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#161 STROKE

10/24/2016

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​Several of my patients have asked about the stroke suffered by Katie May, a model and internet celebrity.  In late January, she visited a chiropractor for treatment of neck pain that she perceived to be caused by a “pinched nerve.”  Sadly, in early February, she suffered a kind of stroke called a cervical or vertebral artery dissection (CAD), and died.  If you think of an artery as a hose, a dissection is when the blood goes between the layers of the outer wall.  For this to happen, the inner lining of the artery has to be damaged by something for the blood to get through it.  There are many things that can cause this damage ranging from high blood pressure, hardening of the arteries, drugs, congenital malformations, and trauma.  Last week the coroner released his conclusion that the cause of the dissection was trauma from the chiropractic adjustment she had received at that time.  While I cannot say the coroner is wrong, the fact is that science does not support his conclusion.  So let me unpackage this thing.
 
            It has long been asserted that cervical manipulation of the spine, in particular rotational manipulation, can cause torsion to the vertebral artery, and very rarely a dissection-type stroke.  However, the supposed risk of this happen has varied widely depending upon the source, ranging from 1:1,000,000 to 1:10,000,000 manipulations.  And I’ve seen numbers as low as 1:200,000.  On a personal note I’ve performed well over 600,000 cervical adjustments in my career and no stroke yet.  But there are two reasons for that.  The first reason is that the most recent science says there is no causal relationship between chiropractic manipulation and artery dissection.  The second is my chosen technique. 
 
            Six neurosurgeons from Penn State Hershey Medical Center, Loma Linda Medical Center, and Pennsylvania State University published their conclusions on 2/16/16 of an in depth “meta-analysis” of 253 published studies.  In their conclusions they state, “There is no convincing evidence to support a causal link between chiropractic manipulation and CAD (cervical artery dissection).”  The go on, “Belief in a causal link may have significant negative consequences such as numerous episodes of litigation.”  The important words here are causal and belief.
 
            The chiropractor who is accused of causing the death of Katie May is most likely a victim of bad timing.  The scenario that best fits the evidence is that Ms. May’s neck pain was due to a dissection already in process, which is impossible to diagnose without ultrasound or CT imaging, and would appear the same as any typical mechanical neck pain.  The chiropractor did his thing and the dissection continued and she died.  There most definitely is a “temporal” relationship between his manipulation and the stroke, but a “causal” one, in all probability not.  I suspect the coroner has not read the latest study on the issue and is going by old science and outdated beliefs.
 
            I said there are two reasons for my spotless record.  The first is science, and the second is that the adjustment technique I use utilizes almost no rotation.  So even if there were to be found a scientific connection between chiropractic manipulation and CAD, by eliminating rotation from the adjustment process, there is no torsioning of the vertebral artery in the first place, making me safer than safe.      
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    Dr. Rick

    After writing an article per week for a year, I just kept going.  These are most of my collection.  They are written with my existing patients in mind, so some stuff may seem odd or unusual, but would make perfect sense to those who know chiropractic and who know me.  Enjoy and share!  For my personal blog visit: 

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     Hello, My name is Andrew and I am a happy, healthy one year old.  But I wasn’t so happy or healthy when I first met Dr. Rick a few months ago.  I had been having problems with my ears for four months, I couldn’t sleep at night and I was miserable.  We’d been to the doctor lots of times but nothing was helping.  In fact, all the medicines the doctor had tried seemed to make me worse instead of better!  Both the regular doctor and the Ear-Nose and Throat doctor said that if the antibiotics didn’t work, then they’d just have to put tubes in.  Now my Mom and dad weren’t about to let them do surgery on me, especially since they had been reading and learned that tubes can cause more problems than they solve.  My mom and dad did a lot of praying.  Then my mom heard that sometimes babies who have a traumatic birth like mine have ear trouble.  You see when I was born they used a vacuum extractor and forceps to pull me out.  I guess all that yanking on my head, hurt my neck.  She also heard that chiropractic care can be the answer.  Now she was skeptical because she couldn’t imagine a chiropractor helping ear infections!?!  But at that point she was willing to try anything!!  Happily, a few weeks of adjustments and my ears were all cleared up.  In addition, I no longer had a stiff neck or shoulders and my whole personality was happier.  I have to tell all babies who have ear troubles, don’t let them give you tubes until you at least try chiropractic care first.  After all, it can’t hurt and if you’re like me, you could be perfectly well with no drugs and no surgery.  In my family, we thank God for Dr. Rick, because I feel better, my mom and dad are happier and sometimes, I even sleep through the night.