Prosperity Through Unity Exceptional Care for Idahoans

June, 2020 The IACP News, Vol. 4, No. 6

Should chiropractors be using and recommending face masks? Americans are at odds over whether it’s necessary to keep taking coronavirus protective measures, and like all health care providers, doctors of chiropractic are being asked if patients should wear face masks while out in public. Now, a leading researcher says the data is clear: The path ahead in the Covid-19 pandemic is being shaped by masks.

“We now have really clear evidence that wearing masks works -- it’s probably a 50% protection against transmission,” said Dr. Chris Murray, director of the Institute for Health Metrics and Evaluation, or IHME, at the University of Washington. Dr. Anthony Fauci, the nation’s top infectious disease expert agrees, and has loudly implored Americans to wear face masks in public.

“I want to protect myself and protect others, and also because I want to make it be a symbol for people to see that that’s the kind of thing you should be doing,” said Fauci. He said that he believes that while wearing a mask is not “100% effective,” it is a valuable safeguard and shows “respect for another person.” Continued on page 5 RESCHEDULED The IACP Annual Convention November 7-8, 2020 at The Grove Hotel

June 2020 | The IACP News | Page 1 I A C P

The mission of the Idaho Association of Chiropractic Physicians (IACP) is to act as the unified voice, leader and stalwart supporter of the individual licensed doctors of chiropractic and supporting associates who provide exceptional health care and wellness to the patients and communities of Idaho. In supporting our Idaho chiropractic physicians, the IACP will work diligently to protect, enhance and build opportunities for the chiropractic industry and increase public access to chiropractic care.

2019-2020 IACP Board of Directors

Dr. Scott Crawford Dr. Thomas Bench Dr. Joan Burrow Dr. Jeremai Hafer President Vice President Secretary Treasurer

2019-2020 IACP Board of Directors

Dr. Tom Tessendorf Dr. Michael Henze Dr. Kimball Arritt Dr. George Fiegel Open Dr. John Maltby II Dr. Grayson Blom District 1 District 2 District 3 District 4 District 5 District 6 District 7

Idaho Association of Chiropractic Physicians 13601 W McMillan Rd., Ste. 102-331, Boise, ID 83713 Phone: (208) 424-8344 • FAX (888) 399-5459 https://iacp.wildapricot.org • [email protected] For advertising info, email C&S Publishing at: [email protected]

Page 2 | The IACP News | June 2020 In This Issue

President’s Message: We are all adapting and making changes Page 4

Should chiropractors be using and recommending face masks? (continued) Page 5

Misinformation during the Coronavirus outbreak Pages 6 - 7

Effects of vitamin D interactions on the developing musculoskeletal system Pages 8 - 12

Journal of Clinical Chiropractic Pediatrics accessible at www.JCCPonline.com Page 12

Vitamin D levels appear to play a role in COVID-19 mortality rates Page 13

ChiroHealth USA Pages 14 - 15

The IACP Marketplace: Featured Businesses & Suppliers Page 16

IACP Annual Convention rescheduled to November 7-8 Page 17

Classified Ads Page 17

Chiropractic News Pages 18 - 20

IACP Membership Application Page 21

Chiropractic College News Pages 22 - 25

Office poster notice Page 26

This month’s poster: Go outside and get the benefits of vitamin D Page 27

IACP News Display Advertising Rates and Sizes Page 28

This table of contents is linked for your convenience. Just click on the page you want.

June 2020 | The IACP News | Page 3 President’s Corner

We are all adapting and making changes

By Dr. Scott Crawford, IACP President

Summer is almost here, which means this year is almost halfway gone. It’s been an interesting year to say the least. Although we all want to get back to the way things were, it seems unlikely. In our practices, we have to adapt and make changes. Large healthcare classes can be traded for Zoom calls or Facebook live. Patient appreciation events can be switched out for food or gas cards, raffles, or other patient contests to benefit them and show your appreciation. My point is, we may be forced to make these changes, but they will help us grow and get out of our comfort zone in a good way.

Our association has also had to adapt and make changes to our convention. We have rescheduled the 2020 IACP Convention to November 7th & 8th and it will still be at the Grove Hotel in downtown Boise. We will still have innovative presenters, networking opportunities, and important discussions to further the association. The Idaho State Board of Chiropractic will also extend individual CE deadlines on a case-by-case basis. For those who have counted on the Convention in the past for all of your CEs, the rescheduled November convention will also provide all of the hours necessary. So hang in there, make needed changes, and adapt your practice to keep up with the craziness surrounding us.

“Join the Pack” Become a member of the IACP

The IACP acts as a resource, representative and leading advocate for the chiropractic industry in Idaho. We cannot continue to properly serve the chiropractic profession without the commitment and support of exceptional industry leaders, such as yourself. The IACP Board and its members believe that membership in the Association is and should be mutually beneficial to both the Doctor and the IACP, which makes it a perfect cooperative relationship. As a member, you will have multiple opportunities to obtain learning and marketing opportunities, at a discounted rate, through membership, as well as, have an opportunity to utilize the services of the IACP team and its Board. You will also have an opportunity to get involved in important issues, from the center, along with other industry leaders and spokespeople. At the same time, the Association continues to grow and provide broader services to the industry with your support. Join now and be a part of the “pack” that will lead us into the future!

Page 4 | The IACP News | June 2020 Should chiropractors being using and recommending face masks?

