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Researching Chiropractic: Reflux, Morton’s neuroma, Hypothyroidism

Chiropractic clinical case histories have been a regular feature of our patient newsletter since its inception. There seems to be no limit to the health problems that respond to chiropractic care. How many people suffering, on drugs, facing a life of limitation could be helped by chiropractic care? 

Probably most of them.

Gastroesophageal reflux diseasepeople-1839564_1920 (1)

A 4-month-old baby girl with GERD was brought by her mother for chiropractic care. The mother reported the child had multiple episodes of reflux and vomiting per day. She received chiropractic and cranial care and her mother reported a large bowel movement and a longer than normal sleep the day after the 1st visit. The baby continued care 2x/week for 2 weeks and 1x/week for the next 4 weeks. By the second visit, her mother reported that the vomiting and reflux had decreased. Within 3 weeks she had no more reflux or vomiting. (1)

Improved behavior, a reduction in violent outbreaks in a 10-year-old boy. child-2844209_1920

This is the case of a 10-year-old boy with behavioral issues, including dramatic changes from a calm manner to suddenly violent actions. He was also reported to have difficulty sleeping due to emotional detachment disorder and frequently suffered from panic attacks.

His mother also reported that he had difficulty noticing when he was sufficiently full following eating. His behavioral volatility caused him to be suspended from school.  Upper cervical, thoracic and lumbopelvic subluxations were discovered in this case. He received spinal adjustments. His changes were recorded through the Measure Yourself Medical Outcome Profile (MYMOP) questionnaires over the course of his treatment. A reduction in an MYMOP score of 6/6 to 16/6 for behavior and violent outbreaks was measured after 8 adjustments. Further improvements were noticed with sleep and anxiety, as well as a dramatically improved awareness of feeling full after eating. (2)

Reflux, irritability, and more in 7-month-old boys. twins-1169064_1920

This is the case of two seven-month-old premature fraternal twin boys with chronic reflux, breastfeeding difficulties, general irritability, excessive crying, plagiocephaly, and scaphocephaly who were presented by their mother for chiropractic care. The children received spinal and cranial adjustments and after 8 weeks of care, the mother reported a decrease in the severity of the twins’ reflux, breastfeeding difficulties, and irritability. At 16 weeks of chiropractic care, the twins’ reflux had ceased and their cranial symmetry had markedly improved. (3)

Morton’s neuroma. woman-3213761_1920

Morton’s neuroma is a nerve tumor in the foot. It is a painful condition that people describe as “walking on a marble.” It usually affects the ball of the foot, often between the 3rd and 4th toes, and feels like a sharp, burning pain. The toes also may sting, burn, or feel numb. The medical or podiatric approach is to give corticosteroid (cortisone) injections or perform surgery to cut out the tumor.
This is the case of a 63-year-old woman who suffered from Morton’s neuroma in her right foot for ten years. She sought chiropractic care for a variety of health complaints. For one month her vertebral subluxations were addressed and reduced using specific chiropractic care. During this period her Morton’s neuroma symptoms completely disappeared and in addition, she reported improvement in her digestion, sleep, and ability to move without pain. (4)

Failure to thrive, oral thrush, and inconsolable crying in a 4-month-old. baby-821625_1920

The baby was medically diagnosed with “Failure to thrive” (FTT) because her weight or size was significantly below that of other children of similar age and gender.  She was reported to have had birth trauma from a nuchal cord-the umbilical cord was completely wrapped around her neck (360 degrees). The child was 4-months-old when she was brought to the chiropractor. She was suffering from inconsolable crying, oral thrush (an overgrowth of the fungus candida Albicans in the mouth and throat), chronic diarrhea and she was dangerously
underweight.

Chiropractic examination detected vertebral subluxations at C1-C4 (upper neck) and T3-T4 (upper back). The child received chiropractic adjustments from the first visit and afterward was checked for vertebral subluxations that were corrected when indicated for seven weeks.
Her FTT symptoms began to resolve after the first visit and completely resolved by the seventh week of care. (5)

Hypothyroidism reduction under chiropractic care.

