safe to say that of those 3,000 cases that occur in the United States of vertebral artery dissection annually a very, very few, perhaps a handful are associated with chiropractic care either on a temporal or a causative basis. This is an important perspective for us to understand. As chiropractors we are acutely attuned to this circumstance. When we hear a discussion of vertebral artery dissection we automatically make a mental tie to, "Was an adjustment part of the picture, et cetera?" The reality is, in the vast, vast majority of cases a chiropractor wasn't anywhere in sight, wasn't anywhere part of this patient's life and times. That's a perspective that we need to keep in mind. That being said, if there was one patient for whom there was relationship between our care and the occurrence of vertebral artery dissection, then that demands our attention. That's why we're here today. Through the research that ChiroSecure has conducted with our partners, we have found that in the medical literature, there are over 72 simple, everyday movements that are known as causes of vertebral artery dissection. Some of these include yoga, painting a ceiling, nose bleeds, hypertension, sexual activity, receiving anesthesia, receiving a shampoo, vomiting, sneezing, but also doing nothing. Some of these are just brought on without any known cause whatsoever. One of the most important things that you could take away from this discussion is a complete change in thinking regarding vertebral artery dissection and chiropractic care. Throughout the years we have always heard that vertebral artery dissection, subsequent cerebrovascular accident, was associated with receiving a cervical spine adjustment. The current thinking is, that to a greater or lesser extent, many of these patients walk into your office or my office in the process of dissection, with the dissection itself producing neck pain and headache and as a result they consult the chiropractor. With respect to this concept, that a significant percentage of persons who develop vertebral artery dissection in relationship to chiropractic care had the dissection when they presented for care, there's an emerging body of literature to support this concept. There are no reliable tests to see if your patient is predisposed to have a vertebral artery dissection. As we move forward there are things you can do to lower your risk, and as you go through these procedures you still need to keep in mind that it's all about what the patient tells you and what your observations are. Keep good notes, your documentation becomes everything. Whatever you observe you need to make sure you document. There are no good tests, there are no indicators, and aside from the heritable conditions we talked about, maybe a question on the case history, maybe a relationship to migraine and so on. There isn't really much to give you and I, as practitioners, a heads up one way or the other as to what's going on. Let's shift gears and talk about pre-adjustment screening tests. When I was in school 35 plus years ago, Phil George was a member of the faculty at the Palmer
Dr. Stu Hoffman:
Dr. Gerry Clum:
Dr. Stu Hoffman:
Dr. Gerry Clum:
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