neurosurgeons in the country, Dr. Joel Franck, MD, said it best when he said that all those other image modalities "study a moment in time."
The problem is that "a moment in time" is not when we find these injuries that chiropractors treat. We need to see the area in motion at the time of pain to determine if an injury has occurred.
Dr. Franck also said that the DMX study is "impressive, and leads to a very important set of clinical information that will definitely alter your treatment."
I guess another question that is asked is, "So what? Wouldn’t we eventually figure out the patient’s problem over time anyway, especially when we combine both X-rays and an MRI?"
The answer to that is a definite, "No!" Again, the reason is that there are many types of injuries that can only be seen through motion.
This brings up an important issue. Insurance companies believe that most patients who come to us are not really injured because a static X-ray or an MRI comes out negative or normal, when the reality is that nobody ever asked them to move.
Here’s a really interesting story. A local doctor referred one of his patient’s in for a DMX study. I’m giving the name and details of this patient because I have her permission and blessing to do so. As a matter of fact, she told me that, if her story saves just one person from the misery that she’s gone through, then it will be worth it.
Her name is Amanda Bennett.
It was in March of 2006. She was the passenger in a friend’s vehicle. Her friend looked up and screamed. Amanda looked up into the rear view mirror and saw a truck barreling toward them at full speed just before it ran into them. She suffered severe injuries to her neck and back.
Here’s the problem. No one could find out why she was in so much pain. Over the course of a year she had five MRI’s, two CT scans, and a multitude of X-rays. Apart from a few bulging discs, everything else appeared normal.
She kept feeling worse and worse, so much so that she couldn’t work or enjoy life. The problem was that the cause of her pain could not be found, so no one believed her. Her doctors thought that it was either emotional, or that she was faking it and trying to milk the system for both sympathy and dollars.
But, one chiropractor, Dr. William Palmer, did believe her and set out to find the answer, and with the DMX system he found it! To find out exactly what was found and how it was found, I suggest the readers go to www.dmxworks.com. There you will find a little "note pad" that when clicked on will reveal the end of this critical story. I say "critical" because, without the DMX, she would have had nowhere else to go, and the results could have been tragic. I will say this though, because she had the DMX study done, the neurosurgeon could clearly see what the problem was and he was able to perform a life-saving surgery. He admits that, without this technology, he, too, would not have been able to figure out what was wrong.
TAC: A motion X-Ray can have exposure times of up to thirty seconds. Does that cause a significant amount of radiation?
POSTLETHWAITE: Actually, the test can be over ninety seconds in total, yet it yields no more exposure than a typical Davis Series. However, you get the benefit of an equivalent to about 2700 X-rays in that amount of time. That is because the typical DMX cervical series requires only 2 mA at about 65 to 70 kVp and not the typical 100 or 200 mA.
The secret is in the Image Intensifier. Instead of the images being exposed on film or even a digital plate, the images are captured by a part of the system that takes a rather tiny X-ray amount, amplifies it, and sends the signal to a monitor for immediate viewing and to a recording device, such as high quality digital video or high quality DVD. The images are sharp and clear so, if there is an injury, it appears to "pop" right out at you when the patient is in motion.
The advantage is that, like I said, we captured an equivalent of about 2700 X-ray views which, if we wanted to, we could print out individually. With such a wealth of information, you can’t help but see what would more than likely be missed.
Another big advantage is that the patients can actually see the results immediately, following the DMX study. In addition, a copy of the study is made available for the patients to take with them when they leave. We also send copies along with the written report to the treating physician, as well as to any attorney, if requested.
TAC: How does this hold up in court when used in Personal Injury cases? Is that appropriate use of the technology?
POSTLETHWAITE: You know, I have yet to show this technology to an attorney who isn’t mesmerized by what he or she sees. At first, it is often thought of as just a novelty. But, once they actually see it in action, they quickly drop that silly notion. Now, they see it as vital to the success of the case.
For example, one local attorney in Tampa, Florida, Matt Mudano, Esq., who uses the results of the DMX studies, said it best when he said, "It is the picture that’s worth a thousand words. It objectifies what have, heretofore, been invisible injuries, injuries that required an adjuster or a jury to accept on blind faith what the patient was saying. With Digital Motion X-Ray you can show it to them and they can see for themselves, and it’s not a myth."
