As a chiropractor, Douglas Van Vorst had a vision to integrate chiropractic care with mainstream medicine.
Having been a chiropractic patient as a child, born with hip dysplasia, he could never understand why chiropractors were isolated from mainstream medicine.
So after three years of working with Amsterdam Memorial Hospital helping them develop bylaws, rules and regulations for a Division of Chiropractic, Van Vorst was proud to finally become the first chiropractor in New York state other than a group of chiropractors at Doctors Hospital in Staten Island to be granted hospital privileges.
He is still one of a handful of chiropractors to have hospital privileges in the state and is the only one in the Capital Region other than Timothy Liszewski, who also works at Amsterdam Memorial Hospital.
Filling a need
Twenty years ago, you would probably never find a radiologist and anesthesiologist working with a chiropractor, let alone in a hospital setting. But for the past 81⁄2 years, Van Vorst has been working with Dr. Albert Fraser, an anesthesiologist, and Dr. Tariq Gill, a radiologist, as part of a pain management team.
“Ten years ago, I noticed there was a need for a certain category of patients with chronic or acute neck and back pain and headaches who did not respond to medication, physical therapy and chiropractic treatments,” said Van Vorst, who has been in practice for 21 years. “Some of these patients needed surgery, but many did not. Many went on to have surgery resulting in unsuccessful outcomes, continuing to suffer back, and many times leg, pain.”
Van Vorst took a course in manipulation under anesthesia, a procedure that had been done in the past by osteopathic physicians, and he became certified.
Soon after, he began working with Fraser and Gill who transferred patients to Van Vorst’s office, which is on the same campus as the hospital.
After working on about 20 patients with success and no complications, Van Vorst was granted hospital privileges in 1999.
Since then, the doctors have performed more than 500 procedures with no complications, on patients with complaints ranging from failed back surgeries, herniated discs of both the neck and back, and chronic headaches.
“Our office is referred many difficult cases that have not gotten better from other chiropractors, orthopedists, and occupational medicine,” said Van Vorst, director of the Chiropractic Division of the Department of Physical Medicine and Rehabilitation at Amsterdam Memorial Hospital. “Probably 90 percent of my referrals are from primary care physicians and orthopedists.”
If conservative treatment fails, Van Vorst and his colleagues use one of three procedures:
u Manipulation under anesthesia, in which the patient is anesthetized with twilight or a light amount of medication and then chiropractic manipulation is performed.
u Manipulation under epidural anesthesia, in which an epidural steroid is injected followed by chiropractic manipulation.
u Manipulation under joint anesthesia, in which a specified joint is injected and then manipulated.
Each procedure is for a specific problem. After a complete musculoskeletal and neurological exam, Van Vorst determines which procedure is right for the patient. Many times, multiple procedures will be performed if there is more than problem.
“We examine and discuss the case prior to performing any procedure,” Van Vorst explained. “Specific protocols for patient selection and after care have been developed by the hospital. A lot of times these procedures are used to address pain so that the patient can move that next step toward rehabilitation.”
After the procedure, the patient will follow up with manipulative therapy and rehabilitative exercises either at Van Vorst’s office or physical therapy.
Van Vorst said the manipulation addresses the mechanical dysfunction of the spine or the inability of the spine to move properly, while the injection eases the chronic irritation and pain.
The procedures are done in the hospital as an outpatient because the chiropractic manipulation must be done within 20 minutes of the injection of anesthetic.
“We also want to watch the patients to make sure they don’t have an adverse reaction to the drugs,” said Van Vorst.
Joe Kausch of Charlton, 47, was suffering from back pain that radiated down his right leg (sciatica) when he was referred to Van Vorst four years ago.
Van Vorst and Fraser did manipulation under epidural anesthesia. The injection calmed down the joint or nerve root, and the manipulation addressed the improper movement of the spine that caused the back pain.
“They made me comfortable enough that I didn’t feel much pain during the manipulation,” said Kausch, who was given exercises to do once he was well enough.
“A month after the procedure, I was cross-country skiing,” recalled Kausch. “Today, I can do anything I want to within reason, and I don’t have back pain. I’m so glad I didn’t have to have surgery.”
Dr. Albert Fraser, anesthesiologist, said he finds having a chiropractor on the pain-management team an asset.
“This has been helpful in getting people more comprehensive pain management,” said Fraser. “Not only do patients have the injections and manipulation done, they have follow-up with a chiropractor. Many patients do not want to take medications by mouth for their pain.”
While Fraser said he thinks there is still a bias against chiropractors in many medical institutions, he said he believes more chiropractors will be granted hospital privileges in the future.
“Overall, our patients with chronic back pain have done well,” he said. “The advantage is they learn how to keep themselves from getting the same recurrent problem. So after the epidural injection gets them out of pain, they can focus on how to reinforce their core strength through exercises. They may still have some pain, but the goal is to get them back to work and to the activities they did before.”
Van Vorst said he sees an average of one to two patients a week who have manipulation under some form of anesthesia in the hospital followed by rehabilitation.
With the use of MRI and CT scanners along with new advancements in anesthesia, the doctors are able to identify potential problems and inject more accurately, and the procedures are safer than in the past, said Van Vorst, who refers patients who do not get well for surgery.
“Ultimately, we are trying to empower our patients to learn how to take care of themselves, by showing them how to exercise properly, and how to stay away from certain exercises that may cause harm,” said Van Vorst. “We want to make them functional and decrease the use of pain medication.”
Dr. Liszewski said he thinks there are a variety of reasons why more chiropractors do not have hospital privileges.
“It takes quite a bit of time to take enough courses to enable a chiropractor with no real hospital training in school to become versed in the protocol of hospital procedures,” he said. “It’s kind of a new frontier.”
Liszewski also said most chiropractic patients are not in a situation where they need treatment in a hospital setting.
Van Vorst said he thinks more chiropractors will become part of hospital-based pain-management teams. “I think medicine realizes that surgery and drugs are not the answer to most back pain,” said Van Vorst. “And that we can work successfully in conjunction with other doctors and try less-invasive methods.”
Reach Gazette Reporter Kathy Ricketts at 395-3183 or [email protected]
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