A 44-year-old woman was complaining of upper shoulder pain and pain between her shoulder blades after a motor vehicle accident. The accident had occurred 23 years earlier! She had also been taking Armour® Thyroid in order to treat symptoms of smiling-4654734_1920low thyroid function (hypothyroidism). Her spinal X-rays revealed an 80.7% loss of normal neck curve (hyperlordosis) in addition to vertebral subluxations.
She received spinal adjustments over a seven-month period to reduce her subluxations and to improve her spinal and postural alignment.

Thirty days into care she began exhibiting symptoms of an overactive thyroid (hyperthyroidism). Her chiropractor suggested that she have her thyroid function checked by her endocrinologist to see if her prescribed thyroid medication should be re-evaluated. After evaluation, the patient’s endocrinologist instructed her to significantly reduce the taking of her thyroid medication. (6)

Do you know anyone who is suffering from any of these symptoms or issues? Please share this article with them and encourage them to make an appointment with us.

Call to make an appointment:  517.627.4547

1. Chuang A. Chiropractic treatment of gastro-esophageal reflux disease in a pediatric patient: A case
report. Journal of Clinical Chiropractic Pediatrics. 2014;14(2):1139-1141.
2. Cook JR. A case report of improved behavior and a reduction in violent outbreaks in a 10-year-old boy
with chiropractic care. Journal of Clinical Chiropractic Pediatrics. 2014;14(3).
https://www.jccponline.com/Case-report.html
3.  Collins K, Alcantara J, Holt K. Resolution of breastfeeding and gastrointestinal complaints in infant
twins with plagiocephaly & scaphocephaly following birth trauma: a case series. Journal of Pediatric,
Maternal & Family Health – Chiropractic. 2015;1:34-41.

4. Lanoue B, Treahy-Geofreda T, Russell D. Resolution of Morton's Neuroma in an elderly patient
receiving Activator Methods chiropractic technique to correct subluxation: a case study. Annals of
Vertebral Subluxation Research. January 4, 2016:1-5.

5. Neally R, Alcantara J. Resolution of failure to thrive in a 4-month-old infant following adjustment of
subluxation: case study & selective review of the literature. Journal of Pediatric, Maternal & Family Health
– Chiropractic. 2015;4:149-153.
6 . Bak AD, Engelhardt PR. Improvement in cervical curve and hypothyroidism following reduction of
subluxation utilizing Chiropractic Biophysics: a case study & selective review of the literature. Annals of
Vertebral Subluxation Research. December 10, 2015:226-237.

Researching Chiropractic: Fibromyalgia and depression, Vomiting, Daily Headaches

Chiropractic clinical case histories have been a regular feature of our patient newsletter since its inception. There seems to be no limit to the health problems that respond to chiropractic care. How many people suffering, on drugs, facing a life of limitation could be helped by chiropractic care? 

Probably most of them.

Fibromyalgia and Depressionwoman-593141_1920

A 48-year-old female suffering from mid-back pain, shoulder pain, neck pain, and depression due to fibromyalgia sought chiropractic care as an alternative method of pain control and to improve her quality of life. Multiple drugs had failed to resolve her problems. 

After performing a case history, physical examination, and chiropractic examination, it was revealed the patient had spinal subluxations in her neck (cervical spine) at C1 and C5-T1. The patient was analyzed at each visit and adjusted to reduce and remove her subluxations. After six months of care, her fibromyalgia symptoms had decreased by 75% and her MD considers it in remission. Her overall quality of life has improved. She continues with weekly chiropractic visits. (1)

Two pediatric patients experiencing vomitingbaby-3036925_1920

One pediatric patient presented to a private practice with complaints of suddenly “feeling sick” and vomiting. He had been very active playing various year-round sports: football, basketball, and baseball. His parents stated, “He gets hit and falls pretty hard on a regular basis while playing these sports.” 

His subluxations were located and corrected (adjusted). The parents reported that the next morning when he woke up, he did not feel sick and was not vomiting. 

The other pediatric patient was a seven-year-old boy complaining of random vomiting after eating (approximately once every six weeks). After two weeks of chiropractic care, there was a complete resolution of vomiting after eating. (2)

Daily Headacheswoman-613309_1920

 A 44-year-old, single female school teacher with daily headaches of 2-year duration. The pain was described as so disabling (6-8 out of 10) that she could not maintain daily activities without painkillers. She began to have feelings of overwhelming sadness and was diagnosed with a major depressive disorder and given a combination of drugs for depression. She had recurrent thoughts of suicide. 