Continued from front page use of masks for the protection of wearers,” the report The wearing of masks while out in public has emerged as a notes. “If correctly used on this basis, face masks, including politically charged issue as President Trump has called for a homemade cloth masks, can contribute to reducing viral return to pre-pandemic life in the hopes of revitalizing the transmission.” The conclusion is based on analysis of three US economy. He has repeatedly declined opportunities to key considerations, including the role of droplets as a route wear a mask in public, telling reporters at a Ford plant in of transmission, and whether masks can help to reduce Michigan last week that he “didn’t want to give the press dispersal of droplets. However the authors note there are the pleasure of seeing it,” though he did wear a mask while only a small number of studies. touring parts of the plant. Prof Trisha Greenhalgh, of the Nuffield Department of But, many officials have urged their residents to wear masks. Primary Care Health Sciences at the University of Oxford, Former acting CDC director Dr. Richard Besser called it “an welcomed the report, saying it adds weight to the argument American thing to do,” and Ohio Gov. Mike DeWine said that face coverings by the general public could be part of a wearing a mask isn’t political, it’s “about loving your fellow route out of lockdown. human being.” Governor Doug Burgum (R-ND) fought back tears while discussing people wearing masks during his daily “It draws together a wealth of evidence including the press briefing about coronavirus, saying that those wearing science of transmission and the efficacy of cloth-based masks during the Covid-19 pandemic may not be doing so materials both in laboratory studies and in randomised for political reasons, but for genuine health reasons. controlled trials, in relation to both source control and protection of the wearer,” she said. “The authors flag the For the first time, the Center for Disease Control and important finding that much if not most transmission of Prevention (CDC) has recommended that even seemingly Sars-CoV-2 [coronavirus] happens from people who do not healthy people wear masks over their mouths and noses currently have symptoms. As would be expected from this when venturing out of their homes into places where it is distinguished group of scientists, the underlying evidence difficult to maintain distance from other people. base is meticulously dissected and presented, including pointing out areas where more research is needed.” But there is still major debate over how much masks — particularly the homemade fabric masks that the CDC Greenhalgh noted that while there have been concerns that recommends for the public — can slow the spread of SARS- use of masks by the public could reduce supply of medical- CoV-2, the virus that causes COVID-19. Researchers, writing grade masks for healthcare workers, a homemade mask is in two new papers, attempt to tackle the efficacy of masks, sufficient for most people. “Medical-grade masks are not one more rigorously than the other, and come to differing needed outside of healthcare settings. A cloth mask provides conclusions. One study examined the effect of masks on very good protection, and is more comfortable to wear,” she seasonal coronaviruses (which cause many cases of the said. common cold) and found that surgical masks are helpful at reducing how much virus a sick person spreads. The other But the report prompted other scientists to express their looked particularly at SARS-CoV-2 and found no effect of reservations, warning that it amounted to no more than either surgical or fabric masks on reducing virus spread, but opinion and overstated the available evidence. Dr Simon only had four participants and used a crude measure of viral Clarke, associate professor in cellular microbiology at spread. the University of Reading, said the report “falls short of delivering new evidence and too casually dismisses Still, hard data is still being collected. A recent report from a precautionary principle when addressing the possibility that multidisciplinary group convened by the Royal Society called masks and coverings could have negative effects on people’s Delve – Data Evaluation and Learning for Viral Epidemics behaviors.” – has weighed up the evidence and come out in favour of the public wearing face masks, including homemade cloth Dr Ben Killingley, consultant in acute medicine and coverings, in a bid to tackle Covid-19. infectious diseases at University College London hospital, was also critical. “The report is overly optimistic about the “Our analysis suggests that their use could reduce onward value of face coverings and it is incorrect to conclude that transmission by asymptomatic and pre-symptomatic the evidence shows that face covering can reduce viral wearers if widely used in situations where physical distancing transmission in the community,” he said. “There is in fact no is not possible or predictable, contrasting to the standard good evidence that face coverings achieve this.”

June 2020 | The IACP News | Page 5 Misinformation during the Coronavirus outbreak How knowledge emerges from noise

The following research article was published in Critical Care they may lead to ill-informed health decisions (1) including Explorations in the April 2020 issue (Vol. 2, Issue 4) doi: isolation orders, travel bans, population quarantines and 10.1097/CCE.0000000000000098 by Rochwerg, Bram MD; even discrimination against travelers from certain countries Parke, Rachael PhD; Murthy, Srinivas MD; Fernando, Shan- or persons of certain ethnic origins. The use of unproven non M. MD; Leigh, Jeanna Parsons PhD; Marshall, John MD; therapeutic or prophylactic interventions also introduces Adhikari, Neill K. J. MD; Fiest, Kirsten PhD; Fowler, Rob MD; unnecessary risks and, unless they are used carefully in the Lamontagne, François MD and Sevransky, Jonathan E. MD. context of an approved clinical study, increase the amount of noise thereby limiting our collective ability to discover During times of uncertainty, it can be challenging to deci- new ways to treat patients. pher which information is credible. Watching major news channels early during the course of an evolving and break- There are however benefits to digitalization of health me- ing story, it is usually clear that the newscasters do not have dia. Based on experiences with previous outbreaks, for complete information; however, this does not stop the con- example, influenza A(H1N1)pdm09 pandemic in 2009, the stant flow of discourse to viewers. To fill this void, it is com- World Health Organization (WHO) and other governmental mon for broadcasters to rely upon information that is not organizations are better prepared. The WHO maintains a live fully vetted, much of which ends up being incorrect once and up-to-date COVID-19 website which contains credible the entire story becomes clear. These same themes may oc- information on the outbreak (www.who.int/health-topics/ cur during medical crises, most clearly demonstrated dur- coronavirus). ing infectious pandemics that elicit a primal fear in people, bringing forth images of blockbuster films in which novel The U.S. Centers for Disease Control and Prevention website viruses wipe out large swaths of the global population. A includes updates on virus status in the United States, travel combination of fear and a lack of credible information in the restrictions, and a world map highlighting areas with COV- early phase of an outbreak are the largest contributors to ID-19 cases (www.cdc.gov/coronavirus). Johns Hopkins runs public hysteria. Information is the best tool to combat hys- a website (www.gisanddata.maps.arcigis.com) that provides teria, and as illustrated in the current infectious outbreak up-to-date and credible data describing the number of those of severe acute respiratory syndrome coronavirus 2, in our infected broken down by severity and separated by country, digital media era, information is everywhere. The more im- as well as the number of deaths. These governmental and portant concern for clinicians and patients, similar to watch- public health organizations sources of information should ing a breaking news story, in which information to believe be considered most trustworthy, as they can be relied upon and which to ignore. to avoid misinformation, and as such the public should be going here as their main source of information during the The ongoing coronavirus disease 2019 (COVID-19) pan- health crisis. demic has demonstrated the volume of information that can be produced in a short period of time; this has been Perhaps unique to this pandemic, compared with others, associated with both benefits (easier access for clinicians) has been the response from the medical community. Al- and risks (misinformation). Media sources including news- though bedside practitioners are in need of data that will papers, magazines, and news shows have been covering this help them to better identify, risk-stratify, and treat affect- story with fervor. Although the objectives of corporate news ed patients, medical research often takes time. Tradition- media include informing the public of the latest medical ally, research is deliberate, and producing trustworthy and updates, they have an obligation to shareholders or private methodologically sound results may not be as rapid as what owners of selling more newspapers, magazines, or adver- is required. For example, according to PubMed, although tisements and the natural inclination to therefore stoke the over 20,000 citations related to H1N1 influenza have been fires of hysteria. Certainly, some sources are worse offend- published since 2009, the large majority (14,000 of these) ers when it comes to this than others who take the time to were published after 2011, over 2 years following the ma- more carefully vet sources. The amount of print and news jor phase of the pandemic. Major contributors to research media dedicated to COVID-19 in the last few months is huge. delays include competing interests of investigators, regula- Tangible risks of misinformation should not be ignored, as tory barriers, time taken for protocol development, ethics

