Triage Nutrition

By G. Douglas Andersen, DC, DACBSP, CCN

More and more chiropractors are treating cash patients on a tight budget. As insurance restrictions increase, this trend will most likely continue. Thus, there is added pressure on the DC to find a treatment plan that will yield the patient, with limited resources, maximum benefit at an affordable price.

When patient dollars are tight, nutritional support many times is the first "luxury" to be eliminated from the doctor's treatment plan. Granted that optimal nutritional support for many patients requires numerous formulas and, thus, results in a large fee. When you are faced with this situation, don't eliminate internal support, just reduce it to the most essential nutrients needed to address the cause of your patient's complaint. This can be accomplished by grouping your patients into four basic supplemental categories. 

1. Pain from inflammation. Acute injuries such as sprained necks, backs, ankles, knees, shoulders, and spinal whiplashes fall into this category. Your nutritional support should be formulas that emphasize or are totally composed of proteolytic enzymes. Trypsin, chymotrypsin, papain, and bromelin are the major natural anti-inflammatory enzymes in the doctor of chiropractic arsenal. They should be given in small doses every two or three hours for two to five days as symptoms dictate. Many times one bottle is all it will take to reduce the inflammation. That is, of course, assuming they are receiving your in-office care as well.
   
   
2. Pain from spasm. Cervical torticollis and conditions where muscle spasm (intrinsic or extrinsic) is the dominant objective findings fall into this category. Supplementation should emphasize magnesium and calcium, and/or the herbs, valerian and passiflora. These supplements should be administered in small amounts each waking hour for the first 24 hours. Dosage in the second 24 hours can consist of slightly larger amounts given four times a day. This should be continued until the patient's symptoms subside. Again, many times it only takes one bottle of supplements, along with your treatment, to achieve the desired results. When using minerals, make sure that the formula you choose discloses what form(s) or mineral(s) is used. The aspartate, citrate and lactate forms of calcium, and the aspartate or glycinate forms of magnesium have greater bioavailability than amino acid chelate, carbonate or oxide forms.

Magnesium is more important than calcium for the patient in acute spasm. Many doctors just use magnesium alone. If you prefer combination formulas, make sure that the calcium/magnesium ratio is no more than 1:1.

3. Pain from long-standing injury. This is the patient who did not seek care in the acute stages of his injury and, thus, does not present with acute muscle spasms or inflammation. This could be anywhere from weeks to months after the initial connective tissue insult occurred. The most common scenario is "Doc, it got better for awhile and then it just hasn't changed for the last few months." The formula you choose must include zinc, manganese, and vitamin C. Most professional companies have rehabilitation formulas that include other synergistic nutrients. Chondroitin sulfates, B-vitamins, silicons, perna canaliculus, shave grass, minerals, and amino acids may be included as well. Again, make sure that zinc, manganese, and vitamin C are present in adequate amounts.

4. Chronic pain. This is the person who has hurt for years and has "finally decided to try chiropractic." Long-term biomechanical dysfunction has led to multiple compensatory spinal imbalances, i.e., the chronic subluxation complex. This is the type of patient who needs reconstructive care. Due to the chronicity of the condition, the first few treatments may result in a magnification of the patient's subjective complaints. Potassium and magnesium salicylates and/or DL phenylalanine are natural pain relievers that can be used to neutralize any patient discomfort created from the initiation of structural changes that you are beginning to orchestrate. The use of these supplements can many times prevent you from losing a patient who, without them, would experience greater irritation and, thus, assume chiropractic is not for them. You know that once you have crossed this initial reactive hurdle, and their body begins to respond to your adjustments, they will feel much better after each treatment. It is at this point that you can change their supplements to a rehabilitation formula, as mentioned in category three.

It must be noted that many patients will have signs and symptoms from more than one category. Triage means determining the priority of need. These categories are a general guideline to help the doctor of chiropractic accomplish this task.

When even minimal nutritional support is added to your in-office adjustments and therapy, and the home stretching and strengthening programs you have designed for your patients, your treatment will yield faster and longer-lasting results.

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