Kid`s Unlimited is a monthly newsletter of various articles, funnies, tidbits and opinions relating to our children and chiropractic. My opinions will always be in red and italicized. Please feel free to share the appropriate articles with patients, friends and other chiropractors. I never buy any lists or put names on my email list unless the names were given to me directly. If you wish to be removed from the list, just type the word "remove" in the subject line and reply back to me.

How I love a fresh glass of pure squeezed orange juice. You know, when you go right out and pick the oranges yourself, cut them up, and squeeze them into a glass. It used to be the only way you could have orange juice. Then as technology became better the concentrate was developed. A new way to package the original. Just add water. Then it became frozen. Then some people decided to mix it with more water and orange-aid was born. After changing the water to vodka, the "screwdriver" drink came into existence. Then as tastes changed, we bottled water and some companies added an essence of orange to the water to give it just a little taste of orange juice.

It`s kind of like what has happened to chiropractic over the years. We used to just have pure unadulterated chiropractic. Then we started concentrating it. mixing it with other things, diluting it down, and even have created offices with just an essence of what was chiropractic. Well you say, "tastes change". That is true. But even in the drink industry, water with orange essence was never called orange juice. What some people are practicing today should never be called chiropractic. We are trying to sell water with essence as orange juice. We are trying to sell health care with a chiropractic essence as chiropractic.

I believe that even though some of the public might like the different tastes, eventually they are going to realize that they have been duped. They still pay fresh squeezed orange juice prices for water with an orange essence. They get a mixture of watered-down care thinking they are getting pure chiropractic. No wonder so many think that chiropractors are whacko...... Why wouldn`t they!!!___________________________________________________________________

Teenagers have been drinking alcohol for centuries. In pre-Revolutionary America, young apprentices were handed buckets of ale. In the 1890`s, at the age of 15, the writer Jack London regularly drank grown sailors under the table.

For almost as long, concerned adults have tried to limit teenage alcohol consumption. In the 1830`s, temperance societies administered lifelong abstinence pledges to school children. Today, public health experts regularly warn that teenage drinkers run greatly increased risks of involvement in car accidents, fights and messy scenes in Cancún.

But what was once a social and moral debate may soon become a neurobiological one.

The costs of early heavy drinking, experts say, appear to extend far beyond the time that drinking takes away from doing homework, dating, acquiring social skills, and the related tasks of growing up.

Mounting research suggests that alcohol causes more damage to the developing brains of teenagers than was previously thought, injuring them significantly more than it does adult brains. The findings, though preliminary, have demolished the assumption that people can drink heavily for years before causing themselves significant neurological injury. And the research even suggests that early heavy drinking may undermine the precise neurological
capacities needed to protect oneself from alcoholism.

The new findings may help explain why people who begin drinking at an early age face enormous risks of becoming alcoholics. According to the results of a national survey of 43,093 adults, published yesterday in Archives of Pediatrics
/pediatrics/index.html?inline=nyt-classifierhttp://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics & Adolescent Medicine, 47 percent of those who begin drinking alcohol before the age of 14 become alcohol dependent at some time in their lives, compared with 9 percent of those who wait at least until age 21. The correlation holds even when genetic risks for alcoholism are taken into account.

The most alarming evidence of physical damage comes from federally financed laboratory experiments on the brains of adolescent rats subjected to binge doses of alcohol. These studies found significant cellular damage to the forebrain and the hippocampus.

And although it is unclear how directly these findings can be applied to humans, there is some evidence to suggest that young alcoholics may suffer analogous deficits.

Studies conducted over the last eight years by federally financed researchers in San Diego, for example, found that alcoholic teenagers performed poorly on tests of verbal and nonverbal memory, attention focusing and exercising spatial skills like those required to read a map or assemble a precut bookcase.

"There is no doubt about it now: there are long-term cognitive consequences to excessive drinking of alcohol in adolescence," said Aaron White, an assistant research professor in the psychiatry department at Duke University
iversity/index.html?inline=nyt-orghttp://topics.nytimes.com/top/reference/timestopics/organizations/d/duke_un and the co-author of a recent study of extreme drinking on college campuses.

"We definitely didn`t know 5 or 10 years ago that alcohol affected the teen brain differently," said Dr. White, who has also been involved in research at Duke on alcohol in adolescent rats. "Now there`s a sense of urgency. It`s the same place we were in when everyone realized what a bad thing it was for pregnant women to drink alcohol."

One of two brain areas known to be affected is the hippocampus, a structure crucial for learning and memory. In 1995, Dr. White and other researchers placed delicate sensors inside living brain slices from the hippocampi of adolescent rats and discovered that alcohol drastically suppressed the activity of specific chemical receptors in the region.

Normally, these receptors are activated by the neurotransmitter glutamate and allow calcium to enter neurons, setting off a cascade of changes that strengthen synapses, by helping to create repeated connections between cells, aiding in the efficient formation of new memories.

But at the equivalent of one or two alcoholic drinks, the receptors` activity slowed, and at higher doses, they shut down almost entirely. The researchers, led by Scott Swartzwelder, a neuropsychologist at Duke and at the Veterans Affairs Medical Center in Durham, N.C., found that the suppressive effect was significantly stronger in adolescent rat brain cells
than in the brain cells of adult rats.

As might be predicted, the cellular shutdown affected the ability of the younger rats to learn and remember. In other experiments, the team found that adolescent rats under the influence of alcohol had far more trouble than did tipsy adult rats when required repeatedly to locate a platform submerged in a tub of cloudy water and swim to it.

Dr. Swartzwelder said it was likely that in human teenagers, analogous neural mechanisms might explain alcohol "blackouts" — a lack of memory for events that occur during a night of heavy drinking without a loss of consciousness. Blackouts were once thought to be a symptom of advanced adult alcoholism, but researchers have recently discovered just how frequent they are among teenagers as well.

In a 2002 e-mail survey of 772 Duke undergraduates, Dr. White and Dr. Swartzwelder found that 51 percent of those who drank at all had had at least one blackout in their drinking lifetimes; they reported an average of three blackouts apiece.

These averages barely suggest the frequency of blackouts among young adults at the extreme end of the drinking scale. Toren Volkmann, 26, is a graduate of the University of San Diego who, at 14, started drinking heavily almost every weekend and at 24 checked himself into a residential alcohol treatment program.