Page 6 | The IACP News | June 2020 approval, peer review and delays related to the publication clinicians. Although the platform is unique in allowing for process. This classic research model does not fit well with engagement with experts and rapid discourse, the lack of pandemic research, where there is a need for rapid informa- scientific vetting and peer review can contribute to hyste- tion to fill gaps and address public concern. For COVID-19, ria, rather than alleviating it. Each day over 100,000 tweets some of these traditional delays have been circumvented are sent using the #COVID19 hashtag (www.symplur.com) (we will discuss how shortly), and as such, many of the ma- and this is increasing exponentially. Filtering the knowledge jor general medicine journals, including Journal of American from the misinformation in social media is extremely chal- Medical Association (JAMA), New England Journal of Medi- lenging, and probably a strategy to be avoided in times of cine (NEJM), and The Lancet have prioritized publications pandemic. At the very least, if using social media, the focus related to COVID-19. This has been facilitated at medical must be on reliable sources presenting vetted information journals through invited content and expedited peer re- and avoiding conjecture and opinion. Even this rule is not view processes. JAMA, The Lancet, and NEJM, for example, absolute, as we have seen dramatic cases of prominent indi- maintain a Coronavirus Resource Center including research viduals advocating for specific unproven therapies (e.g., -hy and multimedia content (www.jamanetwork.com/journals/ droxychloroquine and azithromycin) leading to drug short- jama/pages/coronavirus-alert), most as free online content. ages and increased rates of toxicity. Providing peer-reviewed and easily accessible content has helped to overcome some of the misinformation rampant in Research during a pandemic or health crisis presents chal- lay media. As of March 2020, 1,801 unique citations related lenges beyond the usual difficulties surrounding research to COVID-19 have been indexed in PubMed, 640 in 2019, in the critically ill. Most obviously, pandemic preparedness, and 1,161 in 2020. This represents an enormous amount of planning and management requires time, resources and per- scientific content for a disease that was first discovered in sonnel. Clinical researchers may be diverted to the bedside Wuhan, China in mid-December. It remains to be seen, how caring for affected patients or working with government and valid and trustworthy the data from these publications will public health organizations to contain the outbreak. Prelimi- turn out to be, given the rapidity in which they were pro- nary data from China suggests that mortality in Wuhan (the duced and the expedited peer review and editorial decision- center of the COVID-19 outbreak with the largest number of making required to publish so quickly. There have already cases) has been higher (> 3%) compared with other regions been some highly visible examples of dubious and scien- in China (around 0.7%) and this has been hypothesized to tifically questionable re- be at least partly due to a shortage in healthcare provid- ports, even some that ers. Not only is researchers time diverted to clinical care but have been published so are other resources including funding. Governments are and now corrected in usually the largest research funder, especially in developed highly reputable jour- nations; however, these funds may be required during an nals. The lesson is that outbreak to augment capacity through infrastructure or hu- not everything posing man resources investment. The most dramatic example of as trustworthy research this was the government of China’s investment in building truly is, and it is impor- a new 650,000 square foot hospital with 1,000 beds and 30 tant to both support ICU beds, built in only 10 days to care strictly for COVID-19 high-quality work, but patients. also discourage and prevent work that is not Conclusions: Pandemics and healthcare crises provide ex- trustworthy. traordinary opportunities for the rapid generation of reliable scientific information but also for misinformation, especially Also unique to this out- in the early phases, which may contribute to public hyste- break is the role social ria. The best way to combat misinformation is with trust- media has played in worthy data produced by healthcare researchers. Although information dissemi- challenging, research can occur during pandemics and crises nation and at times, and is facilitated by advance planning, governmental sup- propagation of misin- port, targeted funding opportunities, and collaboration with formation. Twitter has industry partners. The coronavirus disease 2019 research become entrenched as response has highlighted both the dangers of misinforma- an information source tion as well as the benefits and possibilities of performing for both patients and rigorous research during challenging times.

June 2020 | The IACP News | Page 7 What are the effects of vitamin D interactions on the developing musculoskeletal system?

Whether you’re out enjoying the summer sun or hunkering down indoors during the pandemic, it’s important to get ample vitamin D. Vitamin D is a fat-soluble vitamin crucial for efficient calcium absorption, which in turn helps you build and maintain strong bones, decreasing your risk for osteoporosis, or bone disease. Research shows that vitamin D is crucial for keeping bones healthy — warding off rickets, osteomalacia, and osteoporosis.

While there is a lot of confusion and conflicting information about the coronavirus, getting sufficient vitamin D is not contro- versial. The following research paper, produced by Anna Papadopoulou, DC, and published in the June 2020 issue of the Journal of Clinical Chiropractic Pediatrics (JCCP) discusses the effects of vitamin D on the developing musculoskeletal system. The full article, with references, can be seen here.