MDs found no cause. She tried acupuncture, traditional Chinese therapy, and alternative medications to no avail. Chiropractic analysis revealed multiple spinal subluxations. After 3 months of chiropractic care, the patient regained confidence in her health and started reducing the dose of medications. She rated her headache as 3-5/10 on the pain scale. After another 3 months of care, all of her symptoms disappeared. She was able to discontinue all medications after 6 months of chiropractic adjustments. 

As of this writing, she has enjoyed being headache-free and free of depression for the past 6 years.  The patient is continuing maintenance care on a monthly basis. (3)

Do you know anyone who is suffering from any of these symptoms or issues? Please share this article with them and encourage them to make an appointment with us.

Call to make an appointment:  517.627.4547

  1. Dunton TA, Hirshowitz N. Remission of fibromyalgia & resolution of depression in a 48-year-old female following chiropractic care to reduce vertebral subluxation: a case study & review of the literature. Annals of Vertebral Subluxation Research. September 16, 2020:131-134.
  2. Hoying M. Resolution of vomiting, improved health outcomes & structural changes following chiropractic in two pediatric patients with pseudosubluxation: a case series. Journal of Pediatric, Maternal & Family Health, Chiropractic. September 8, 2020:34-40.
  3. Chu ECP, Ng M. Long-term relief from tension-type headache and major depression following chiropractic treatment. Journal of Family Medicine and Primary Care. 2018 May-Jun;7(3):629-631. 

Chiropractic Healing from the Past

https://en.wikipedia.org/wiki/Daniel_David_PalmerDD Palmer discovered chiropractic in 1895. He saw its potential as a powerful drug-free natural healing art, a rediscovery of ancient practices going as far back as ancient Egypt and Greece. With his understanding of anatomy and physiology, Palmer developed a system of natural care he called CHIROPRACTIC.

Palmer divided his discovery (or re-discovery) into two parts:
1. A procedure to locate nervous system interference or blockages in a person’s spine and
2. A procedure to release or unblock the flow of nerve energy.
The nervous system blockage he called a subluxation, the procedure used to release this blockage he called an adjustment. While these are common terms today, used by chiropractors throughout the world, they were a breakthrough in his day – and quite controversial. But that
didn’t matter because it worked! It worked very well.

Palmer founded a school to teach his new method. Initially, he would only teach people who were themselves health care professionals. His first students were doctors of osteopathy, naturopathy, and medicine. Later, seeing a great need, he expanded the curriculum and
permitted non-professionals to enter the Palmer School of Chiropractic and learn this new science, art, and philosophy.

Palmer’s writings inspired many. Below is one of his more famous selections. It is as relevant today as it was when it was first published in 1910. In the dim ages of the past when man lived in rude huts and rocky caves, even up to the present time, he resorted to charms, necromancy, and witchcraft for the relief of mental and physical suffering. His whole object was to find an antidote, a specific for each and every ailment which could and would drive out the intruder, as though the disorder were a creature of intelligence.

In his desire to free himself from affliction and prolong his existence, he has searched the heavens above, he has gone into the deep blue sea, the bowels of the earth, and every portion thereof. He has tried animal and mineral poisons, penetrated the dark forest with superstitious rite and incantations, has gathered herbs, barks, and roots for medical uses. In his frenzy for relief … he has slaughtered man, beast, and bird, making use of their various parts alive and dead. He has made powders, ointments, pills, elixirs, decoctions, tinctures, and lotions of all known vegetables and crawling creatures….(1)

In his maddening search for something out there, something outside of his body to heal him, man forgot to look inside – where health and healing truly arose. Dr. Palmer’s words were a wake-up call to humanity. He was crying out: “Look within; what is preventing proper function? What is interfering with healing? Release the blockage and health will be restored.”

Such was the message of his new discovery, chiropractic, which was to bring to suffering humanity. This natural healing art, science, and philosophy – Chiropractic – has saved untold millions from drugs and surgery.

It continues to do so today.

Researching Chiropractic: Bedwetting, weight loss, Meniere’s disease

Chiropractic clinical case histories have been a regular feature of our patient newsletter since its inception. There seems to be no limit to the health problems that respond to chiropractic care. How many people suffering, on drugs, facing a life of limitation could be helped by chiropractic care?

Probably most of them.