Now, Counselor Mudano’s comment, along with Dr. Franck’s that I quoted earlier, are very powerful statements coming from those who realize the tremendous value of these studies, both from the standpoint of higher quality care on the part of the practitioner, as well as higher settlement offers and judgments awarded from a legal aspect.
Here’s another interesting story. Another local attorney had a case where the insurance company would not pay because they did not believe that the client was really injured. They offered a zero settlement. Nothing! However, the attorney had the client tested in our facilities where we found conclusive evidence of ligament damage. A copy of the study was given to the attorney, as well as the written report.
After he presented a copy of the Digital Motion X-ray study to the insurance company, it voluntarily offered a settlement of three quarters of a million dollars, based on what the company’s adjusters saw for themselves! And that’s not an isolated instance, either. This attorney has many high dollar settlements based on the objective findings of the DMX technology.
Personally, I have done thousands of studies over the past fifteen years and, over that time, I’ve only needed to testify in court seven times. They almost always settle these cases, because the picture is worth a thousand words. That’s how powerful these DMX studies are in proving whiplash injuries!
Now, this is great for the chiropractors, especially those involved with personal injury patients. Did you know that there are 6.4 million auto accidents each year? Out of that, there are 3.5 million injuries. The total amount being spent on these accident victims is about 230 billion dollars each year. These people need our help and, believe me, there are plenty to go around.
I think that, if a chiropractor isn’t into personal injury, he or she needs to get into it. These people need to see a chiropractor because chiropractic is the number one way to treat them.
TAC: There was some confusion there in the 90’s regarding this technology and the FDA. Could you explain some of that, and what does that mean for you today?
POSTLETHWAITE: As a matter of fact the FDA had done a fantastic job making sure that everything was acceptable every step of the way. It wasn’t always easy, but it was all necessary. The FDA regulates all medical manufacturers and they still come in periodically to inspect everything in our operation, from paperwork to testing procedures.
The good news is that, in 1994, we got FDA clearance to begin manufacturing. From that day on, we’ve been manufacturing these systems according to the strict guidelines of the FDA regulations.
In addition, since the 90’s, we’ve hired FDA consultants who actually help teach the FDA courses. We have them come in on a regular basis just to double check everything we do to make sure that we remain in compliance at all times. If anything needs to be changed, we change it on the spot.
By the way, we are classified by the FDA as a Class 2 medical device, and we are NOT considered experimental or investigational.
TAC: Have hospitals caught on to this technology and, if not, why might that be?
POSTLETHWAITE: No, hospitals haven’t caught on yet, for the most part. However, hospitals are usually for emergency care, such as fractures, contusions, lacerations, and other complications that can accompany severe injuries, more of life-and-death situations.
Typically, hospitals just give the whiplash patients some pain pills and muscle relaxers, and then send them on their way. This, however, is great for chiropractors, because we can actually do something about it.
I do need to say, though, that the doctors who work in hospitals who have seen the DMX system are very much impressed. As a matter of fact, they often comment on how they really do need this technology to diagnose injuries, especially when there is damage to the Atlas or odontoid.
Also, to be quite honest, we haven’t really marketed to hospitals, but rather preferred to keep it mostly within the "chiropractic family" and focus on helping them with their patients and helping them bring chiropractic to a higher level in the 21st century.
TAC: Now, when we spoke before, you mentioned many of these images significantly show direct contradictions to many current assessment methods, including Motion Palpation. Could you explain that more in depth?
POSTLETHWAITE: Well, it’s not so much contradiction as it is the limitation of assessment. For example, while you can palpate for tenderness and swelling of the capsular ligaments, you’re limited in that you can’t tell if it’s stretched, torn, and to what degree. No one can palpate the anterior or posterior longitudinal ligament; yet, I guarantee, that, in a lateral plain film, whenever you see a flattening or reversal of the normal curve, some interpretations read something like, "Hypolordosis, indicative of muscle spasm."
That’s nonsense! In order for it to be that way, damage to the anterior and posterior ligaments have to be involved, no question about it. I suppose, in that respect, I do contradict conventional wisdom.
The advantage of the DMX is that, when the patient goes from full flexion to full extension, the anterior and posterior slippage is clearly visualized and that removes all doubt concerning damaged ligaments.
TAC: What are the most common symptoms that the DMX system is used to investigate?
