Patient care goes beyond technique

Building an action plan of wellness and lifestyle for patients in today’s chiropractic practice starts from the day they walk in the door. For Dr. James Chestnut, a wellness-focused practice means one that is focused on not just restoring function but also on maintaining function and preventing future health degeneration.

“The tools for a wellness practice are chiropractic care and lifestyle education and intervention,” the Victoria, B.C. chiropractor says. “I believe wellness and lifestyle are fields of expertise and that a chiropractor or any other practitioner who delivers lifestyle advice should have specific education and training in this field and should deliver evidence-based lifestyle education and intervention. I also believe there is an onus to record the health benefits that are derived so that both doctor and patient can be sure that the intervention is having a positive effect on health outcomes,” he says.

An internationally known pioneer in the area of lifestyle, renowned speaker and author of The 14 Foundational Premises for the Scientific and Philosophical Validation of the Chiropractic Wellness Paradigm, Chestnut is the developer of the Innate Lifestyle Program, a comprehensive lifestyle program being delivered by licensed centres around the world. He believes that chiropractors, because of their paradigm to address the cause rather than treat effects or symptoms, are the best qualified for wellness and prevention.

“Prevention cannot occur after a diagnosis and treating effects does not correct causes so I have always felt that chiropractors should be the practitioners in charge of lifestyle for wellness and prevention – if they have sufficient knowledge in the human species lifestyle requirements,” Chestnut says.  

He believes chronic illness is the single greatest threat to health, to quality and quantity of life, to the Canadian economy and to the standard of living.

“The knowledge and ability to educate and empower patients regarding healthy lifestyle change is the skill set that is most needed, and will be most sought after by individuals, governments, insurance companies and corporations in the 21st century,” Chestnut says.

Today’s chiropractic practice should deliver more than technique, according to Dr. Adrian Raphael. “Wellness really means giving people the tools they need to live a long, healthy, happy life outside the office. It doesn’t necessarily mean having multiple treatment or auxiliary services like massage, physio, acupuncture and naturopathic. While these can help patients, really the goal is to have the patient alter their belief systems and subsequent behaviours to live a better life. Teach them how to fish rather than feed them the fish, so to speak,” he says.

A graduate (2009) of the Logan College of Chiropractic school in St. Louis, Mo., Raphael is also a certified strength and conditioning specialist and has a Crossfit Level 1 certification as a doctor.

“Chemical, physical and emotional stressors are placed on people every day in varying degrees, all of those stressors create of course a stress response, which chronically can cause havoc,” he says from his Beyond Wellness Chiropractic clinic in Brampton, Ont. “Stress hormones and insulin resistance have been linked to virtually every chronic disease. Chiropractic has been shown to decrease cortisol levels… something if done on a regular basis can truly arm our patients with the best wellness defence from the inside out. Chiropractic helps give their body the ability to handle the various stressors placed on them in their every day life.”

A firm proponent of the “knowledge is power” approach to health-care delivery, Raphael points out that with knowledge, his patients are armed to beat chemical, physical and emotional stresses. In his practice, he teaches what he calls the four pillars of health: nervous system and spinal health; quality nutrition; optimal fitness; and personal power.

“We deliver these pillars on our message board where we have weekly inspiring messages, recipes and workouts scaled for anyone at any age with any ability. We host workshops and lifestyle makeovers roughly every quarter. As well, we have it a part of our policies to work with patients on home care exercises, supplements to consider on their fourth visit and address nutrition on a layer deeper at their progress exam on the 12th visit. What makes a wellness practice successful is the ability to move people to a better way to live,” Raphael says.

Getting trained
At the Kulhay Wellness Clinic and Educational Centres, one of Canada’s first and among Toronto’s largest wellness-focused chiropractic clinics, it’s all about treating the whole body, not only the disease.

“Our approach is three-fold: to promote a holistic approach, good health through physical action and mental and spiritual awareness,” Dr. Katrina Kulhay says, the clinic’s founder. “Our goals are to improve quality of life for all, increase active lifespan and productivity and control or eliminate degenerative disease.

“Our prevention focused educational programs are based on complimentary health care, current advances in preventative medicine and alternative health-care treatments,” she says.

An award-winning chiropractor and anti-aging expert, Kulhay has long been a leading advocate of the combined medical and alternative wellness approach. In addition to offering colon hydrotherapy, infrared sauna and between intravenous vitamin therapy, her clinics have more recently introduced a Live Cell Blood Analysis procedure. Live Cell Microscopy uses one drop of blood taken from a fingertip puncture and then views it immediately under the microscope.