Bedwetting, constipation, allergies (and more)child-2086910_1920

The parents brought their 6-year-old son to the chiropractor. The child had multiple problems including nocturnal enuresis
(bedwetting), headaches, ADHD, asthma, allergies, constipation, earaches, and cold hands. The boy had been taking several different prescriptions and over-the-counter medications including pain relievers, laxatives, Qvar ®(beclomethasone dipropionate) inhaler, Nasonex®, Albuterol®, Benadryl®, and Claritin®.

The child was given a chiropractic examination which revealed numerous vertebral subluxations throughout his spine. He was given a series of chiropractic adjustments. After twenty adjustments there was complete resolution of enuresis. By the 25th visit, the patient’s parents reported complete resolution of cold hands and constipation, as well as 80% relief of all remaining symptoms. (1)

Weight loss, heart rate variability, and nervous system imbalanceman-945438_1920

Chiropractic is so much more than back pain; chiropractic rebalances the nervous system so the entire body functions with improved efficiency. In this case, a 38-year-old man with a chief complaint of intermittent low back pain began chiropractic care. Nervous system imbalance (dysautonomia) was discovered using multiple instruments that included spinal heat readings (thermography) and heart rate variability. The patient was given a series of chiropractic adjustments to reduce his subluxations.

Over the series of adjustments (13 months), he lost 61 pounds with a 9.5% decrease in fat mass. His intermittent back pain resolved as well. (2)

Meniere’s Diseasewoman-5495263_1920

A 64-year-old woman suffering from neck pain, headaches, arm weakness, vertigo, and anxiety began chiropractic care. She reported that she had also been suffering from Meniere's disease for three and a half years.  A chiropractic exam revealed a vertebral subluxation at C1. Cervical x-rays, neurocalography, orthopedic testing, and visual analog scale assessments confirmed this finding.

The patient experienced a significant improvement in symptoms of Meniere's, vertigo, anxiety, and headaches as a result of chiropractic care. She experienced overall better health including increased strength, energy, and a more positive mental outlook. (3)

  1. Herring R, Wright D. Resolution of nocturnal enuresis, constipation, headaches, allergies & cold hands in a 6-year-old male following chiropractic for vertebral subluxation: case study & review of the literature. Journal of Pediatric, Maternal & Family Health, Chiropractic. August 10, 2020:26-33.
  2. Cole J, Lewis N. Improvements in heart rate variability and reduction in dysautonomia following chiropractic care: a case study and selective review of the literature. Annals of Vertebral Subluxation Research. July 9, 2020:109-125.
  3. Malachowski T, Britt C. Improvement in Meniere's Disease following upper cervical chiropractic care: a case report & review of the literature. Journal of Upper Cervical Chiropractic Research. August 17, 2020:28-38.

Researching Chiropractic: Asthma, Diabetes, and Fibromyalgia

Chiropractic clinical case histories have been a regular feature of our patient newsletter since its inception. There seems to be no limit to the health problems that respond to chiropractic care. How many people suffering, on drugs, facing a life of limitation could be helped by chiropractic care?  Probably most of them.

researching chiropractic

Asthma, stomach and intestinal complaints, colds, and chiropractic

A 23-month-old child suffering from asthma, gastrointestinal complaints, and frequent colds was brought to a chiropractic office for evaluation and possible care by her parents. She was on various asthma medications and was under constant monitoring by her pediatric pulmonologist. 

Chiropractic care consisted of adjustments to address areas of vertebral subluxations in her cervical (neck), thoracic (midback), and lumbosacral (lower back) spine. 

Within approximately 11 months, the patient’s parents reported a 90% improvement in their child’s condition. All medications were discontinued with a dramatic decrease in asthma symptoms, sinus problems, and frequency of colds. 

Fibromyalgia and chiropractic

 A 36-year-old woman began chiropractic care due to injuries sustained in a motor vehicle accident three days prior. Chiropractic examination found vertebral subluxations and the patient was placed on a schedule of chiropractic care. 

The patient was seen over a 12-week period. She responded well to care with dramatic improvement in fibromyalgia symptoms and was placed on a long-term maintenance plan.  

