I think it’s a little bit of both. One, I think it’s because the patients with that many comorbidities are typically in the medical model for those comorbidities. Within the VA system, there are frequent opportunities for a primary care provider to say, “I think chiropractic would be a good supplement for these other conditions we’ve been seeing you for, because there’s a musculoskeletal complaint with it. So why don’t you see the chiropractor for that.” The other thing is that the patients themselves are a little bit different. I don’t know how many of chiropractors in the field are going to be exposed to the amount of PTSD and traumatic brain injuries that we’re seeing, particularly in the veterans returning from Iraq and Afghanistan. So I think that it’s maybe a combination of both of those things.

While retaining patient confidentiality, can you talk about a case or two that you saw at the VA that was particularly satisfying?

There are always those nuggets, those gems that are beyond your expectations and remind you that the reason that you went into chiropractic in the first place is the reward of that patient interaction. I had an experience this past week with a veteran where, on paper, I would normally have thought, “What can I really do for this individual?” It’s someone who has been a paraplegic for 20 years, who had an incident where he fell and fractured T8, his eighth thoracic vertebra. It was unstable and ended up causing a cord contusion that led to a significant amount of bruising. Of course, at that time technology was more limited than what we have now, as far as proteolytic enzymes and other methods for decreasing the inflammation in the cord. He ended up being paraplegic, and also ended up with Harrington stabilization rods in the thoracic spine to stabilize the fracture. Ultimately, now, 20 years later, he woke one day with acute neck pain and a classic C5 radiculopathy into the upper part of the lateral arm. The bottom line is that by the time I was able to have the consult come to me, he had already had a Medrol [steroid medication] pack, so most of the acute inflammatory response, most of the acute symptoms were resolved. But he still had a very bothersome kink in the neck and some tingling in the upper lateral arm.

As I said, when I looked at it on paper and saw all the complications, I wondered how I could help this person. His imaging studies showed gross amounts of degenerative changes, and even a disc that was impinging on the nerve root at the lateral recess. But I had made a rule for myself that I would always see patients in person rather than looking at it and filtering it by the electronic consult. So we brought the person in. It turns out that he’s very active, very much engaged in his health, and is very aware of his limitations and his possibilities. Ultimately, his exams showed nothing that would be a contraindication to spinal manipulation of the cervical spine. While he was in his wheelchair, I applied his first chiropractic adjustment and there was instantaneous relief from the lack of motion and also a decrease of the tingling sensation he had in the upper arm.

That’s going to lead to a happy patient as well as a happy doctor.

Absolutely. It was a fantastic experience and it reminded me that we so often categorize our patients by condition and symptom rather than looking at them as individuals that are trying to survive in the environment that they’re in, whether it’s a physical environment, the emotional stressors of life, the lifestyle choices, whether it’s lack of water and too much coffee, or whatever it may be. So when you start interacting on that intimate personal level, it really does allow you to have interactions that are beyond the classic symptoms or conditions.

Do chiropractors working for the VA have to be military veterans? Do you think it’s helpful if they are veterans?