"It was common for me to basically black out at least once or twice every weekend in late high school and definitely through college, and it wasn`t a big deal to me," said Mr. Volkmann, a co-author, with his mother, Chris, of "From Binge to Blackout: A Mother and Son Struggle With Teen Drinking," to be published in August. "I wouldn`t even worry about what happened, because I wouldn`t know."

Blackouts are usually mercifully brief, and once they are over, the capacity to form new memories returns. But younger rats subjected to binge drinking also displayed subtler long-term problems in learning and memory, the researchers found, even after they were allowed to grow up and "dry out."

In experiments conducted by the Duke team, the reformed rat drinkers learned mazes normally when they were sober. But after the equivalent of only a couple of drinks, their performance declined significantly more than did that of rats that had never tippled before they became adults. The study was published in 2000 in the journal Alcoholism: Clinical and Experimental Research. Other research has found that while drunken adolescent rats become more sensitive to memory impairment, their hippocampal cells become less
responsive than adults` to the neurotransmitter gamma-amino butyric acid, or GABA, which helps induce calmness and sleepiness.

This cellular mechanism may help explain Jack London`s observation, in "John Barleycorn: Alcoholic Memoirs," that when he was a teenager he could kee drinking long after his adult companions fell asleep.

"Clearly, something is changed in the brain by early alcohol exposure," Dr. Swartzwelder said in an interview. "It`s a double-edged sword and both of the edges are bad.

"Teenagers can drink far more than adults before they get sleepy enough to stop, but along the way they`re impairing their cognitive functions much more powerfully."

Alcohol also appears to damage more severely the frontal areas of the adolescent brain, crucial for controlling impulses and thinking through consequences of intended actions — capacities many addicts and alcoholics of all ages lack.

In 2000, Fulton Crews, a neuropharmacologist at the University of North
ity_of_north_carolina/index.html?inline=nyt-orghttp://topics.nytimes.com/top/reference/timestopics/organizations/u/univers Carolina, subjected adolescent and adult rats to the equivalent of a four-day alcoholic binge and then autopsied them, sectioning their forebrains and staining them with
a silver solution to identify dead neurons.

All the rats showed some cell die-off in the forebrain, but the damage was at least twice as severe in the forebrains of the adolescent rats, and it occurred in some areas that were entirely spared in the adults.

Although human brains are far more developed and elaborate in their frontal regions, some functions are analogous across species, Dr. Crews said, including planning and impulse control. During human adolescence, these portions of the brain are heavily remolded and rewired, as teenagers learn — often excruciatingly slowly — how to exercise adult decision-making skills, like the ability to focus, to discriminate, to predict and to ponder
questions of right and wrong.

"Alcohol creates disruption in parts of the brain essential for self-control, motivation and goal setting," Dr. Crews said, and can compound pre-existing genetic and psychological vulnerabilities. "Early drinking is affecting a sensitive brain in a way that promotes the progression to addiction.

"Let`s say you`ve been arrested for driving while drunk and spent seven days in jail," Dr. Crews said. "You`d think, `No way am I going to speed and drive drunk again,` because you have the ability to weigh the consequences and the importance of a behavior. This is exactly what addicts don`t do."

In another experiment, published this year in the journal Neuroscience, Dr. Crews found that even a single high dose of alcohol temporarily prevented the creation of new nerve cells from progenitor stem cells
/stemcells/index.html?inline=nyt-classifierhttp://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics in the forebrain that appear to be involved in brain development.

The damage, far more serious in adolescent rats than in adult rats, began at a level equivalent to two drinks in humans and increased steadily as the dosage was increased to the equivalent of 10 beers, when it stopped the production of almost all new nerve cells.

Dr. Crews added, however, that adult alcoholics who stop drinking are known to recover cognitive function over time.

The same may hold true for hard-drinking teenagers. In 1998, Sandra Brown and Susan Tapert, clinical psychologists at the University of
ity_of_california/index.html?inline=nyt-orghttp://topics.nytimes.com/top/reference/timestopics/organizations/u/univers California, San Diego, and at the Veterans Affairs Medical Center there, found that 15-to-16-year-olds who said they had been drunk at least 100 times performed significantly more poorly than their matched nondrinking peers on tests of verbal and nonverbal memory.

The teenagers, who were sober during the testing, had been drunk an average of 750 times in the course of their young lives.

"Heavy alcohol involvement during adolescence is associated with cognitive deficits that worsen as drinking continues into late adolescence and young adulthood," Dr. Tapert said.

Two M.R.I. scan studies, one conducted by Dr. Tapert, have found that hard-drinking teenagers had significantly smaller hippocampi than their sober counterparts. But it is also possible, the researchers said, that the heavy drinkers had smaller hippocampi even before they started to drink.

Teenagers who drink heavily may also use their brains differently to make up for subtle neurological damage, Dr. Tapert said. A study using functional M.R.I. scans, published in 2004, found that alcohol-abusing teenagers who were given a spatial test showed more activation in the parietal regions of the brain, toward the back of the skull, than did nondrinking teenagers.

When female drinkers in the group were tested in their early 20`s, their performance declined significantly in comparison with nondrinkers, and their brains showed less activation than normal in the frontal and parietal regions.

Dr. Tapert hypothesized that when the drinkers were younger, their brains had been able to recruit wider areas of the brain for the task.

"This is a fairly sensitive measure of early stages of subtle neuronal disruption, and it is likely to be rectifiable if the person stops drinking," Dr. Tapert said.

The good news is that the brain is remarkably plastic, she added, and future studies may show that the teenage brain, while more vulnerable to the effects of alcohol, is also more resilient.

She pointed to test results from the original group of teenagers, recruited from substance abuse treatment centers and brought into the lab when they were 15 by Dr. Brown. When Dr. Tapert retested the teenagers eight years later, those who had relapsed and who continued to get drunk frequently performed the worst on tests requiring focused attention, while those who reported the most hangovers performed the worst on spatial tasks.

On the other hand, the relative handful of teenagers and young adults in the group who stayed sober — 28 percent of the total — performed almost as well, at both the four-year and the eight-year mark, as other San Diego teenagers who had rarely, if ever, had a drink.

Mr. Volkmann, the University of San Diego graduate, was not part of Dr. Tapert`s study. While in college, Mr. Volkmann said, he thought he drank for the fun of it. His moment of truth came in the Peace Corps
orps/index.html?inline=nyt-orghttp://topics.nytimes.com/top/reference/timestopics/organizations/p/peace_c in Paraguay, when he began waking up with sweats and tremors. He discovered he could not control his drinking even when he wanted.

