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 Expert
Posts: 2457
  
| Three 4 Luck - 2016-06-01 1:00 PM
Bear - 2016-06-01 12:34 PM Three 4 Luck - 2016-06-01 10:44 AM Bear - 2016-06-01 10:04 AM Three 4 Luck - 2016-06-01 9:29 AM Dr Ramey is an entertaining storyteller, but he is a very in the box thinker, and I have seen him dismiss things other vets and MDs are using very successfully, like PRP. I asked him about that once, and his answer was basically if your vet is having so many success stories maybe she should be writing up case studies. Maybe she has better things to do?
Anyway, I take his FB posts with a grain of salt when I run across them. See, now I look at it differently than you. I'm assuming you are referring to platelet-rich therapy for ligament/tendon injuries in horses. I'll admit that there is a lot of excitement and optimism over PRP therapy, but I'm not sure there is yet a consensus on it, owing to a lack of large, randomized, controlled clinical trials. I emphasize that it does appear promising, however to a purist, the jury is still out. At least that's my understanding of where we're at. Maybe this issue has been settled and I'm just unaware of it, so correct me if I'm wrong. The last time I read about it, that's what I walked away with. Medicine, including veterinary medicine needs people like Dr Ramey to hold the line and insist on adherence to certain unwavering principles, in my opinion. There's something to be said for people who think "inside the box". I'd love to hear some opinions of some vets on this.
Anyway, I was just pointing out that a treatment that has become accepted as fairly mainstream in the last few years was poopooed upon as a waste of money by the instigator of this conversation. It may not have all the evidence needed for consensus YET, but from what I have seen, it's only a matter of getting it proven because the merit is there. And, that is completely consistent with how I look at things. A lot of treatments "widely accepted as mainstream" prior to actually holding up to the scrutiny of scientific evaluation have gone by the wayside. Just because the mainstream, including a lot of competent doctors, widely accept a given treatment, doesn't mean it's gospel. I can cite endless examples. Bleeding to let out "evil humors", drilling holes in skulls for headaches, thalidomide, numerous operations, and so forth. Every year, it seems, medications formerly FDA approved, have been subsequently removed because of good studies that demonstrate a lack of efficacy or even safety. I don't know what treatment you are suggesting I "poo pooed", but in that same remark you suggested it still might not be proven therapy. I'm not ashamed to admit that many times in the course of my career I poo pooed a treatment modality, only to later change my mind as a result of good scientific study. I remember when laparoscopic gallbladder surgery was first introduced. I poo pooed it at first then as well. Two years later I was performing the operation routinely, as well as other operations. What changed my mind? Science and data. I'm not ashamed of that...I'm proud. Here's a remark you made that I find illustrative".....something that obviously works in a lot of cases." Think about that long and hard in the context of this discussion.
If something "obviously works in a lot of cases", it is still anecdotal until tested with appropriate controls. Thus, it would fall into the category of holistic or unproven alternative treatment.
Alternative treatment, to me, is a label that the "natural" community has hijacked. Alternative medicine is another avenue, usually proven but still new; like Bear's example of the gallbladder surgery. It started as new and an alternative to the invasive, traditional surgery. But with appropriate testing and data, it became routine.
Make sense? It can get convoluted while unraveling some of these terms ....  | |
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 Expert
Posts: 3782
 
Location: Gainesville, TX |  | |
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 BHW Resident Surgeon
Posts: 25351
Location: Bastrop, Texas | I thought you were referring to me when you spoke of the "instigator". After all, I did start the thread. Give yourself a pat on the back for the "gotcha" if it makes you feel better.
As to that last sentence you asked about, on the one hand you suggest the therapy you were talking about is definitely effective, but you admit that you can't say whether it's been proved through careful study. That's like saying, "I know eye-of-newt is a cure for moon blindness because I gave it to my mare and she's better". | |
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BHW Resident Surgeon
Posts: 25351
Location: Bastrop, Texas | lindseylou2290 - 2016-06-01 1:27 PM
Three 4 Luck - 2016-06-01 1:00 PM
Bear - 2016-06-01 12:34 PM Three 4 Luck - 2016-06-01 10:44 AM Bear - 2016-06-01 10:04 AM Three 4 Luck - 2016-06-01 9:29 AM Dr Ramey is an entertaining storyteller, but he is a very in the box thinker, and I have seen him dismiss things other vets and MDs are using very successfully, like PRP. I asked him about that once, and his answer was basically if your vet is having so many success stories maybe she should be writing up case studies. Maybe she has better things to do?