By Anna E. Papadopoulou MChiro, DC, DACNB tamin D supplementation, and several articles on vitamin D and musculoskeletal development were identified and con- ABSTRACT sidered in the study. The American Academy of Pediatrics Introduction: Vitamin D deficiency is a global public health and the Canadian Pediatric Society and European guidelines issue and large health agencies encourage the use of vita- recommended 400 IU/day for infant - adolescent. The US min D supplementation. Vitamin D is an essential hormone Institute of Medicine and World Health Organization recom- which is responsible for both musculoskeletal development mended adequate nutritional intake prior to supplement- and systemic health. The goal of this narrative review was to ing children 0 –1 and 1–18 years old with 400 and 600 IU/ investigate the following clinical issues: 1) Impact of Vitamin day, respectively. Clinicians must be aware of key points that D on the developing musculoskeletal system in the pediatric would significantly affect the correct recommendation and patient and the growing child’s need for nutritional intake supplementation of Vitamin D. These are history, anthropo- or supplementation,2) Factors important to determine the metric measurements, physical activity levels, dietary habits need for supplementation and appropriate supplementa- and sun exposure parameters to achieve optimal musculo- tion, 3) Risk for overdose of Vitamin D. Methods: Litera- skeletal results. Conclusion: At present, 400-600IU/day Vi- ture search of large search engines. Limits used: age 0-18 tamin D supplementation is the daily recommendation for years, English language and published in the last 10 years. pediatric population based on the global healthcare agen- Key words used ‘Vitamin D and pediatric’, Vitamin D and de- cies. Understanding the great impact of vitamin D on the velopment’, ‘Vitamin D and deficiency’, ‘Vitamin D and side musculoskeletal system, future work must be done to ex- effects’. Results: One Cochrane review, two global epidemi- amine the prophylactic use of vitamin D and its appropriate ological reviews on nutritional rickets, six guidelines on Vi- adapted supplementation.

Page 8 | The IACP News | June 2020 Introduction Methods World Health Organization (WHO), US Institute of Medicine Literature search of large search engines, PubMED, Co- (IOM), the Endocrine Society in the USA and the European chrane library, WHO. Key words used ‘Vitamin D and pediat- guidelines acknowledge that vitamin D deficiency is a global ric’, Vitamin D and development’, ‘Vitamin D and deficiency’, public health issue and encourage the use of vitamin D, ad- ‘Vitamin D and side effects’. vising on supplementation and daily recommended dosage. Vitamin D is an essential hormone, which has attracted in- Inclusion criteria: Articles in English language, Published creasing attention in the last decades. It exists in two forms within the last 10 years, Vitamin D supplementation con- D3 -cholecalciferol and D2 or ergocalciferol. sideration for healthy pediatric population 0-18 years old. Guidelines from global health agencies. Vitamin D is unique as it is both absorbed via dietary intake, in the small intestine by chylomicrons or can be synthesized Exclusion criteria: supplementation for disease specific con- by an endogenous process. The dual absorption mechanism ditions, articles specific to premature infants. Articles- com highlights its importance. Correct absorption is thus subject menting on Vitamin D interaction with other drugs and -mi to adequate nutritional intake. Fatty fish, fish liver oil, and cronutrients. Excluded articles older than 10 years egg yolks are typically good sources of Vitamin D2. Endog- enous synthesis is the second way of producing and absorb- Results ing pre-vitamin D3. One Cochrane review, two global epidemiological reviews on nutritional rickets, six guidelines on Vitamin D supple- Sun UV exposure, (290–320 nm) interacts with 7-dehydro- mentation, and several articles on vitamin D and musculosk- cholesterol and is absorbed in the skin. Factors influencing eletal interaction were identified to answer the three ques- the effectiveness of this process are average skin exposure tions reviewed. to sun light, color of skin and latitude of the country. Both versions of Vitamin D (D2 and D3) are inactive until they 1) What is the Vitamin D impact on the musculoskeletal reach the liver, where the first hydroxylation happens and (MSK) system in the developing pediatric patient and how the following hydroxylation occurs in the kidney. The final does this translate into the growing child’s need for nutri- product is the bioactive hormone, calcitriol. This is an im- tional intake or supplementation? portant hormone as it dictates the homeostasis of several minerals (calcium and phosphate) in the plasma. These min- The American Academy of Pediatrics and the Canadian Pe- erals and the concentration of parathyroid hormone play a diatric Society, the European guidelines recommended 400 paramount role in the bone metabolism throughout a life- IU/day for infant through adolescent age groups. Whereas time. IOM and WHO recommended adequate nutritional intake and if this is not met, to supplement children 0–1 and 1–18 Well-being of skin, gut, liver, kidney and bone is vital for years old with 400 and 600 IU/day, respectively. Vitamin D metabolism. Activated Vitamin D works as a hormone, and its half-life (25(OH)D) is approximately 2–3 Homeostasis between vitamin D metabolism and parathy- weeks. This allows it to be a gene expression regulator, as roid hormone ensure an efficient bone mineralization pro- part of immune function, cell proliferation and differentia- cess in early infancy and childhood. Fine balance between tion, and cell apoptosis. The most commonly utilized bio- calcium and phosphorus concentration in the bloodstream marker for vitamin D sufficiency is 25(OH)D and this can be is additionally vital. Randev et al., 2018, explained that cor- measured in the blood. rect mineralization in early life safeguards against early os- teoporosis in adulthood. The clinical questions asked here were: 1) How does Vitamin D impact the musculoskeletal (MSK) Shore, 20137 identified that infants younger than three system in the developing pediatric patient and how does months are somewhat protected from Vitamin D deficien- this translate into the growing child’s need for nutritional cy if sufficient placental transfer from the mother has oc- intake or supplementation? curred. However, other studies such as Bentley, 2013 ex- 2) What are the specific factors that we clinicians need to pressed their concern as it indicated that maternal calcium consider in order to help parents decide the appropriate and vitamin D deposits are not sufficient for fully protecting supplementation for their child? the infant and supplementation is encouraged both during 3) Is overdose a concern? Continued on next page

June 2020 | The IACP News | Page 9 What are the effects of vitamin D interactions on the developing musculoskeletal system?