The son of an anesthesiologist and a former teacher in Olympia, Wash., Mr. Volkmann spent a month in a residential treatment program and six months in a halfway house. He has since returned to San Diego.

He said in an interview that he had no way of knowing exactly how drinking affected his overall brain function. But on one point, he is clear.

"My memory is definitely better now," he said. "Every day now, I can count on the fact that when I think back to the night before, I know what happened."

Gambling With Your Life
Millions of medical mistakes happen in the lab. Here`s how to protect yourself.
By Pamela F. Gallin, MD, and Joseph K. Vetter
From Reader`s Digest
August 2006

"I Was in Total Shock"
Lenore Janecek was headed toward her Chicago home on a September afternoon in 2000 when she received a call on her cell phone that would change her life forever. It was her doctor. He told her that the test results from her routine colonoscopy two weeks earlier revealed she had intestinal cancer. Stunned, Janecek, 61, pulled over. "There must be a mistake," she insisted. But the doctor, a gastroenterologist, assured her there was no mistaking the diagnosis. Janecek would need immediate surgery.

There are few things more dreaded than a cancer diagnosis. But for Janecek, the news was doubly traumatic: She had been successfully treated for intestinal cancer ten years earlier, so the thought that the disease had come back was terrifying.

On September 26, in a procedure that lasted three hours, the surgeon made an incision running the length of Janecek`s abdomen and removed about two feet of her small and large intestines. The surgery was an ordeal, but at least, she thought, the worst was behind her. In the weeks that followed, however, Janecek, a mother of two who ran her own health insurance consulting firm, became concerned that her recovery was not going well. The pain and digestive troubles were worse than she`d expected. She wondered if they`d gotten all the cancer.

Then, at her six-week checkup with the gastroenterologist, Janecek received ominous news: She might have been the victim of an error at the hospital lab. A genetic test later confirmed that the tissue sample her diagnosis was based on had been contaminated with cancerous cells from another patient`s specimen. Janecek did not have cancer. Her surgery had been unnecessary. "I was in total shock," she recalls. "First shock, then anger."

It turned out that the gastroenterologist had questioned the initial lab result, but the lab`s review of its procedures still failed to uncover the error. Janecek sued the hospital for negligence and won a $3 million award from the jury. But six years after her ordeal, she continues to suffer bouts of severe abdominal pain and other digestive symptoms stemming from the surgery. "It`s like someone punched me as hard as they could right in my abdomen, and I didn`t see it coming," she says. "And I will have that for the rest of my life."

Behind Closed Doors
When most people think of medical errors, they think of the sensational cases -- the surgeon who removes the wrong organ, or the patient who dies because he was prescribed the wrong drug. In fact, it`s been estimated that medical errors may cause up to 100,000 deaths each year in this country. But stories like Janecek`s highlight a problem that hasn`t gotten as much attention: errors that occur in pathology labs, where tens of millions of blood samples, biopsies and tissue specimens are analyzed every year, and radiology labs, where a mislabeled MRI or a misinterpreted x-ray or CT scan can have dire consequences for a patient.

No one knows for sure how many lab errors happen annually. Most mistakes are reported on a voluntary basis, and many are never reported at all. Experts are quick to emphasize that the vast majority of medical tests are error-free. But errors do add up, given the huge volume of testing nationwide. For example, a typical large medical center does some 5 million clinical pathology tests each year.

It`s not just the amount of testing that makes mistakes inevitable. It`s also the complexity of the process. Testing starts in the doctor`s office or at the lab, where a specimen is drawn and labeled or an image is taken and ID`d. It then is analyzed and interpreted by the experts. Finally, the results are sent back to the doctor to aid diagnosis and treatment. Errors at any step along the way can threaten your health -- or even your life. Paul N. Valenstein, a pathologist at St. Joseph Mercy Health System in Ann Arbor, Michigan, knows of a case in which a patient died when a lab did not get his test results to the right doctor in time, even though the results were accurate.

Are Lab Errors Common?
While the accidental contamination of one patient`s tissue with another`s, as happened to Janecek, is relatively rare, other more common mistakes can be just as serious. Identification errors occur when specimens are mislabeled or incorrect patient data is entered into laboratory computer systems. A new study of 120 clinical pathology labs, where blood, urine and other fluid tests are done, estimates that each year in the United States, more than 2.9 million of these errors occur, and more than 160,000 patients are harmed in some way as a result. The harm ranges from the stress and anxiety caused by an incorrect diagnosis that`s later reversed, to far more dangerous, though less common, outcomes, such as delayed treatment, transfusions of the wrong blood type, even unnecessary surgery.

"This is a serious problem," explains Dr. Valenstein, the study author. And "our error projection is undoubtedly an underestimate."

When it comes to cancer, diagnostic mistakes can be catastrophic. Based on an analysis of reported errors in patients tested for cancer or precancerous lesions at four major hospitals, Stephen Raab, chief of pathology at the University of Pittsburgh Medical Center, and his colleagues estimate that at least 305,000 specimens are wrongly diagnosed each year. And some 40 percent of these errors, or nearly 128,000 cases, result in harm to the patient. In rare instances, mistakes in cancer diagnosis can lead to unnecessary organ removal or even death. More often these errors cause less serious but still troubling harm: the fear and stress of being told you have cancer when you don`t, the trauma of having to be retested and, perhaps most significantly, delays in diagnosis and treatment when signs of cancer are missed in an initial test.

Trouble With Images
Like their counterparts in pathology, the radiologists who perform and analyze everything from old-fashioned (but still common) x-rays to high-tech CT scans are largely unseen players in the medical process. But though less visible to you than your family physician, their role in ensuring your health is just as vital -- and their mistakes can be just as costly.

When Elaine Thomas,* a petite 42-year-old social worker, had her annual mammogram at a local hospital in July 2002, she didn`t think she had anything to worry about, since neither the radiologist nor her gynecologist contacted her about the results. "No news is good news," she says. "If you don`t hear anything, you assume it`s okay."

Thomas had to delay her next mammogram. But with no history of breast cancer in her family and having just had a physical breast exam, she wasn`t concerned. That changed suddenly one morning in May 2004 when she felt a lump under her left breast. Thomas, mother of an eight-year-old son, called a local radiology clinic as soon as it opened, and scheduled a mammogram for later that day. After analyzing the image, the radiologist told her there was a clearly visible concentrated white area -- a dense mass that was cause for concern. "Even I could see it," Thomas says. An ultrasound exam and biopsy confirmed it was cancer.