Anyway, I take his FB posts with a grain of salt when I run across them. See, now I look at it differently than you. I'm assuming you are referring to platelet-rich therapy for ligament/tendon injuries in horses. I'll admit that there is a lot of excitement and optimism over PRP therapy, but I'm not sure there is yet a consensus on it, owing to a lack of large, randomized, controlled clinical trials. I emphasize that it does appear promising, however to a purist, the jury is still out. At least that's my understanding of where we're at. Maybe this issue has been settled and I'm just unaware of it, so correct me if I'm wrong. The last time I read about it, that's what I walked away with. Medicine, including veterinary medicine needs people like Dr Ramey to hold the line and insist on adherence to certain unwavering principles, in my opinion. There's something to be said for people who think "inside the box". I'd love to hear some opinions of some vets on this.
Anyway, I was just pointing out that a treatment that has become accepted as fairly mainstream in the last few years was poopooed upon as a waste of money by the instigator of this conversation. It may not have all the evidence needed for consensus YET, but from what I have seen, it's only a matter of getting it proven because the merit is there. And, that is completely consistent with how I look at things. A lot of treatments "widely accepted as mainstream" prior to actually holding up to the scrutiny of scientific evaluation have gone by the wayside. Just because the mainstream, including a lot of competent doctors, widely accept a given treatment, doesn't mean it's gospel. I can cite endless examples. Bleeding to let out "evil humors", drilling holes in skulls for headaches, thalidomide, numerous operations, and so forth. Every year, it seems, medications formerly FDA approved, have been subsequently removed because of good studies that demonstrate a lack of efficacy or even safety. I don't know what treatment you are suggesting I "poo pooed", but in that same remark you suggested it still might not be proven therapy. I'm not ashamed to admit that many times in the course of my career I poo pooed a treatment modality, only to later change my mind as a result of good scientific study. I remember when laparoscopic gallbladder surgery was first introduced. I poo pooed it at first then as well. Two years later I was performing the operation routinely, as well as other operations. What changed my mind? Science and data. I'm not ashamed of that...I'm proud. Here's a remark you made that I find illustrative".....something that obviously works in a lot of cases." Think about that long and hard in the context of this discussion.
If something "obviously works in a lot of cases", it is still anecdotal until tested with appropriate controls. Thus, it would fall into the category of holistic or unproven alternative treatment.
Alternative treatment, to me, is a label that the "natural" community has hijacked. Alternative medicine is another avenue, usually proven but still new; like Bear's example of the gallbladder surgery. It started as new and an alternative to the invasive, traditional surgery. But with appropriate testing and data, it became routine.
Make sense? It can get convoluted while unraveling some of these terms ....
Thank you. You said it much better than I did. Too much hot sun, I guess. | |
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 Elite Veteran
Posts: 851
Location: West Texas | casualdust07 - 2016-06-01 12:41 PM
Tdove - 2016-06-01 9:23 AM
casualdust07 - 2016-05-31 8:36 PM
GLP - 2016-05-31 4:34 PM
Tdove - 2016-05-31 2:59 PM
I don't much think a vet certification is worth a darn either. There are a lot of vets that aren't very good. Experience goes a long way. No vet can be good at everything either. Certain vets are better at certain things, much of it to do with aptitude and experience. I wouldn't give a first year vet the time of day with my horse. Most have no idea how little they know. The same is true with most other things. I know non vet experts that are great at what they do, because they are focused on learning one thing and have gained the experience in doing it to be good at it. I have devoted a lot of time to equine nutrition, and I don't take much stock in a PhD in Equine Nutrition....they are the ones bringing us the junk food for horses. Many of the best dentist are non vets. Most vets are terrible dentist, and even worse nutritionist. Finally, Chiropractic services are best performed by a chiropractor. They do it for a living and experience and talent is what makes them good, not a vet degree. Seriously, a certification means little to me in any field. Mastery is dependent on skill and experience, no certification or bona fide degree alone provides this to you. It is just a starting place and in some cases is not necessary at all.