“It indicates imbalances in the body, presence of metabolic by-products, pathogenic microorganisms and pH of the blood terrain,” Kulhay explains. “The live blood thus acts as an ‘educational feedback mechanism’ motivating people to improve their diet, supplement and lifestyle habits.”

To get her wellness and lifestyle message out to patients, Kulhay uses a spectrum of marketing modes, including a professional website, email blasts, newsletters and social media.

“But our approach starts even before the patient enters our clinics,” she says. “Our voice mail message: ‘Hello, how can I brighten your day?’ It projects your wellness image and tells the world you love your practice.”   
Wellness training may need to go well beyond what’s being taught in chiropractic college, according to Calgary-based Dr. D.J. LeDrew, who runs the Full Potential Chiropractic clinic and author of the how-to book, Tired of Being Sick and Tired, on maintaining high level wellness.

“A wellness practice deals with bigger health challenges than just musculoskeletal issues,” LeDrew, who studied kinesiology at the University of Calgary – and attended the Los Angeles College of Chiropractic – insists.  “I’ve always been interested in physiology, kinesiology and nutrition, and felt I needed more in getting to the root causes of patients’ health challenges.”

To help achieve that goal, LeDrew undertook the Chiropractic Wellness Lifestyle Program, provided by the International Chiropractors Association (ICA), headquartered in Arlington, Va. The program entails instruction in a clinical format, focused on addressing key aspects of wellness and optimal health in the context of the chiropractic paradigm.

The Certified Chiropractic Wellness Lifestyle Practitioner (CCWP) certification credential is awarded by the ICA to doctors of chiropractic upon completion of onsite seminar course-work, home study modules assignments, examinations and other requirements.

“The program gave me a deeper understanding of wellness,” LeDrew remarks.  “It’s more than the basics I was taught in school. This kind of in-depth training is giving chiropractors the opportunity to take what we’ve seen and learned in our practice and take it a step further, educating our patients everyday about their diet, blood pressure, chronic issues and natural health options.”   

Patient education
To offer wellness-based care in her practice, Dr. Andrea Ferretti zeroes in on the environment impacting all aspects of her patients’ health.

“This means examining lifestyle, the day-to-day choices regarding purity and sufficiency versus toxicity and deficiency that result in how much health we experience,” Ferretti states from her Wellness Centre clinic in Dundas, Ont. “This approach is challenging in modern, industrialized living. Exposure to heavy metals, fake estrogen and electro-magnetic radiation alone has increased exponentially. Without educating patients about the raw materials necessary to be healthy – including diet, movement, thought patterns – they remain overwhelmed by the stressors that they face personally and environemntally,” she says. “A wellness-focused chiropractic practice educates each patient to ensure that the day-to-day choices that patient makes are congruent with their genetic profile for their health and well-being.”

A follower of the wellness strategy as advanced by Chestnut and the ICA, Ferretti has all her staff take the certification program. From her perspective, patient and public education lectures are a part of a wellness practice offering, and provides answers to the confusing and often misleading information concerning health in industrialized society.

“There are times when teaching a person to ask the right questions regarding their lifestyle choices is all it takes to allow a shift in their paradigm, to ease them away from poor health choices,” Ferretti says. “the success of a wellness-based practice is driven by the desire for a long and healthy life – for oneself, one’s family and one’s community. Any practice that is a source of scientific and clinical holistic wellness and that provides to their patients evidence regarding the benefits of chiropractic care and wellness lifestyle choices is a wellness practice,” she says.

The 14 Foundational Premises by Chestnut is a “textbook” that Ferretti insists provided her practice, “with a level of certainty for the chiropractic health service [she] offers, but it was the wellness certification program that gave [her] the training and skills to effectively coach patients into empowerment regarding their health.”

What are the rewards of building a chiropractic wellness practice? “That is simple,” Chestnut chuckles. “Better patient outcomes. In terms of patient outcomes, a chiropractor must address the lifestyle factors that drive health and illness. You simply cannot correct nutritional, exercise or psychosocial health deficiencies and toxicities with adjustments and you simply cannot get the same physiological response to chiropractic adjustments in patients who are deficient or toxic.

“You could argue about whether or not you are obligated to provide lifestyle care but you cannot logically argue about whether or not chiropractic plus lifestyle elicit better patient outcomes than either alone,” Chestnut says. My obligation is to patients and to patient outcomes. I strongly believe and can support with the best evidence from the best physiologists and neurophysiologists in the world, published in the world’s most respected journals, that the chiropractic health tenets are correct and that this makes chiropractic the best choice to elicit the best patient outcomes.”

Jack Kohane is a Toronto-based freelance journalist writing for several national  health-care magazines and the National Post.