Thomas, daughter of a plastic surgeon, knew the importance of getting other opinions. After looking at all of her mammograms and the reports, three different surgeons agreed that she would need immediate treatment for breast cancer. But there was something else. All three told her that the worrisome mass that appeared in her most recent mammogram was also visible, though in a less developed stage, in the 2002 mammogram. It was something that should have been followed up on right away, they said, with additional mammography or ultrasound. Yet although the radiologist`s report from the earlier exam indicated that dense breast tissue had made evaluation difficult, it recommended only routine follow-up. On hearing this, the normally upbeat Thomas recalls, "I was pretty ticked off."

By now, Thomas had invasive breast cancer. She underwent surgery, chemotherapy and 35 radiation treatments. She is now cancer-free, but she will never know whether her treatment might have been less traumatic if the radiologist had recommended more urgent action nearly two years before her disease was discovered.

There are three main stages in the imaging process where errors can occur: recognizing an abnormality, accurately diagnosing it, and communicating the result to the physician and patient. Freya Schnabel knows the importance of getting it right the first time. As chief of breast surgery at Columbia University Medical Center, she depends upon mammograms and other imaging tools to help ensure she gives patients the care they need. And she knows that when labs make mistakes, patients pay. Not being informed about abnormal mammograms is "a huge danger," says Dr. Schnabel. "I hear about these cases all the time." In fact, delay in the diagnosis of breast cancer is the most common reason for malpractice lawsuits in the United States.

Patients can be harmed by the mishandling of other radiology procedures as well. A recent study by U.S. Pharmacopeia found that 12 percent of radiology-related medication errors, including incorrect dosing of sedatives or contrast agents, resulted in harm to the patient. That`s seven times the percentage of all medication errors combined that were harmful. The American College of Radiology challenged these findings, arguing that drug errors occur in only a small fraction of imaging procedures. Still, the findings are "a call to action for hospitals, radiological centers, health care practitioners and patients," says study author John P. Santell.

Reducing Mistakes
As health care providers struggle to improve patient safety, Dennis O`Leary, MD, president of the Joint Commission on Accreditation of Healthcare Organizations, says they need to change the way they think about errors. "The fact is, people make mistakes," he says. "That includes doctors, nurses and lab technicians. The challenge is designing internal systems that catch human errors before they reach the patient. And most health care organizations are still in their infancy in understanding how to do that."

A key first step would be for diagnostic labs to institute double checks. For example, have multiple pathologists examine slides so cancer cells don`t go undetected. And have two radiologists analyze every scan. Another step would be to create ways to ensure a surgeon doing a biopsy sends a properly diagnosable tissue sample to the lab. These and other measures might increase costs, but to Dr. O`Leary, it`s a no-brainer: "What`s more important, building a new heart catheterization lab or making sure you`ve got enough personnel to keep errors from reaching patients? There`s money in the system. It`s just a matter of priorities."

FDA Issues Nationwide Health Alert on Dole Pre-Packaged Salads

DATELINE recently featured a segment on popular salad mixes being sold in plastic bags in supermarkets. The documentary highlighted the entire production process and disclosed that E-coli had been showing up in the bagged salad.

It has not been ascertained how the salad mix gets contaminated with E-coli, but serious illness and even deaths have been occurring in many states. One woman featured spoke about her child who had almost died after eating salad prepared from the mix and was ill for a long time after.

The public is warned not to buy any salad mix until the cause of the contamination has been determined.

The Dole Company has since recalled their product. For further information, check the MSNBC link below and click on "Launch" below the salad:

http://www.msnbc.msn.com/id/12536902/

Origins: In May 2006, the warning quoted above began appearing in inboxes. It is a mixture of two items: an October 2005 warning from the Food and Drug Administration about E. coli found in prepackaged salads vended by Dole in the Minnesota area, and a 30 April 2006 NBC Dateline segment about that October 2005 outbreak and the potential for additional contaminations of similar nature.

Though thrown together from two sources, the e-mailed alert is accurate: E. coli was found in bagged salad mix in October 2005, and the FDA did issue a nationwide consumer alert about it. Dole Food Company recalled the implicated salad products, but even so 23 people who had eaten the contaminated greens became ill, with eight having to be hospitalized and one child developing a severe complication called hemolytic-uremic syndrome (in which red blood cells are destroyed and kidneys fail).

Escherichia coli are bacteria that live in the intestines of humans and animals. While most of its strains are harmless, one strain (O157:H7) produces a powerful toxin that results in severe illness in humans. E. coli gets into us through being swallowed; it rides in as part of a contaminated foodstuff, or through hand-to-mouth contact by people who have handled items laden with the bacteria, or through our swimming in water where the microbes are present. Such infections usually culminate in severe bloody diarrhea and abdominal cramps, with the illness resolving in 5 to 10 days without treatment. However, in about 2% to 7% of infections (usually in children under 5 years of age and the elderly), the pathogen causes hemolytic uremic syndrome, a serious and life-threatening condition in which the red blood cells are destroyed and the kidneys
fail.

Since 1995, 19 confirmed outbreaks have sickened 400 people nationwide and caused two deaths.

While raw and undercooked meat are the culprits that first come to mind as carriers of the bacteria, Dr. Steve Swanson of the Centers for Disease Control says: "Next to ground beef, lettuce is the most commonly implicated food item for E. coli 0157 infections." Unlike most other E. coli-bearing foodstuffs, lettuce is rarely eaten cooked, a process that normally kills the microorganisms.

Though the outbreak the FDA issued its warning about occurred in October 2005, they do not yet know how the potentially deadly bacteria came to be in those prepackaged salads. The lettuce was washed a number of times during processing, which tends to rule out the most obvious mode. One theory advocates the pathogen was absorbed into lettuce leaves through the plant`s root system, the bacteria being picked up from contaminated groundwater. Alternatively, the microbe could have been in the plastic bags used to package the salads.

It is that uncertainty that prompted the warning about bagged salads: because the method of contamination in that October 2005 outbreak has not been pinned down, the potential for further illness from the same source cannot be eliminated. Rinsing "ready to eat" salads at home may not be an effective countermeasure if E. coli has managed to work itself into the leaves rather than sitting upon them, where it can be washed off. If the pathogen got into lettuce leaves via being pulled up through the plant`s roots, all the washing in the world will not make lettuce safe to eat.