Amen to this!!! 
Gosh this stabs my heart. If you only knew how we truly feel. I'm just starting my fourth year of vet school, and am waiting on an emergency to come in.. so I have a few minutes to respond.
Every day we feel stupid, or at least I do. Every day I'm surrounded by vets who have anywhere from 2-40+ years experience on me. They ask me questions, they probe my brain, they challenge me. I feel like an idiot 99% of the time. In NO way do we feel like we know everything. In NO way do we feel like experts. We are shaking in our boots trying to remember everything we are taught, trying to figure out how these senior vets are so calm and collected making life and death decisions on horses. We use up what little vacation time we have to visit more and more clinics so we can get as much experience as we get. We take a job first year out of school making anywhere from 20-30,000 for that first year. Can you imagine, having a doctorate degree, and making $25,000? High paying internships pay around $35,000 and are few and far between. We **** sure don't do it for the money, we do it because we have this crazy calling to try and help both animals and people. Associates are lucky to break into 6 figure incomes.
So, I'm not sure what 1st year out of school vets you are talking about.. but I can tell you, every single one I have met knows exactly where they stand, how much they don't know, and how far we have to go. So, I'm going to pretend I didn't read this and I'm going to keep plugging along, head low, taking in as much as I can being the low man on the totem pole.
And how is being a vet unique to any other knowledge intensive profession? I did not say that to run down vets or new vets, especially. It is simple, my point was to say that certification doesn't mean anything to me. Experience and quality of performance do. This is true of any age group of professionals and not just vets. It is impossible to be a top vet within 5 years of vet school. Sorry, that is a fact. It wasn't meant to belittle you. It was meant to prove a point that experience matters much much more than a degree. This is true in every walk of life. If you want to be great at something, it will take a long time and experience.....You name it from horse training to investment banking. Most everyone works up the latter, that is how it should be. I don't know of any young person that fully realizes how little they know. You will likely find that out as time goes on. It never stops, if you are honest with yourself. So no I don't feel sorry for you. I don't think you should feel bothered by my post. I encourage you to go forward and be the best you can be, then you will be one of the good vets one day. It would be no different what you were studying to be, on the job is where you become successful or not. It really is 90% of your education in the long run. This is not meant to be negative toward you, but honestly finishing vet school does not and should not be any reason to expect any kind of salary. It only proves my point that your worth as a vet is not determined by that very hard earned diploma. As always, it is what you do with a degree (ANY degree ) that matters.
I use vets almost everyday. I respect them and value them. I value the intense training at school and on the job they get. Sometimes that training does make them less attentive to other non vet specialist. I think that is what we are seeing in the article. The author has a very valid main point, but I just go further to say that no certification means too much to me, though yes some online certifications or weekend equine message is absolutely laughable. That is no doubt the point of the article, in which I do agree.
What bothered me about your post is the assumption that you think we assume we know it all when we graduate. I was clarifying that we very much know that we have a long way to go. I don't disagree with the need for experience but I do disagree with your opinion that we graduate thinking we know more than we do, because we graduate knowing how far we still have to go.
Except I made no such assumption. I never wrote or implied you or anyone else thought you knew everything. Those are two separate matters, altogether. I know more seasoned vets that think they know everything, than I have ever met those just starting. Now young horse trainers, just the opposite. Seasoned trainers realize they don't know everything and the young ones think that have all of it down. But now I'll probably get myself in trouble with that too ;) | |
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 I Prefer to Live in Fantasy Land
Posts: 64864
Location: In the Hills of Texas | I find it interesting that many things are done on our horses way before they are introduced into human therapies. I can't remember how long ago injecting hocks was being done but 20 years is probably about right. Now if the human side would speed up and allow hylauronic acid be injected into human shoulders. | |
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| Bear - thank you for starting a very entertaining thread. BHW has gotten kinda boring lately. | |
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New Info Detective
Posts: 1551
| I'm curious Bear, do you yourself ever use a chiropractor or massage therapist?