Diabetes and chiropractic

A 61-year-old man presented to the chiropractor with a 20-year history of type 2 diabetes. Chiropractic adjustments were applied to the sites of vertebral subluxations, and dietary modification to reduce inflammation in the body was recommended as well. After 1 month of chiropractic treatment and dietary changes, the patient decided to cease taking medication for the treatment of his type 2 diabetes.  After 2 months of chiropractic care, he returned to his medical doctor who confirmed that his blood-glucose levels had normalized. 

Dr. C notes that her sister dropped her insulin needs to virtually nil after getting under care.

Do you know anyone with the above issues?

Please refer them to us. We can help! 517.627.4547

Your Listings: How are yours?

We’re not talking about your listing in the phone book (do people use them anymore?) or whether your boat is tilting in the water. When chiropractors use the word “listing” it’s used to describe the direction your vertebrae or spinal bones are subluxated or out of position.  

sailing-boat-3399011_1920

For example, let’s say you’re told your listing is “C-1 right.” What does that mean? Well, C1 is shorthand for your first cervical (neck) vertebra. It’s located just underneath your skull. “C-1 right” means that C1 is shifted to the right. C-1 RA means that the vertebra is shifted right and has rotated anterior (or forward) on the right. 

If we said that your C-2 is left that would indicate that your second cervical vertebra is shifted left. Your seven cervical vertebrae are named C-1, C-2, C-3 all the way to C-7.  

You also have 12 thoracic vertebrae named T-1 to T-12. You have five lumbar (lower back) vertebrae named L-1 to L-5. 

Your vertebrae can misalign in many individual directions – left, right, inferior (down), superior (up), rotation, anterior (towards the front), posterior (towards the back), medial (towards your center), lateral (away from your center) – and many combinations of directions. There are also different listing systems based on the various adjusting techniques chiropractors use. 

It can get very complicated. 

How do doctors of chiropractic determine what your listing is? X-ray analysis is a common tool that is used but there are others in use in the profession.

 

To discover if you have any listings, schedule an appointment with Dr. Charmaine or Dr. Ray.  Please Contact us  or call 517.627.4547

10 reasons to take children to a chiropractor

 

We get asked this a lot. Why would you take a child to a chiropractor? They aren’t old enough to have back pain. IMG_1269

There are lots of reasons for taking children to a chiropractor and here some popular and very beneficial ones:

  1. To maximize their child’s neural plasticity (brain and nerve development). 
  2. To enhance their child’s overall health and wellbeing. 
  3. To strengthen immunity and reduce the incidence of colds, ear-aches, and general illness. 
  4. To help with colic and Irritable Baby Syndrome. 
  5. To help with asthma, breathing difficulties, and allergies. 
  6. To improve spinal posture. 
  7. To improve their child’s ability to concentrate. 
  8. To assist with behavioral disorders and enhance emotional wellbeing. 
  9. To help alleviate digestive problems.
  10. To assist with bed-wetting and sleep issues. 

Your child’s health is their greatest asset.

To schedule an appointment or talk to Dr. Charmaine or Dr. Ray please Contact us  or call 517.627.4547

What is Chiropractic Philosophy?

Every healing art follows a philosophy. While medicine follows a mechanistic philosophical model (the body functions like a machine and is chiropractic philosophy unreactive), chiropractic follows a vitalistic philosophical model (the body is intelligent and reactive). 

Chiropractic recognizes that the ultimate healer is your inner healing ability that can heal anything – from a cut to cancer. Our purpose as chiropractors is to help your natural healing ability to function as close to 100% as possible. 

  We do that by correcting subluxations – structural distortions in the body that interfere with the flow of energy and information throughout the body. 

  Chiropractors are specialists in locating and correcting subluxations in everyone – from the newborn to the elderly – so you’ll function with more balance, harmony, and energy. 

To learn more about our chiropractic practice, please click here.

To schedule an appointment or talk to Dr. Charmaine or Dr. Ray please Contact us  or call 517.627.4547

Researching Chiropractic: Strength Building, Failure to Thrive, Thyroid Issues

Chiropractic makes you stronger. We know that professional and amateur athletes love chiropractic. Now there is a simple study showing that chiropractic makes you stronger. In this study grip strength was recorded for 100 male and female patients before and after chiropractic care. The results were statistically significant.

In this study 95% of the patients had a more than 5% increase in grip strength immediately after chiropractic care. A majority (31%) of the patients showed between 11-15% increase in grip strength; some had over 40% increase and one patient’s strength increased by 85%!