The e-mailed alert advocates swearing off packaged salads until the source of that October 2005 contamination has been isolated (which, in light of how much time has so far elapsed, one could reasonably conclude might well be never). Those who are super-cautious about matters relating to their family`s health might wish to heed that suggestion. For those of slightly less cautious nature, Dateline NBC offered these tips on how to protect yourself from E. coli in lettuce:
But be sure you wash your hands before handling lettuce or any raw produce ... especially if you have been in contact with any raw meat.

Even though most of these bag salads are pre-washed and labeled "Ready to eat," experts say it doesn`t hurt to wash it again.

Check the expiration date before you eat it. Even if the lettuce looks good, you should know E.coli can grow quickly in greens that are deteriorating.
The Centers for Disease Control suggest the following ways to guard against ingesting E. coli:
Cook all ground beef and hamburger thoroughly. Because ground beef can turn brown before disease-causing bacteria are killed, use a digital instant-read meat thermometer to ensure thorough cooking. Ground beef should be cooked until a thermometer inserted into several parts of the patty, including the thickest part, reads at least 160°F. Persons who cook ground beef without using a thermometer can decrease their risk of illness by not eating ground beef patties that are still pink in the middle.

If you are served an undercooked hamburger or other ground beef product in a restaurant, send it back for further cooking. You may want to ask for a new bun and a clean plate, too.

Avoid spreading harmful bacteria in your kitchen. Keep raw meat separate from ready-to-eat foods. Wash hands, counters, and utensils with hot soapy water after they touch raw meat. Never place cooked hamburgers or ground beef on the unwashed plate that held raw patties. Wash meat thermometers in between tests of patties that require further cooking.

Drink only pasteurized milk, juice, or cider. Commercial juice with an extended shelf-life that is sold at room temperature (e.g., juice in cardboard boxes, vacuum sealed juice in glass containers) has been pasteurized, although this is generally not indicated on the label. Juice concentrates are also heated sufficiently to kill pathogens.

Wash fruits and vegetables thoroughly, especially those that will not be cooked. Children under 5 years of age, immunocompromised persons, and the elderly should avoid eating alfalfa sprouts until their safety can be assured. Methods to decontaminate alfalfa seeds and sprouts are being investigated.

Drink municipal water that has been treated with chlorine or other effective disinfectants.

Make sure that persons with diarrhea, especially children, wash their hands carefully with soap after bowel movements to reduce the risk of spreading infection, and that persons wash hands after changing soiled diapers. Anyone with a diarrheal illness should avoid swimming in public pools or lakes, sharing baths with others, and preparing food for others.
Barbara "foodborne in the U.S.A." Mikkelson

______________________________________________________________________________
Elderly may not benefit much from flu vaccines, study finds
By Tina Hesman Saey
ST. LOUIS POST-DISPATCH
ST. LOUIS -- Flu shots may be less effective at keeping the elderly healthy than previously thought.
Researchers led by Dr. Daniela Rivetti of the public health department in Asti, Italy, examined data collected in 64 studies of flu vaccine effectiveness in people over age 65.
In older people living in nursing homes, the flu shot prevented 45 percent of respiratory illnesses, hospitalizations and flu-related deaths, the researchers found. But for older people still living in the community, the shots prevented only 25 percent of hospitalizations for influenza or other respiratory illnesses.
The review appears in the Cochrane Database of Systematic Reviews, a publication of the Cochrane Collaboration, an international organization that evaluates medical research.
The Centers for Disease Control and Prevention recommends that older adults get flu shots, but acknowledges the vaccine is not perfect, especially for elderly people whose immune systems don`t respond to it.
Some critics of immunization policy say school children should be the vaccine targets.
"If we`re really going to control influenza, we have to immunize the people who spread it and who will respond to the vaccine," said Dr. Paul Glezen, an epidemiologist at the Influenza Research Center at Baylor College of Medicine in Houston.
Children tend to have poorer hygiene than adults, get sicker and spread illness more readily, said Dr. Elizabeth Babusis, a vaccine researcher at St. Louis University.
"They do tend to be like little Petri dishes," she said, but cautioned against basing policy on the analysis of data from a jumble of studies.
In February, the Committee for Immunization Practices voted to include children up to age 5 in the group who are recommended to get yearly flu shots.
About 73 percent of the U.S. population is now included in the recommendations, and health officials are moving toward universal vaccination as the supply allows, said CDC spokesman Curtis Allen.
Flu shots for everyone could protect the elderly by reducing the chance of coming into contact with an infected person.
Some researchers say the review shows that current flu vaccines have benefits for the elderly.
"It depends on what your expectations are," said Dr. Steven Lawrence, an infectious disease researcher at Washington University. "I look at the same numbers and say, `This works pretty darn good. It prevents death in half the people who get it.`"

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AP) A new study based on more than three decades of U.S. data suggests that giving flu shots to the elderly has not saved any lives.

Led by National Institutes of Health researchers, the study challenges standard government dogma and is bound to confuse senior citizens. During last fall`s flu vaccine shortage, thousands of older Americans, heeding the government`s public health message, stood in long lines to get their shots.

"There is a sense that we`re all going to die if we don`t get the flu shot," said the study`s lead author, Lone Simonsen, a senior epidemiologist at the National Institute of Allergy and Infectious Diseases in Bethesda, Md. "Maybe that`s a little much."

The study should influence the nation`s flu prevention strategy, Simonsen said, perhaps by expanding vaccination to schoolchildren, the biggest spreaders of the virus.

However, the U.S. Centers for Disease Control and Prevention in Atlanta plans no change in its advice on who should get flu shots, saying the NIH research isn`t enough to shift gears.

"We think the best way to help the elderly is to vaccinate them," said CDC epidemiologist William Thompson. "These results don`t contribute to changing vaccine policy."

The CDC currently recommends flu shots for people age 50 and over, nursing home residents, children 6-23 months, pregnant women, people with chronic health problems and certain health care and day care workers. When vaccine was scarce a few months ago, healthy people under 65 were urged to forgo the shot.

Although the study, published Monday in the Archives of Internal Medicine, looks at data from the whole U.S. elderly population over time, it doesn`t directly compare vaccinated vs. unvaccinated elderly, Thompson said. Previous studies that made that comparison found the vaccine decreased the rate of all winter deaths.

It`s also unlikely that a single study would trigger a change in policy, said CDC spokesman Glen Nowak.

But the former head of the nation`s vaccine strategy, Dr. Walter Orenstein, said Simonsen`s work "should make us think twice about our current strategy and (about) potentially enhancing it."