Edited by Turner1 2016-06-01 3:58 PM
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 Owner of a ratting catting machine
Posts: 2258
| casualdust07 - 2016-06-01 12:41 PM
Tdove - 2016-06-01 9:23 AM
casualdust07 - 2016-05-31 8:36 PM
GLP - 2016-05-31 4:34 PM
Tdove - 2016-05-31 2:59 PM
I don't much think a vet certification is worth a darn either. There are a lot of vets that aren't very good. Experience goes a long way. No vet can be good at everything either. Certain vets are better at certain things, much of it to do with aptitude and experience. I wouldn't give a first year vet the time of day with my horse. Most have no idea how little they know. The same is true with most other things. I know non vet experts that are great at what they do, because they are focused on learning one thing and have gained the experience in doing it to be good at it. I have devoted a lot of time to equine nutrition, and I don't take much stock in a PhD in Equine Nutrition....they are the ones bringing us the junk food for horses. Many of the best dentist are non vets. Most vets are terrible dentist, and even worse nutritionist. Finally, Chiropractic services are best performed by a chiropractor. They do it for a living and experience and talent is what makes them good, not a vet degree. Seriously, a certification means little to me in any field. Mastery is dependent on skill and experience, no certification or bona fide degree alone provides this to you. It is just a starting place and in some cases is not necessary at all.
Amen to this!!!
Gosh this stabs my heart. If you only knew how we truly feel. I'm just starting my fourth year of vet school, and am waiting on an emergency to come in.. so I have a few minutes to respond.
Every day we feel stupid, or at least I do. Every day I'm surrounded by vets who have anywhere from 2-40+ years experience on me. They ask me questions, they probe my brain, they challenge me. I feel like an idiot 99% of the time. In NO way do we feel like we know everything. In NO way do we feel like experts. We are shaking in our boots trying to remember everything we are taught, trying to figure out how these senior vets are so calm and collected making life and death decisions on horses. We use up what little vacation time we have to visit more and more clinics so we can get as much experience as we get. We take a job first year out of school making anywhere from 20-30,000 for that first year. Can you imagine, having a doctorate degree, and making $25,000? High paying internships pay around $35,000 and are few and far between. We **** sure don't do it for the money, we do it because we have this crazy calling to try and help both animals and people. Associates are lucky to break into 6 figure incomes.
So, I'm not sure what 1st year out of school vets you are talking about.. but I can tell you, every single one I have met knows exactly where they stand, how much they don't know, and how far we have to go. So, I'm going to pretend I didn't read this and I'm going to keep plugging along, head low, taking in as much as I can being the low man on the totem pole.
And how is being a vet unique to any other knowledge intensive profession? I did not say that to run down vets or new vets, especially. It is simple, my point was to say that certification doesn't mean anything to me. Experience and quality of performance do. This is true of any age group of professionals and not just vets. It is impossible to be a top vet within 5 years of vet school. Sorry, that is a fact. It wasn't meant to belittle you. It was meant to prove a point that experience matters much much more than a degree. This is true in every walk of life. If you want to be great at something, it will take a long time and experience.....You name it from horse training to investment banking. Most everyone works up the latter, that is how it should be. I don't know of any young person that fully realizes how little they know. You will likely find that out as time goes on. It never stops, if you are honest with yourself. So no I don't feel sorry for you. I don't think you should feel bothered by my post. I encourage you to go forward and be the best you can be, then you will be one of the good vets one day. It would be no different what you were studying to be, on the job is where you become successful or not. It really is 90% of your education in the long run. This is not meant to be negative toward you, but honestly finishing vet school does not and should not be any reason to expect any kind of salary. It only proves my point that your worth as a vet is not determined by that very hard earned diploma. As always, it is what you do with a degree (ANY degree ) that matters.
I use vets almost everyday. I respect them and value them. I value the intense training at school and on the job they get. Sometimes that training does make them less attentive to other non vet specialist. I think that is what we are seeing in the article. The author has a very valid main point, but I just go further to say that no certification means too much to me, though yes some online certifications or weekend equine message is absolutely laughable. That is no doubt the point of the article, in which I do agree.
What bothered me about your post is the assumption that you think we assume we know it all when we graduate. I was clarifying that we very much know that we have a long way to go. I don't disagree with the need for experience but I do disagree with your opinion that we graduate thinking we know more than we do, because we graduate knowing how far we still have to go.