From the paper: Removal of vertebral subluxation can lead to improved motor function, better body function and healthier well-being. (1)

weights-869225_1280

Failure to thrive, oral thrush and inconsolable crying in a 4-month-old. The baby was medically diagnosed with “failure to thrive” (FTT) and MDs recommended surgical insertion of feeding tubes (i.e. gastrostomy) into the baby’s stomach. The mother refused and sought alternative care.

At 4-months-old the baby was brought to the chiropractor. In addition to FTT she suffered from inconsolable crying, chronic diarrhea and was dangerously underweight. Chiropractic examination detected vertebral subluxations at C1-C4 (upper neck) and T3-T4 (upper back) that were adjusted on the first visit.

Following the first visit, she slept a few hours continuously, without waking up and crying. After three visits she stopped arching in extension and screaming and her stools were becoming a normal color and well-formed. Eventually, she was sleeping through the night and was notably a happier baby, consistently gaining in strength and health each week. The child did not have the gastrostomy surgery.

Five years later the child was healthy and well-developed. (2)

people-1839564_1920

Hypothyroidism reduction. A 44-year-old woman with upper shoulder pain and pain between the shoulder blades that occurred after a motor vehicle accident 23 years earlier sought chiropractic care. She also suffered from low-thyroid function (hypothyroidism) and was taking Armour ThyroidT. Spinal X-rays revealed a significant loss of normal neck curve (hypo-lordosis) in addition to vertebral subluxations.

She received spinal adjustments to reduce her vertebral subluxation complexes (VSC). In addition to improvement in her pain, she began exhibiting signs/symptoms of an overactive thyroid (hyperthyroidism). Her endocrinologist found improved thyroid function and instructed her to significantly reduce her thyroid medication. (3)

back-5163495_1920 (1)

Taking Out Adenoids Does NOT Help Ear Infections

Removal of the adenoids, often associated with swollen tonsils, is the first surgical treatment for many babies and young children. Although recommended for ear infections, it is not effective. (4) If your child is suffering from ear infections bring him/her in for a chiropractic checkup and adjustment so you may avoid drugs and surgery.

new-born-baby-1863964_1920

Resources:

  1. Ng K. Improvement in motor function measured by grip strength following chiropractic adjustments to reduce vertebral subluxation in 100 subjects. Annals of Vertebral Subluxation Research. March 23, 2020: 33-42.
  2. Neally R, Alcantara J. Resolution of failure to thrive in a 4-month-old infant following adjustment of subluxation: case study & selective review of the literature. Journal of Pediatric, Maternal & Family Health – Chiropractic. 2015;4:149-153.
  3. Bak AD, Engelhardt PR. Improvement in cervical curve and hypothyroidism following reduction of subluxation utilizing Chiropractic Biophysics: a case study & selective review of the literature. Annals of Vertebral Subluxation Research. December 10, 2015:226-237.
  4. Koivunen P, Uhari M, Luotonen J et al. Adenoidectomy versus chemoprophylaxis and placebo for recurrent acute otitis media in children aged under 2 years: randomised controlled trial. BMJ. 2004 Feb 28;328(7438):487.

Chiropractic: Run Faster, Jump Higher, Be Stronger

It’s summertime and we’re out playing. Can Chiropractic really help sports performance? It certainly does, and that’s why professional sports teams keep chiropractors on staff so their players’; bodies are more balanced, their nervous systems are healthier, their muscles function at their peak and, if they get hurt, they recover faster from injuries.

Name the sport:golf-83869_1920

  • golf
  • tennis
  • football
  • soccer
  • track
  • swimming
  • hockey
  • martial arts
  • wrestling
  • all the others

Chiropractic can give you the winning edge. Of course, you don’t need to be a professional athlete to benefit from chiropractic;
anyone who uses his/her body needs it to function at its peak. That means everyone, including you, your family, your friends and sports team, can have the winning edge. (1-3)

surfing-1208255_1920

1.Haldeman S. Spinal manipulative therapy in sports medicine. Clinics in Sports Medicine 1986;5:277.
2.Lauro BM. Chiropractic effects on athletic ability. Chiropractic: The Journal of Chiropractic Research and
Clinical Investigations. 1991;6(4):84-87.
3.Interview with Nick Athens, DC Chiropractic Achievers. November/December 1989;38.