Continued from last page 2) What are the specific factors that clinicians need to con- sider in order to help parents decide the best supplementa- pregnancy and in early infancy. In terms of dosage during tion for their child? pregnancy, 2800 IU /day, had a positive increase in bone mineralization of offspring at both one year and six years Common factors that play a significant role in appropriate after the supplementation. supplementation of pediatric cases are: exclusive breast feeding, fortified formula, fortified nutrition in -diet, aver This highlighted the importance of appropriate dosage and age daily exercise, and daily sun exposure based on their early vitamin D supplementation inpregnancy. country’s latitude, cultural dietary habits, anthropometric measurements and BMI. These factors should be evaluated Infancy and childhood is predominantly concerned with lon- in the history taking and then combined with any physical gitudinal growth and remodeling of the axial and appendic- findings in the examinations. ular skeleton. On average children are expected to grow 5-6 cm and gain 2.5 kg per year until puberty, subject to gender Obesity in adolescence is a growing issue. One-third of elev- variations. To meet these needs, the UK health department en-year-old children in developed countries, in 2014 were recommends 340-400 IU/day of Vitamin D. The Endocrine obese. Nutritional choices in adolescence are questionable Society Clinical Practice Guideline and the IOM support the and it can be very difficult to accurately determine if suffi- need of supplementation with 400IU/day in this population. cient vitamin D containing foods are consumed. Additionally they recommend at least 15 minutes of uncov- ered forearm and leg exposure to sunlight between May- Obesity in adolescent children was found to have a faster September. exponential catalysis of 25(OH)D and parathyroid hormone compared to non-obese peers, especially females, increas- Holick et al., 2011, recommended that supplementation of ing the destruction of bone minerals. This signifies the im- 600–1000 IU/day should be considered if recommended portance of considering anthropometric measurement of daily sun exposures are not met. If the child is already defi- children when supplementing vitamin D and adjust this val- cient, they suggested a much higher dosage: 2000 IU/day of ue according to their BMI. vitamin D for at least six weeks or 50,000 IU of vitamin D2 once a week for at least six weeks in an attempt to normalize One of the most commonly associated deficiencies of vi- the blood level of 25(OH)D above 30 ng/ml. tamin D in the pediatric population is nutritional rickets. Rickets was first described in the mid-17th century.- Com Additional adaptations of this dosage should be based on mon signs and symptoms of nutritional rickets is insufficient dietary vitamin D intake and overall bodyweight. Lack of mineralization of bone and cartilage, resulting in bowing agreement is seen in the statement from the European of bones, stunted growth, and skeletal malformation. Thus Academy of Pediatrics (EAP) which still recommends 400 IU/ rickets is the result of disruption of appropriate endochon- day during the first year of life & 600 IU/day after the first dral ossification by not properly mineralizing the osteion. year of life (1–18 years). Two global epidemiological reviews on nutritional rickets found that calcium deficiency is also a major component in The age group 9–18 years old, commonly is faced with rapid nutritional rickets particularly in some African, Middle East- growth spurts and increased body mass, increasing the need ern and Asian countries, despite their dietary lifestyle and for dietary calcium and phosphorus to maximize skeletal sunshine exposure. mineralization and maturation. During puberty, reduction in physical activity is commonly observed in females according Rickets typically develops in infants three to 18 months of to the WHO Health Behavior in School-age Children survey age, if the problem is due to Vitamin D bioavailability. Rick- and this gender gap increases with age. When exercise is ets due to lack of serum calcium can be seen up to the age decreased, there is less axial compression to aid bone min- of 16. Rickets characteristically has two mechanisms: first, eralization. Similarly, if an inactive child enters a highly com- hypocalcaemia due to inappropriate gut absorption lead- petitive sport, they might be more vulnerable for fracture if ing to reabsorption of calcium from bones (can also lead to bone mineralization is out of balance. seizures or tetany). Secondly, alteration of parathyroid hor-

Page 10 | The IACP News | June 2020 mone can result in hyperparathyroidism, hypercalcemia, re- Although the recommendations vary slightly among orga- spiratory distress, muscular hypotonia, and skeletal demin- nizations, consensus occurs in the recommendation of 400 eralization commonly found in infants. The most effective IU/day in the infant and early childhood ages and 600IU/ diagnosis of rickets is done with the use of biochemical tests day in adolescent age population. Although these recom- and x-rays (disordered mineralization and ossification of the mendations are fairly straight-forward, the question that physes of long bones). we are called to answer as MSK clinicians, is whether these supplementation values are appropriate for the population 3) Is overdose a concern? we treat. For example, most of the pediatric population in developed countries is not likely to have been exclusively Supplementation of vitamin D is not completely without po- breastfed for the recommended time (only 42% globally are tential adverse effects. Some signs and symptoms are weak- breastfed to six months age or more). Further, 144 milion ness, nausea, loss of appetite, headache, abdominal cramps children globally have stunted growth and a further 38.3 and diarrhea. However, given that the pediatric population million are overweight. Add those to uncertain sun exposure is likely to be deficient, the recommended dosage is very and the risk for poor vitamin D status is high. Additional con- unlikely to cause toxicity. Based on the literature, it is under- sideration and adaptation of recommended dosages is es- stood that although the risk of overdosing of Vitamin D is sential in obese patients, malabsorption syndromes, or on possible, this is extremely unlikely. medications that interact with vitamin D absorption.

Discussion Therefore, it is important that we as clinicians take careful The purpose of this review was to improve understanding nutritional and physical activity histories of the pediatric of the recommendations for Vitamin D supplementation patient particularly regarding exclusive breast feeding, for- for the growing child’s musculoskeletal health, the required tified formula, nutrition and mean time of sunshine expo- dosages, and the factors in individual patients that affect sure, as well as if the family moved from a different location those dosages along with the risk of overdose in order to to current geographic latitude. Ideally, vitamin D deficiency better serve my patients. is diagnosed based on a blood test via the GP. If access to blood tests is difficult or isn’t the best first step, then the current ‘over the counter’ recommendation of 400 IU daily is indicated.

The WHO, in a position report in 2019, highlighted that not all health care practitioners are on board with supplementa- tion despite exclusive breast feeding and skin pigmentation considerations. The WHO is urging primary health clinicians to be familiar with daily recommended dosages, and to be vigilant in picking up early signs of vitamin D deficiency.