Not all of you. I've met some whoppers right of vet school. I like my veterinarians how AARP likes their membership- wrinkled, gray, and cranky. Those guys know what's up and don't jack around. They don't prance because they'll throw something out and they have nothing to prove because they own the whole hospital and can fire you as a client way before you can fire them as a vet. If you're lucky enough to win some of those guys to your side, your animals will only profit.
A young vet to me is someone younger than 50, and will be held in suspicion until proven otherwise.
For the record, (since I hold us youngsters in suspicion) I'm 31 years old, and I like proven facts as well. I do however, indulge in equine chiropractic care (only by an MD or DVM), equine massage (one guy, aged 70), and equine dentists (only by reference from competitors I respect). | |
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 Elite Veteran
Posts: 678
Location: Canada | My farrier who took a year long (every day) College Course (which is now two years long because the one year was too intense) to become a "Certified" Farrier, I also know someone who took a week long course and also became a "Certified" farrier. They are both "certified"; however one was through a College program and one was through a hosted farrier program at someones barn.
The problem with Certified is that Farrier #2 doesn't have nearly the same level of educational training that Farrier #1 has yet he can call himself a "Certified Farrier." Using Vets and Doctors for example you can not legally call yourself a doctor or a vet without completing your education and passing the required medical exams. Those exams are standardized and all doctors and vets coming out of school should have the same level of basic understanding as their peers. Some of course will have specialized training but the BASIC level of understanding should be the same among all graduates.
There is no standardize testing for Equine Massage Therapy, Chiropractic, Herbalist etc so while you may come across someone who has taken years of training and have a wealth of knowledge you may also get the individual who likes horses, has no background in horses but took a weekend course to become certified. Person A who has years of training and Person B who took a weekend course can both call themselves "certified" but the BASIC level of understanding will not be the same in both cases.
I believe in alternative therapies but I think that the Veterinarian association needs to move with the times and start standardized courses for alternative therapies. Then those calling themselves Certified should have the same basic level of understanding.
Edited by RunNitroRun 2016-06-01 4:46 PM
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Too busy outside!
Posts: 5417
| RunNitroRun - 2016-06-01 2:44 PM My farrier who took a year long (every day) College Course (which is now two years long because the one year was too intense) to become a "Certified" Farrier, I also know someone who took a week long course and also became a "Certified" farrier. They are both "certified"; however one was through a College program and one was through a hosted farrier program at someones barn. The problem with Certified is that Farrier #2 doesn't have nearly the same level of educational training that Farrier #1 has yet he can call himself a "Certified Farrier." Using Vets and Doctors for example you can not legally call yourself a doctor or a vet without completing your education and passing the required medical exams. Those exams are standardized and all doctors and vets coming out of school should have the same level of basic understanding as their peers. Some of course will have specialized training but the BASIC level of understanding should be the same among all graduates. There is no standardize testing for Equine Massage Therapy, Chiropractic, Herbalist etc so while you may come across someone who has taken years of training and have a wealth of knowledge you may also get the individual who likes horses, has no background in horses but took a weekend course to become certified. Person A who has years of training and Person B who took a weekend course can both call themselves "certified" but the BASIC level of understanding will not be the same in both cases. I believe in alternative therapies but I think that the Veterinarian association needs to move with the times and start standardized courses for alternative therapies. Then those calling themselves Certified should have the same basic level of understanding.
Hey there! That was the clearest and most practical explanation to this issue so far! I agree everything you said. I personally would love an extra classification to a certification that would show that a higher level of learning and practice had been achieved. There is a very wide range of aptitude within the single term, "certified." All a certification essentially means is that the certified person has met the standards set by the certifying agency. So unfortunately, this leaves it to the consumer to do their own investigation process to see if their certified specialist actually holds a reputable certificate from a reputable company and not just a weekend participation certificate. But- just because there are some certificates out there that aren't backed by an excellent standard, it does not mean that all awarded certificates are the same- that type of thinking is not only incorrect, but exceedingly critical and judgemental.