Orenstein is former director of the CDC`s National Immunization Program and now leads a program for vaccine policy development at Emory University.

A shift to vaccinating schoolchildren, the age group most likely to spread the flu virus, is advocated by colleagues of Orenstein`s at Emory in a separate report to be published Tuesday in the American Journal of Epidemiology.

The NIH and Emory papers, one a highly technical statistical analysis of death data and the other a commentary based on field studies and mathematical modeling, come during a season that focused the nation`s attention on vaccine supplies.

As a vaccine shortage loomed last fall, the CDC urged shots only for the highest-risk groups. Most of the 36,000 people who die each year of flu-related causes are elderly and the nation`s strategy has focused on getting shots to them, as well as other high-risk groups.

Last week the CDC reported that about 59 percent of older Americans got shots in 2004, down from 65 percent in 2003. Based on her research, Simonsen doesn`t expect to see a corresponding increase in flu-related deaths this year, something that "can be seen as good news."

The flu vaccine is less effective in the elderly than in younger people. It works, but not very well, said Ira Longini, a biostatistics professor at Emory University`s Rollins School of Public Health and a proponent of vaccinating schoolchildren.

While it`s smart for senior citizens to get their yearly flu shots because it can decrease their risk of getting sick, he said, a smarter government strategy would emphasize shots for children, ages 5 to 18. His statistical models show that strategy could save more elderly Americans from hospital visits and death.

"If we really want to make a difference and control influenza, we simply have to change the policy. We have to vaccinate large numbers of children," Longini said.

He and his colleague Dr. Elizabeth Halloran write that if 70 percent of schoolchildren were vaccinated, the elderly would be protected without flu shots. The strategy would require 42 million doses of flu vaccine. Even during this season`s shortage, there were 57 million doses available, their report says.

Yearly flu shots have been recommended for people 65 and older since the 1960s and for those 50 and older since 2000. Vaccination rates have risen among seniors from 20 percent before 1980 to 65 percent in 2001, according to the NIH study.

Simonsen and her team of researchers could find no corresponding decrease in death rates. Their analysis took into account the fact that people are living longer and that more virulent strains of flu dominated the 1990s.

The CDC`s Thompson said Simonsen didn`t take into account the effect of a gradual lengthening of the average flu season over the decades. But Simonsen said that no matter what model she used to define a flu season, she came to the same result.

Older Americans should keep their risk in perspective, said Dr. Lisa Schwartz and Dr. Steven Woloshin, senior researchers at the VA Outcomes Group, a small group of researchers trying to promote the straightforward presentation of medical information.

For the average senior citizen, the annual risk of dying from the flu is low: about 1 in 1,000. They said senior citizens still should try to get flu shots, but shouldn`t panic if vaccine isn`t available.

For years, the Centers for Disease Control and Prevention (CDC) has been telling anyone who would listen: "Every year in the United States, on average: 5 percent to 20 percent of the population gets the flu, more than 200,000 people are hospitalized from flu complications, and about 36,000 people die from flu." (1)

It is not clear how the specific statistic — 36,000 American deaths a year"on average" — was formulated or from what sources it was derived. It seems to have just suddenly appeared, like a rabbit from a top hat. It certainly could have been any other number of thousands of cases. After all, what area few thousand deaths up or down?

No one knows when the next number change will come but, when it does, it is guaranteed to be an increase. Scaring people, especially old people, out of their wits always sells vaccine and that seems to have become the CDC’s main purpose.

Another well-kept secret is over how many years the influenza deaths were "averaged." Did the CDC calculate "average deaths" from 2000 to 2004 or from 1980 to 2004?

To have 36,000 deaths "on average," there must be years with 26,000 deaths and about the same number of years with 46,000 deaths and, not to belabor the point, as many years with 16,000 deaths as with 56,000. At least, this is what most people would think averaging and "on average" mean.

The past influenza season came and went very quietly because the CDC was busy with dying birds in the Far East and Turkey. We will never find out where exactly the most recent "deaths from flu" will fit on the curve, but it is a good bet that 2005-2006 will not be, propaganda-wise, a "real good year."

Testifying before the committee on government reform of the U.S. House of Representatives on Feb. 12, 2004, CDC Director Julie L. Gerberding, MD, carefully stated that "CDC scientists estimate that an average of 36,000 people die from influenza-related complications each year in the United States." (2)

It is not clear why the director made the distinction, while under oath, between deaths from the flu and deaths from complications of the flu. A few people, including this writer, think there is a distinct difference between the two; many others do not think so.

To place the CDC influenza deaths in perspective, the U.S. lost 33,741 officers and enlisted men and women in Korean War battles from 1950 to 1953. (3) And a special communication published by the Journal of the American Medical Association listed 43,000 deaths due to motor vehicle crashes and 29,000 involving firearms in the U.S. in 2000. (4) The National Vital Statistics Report for 2001, published on Sept. 18, 2003 [Vol. 52, No. 3], was the last official U.S. government report on influenza mortality before the CDC director’s appearance at the February 2004 Congressional hearing. Certified figures about Influenza mortality [J10-J11] were listed on page 31 of the report. (5) There were, in all, 257 influenza deaths recorded in 2001. Of those, 13 deaths were under the age of 5; 50 were between 5 and 54; 21 from 55 to 64; 21 between 65 and 74; 56 from 75 to 84; and 96 were 85 years old or older.

Also in 2001, there were 61,777 official deaths due to pneumonia (J12-J18) of which 48,686 (79 percent) were 75 years old or older. The same document (table 11, page 35) lists the reciprocal number of deaths per 100.000 population. In 2001, influenza-pneumonia deaths (J10-J18) amounted to 21.8 per 100.000 with influenza at 0.1 and pneumonia at 21.7. With the U.S. population being around 284 million in 2001, it would seem that the calculated number of 284 (0.1/100.000) deaths from influenza would be close enough to the actual listed number of 257.

"Pneumonia" is caused by bacteria, viruses and fungi. Elderly patients (75 years and over) who have laboratory confirmed influenza disease may develop pneumonia but die from other underlying serious conditions, such as heart or kidney failure to name just two. It is not known how many of the 48,686 elderly individuals who died in 2001 had received the influenza vaccine that year. People of that age are usually vaccinated early in the season and certainly more frequently than others. In the U.S., influenza/influenza-like illnesses only occur during the flu season, a period of three months on average and rarely four months. Pulmonary complications and specifically deaths due to influenza will only occur during that short period, while other causes of pneumonia deaths exist year-round.

