shoot involving Ms. May. He used a Bow- Hunter’s Stroke as an example of th e mechanism of causation — that is the strain of maintaining a stressed position for a period yielded the injury. He related how rare these events are in chiropractic. The discussion moved to comments from Dr. Brockington, the neurovascular surgeon. She was asked point blank by Dr. Oz, “Do you think manipulation caused the dissection?” She did not say the chiropractor caused this stroke. She did not raise undue concern about cervical spine adjusting. In response, she related that she, as a stroke specialist, sees strokes every day. Some of the strokes she sees have known causes and many don’t. She related that she recently saw a gentleman who developed an arterial dissection while painting. She noted that these conditions can occur in seemingly healthy persons in their 30-50s with no prior history. She reviewed an angiogram to show what a dissection looked like on imaging and to explain how it was related to blood flow and oxygenation of the brain. She discussed that most dissections don’t lead to stroke, but cervical artery dissection did account for 1 in 5 strokes in middle-aged persons. The conversation moved to the second question about the value of a patient history. Dr. Shoshany related that, as a clinician, Dr. Oz appreciated that the patient history was the most valuable tool we have to work with. He related the importance of knowing about a history of stroke, aneurysm, dissection, collagen disorders, etc. Dr. Oz then walked the audience through the 5 Ds, the 3 Ns and the A associated with cervical artery dissection: x Diplopia The advice given was that one should think of their neurologist or visiting the emergency room rather than chiropractor when one has neck pain with these additional symptoms. The third question about what the profession is doing about this problem allowed Dr. Shoshany to explain that the profession has been addressing this situation for decades. He also added that he has delivered more than 200,000 cervical adjustments in his 20+ years of practice in Manhattan without a single occurrence of this problem. He added that Life University, the largest single campus chiropractic program in the world, has provided an estimated 4.5 million cervical adjustments during the past 25 years without any incident of this nature. Finally, he added that among the 17 chiropractic educational programs in the United States, there has not been a single incident, to his knowledge, of this nature in the past 20 years. Dr. Oz read a statement from the American Chiropractic Association (ACA) commenting on how DCs are educated and trained in differential diagnosis based on history, examination, etc., and that they are trained to refer when necessary for further evaluation or emergency intervention. Dr. Shoshany again emphasized the safety of chiropractic and offered the view that when you consider our safety record in light of 45 people dying every day of opioid use and abuse, chiropractic care is even safer than first thought. The segment ended with Dr. Oz offering the following comments: x Dysphagia x Dysarthria x Drop Attacks x Dizziness x Nausea x Numbness x Nystagmus x Ataxia
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