Wagner et al in 2008 urged pediatricians and health care professionals to make vitamin D supplements readily avail- able, considering the high likelihood of deficiency. Other authors support this point. Supplementation is now recom- mended to be initiated within the first few weeks of life and continue throughout childhood.

Fortunately, Vitamin D supplementation provides a cost ef- fective and easy way to tackle nutritional rickets and once again reduce its prevalence in the pediatric population around the world which will help safeguard the next gen- eration against adult conditions such as early osteoporosis. Despite the fortification of food, the standards are variable across the globe. Thus a revision of early supplementation with higher dosage should be investigated. A very small Continued on next page

June 2020 | The IACP News | Page 11 What are the effects of vitamin D interactions on the developing musculoskeletal system?

Continued from last page number of articles have been currently available where in- vestigation of 2000-5000IU/ day have been tested. This is a fast changing subject and thus results are subject to up- dates. We clinicians need to stay aware of this rapidly chang- ing data as it becomes available for the betterment of our patients.

Conclusion 125th Founder’s At present, 400-600IU Vitamin D supplementation is the dai- Day Celebration ly recommendation for the pediatric population based on at Palmer College of Chiropractic the large healthcare agencies. However, as primary care cli- Davenport, Iowa l Sept. 18–19, 2020 nicians, these values must be modified based on the history of each case. Anthropometric measurements, physical ac- For more information visit palmer.edu/chiropractic-125 tivity levels, dietary habits and sun exposure are key points that would significantly affect the correct recommendation and supplementation of Vitamin D. Correct advice can help reduce nutritional rickets in children and safeguard the de- The Trusted Leader in Chiropractic Education® veloping musculoskeletal system.

Journal of Clinical Chiropractic Pediatrics Accessible at www.JCCPonline.com

The Journal of Clinical Chiropractic Pediatrics (JCCP), is an open-access peer- reviewed journal published by the ICA Council on Chiropractic Pediatrics as a service to the profession and to help educate the public about chiropractic pediatric care. The JCCP is an excellent resource for DCs and parents looking for evidence-based management of pediatric and pregnant patients with chiropractic care.

“The sharing of scholarly papers, of research big and small, even of practitioners’ case reports is vital to developing clinical trials and larger research projects, “said Co-Editor Cheryl Hawk, DC, PhD. “The availability of these papers can have a significant impact in providing the evidence for chiropractic pediatric care and also making a difference in patient outcomes.” There journal is offered without charge.

Page 12 | The IACP News | June 2020 Vitamin D levels appear to play role in COVID-19 mortality rates Patients with severe deficiency are twice as likely to experience major complications

After studying global data from the novel coronavirus (CO- relation between vitamin D levels and cytokine storm — a VID-19) pandemic, researchers have discovered a strong hyperinflammatory condition caused by an overactive- im correlation between severe vitamin D deficiency and mor- mune system — as well as a correlation between vitamin D tality rates. Led by Northwestern University, the research deficiency and mortality. team conducted a statistical analysis of data from hospitals and clinics across China, France, Germany, Italy, Iran, South “Cytokine storm can severely damage lungs and lead to Korea, Spain, Switzerland, the United Kingdom (UK) and the acute respiratory distress syndrome and death in patients,” United States. Daneshkhah said. “This is what seems to kill a majority of COVID-19 patients, not the destruction of the lungs by the The researchers noted that patients from countries with virus itself. It is the complications from the misdirected fire high COVID-19 mortality rates, such as Italy, Spain and the from the immune system.” UK, had lower levels of vitamin D compared to patients in countries that were not as severely affected. This does not This is exactly where Backman believes vitamin D plays a mean that everyone — especially those without a known major role. Not only does vitamin D enhance our innate im- deficiency — needs to start hoarding supplements, the re- mune systems, it also prevents our immune systems from searchers caution. becoming dangerously overactive. This means that having healthy levels of vitamin D could protect patients against se- “While I think it is important for people to know that vitamin vere complications, including death, from COVID-19. D deficiency might play a role in mortality, we don’t need to push vitamin D on everybody,” said Northwestern’s Vadim “Our analysis shows that it might be as high as cutting the Backman, who led the research. “This needs further study, mortality rate in half,” Backman said. “It will not prevent a and I hope our work will stimulate interest in this area. The patient from contracting the virus, but it may reduce compli- data also may illuminate the mechanism of mortality, which, cations and prevent death in those who are infected.” if proven, could lead to new therapeutic targets.” Backman said this correlation might help explain the many Backman is the Walter Dill Scott Professor of Biomedical mysteries surrounding COVID-19, such as why children are Engineering at Northwestern’s McCormick School of Engi- less likely to die. Children do not yet have a fully developed neering. Ali Daneshkhah, a postdoctoral research associate acquired immune system, which is the immune system’s in Backman’s laboratory, is the paper’s first author. Backman second line of defense and more likely to overreact. and his team were inspired to examine vitamin D levels af- ter noticing unexplained differences in COVID-19 mortality “Children primarily rely on their innate immune system,” rates from country to country. Some people hypothesized Backman said. “This may explain why their mortality rate that differences in healthcare quality, age distributions in is lower.” Backman is careful to note that people should not population, testing rates or different strains of the coronavi- take excessive doses of vitamin D, which might come with rus might be responsible. But Backman remained skeptical. negative side effects. He said the subject needs much more “None of these factors appears to play a significant role,” research to know how vitamin D could be used most effec- Backman said. “The healthcare system in northern Italy is tively to protect against COVID-19 complications. one of the best in the world. Differences in mortality exist even if one looks across the same age group. And, while the “It is hard to say which dose is most beneficial for COVID-19,” restrictions on testing do indeed vary, the disparities in -mor Backman said. “However, it is clear that vitamin D deficiency tality still exist even when we looked at countries or popula- is harmful, and it can be easily addressed with appropriate tions for which similar testing rates apply. supplementation. This might be another key to helping pro- tect vulnerable populations, such as African-American and “Instead, we saw a significant correlation with vitamin D de- elderly patients, who have a prevalence of vitamin D defi- ficiency,” he said. ciency.”