Nice post- thanks for coming on over! | |
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BHW Resident Surgeon
Posts: 25351
Location: Bastrop, Texas | Turner1 - 2016-06-01 3:56 PM
I'm curious Bear, do you yourself ever use a chiropractor or massage therapist?
Yes, I've used a chiropractor both for my horses as well as myself.
I definitely think they have a useful role. Generally speaking, we in medicine don't do a very good job with disorders of the spine and back pain in general. It's hard to find a good doctor who really takes the time to properly evaluate back pain....particularly low back pain.
I'm talking of the kind of pain due to either osteoarthritis or degenerative disc disease. Too many docs, I'm ashamed to say, simply hate seeing people with back pain, and when they do they can't wait to get the patient out the door. Now I will say, in defense of my colleagues, that there are reasons for this. A lot of people commonly use back pain as an excuse to get out of work, claim disability, or obtain narcotics. I could go on and on, but there's a capsule summary.
This is where I think a good chiropractor is absolute gold. Their #1 focus, by preference, is the spine. It's what they do. A good chiropractor knows red flags that should alert him to the possible presence of something more sinister masking as garden variety back pain, for example, metastatic breast cancer, expanding aortic aneurysm, or prostate cancer, to name just a few. As a medical doctor, having a good relationship with a conscientious, well trained chiropractor can be a Godsend.
As to massage therapists, I've never used one, but I sure could use one now. If I found a good one for my horses, I'd definitely give it a try, under the right circumstances. In my opinion, when it comes to something like massage therapy, word of mouth from a trusted friend would be more valuable to me than being "Certified". | |
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Too busy outside!
Posts: 5417
| Bear - 2016-06-01 3:30 PM Turner1 - 2016-06-01 3:56 PM I'm curious Bear, do you yourself ever use a chiropractor or massage therapist? Yes, I've used a chiropractor both for my horses as well as myself. I definitely think they have a useful role. Generally speaking, we in medicine don't do a very good job with disorders of the spine and back pain in general. It's hard to find a good doctor who really takes the time to properly evaluate back pain....particularly low back pain. I'm talking of the kind of pain due to either osteoarthritis or degenerative disc disease. Too many docs, I'm ashamed to say, simply hate seeing people with back pain, and when they do they can't wait to get the patient out the door. Now I will say, in defense of my colleagues, that there are reasons for this. A lot of people commonly use back pain as an excuse to get out of work, claim disability, or obtain narcotics. I could go on and on, but there's a capsule summary. This is where I think a good chiropractor is absolute gold. Their #1 focus, by preference, is the spine. It's what they do. A good chiropractor knows red flags that should alert him to the possible presence of something more sinister masking as garden variety back pain, for example, metastatic breast cancer, expanding aortic aneurysm, or prostate cancer, to name just a few. As a medical doctor, having a good relationship with a conscientious, well trained chiropractor can be a Godsend. As to massage therapists, I've never used one, but I sure could use one now. If I found a good one for my horses, I'd definitely give it a try, under the right circumstances. In my opinion, when it comes to something like massage therapy, word of mouth from a trusted friend would be more valuable to me than being "Certified".
Genrally speaking, is this the common consensus of orthopaedic doctors as well, or just those in the field you used to practice in? It seems a little judgemental is all.... can you explain how you are quaified to cast such a broad theory? | |
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 Three in a Bikini
Posts: 2035
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This just keeps getting better and better... | |
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BHW Resident Surgeon
Posts: 25351
Location: Bastrop, Texas | trickster j - 2016-06-01 6:19 PM
Bear - 2016-06-01 3:30 PM Turner1 - 2016-06-01 3:56 PM I'm curious Bear, do you yourself ever use a chiropractor or massage therapist? Yes, I've used a chiropractor both for my horses as well as myself. I definitely think they have a useful role. Generally speaking, we in medicine don't do a very good job with disorders of the spine and back pain in general. It's hard to find a good doctor who really takes the time to properly evaluate back pain....particularly low back pain. I'm talking of the kind of pain due to either osteoarthritis or degenerative disc disease. Too many docs, I'm ashamed to say, simply hate seeing people with back pain, and when they do they can't wait to get the patient out the door. Now I will say, in defense of my colleagues, that there are reasons for this. A lot of people commonly use back pain as an excuse to get out of work, claim disability, or obtain narcotics. I could go on and on, but there's a capsule summary. This is where I think a good chiropractor is absolute gold. Their #1 focus, by preference, is the spine. It's what they do. A good chiropractor knows red flags that should alert him to the possible presence of something more sinister masking as garden variety back pain, for example, metastatic breast cancer, expanding aortic aneurysm, or prostate cancer, to name just a few. As a medical doctor, having a good relationship with a conscientious, well trained chiropractor can be a Godsend. As to massage therapists, I've never used one, but I sure could use one now. If I found a good one for my horses, I'd definitely give it a try, under the right circumstances. In my opinion, when it comes to something like massage therapy, word of mouth from a trusted friend would be more valuable to me than being "Certified".