Most people who have influenza-like illness, as the condition is fondly referred to by the CDC, do not have influenza; only a small percentage of them are ever confirmed by culture or other accurate laboratory means. For the period 2000-2005, influenza virus positive cultures were 11 to 18.9 percent of the obtained cultures with a mean of 12.5 percent. It is well known that the virus strains in the community may be different from those in the available vaccine. Because immunity is strain-specific, vaccination in such cases is essentially ineffective in preventing disease. The percent of antigenic match between 2000 and 2005 varied from 11 to 63.2 percent with a mean of 54.2 percent. The maximum effectiveness of the vaccination effort, therefore, ranged between 2.1 percent in 2003-2004 and 11.5 percent in 2002-2003 with a mean of 7.2 percent. (6)

Taking all these facts into consideration, it is safe to say that only a small percentage of the 61,777 individuals who died of pneumonia in 2001 actually had influenza. Clearly, therefore, a large majority of individuals who died that year of pneumonia did not die of influenza or influenza-related complications.

In addition, the CDC figures clearly show that a large percentage of those who died were elderly and, historically, the elderly, as a group, have always been better vaccinated. As to the 257 individuals who were actually listed as influenza deaths in the 2001 statistical report, the influenza virus was actually identified in only 18 of them, the 18 classified as J10.(6) Apparently in 2001, not even 257 people died of influenza or influenza-related complications.

The Monthly Vital Statistics Report of Sept. 17, 1981 sheds additional light on the issue. Under pneumonia and influenza, the report states: "An estimated 52,720 deaths in 1980 were attributed to pneumonia and influenza. The age-adjusted death rate for this cause increased about 14 percent from 11.1 per 100,000 population in 1979 to 12.6 in 1980, reflecting the influenza epidemics in 1980 and the absence of one in the previous year. For pneumonia and influenza, death rates increased for the age groups 35 years and over." (7)

The above statement by none other than the CDC suggests that around 1.5 deaths per 100,000 were or could have been attributed to influenza or influenza complications in 1980, an epidemic year, when one would have expected a very large number of cases and more severe illness and certainly in a period when influenza vaccination was not as popular as it is now.

Considering that the U.S. population was around 226.5 million in 1980, 1.5 deaths per 100.000 would translate to around 4,000 deaths that year. So here we have official CDC statistics listing around 4,000 deaths, unconfirmed by viral cultures, from influenza and influenza-related complications in 1980, a banner year, and maybe 18 or 257 in 2001 and the propaganda machine is still talking about "an average of 36,000 deaths" a year.

2. J.L. Gerberding. Protecting the Public`s Health: CDC Influenza Preparedness Efforts. Testimony before the Committee on Government Reform U.S. House of Representatives, Feb. 12, 2004.

4. A.H. Mokdad et al. Actual Causes of Death in the United States, 2000. JAMA. 2004; 291: 1238-1245. Available at

5. E. Arias et al. Deaths: Final Data For 2001. National Vital Statistics Reports. Volume 52, Number 3. Sept. 18, 2003.

6. D.M. Ayoub, F.E. Yazbak. Influenza Vaccination During Pregnancy: A Critical Assessment of the recommendations of the Advisory Committee on Immunization Practices. J. Am Phys Surg. 2006; 11(2): 41-47. Available at

7. Annual Report of Births, Deaths, Marriages and Divorces: United States 1980. Monthly Vital Statistics Report: Vol. 29, No.13. Sept. 17, 1981.

Below are some highlights from this in depth article regarding the FDA and its link to the troubles within our healthcare system… pretty powerful article. I encourage you, when you have the time to read it completely.

Merck`s top management team reportedly remains un-phased by Vioxx litigation woes. In fact, Prudential Equity Group analyst, Timothy Anderson, says Merck`s Chief Executive, Richard Clark, specifically told him that "Vioxx does not keep him up at night."

According to Mr Anderson, "the company believes that lower court cases will be overturned on appeal, and it is even considering trying to reintroduce Vioxx."

When it comes to saving Merck in the Vioxx litigation, the FDA is at odds with some of the most powerful leaders in Congress. Senator Charles Grassley (R-Iowa), chairman of the Senate Finance Committee, is on record as saying the Vioxx debacle has shown that the FDA has gotten too cozy with drug companies to conduct proper oversight.

"The Vioxx example showed that the FDA and Merck were too close for comfort," he said in a speech. "Testimony and documents at our Finance Committee hearing showed that the FDA allowed itself to be manipulated by Merck."

Documents indeed reveal that the FDA knew about the problems with Vioxx very early on. A memo written by Shari Targum, MD, Project Manager for the Division of Anti-inflammatory Drug Products, clearly shows that as of November 18, 1999, the Data and Safety Monitoring Board of the VIGOR study, a committee independent from Merck, was concerned over the deaths from cardiovascular events in the Vioxx group, compared to the group taking another painkiller.

This memo documents a clear date of recognition by the FDA of when cardiovascular events were brought to the attention of Merck.

A partner in the LA based, Baum Hedlund law firm, attorney Karen Barth Menzies, has been litigating claims against drug companies for more than a decade and says "the Vioxx public health debacle has served to highlight deep-seeded problems within the FDA."

"Drug companies are profit-driven," she explains, "and are loath to issue warnings about risks associated with their drugs, even those that become quite clear."

"Medicine is no longer about health," Ms Menzies notes, "its about market share and profits."
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Last month, when I discussed using a portable chiropractic adjusting table or a desk to x-ray someone small who couldn’t stand, Wes Sheader, D.C., DICCP wrote to say he uses the floor which precludes the youngster falling off a desk or table. This is a very good point. Unfortunately, when that is done, there is no grid or bucky diaphragm to produce an optimal film.The rule in x-ray is that the requirement for a grid occurs when the patient measures greater than 13 centimeters with the calipers. I cannot remember what infants or young patients measured since I haven’t had the privilege of caring for patients since 1980. But most spine thicknesses of youngsters probably exceed 13 centimeters. The 13 centimeter rule also applies to the cervical region in a lateral neutral film in adults. Most patients measure less than 13 centimeters in the lateral cervical area so those patients may benefit by a reduction in radiation if the cassette is placed on the front of the cassette carrier instead of in the tray. Thank you Dr. Sheader for bringing this to our attention.