By analyzing publicly available patient data from around Click here for the full story at ScienceDaily. the globe, Backman and his team discovered a strong cor-

June 2020 | The IACP News | Page 13 A key focus for your practice: Athletes

By Dr. Ray Foxworth, President of ChiroHealthUSA Some of the best athletes in history have relied upon chiro- Certified Medical Compliance Specialist practic care to reach new heights. Emmitt Smith, the Cowboys running back who holds the record for most NFL career rush- Most patients come into our offices with recent injuries, ing yards, used chiropractic treatment throughout his career. or not so recent, but they have finally become unbearable. Jerry Rice, widely acknowledged as the greatest NFL receiver Often, we are the last stop before surgery. Truthfully, the ever, said chiropractic was “key” to helping him stay on the patients who need us most are the ones in our communities field and have a lengthy career. Former heavyweight boxing who are the healthiest. champion Evander Holyfield routinely got three chiropractic adjustments a week and got adjusted before every fight. Athletes can rely on chiropractors to reach peak perfor- mance levels and minimize the stresses that sports and The Picture of Health? training can put on their bodies. This is especially important for youth athletes, with seasons lasting longer and training Chiropractic can help athletes who aren’t as healthy as they becoming more competitive. It’s more common to see adult- might appear. One fascinating paper that appeared in the type athletic injuries in our young patients such as a torn journal Sports Medicine argued that athletes, while seem- anterior cruciate ligaments (ACL), tendonitis, torn cartilage, ing to be the fittest and healthiest among us, actually are and torn rotator cuffs. The injuries these kids are sustaining not. Philip B. Maffetone and Paul B. Laursen argued that today have the potential to cause permanent damage that “coupled with our modern-day, highly processed, high gly- affects future joint stability. cemic diets, over-exercise can create or exacerbate chronic inflammation, oxidative stress, and compromised immunity. Concern about sports injuries, particularly the possibility Ultimately, these symptoms reveal an unhealthy athlete.” of concussions, are causing parents to rethink their child’s participation in sports activities. Athletes have options when Chiropractors, they argued, can bring a new level of health it comes to treating sports-related pain. They might choose and performance to athletes by removing imbalances thus the pharmaceutical path, but drugs can dull reaction times relieving stressors on the nervous system. Good posture, and can become addictive. They can choose surgery to re- muscle strength, and spinal health are all connected, so a pair damage, but that might leave them unable to perform spine out of alignment can and will affect physical perfor- for a lengthy time. Or, they can choose chiropractic treat- mance. ments, which can relieve or prevent pain and keep the body balanced, flexible, and able to perform at its peak. In a day and age where many youth athletes train like pro- fessionals, it has never been more important as a profession Chiropractic treatments are proven effective for a number to begin educating parents, coaches, and youth athletes on of sports ailments, including: the importance of recovering like a pro. Chiropractic care’s ability to bring the body back to its ideal state will prevent • Groin pain injuries, promote healing and repair, and allow athletes to • Tennis elbow maintain peak performance as they age. If made a regular • Back and shoulder pain part of a training regimen, it can help athletes reach new • Headaches from injuries to the head and neck heights in the competitive world of sports, giving them a • Ankle and knee injuries crucial edge that can be a key to victory at any age.

The Treatment Used by the Best Dr. Ray Foxworth is a certified Medical Compliance Specialist and President of ChiroHealthUSA. A practicing Chiropractor, To say that chiropractic treatment is proven as effective for he remains “in the trenches” facing challenges with billing, the issues listed above is an understatement. A recent study coding, documentation and compliance. He has served as estimated that 90% of world-class athletes depend on chi- president of the Mississippi Chiropractic Association, former ropractic care to reach peak performance and reduce and Staff Chiropractor at the G.V. Sonny Montgomery VA Medi- treat injuries. All NFL teams use chiropractors, as well as the cal Center and is a Fellow of the International College of Chi- majority of NBA, MLB, and NHL teams, and 72% of PGA golf- ropractic. You can contact Dr. Foxworth at 1-888-719-9990, ers. [email protected] or visit www.chirohealthusa.com.

Page 14 | The IACP News | June 2020 June 2020 | The IACP News | Page 15 IACP Marketplace

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Page 16 | The IACP News | June 2020 Idaho chiropractors, do you have something to sell, share, or advertise with your fellow practitioners? List it as an IACP classified ad. These ads will be listed online and included in the IACP newsletter for two months. Email your ad to:[email protected]

Practice for sale:Fabulous practice in Meridian ID! Contact: Dr. Ryan Griffeth, 2525 Stokesberry Pl, Suite B, Meridian, ID 83646, 208-955-6610, [email protected]

Associate Chiropractor — Great Pay With a Successful Team of Doctors; $50,000.00 – $200,000.00 per year. BE SUCCESSFUL IN CHIROPRACTIC! Looking to mentor a principled, ethical, and hard working Doctor who loves and wants to be successful in Chiropractic. Learn how to build a dynamic high-volume “relief and wellness” style family practice. You’ll be paid well with a base pay, bonuses, benefits, and a 401K. You’ll be trained to manage your patients while being supported by a group of successful Doctors. Located in Beautiful Meridian Idaho. Learn about us at Betterlifechiro.net . Call Dr Strickland at 208-989-1060

RESCHEDULED The IACP Annual Convention November 7-8, 2020 at The Grove Hotel

Join your fellow chiropractic colleagues for the rescheduled 2020 IACP Annual Convention November 7-8, 2020 at The Grove Hotel in Boise. The event will be filled with innovative presentations, networking opportunities, and discussions on our efforts to grow the chiropractic industry into the future. Early bird registration is open through September 26th, 2020. Our fresh and diverse set of speakers, along with our exhibition of industry partners, will provide you with professional development as well as applicable products and services to benefit your practice. Our CA track will focus on multiple areas of practice management, billing, coding, documentation, and audit protection. Book your discounted room at The Grove Hotel here. We will proceed with the conference, barring further government restrictions. If we must cancel, all registrants will receive a full refund.

June 2020 | The IACP News | Page 17 Chiropractic News

The Foundation for Chiropractic Progress How can you stop launches ambassador program tension headaches on your own?