It's just my opinion/observation after 37 years in the business.
I just don't think we do a very good job in this particular area.
Now, having said that, there are lots of docs who do a good job, but not nearly enough. I just don't think most doctors like dealing with low back pain. Orthopedic consensus doesn't matter. Ortho docs seldom see the typical back pain patient as he/she walks in off the street. They see those who are particularly symptomatic and fail conservative treatment......at the most, 5-10 percent of patients presenting to the primary care doctor. There are a number of reasons why a lot of doctors dislike seeing people with back pain, as I pointed out. We are digressing here anyway. | |
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Too busy outside!
Posts: 5417
| Bear - 2016-06-01 5:15 PM trickster j - 2016-06-01 6:19 PM Bear - 2016-06-01 3:30 PM Turner1 - 2016-06-01 3:56 PM I'm curious Bear, do you yourself ever use a chiropractor or massage therapist? Yes, I've used a chiropractor both for my horses as well as myself. I definitely think they have a useful role. Generally speaking, we in medicine don't do a very good job with disorders of the spine and back pain in general. It's hard to find a good doctor who really takes the time to properly evaluate back pain....particularly low back pain. I'm talking of the kind of pain due to either osteoarthritis or degenerative disc disease. Too many docs, I'm ashamed to say, simply hate seeing people with back pain, and when they do they can't wait to get the patient out the door. Now I will say, in defense of my colleagues, that there are reasons for this. A lot of people commonly use back pain as an excuse to get out of work, claim disability, or obtain narcotics. I could go on and on, but there's a capsule summary. This is where I think a good chiropractor is absolute gold. Their #1 focus, by preference, is the spine. It's what they do. A good chiropractor knows red flags that should alert him to the possible presence of something more sinister masking as garden variety back pain, for example, metastatic breast cancer, expanding aortic aneurysm, or prostate cancer, to name just a few. As a medical doctor, having a good relationship with a conscientious, well trained chiropractor can be a Godsend. As to massage therapists, I've never used one, but I sure could use one now. If I found a good one for my horses, I'd definitely give it a try, under the right circumstances. In my opinion, when it comes to something like massage therapy, word of mouth from a trusted friend would be more valuable to me than being "Certified". It's just my opinion/observation after 37 years in the business. I just don't think we do a very good job in this particular area. Now, having said that, there are lots of docs who do a good job, but not nearly enough. I just don't think most doctors like dealing with low back pain. Orthopedic consensus doesn't matter. Ortho docs seldom see the typical back pain patient as he/she walks in off the street. They see those who are particularly symptomatic and fail conservative treatment......at the most, 5-10 percent of patients presenting to the primary care doctor. There are a number of reasons why a lot of doctors dislike seeing people with back pain, as I pointed out. We are digressing here anyway.
OK, and again, as before, this is all your personal opinion- thank you for clarifying. As it was stated "we in medicine" I assumed you were including other individuals beliefs with yours- but these are your beliefs and opinons exclusively, is that correct?
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BHW Resident Surgeon
Posts: 25351
Location: Bastrop, Texas | I'll try to clarify so you can understand, trickster.
Yes, my comments were my opinion, but I based that on the opinions of other docs with whom I've worked for 37 years. Back pain can be very frustrating to deal with. I have read a study recently where over 600 doctors were surveyed. I don't recall all the details right off hand, but one thing that I walked away with was that roughly 2/3rds of those docs felt that their management was inadequate. Interestingly, in that same paper, roughly the same percentage of patients felt they were well managed. In either case, the findings merely reinforced the notion that there is considerable room for improvement. If you are really interested, I can see if I can find it for you.