Cassettes that are more than seven years old usually need to be replaced because of usage deterioration. When they are replaced, I strongly recommend that each cassette be identified with a number placed inside the cassette so it will be seen on the finished radiograph. Next, place that same number on the outside of the cassette. Now take it one step further and designate each cassette for a specific view such as A.P. lumbar and use it for every A.P. lumbar film. Place “A.P. lumbar” on the outside of the cassette so you or the office personnel can see it easily. At some time in the future, if you begin to notice that only the A.P, lumbar produces underexposed radiographs, you know which cassette is at fault. If the detail is still good in the films with that cassette, but films are generally underexposed, you can adapt your exposure chart to reflect that for the one view. Also place the date of purchase on the outside of the cassette so that when a seven year duration is nearing, you know it will soon be time to replace the cassette. It is best to change cassettes for all the spine views at the same time so you get cassettes with equal screen speed.

From time to time, I receive films that are badly underpenetrated or badly overpenetrated. When films are badly overpenetrated, in order to visually see a difference in a retake radiograph, you must reduce the Mas by at least fifty per cent. Usually, if the original film is very dark, a fifty per cent reduction in Mas usually will not change the retake film sufficiently. It may require a reduction of eight Kvp in addition to a reduction of fifty per cent Mas. Obviously, this is why we recommend that your office keep a record the exposure factors in the event that you may need to retake a film or two.

When a radiograph is underexposed or underpenetrated, a retake film must have an increase of at least fifty per cent Mas. If you can hardly make out the vertebrae, you probably have to double the Mas.

The darkroom is far more important than many chiropractic doctors realize. Georgia state law mandates that the darkroom be light tight. Probably, other states do also. Processing chemistry should be changed every month. Some stretch it to a month and a half or two months. Degradation of the film image occurs as time exceeds one month in many instances. The safelight, if used, should be at least three feet from the loading bench. Ceiling safelights have a tendency to be bright so we recommend that you wrap the ceiling fluorescent safelight in paper to reduce the amount of light that emanates from the ceiling.

To determine if the darkroom is light tight, it is necessary to go into the darkroom with the safelight off, close the door tightly and close the eyes for five minutes. Life college now recommends 15 minutes. Someone outside the darkroom needs to knock on the door when the time is up. The person inside the darkroom then opens his/her eyes. If any structures are visible, there is too much light entering the darkroom. Sometimes weather stripping is necessary to be utilized along the door edging and the top of the door. The most frequent place where light enters the darkroom is underneath the door. Temporarily, that can be fixed with a large beach towel. Installation of a draw drape with relatively heavy cloth extending to the floor is the best answer for that problem. Every light leak should be eliminated.

Compared to a film taken without collimation, a retake with collimation of a quarter inch on each side will make a demonstrable difference. Every film taken with collimation is calculated to be better than one without collimation. An added bonus for the patient is less ionizing radiation.

Prior to using your x-ray equipment, or if it hasn’t been in use for two hours, turn on the x-ray machine and set the Kvp at 50, the Ma at 100 with the time at .1 (one tenth of a second) then fire once. Wait thirty seconds and fire again. Some suggest raising the Kvp to 75 on the second exposure. The tube is now warmed up for heavy lumbar exposures within the capability of the tube. The tube capacity is determined by the tube manufacturer and is provided to all buyers of the equipment in the form of a ”tube rating chart”. This chart graphically delineates the tube capability with respect to the amount of Kvp, Ma and time that can be used under given circumstances.

If your office does not have a tube rating chart, merely write or call the manufacturer of the x-ray tube and ask for the tube rating chart for that tube. You should be able to find the name of the manufacturer and the serial number on the tube. Ask that it be sent and not faxed. Some faxed tube rating charts are impossible to make out.

I hesitate to say this but some used x-ray dealers are like some used car dealers. Untrustworthy, to say the least. Here is an example. In the 1970s, I was interested in upgrading my x-ray installation. I did not want to pay new x-ray equipment prices. I went to a used x-ray dealers’ showroom and saw two sparkling G.E. units. I was told one was two years old and the other was five years old. I recorded the serial numbers of each and contacted G.E. with that information, asking the exact age of the units. The first was fifteen years old and the second was twenty five years old. I found out that they had the units dismantled and sent to an auto-body shop for complete repainting. They looked like new. Unfortunately, these kinds of things are happening so be careful if you are in the market for another used unit.

To some of you, much if not all the information in this article is basic knowledge that you learned and have put into practice for some time. However, based on my work as a chiropractic radiologist, I talk to many of our chiropractic colleagues who are unaware of many of the things that I have included in this article.

We all know chiropractors receive training in radiology to enable our profession to recognize normal findings as well as normal variants and distinguish them from pathological findings and conditions. General practitioner chiropractors are responsible for everything that is found on the film studies produced in their offices. You may not know what the condition is but you are required to recognize the potential seriousness of radiological findings and refer the patient in a timely manner when circumstances indicate. It is therefore imperative and vital that each office produce the best films of which the equipment is capable. With good detail and proper positioning, many of the abnormalities are easily visualized so you can make a determination in yours and the patient’s best interest. The better the quality of the films, the better your chances of perceiving abnormalities that may require immediate referral. Optimal film quality can give you greater confidence that you can accept the patient with a high potential for success.

As we all know, there are times when some of our radiographs may be suboptimal. Information in this article may help some to improve the films on a regular basis. Sometimes an upgrade in equipment is necessary. When a chiropractor has devoted sufficient time and study to a set of films and is uncertain as to whether the findings represent a potential serious involvement that may require a referral, the films should be sent to a chiropractic radiologist as soon as practical to rule out serious pathology.

Serious problems have arisen in all age groups who visit chiropractors. One of my patients once had a child under two years of age that died of a kidney malignancy before they moved from New England to Florida where I was practicing. One of my patients was a 29 year old teacher who was hit in the head with a volleyball and her chief complaint was torticollis. Three M.D.s missed the possibility of her cancer which I postulated despite the fact that her spine films were unremarkable from a pathological standpoint. She was referred to a gastroenterology group which found the primary cancer in the colon. It was an annular carcinoma. She died a year later with metastatic malignancy from the colon to the small intestines, stomach and liver. People of all ages may develop serious conditions so we must have a high index of suspicion and practice responsibly.

It is no disgrace to be unsure of what is depicted in radiographs. There are chiropractic radiologists throughout the United States and some foreign countries who are ready to help interpret your film studies.

David D. Millman, D.C., D.A.C.B.R. confines his practice to film reading. His office is located at 1592 Valley Stream Drive, Marietta, GA. Tel..770 977-3304..Please call prior to sending films.