A long commute allows me time to reflect and unwind at the end of the day. On Monday of this week, the last appointment of the day stuck in my mind during my ride home. This patient was like most of the patients you probably have who come into your office. She had back pain that was severe and she wanted relief.
Why was I ruminating on this particular patient? Her story was similar to others I’ve seen. Her back pain has been bothering her for a long time. She’s been taking 1-2 over-the-counter naproxen tablets for 3 years and they were dulling the pain enough so she could get through her day. However, when her Primary Care Physician ordered labs and reviewed them with her at her yearly physical, he noticed that she had elevated liver enzymes, a fatty liver, and kidney dysfunction. When she revealed to him that she was taking naproxen for years, he concluded that her kidneys were shutting down because of the NSAIDs. She immediately stopped taking the medication and found my office to help address her back pain through a referral.
The thing that was occupying my mind during my drive home was, “What would the care plan be if this patient saw another Chiropractor in my town?”. Would he/she treat her pain and make her comfortable, or treat the whole person and save her life? If this was your practice and this woman came into your office tomorrow, what would you do? What kind of care would you offer? Pain relief or total wellness care?
First, let me tell you a little more about her. She was a 62-year-old female. When I met with her, I took a thorough history and gathering several objective tests like posture pictures, digital X-rays, In-body composition measures, and a functional movement screen as well as labs she had brought in. As I was talking with her, I learned that she had a husband, grandkids, and a business that all needed her attention. She was not her best self because of the pain and her energy level was low, she graded it a 1 or 2 on a scale of 1-10. Her physical complaints were not a mystery as her body composition revealed that she had 112 lbs. of fat (225 lbs. total weight) on a 5’3” frame and a 46-inch waist circumference. No wonder her energy was low! No wonder she had back pain! In addition, her blood pressure was high, her resting pulse was elevated, and her cholesterol, triglycerides, c-reactive protein, blood sugar, and fasting insulin were all elevated. Oh, by the way, her vitamin D3 was 12! Her back pain will make her uncomfortable but these other findings will most likely end her life much earlier than she would like. She is a classic case of Metabolic Syndrome: Elevated waist circumference (visceral fat), Elevated BP, and elevated blood sugar and triglycerides.
What would you suggest for this patient? What would your care plan include? Without knowing you, I know that you see patients like her all the time because 1 out of 2 people over the age of 50 have Metabolic Syndrome. They are walking into your office every day? What are you doing to help these patients who need more than back pain relief?
As for me, I was frank with her and told her that she is at a crossroads in her life. She can continue doing what she’s doing and encounter more and more life-threatening issues, or she can make a serious lifestyle change. My care plan for her is a year-long program with an initial intensive phase of 3 months with the first month being a liver detox, nutrition consultation, a fitness evaluation, and adjustments. Once we get her feeling better and start to get her systems back online, we’ll put her on the 8 Weeks to Wellness program for months 2 & 3. She understands that her health is everything and that her back pain is only part of the issue. In order to be there for those who need her, she needs to make a serious commitment to her health.