ETA: The short answer is no, it's not my opinion exclusively. I know it may seem a little confusing.
Edited by Bear 2016-06-01 8:27 PM
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 Elite Veteran
Posts: 933
Location: north dakota | Bear - 2016-06-01 8:18 PM
I'll try to clarify so you can understand, trickster.
Yes, my comments were my opinion, but I based that on the opinions of other docs with whom I've worked for 37 years. Back pain can be very frustrating to deal with. I have read a study recently where over 600 doctors were surveyed. I don't recall all the details right off hand, but one thing that I walked away with was that roughly 2/3rds of those docs felt that their management was inadequate. Interestingly, in that same paper, roughly the same percentage of patients felt they were well managed. In either case, the findings merely reinforced the notion that there is considerable room for improvement. If you are really interested, I can see if I can find it for you.
this is a subject that one of the Dr's I work with and I discuss frequently. Basically the conclusion is other than the ones that need surgury weight loss, chiro, message therapy and most importantly strenthing the core is usually a better option than a MD visit and a pill. | |
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BHW Resident Surgeon
Posts: 25351
Location: Bastrop, Texas | ndcowgirl - 2016-06-01 8:24 PM
Bear - 2016-06-01 8:18 PM
I'll try to clarify so you can understand, trickster.
Yes, my comments were my opinion, but I based that on the opinions of other docs with whom I've worked for 37 years. Back pain can be very frustrating to deal with. I have read a study recently where over 600 doctors were surveyed. I don't recall all the details right off hand, but one thing that I walked away with was that roughly 2/3rds of those docs felt that their management was inadequate. Interestingly, in that same paper, roughly the same percentage of patients felt they were well managed. In either case, the findings merely reinforced the notion that there is considerable room for improvement. If you are really interested, I can see if I can find it for you.
this is a subject that one of the Dr's I work with and I discuss frequently. Basically the conclusion is other than the ones that need surgury weight loss, chiro, message therapy and most importantly strenthing the core is usually a better option than a MD visit and a pill.
Exactly. | |
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Too busy outside!
Posts: 5417
| Bear - 2016-06-01 6:18 PM I'll try to clarify so you can understand, trickster. Yes, my comments were my opinion, but I based that on the opinions of other docs with whom I've worked for 37 years. Back pain can be very frustrating to deal with. I have read a study recently where over 600 doctors were surveyed. I don't recall all the details right off hand, but one thing that I walked away with was that roughly 2/3rds of those docs felt that their management was inadequate. Interestingly, in that same paper, roughly the same percentage of patients felt they were well managed. In either case, the findings merely reinforced the notion that there is considerable room for improvement. If you are really interested, I can see if I can find it for you. ETA: The short answer is no, it's not my opinion exclusively. I know it may seem a little confusing.
Thank you for trying to clarify- you jump back and forth between your opinion, everyone else's opinion, our opinion, theory and fact very often in the same few sentences- and it doesn't appear you discriminate between them when you write.
Aa far as back pain- it is also a troubling issue in horses as well. It could be caused by poor saddle fit, direct trauma, poor training/riding, sore stifles/hocks/rear suspensories, shoeing, strain to the Supraspinous lig, etc. etc. etc. Once a vet can identify and alleviate the primary pain source, the back tightness and spasming can be resolved with massage, trigger point, Myofacial and a few other alternative remedies. These actually are the majority of the cases that are referred to me because the veterinarians know that I can create a positive change in these secondary issues once the primary issues are resolved. This btw, is why it is important for a certified practitioner to work under verterinary guidance. (I mention this just to provide you with some insight as to how these non-veterinary practices performed by certified (or not) individuals can help heal the horse as a whole).
eta: In consideration of back pain in humans, I wonder how many of these cases are expressed as symptoms of a structural imbalance or compensation from another part of the body? In horses, the back pain seems to mostly be caused by something else-
I know horses are quadrupeds and not bi-peds, but it could be interesting to ponder possible similarities between them. Perhaps that is why back pain is such a difficult syndrome to treat-
Edited by trickster j 2016-06-01 8:53 PM
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