POSTLETHWAITE: Unresolved headaches, chronic neck pain, or any pain of any joint that increases with motion. This is especially true when the patient has had the static films or MRI’s and there are no positive findings.
TAC: In your mind, should this replace plain films, or be used as an adjunct?
POSTLETHWAITE: We are not trying to replace static X-rays. Plain films serve a very important part in determining whether it is generally safe to adjust the patient. The primary contraindications, such as fractures, congenital defects, certain diseases, and tumors, are revealed through regular static images. It is also used for the chiropractor to evaluate to determine the areas that need to be adjusted, as well as to help determine the proper line of drive.
However, no single test can tell us everything. The DMX offers the practitioner the opportunity to see far more views than are humanly possible with static X-rays and, thereby, fill in the gaps of missing information. If ligament damage is suspected, this is an extra safety measure for the practitioner from adjusting into an area where a torn ligament may cause unexpected complications. It also helps answer a common question, "Why doesn’t my adjustment hold?"
The answer is, "It can’t."
TAC: Is it difficult for doc’s to be reimbursed on the cost of the exam through insurance?
POSTLETHWAITE: Usually not. This is especially true with auto insurance. However, we have sold a lot of our systems where the docs don’t bill insurance at all. Instead, they have a cash, wellness or decompression practice, where they bill the patient a flat rate.
However, I, personally, wouldn’t ignore a personal injury aspect to a practice. Remember, if a patient drives, then he or she is required by law to carry PIP insurance. I don’t care how the economy for the country appears; people are not going to give up driving! Automobile accidents occur regardless of what the stock market is doing. They take no holidays. Personal injury patients become the one safeguard the chiropractor has against a recession because, when patients use their insurance, it doesn’t reduce their discretionary income.
The DMX system stands apart from other examinations when it comes to answering an insurance company’s question concerning a patient’s reported injury…. "Prove it." Now that question can be easily answered.
However, the procedure is also covered by Major Medical and Worker’s Compensation. The key here is to bill it properly and in a timely manner. By billing properly, I mean, have the proper documentation and reports accompany the bill.
TAC: Where do you see the future of chiropractic headed?
POSTLETHWAITE: I really believe that this is the best time to be a chiropractor. We have reimbursements from insurance companies, and we have better relationships with the medical communities. And, the DMX technology allows us to bridge the gap between chiropractors and medical doctors. It brings us together to work in team effort for the benefit of the patient, as evidenced by Dr. Joel Franck, MD, the neurosurgeon I mentioned earlier.
TAC: Any final words for our readers?
POSTLETHWAITE: Yes. We are active in bringing this technology and chiropractic into the future. For example, we have developed an EMR (Electronic Medical Record) system where we create an interpretive narrative report, custom made for the DMX technology. It’s called the iDMX and it prevents interpretation errors, saves time and eliminates transcription cost. The report is impressive in its appearance and lets those who see it know you truly are a professional.
Recently, we have implemented what we call DMR, for digital motion reporting. This incredible technology, for the first time in the health care industry, allows us to include a voice-over along with circles and arrows that point out the areas of injury, and all this is done in "real time" over a copy of your Digital Motion X-Ray study. In other words, your report on DVD, in movie format, when seen by another, will be the closest you can get to having the doctor standing right next to you, giving you the report and pointing out areas of interest or concern in person. It is truly amazing.
Since our technology is now video-based, I figure that the best way to educate the public as well as other professionals is by demonstrating it. So, now, we actually stream in information by video right through the internet. Our Video E-mail Marketing system has proven to be an effective strategy to be used by our owners to get more referrals. Each one of these video e-mails can be fully customized to show the doctor’s information, along with the logo and picture. You know, in this age of technological advances, a video image is more personalized than just plain text.
We’ve also introduced what is called a "lenticular" motion X-ray postcard. It’s a postcard where the picture on the front appears to move when you tilt the card back and forth.
And, finally, we are not out to sell these DMX Systems to everyone. They are individually made to order and, unfortunately, not everyone who wants one can get one quickly. We only make about forty units a year, so we’re quite limited.
Actually, we only provide the DMX System to those aggressive chiropractors who look out over the horizon to what could very well be the Golden Age of Chiropractic. If any readers feel like they are in this category, they should give me a call and let’s get started.
For more information, call DMX-Works at 1-800-839-6757 or through their website at www.dmxworks.com.