Putting The Stroke Issue to Bed

Patient develops a dissection. Patient dissection develops into an embolism. Embolism develops into a stroke, etc. that the chiropractor caused. That's the old thinking. The current thinking is, in the majority of these cases, that the pa- tient dissects, the dissection produces neck pain and headache, the patient seeks care for the neck pain and headache and they go on to have emboli and stroke at essentially the same rate whether they attend to a chiropractor or to a medical doctor. This is a very critical understanding for us to really fully ap- preciate in this discussion. The literature that was generated by David Cassidy in 2008 compared the population of persons in the province of Ontario over a 9-year period which generated over 110 million person years of data regarding this process of arterial dissection. What Cassidy found was that people, when they dissect, they seek care for the pain. Whether they seek care from a chiropractor or they seek care from a medical doctor, they go on to stroke at essentially the same rate. Now this is a very important element because I think it's logical for us to assume that the medical doctors involved are not providing cervical adjustments. The chiroprac- tors involved in the care are providing cervical adjustments. If there is no in- crease in risk and that the basic background risk associated with medical care is not exceeded by the patients under chiropractic care, then it's logical to con- clude that what the chiropractor is doing in his or her office is not contributing to this problem. That's the takeaway of Cassidy. Now, the question that remains before us at this point is did the chiropractor fail to recognize an evolving dissection? As I said a few moments ago, this may get presented in a very benign manner that there was no sign of any possible dissection other than neck pain. Now you see patients with neck pain day in and day out. Thankfully, the infinite majority of them, the overwhelming ma- jority of them have nothing to do with the dissection and its mechanical neck pain. There are some signs. We'll talk about those in just a minute that you might want to pay a little bit more, not might want to. You should pay a little bit more attention to if you see them in your office. The second question is, did the care of the chiropractor worsen the evolving dissection that the patient presented with? If we now know in retrospect that the pose that was held by Ms. May on Janu- ary 27 that resulted in the neck pain began the dissection, was the care of the chiropractor involved in worsening this dissection or did this evolve as it was going to evolve regardless of whether or not a chiropractor was involved? Next slide, please. Now in terms of again, how does this circumstance of Ms. May square with the evidence that's been published to date? She does fall into that age group of persons under 45 years of age. We know from Cassidy and we know from Kosloff and Elton and other studies that persons under the age of 45 have a little bit higher incidence of dissection than persons over age 45. We know that she was in that age group. We also know obviously that she was fe- male.

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