The Foundation has launched an Ambassador Program, By Dr. Sherry McAllister, executive vice president, Founda- which entails an Ambassador, or group of Ambassadors, tion for Chiropractic Progress from each Group Member State Association to serve as feet on the ground promoting the value of chiropractic care in The outbreak of COVID-19 has forced many of us into self- local communities nationwide. quarantine to avoid getting sick. During this period, you may feel a little more stressed than usual. You’re likely working Ambassadors spearhead the Foundation’s marketing cam- and teaching your children in your living space. You may be paigns to further promote the value of chiropractic at the worried about your job or economic pressures. Or dealing grassroots level. The Foundation provides the Ambassadors with increased childcare and homeschooling. You may even with patient education and community outreach materials feel more significant strain on your mental health without to market chiropractic effectively throughout their State. the in-person social interactions with friends and family that you’re used to. As a special thank you, all Ambassadors receive a compli- mentary Gold Membership with the Foundation for their ac- This is a challenging time. This added stress and lifestyle tive engagement in helping to advance the profession. changes can lead to tension headaches, which feel like a tight pain around crown around your head. Tension head- If you or someone you know may be interested in becoming aches can be triggered by a few things including: an Ambassador, please email Marketing Manager Megan Gilson at [email protected] to see if you qualify. • Stress and anxiety • Staring at a computer or phone all-day • Poor posture • Sleeping on your stomach • Poor diet • Dehydration • Clenching your jaw

A chiropractic adjustment can help to reduce the tension in your shoulders and neck that may be causing the problem. However, if you are homeward bound for the foreseeable future, here are a few ways to manage your headaches on your own:

• Stretching exercises to help ease your pain • Daily exercise • Relaxation techniques like meditation or deep breathing • Using a heating pad on sore shoulder and neck muscles • Taking screen breaks • Practicing good posture • Getting enough sleep • Eating healthy and drinking plenty of water • Fresh air

Once you’ve started a routine of chiropractic care, a disrup-

Page 18 | The IACP News | June 2020 tion to your treatment plan can be hard on your body. Re- be offered as an alternative to opioids. Research has shown member to take care of your physical and mental health in repeatedly that chiropractic care may have a profound effect the best way you can. on those with back pain. One recent study, which included data from six smaller studies, stated that people who saw a Advances in the Management of Traumatic chiropractor were 64% less likely to use opioids than people Injuries distance learning course June 27-28 who didn’t, researchers reported in the journal Pain Medi- cine. The Advances in the Management of Traumatic Injuries (AMTI) is a new program offered by the Council of Applied New York State’s pilot program, authorized in the recent Chiropractic Sciences of the International Chiropractors As- state budget, will get the final green light once Medicaid ap- sociation. AMTI is designed to educate chiropractors on proves the program. The program provides for “non-phar- up-to-date evidence-based subluxation identification and macologic treatments such as acupuncture and chiropractic management due to spinal injuries. This 80-hour, 6 module services as an alternative to opioid treatment for individuals program will help maximize patient recovery, instruct how suffering from chronic lower back pain.” to properly document injuries and use the most relevant clinical practice guidelines to support care plans. Upon com- The council views the pilot program as part of its wider ef- pletion, candidates will receive a certificate. forts to highlight chiropractic care and position chiropractic as a first choice before even receiving a prescription for opi- AMTI Module 3 is all about imaging for your patients that oid care, says Dr. John LaMonica, one of the three area chi- come in with traumatic injuries. We will hear from 3 experts ropractors who has been meeting with legislators and testi- in the field of traumatic injury imaging and documentation- fying at various New York State Joint Senate Task Force on Dr. Joe Betz, Dr. Cliff Tao and Dr. Joseph Ugorgi during this 2 Opioids, Addiction & Overdose Prevention hearings across day, 13 hour webinar. the region. Following months of effective advocacy by the council, the pilot program was negotiated into the gover- Module 3 will be a detailed overview of the traumatic inju- nor’s budget bill and will be developed within the confines ries to the cervical, thoracic and lumbo-pelvic spine. These of Medicaid to offer chiropractic care, and other non-phar- are the most common injuries that present to the chiroprac- macological options such as acupuncture, as an option to tic office and are often described as “sprain/strain” inju- opioids. The program targets patients with low back pain. ries. Under representing these injuries is perhaps the most common mistake made in chiropractic clinical practice. This Reducing the transmission of SARS-CoV-2 course will teach doctors to look beyond the muscle strain and neck pain diagnoses to more thoroughly determine the Respiratory infections occur through the transmission of vi- true extent of soft tissue damage including ligamentous in- rus-containing droplets (>5 to 10 μm) and aerosols (≤5 μm) stability, disc injury, facet joint injury, etc., that occur from exhaled from infected individuals during breathing, speak- motor vehicle collisions. Participants will learn proper imag- ing, coughing, and sneezing. Traditional respiratory disease ing techniques including analysis for ligamentous instability control measures are designed to reduce transmission by on X-rays, as well as when to refer for the various types of droplets produced in the sneezes and coughs of infected MRI and CT scans. Proper documentation and a review of individuals. However, a large proportion of the spread of applicable clinical practice guidelines will be reviewed to coronavirus disease 2019 (COVID-19) appears to be occur- help bolster the clinical decision-making process. ring through airborne transmission of aerosols produced by asymptomatic individuals during breathing and speaking. Click here for more information or to register for this Zoom Aerosols can accumulate, remain infectious in indoor air for webinar. hours, and be easily inhaled deep into the lungs. For society to resume, measures designed to reduce aerosol transmis- New York State recognizes chiropractic sion must be implemented, including universal masking and as a top choice against opioid abuse regular, widespread testing to identify and isolate infected asymptomatic individuals. In April, New York State made a progressive move against opioid abuse, which also brought chiropractic to the fore- Humans produce respiratory droplets ranging from 0.1 to front of options for care. The New York Chiropractic Coun- 1000 μm. A competition between droplet size, inertia, grav- cil announced that the state’s 2020-21 budget establishes ity, and evaporation determines how far emitted droplets a new Medicaid pilot program in which chiropractic must Continued on next page

June 2020 | The IACP News | Page 19 Chiropractic News

Continued from last page alveolar region of the lungs, where immune responses seem to be temporarily bypassed. SARS-CoV-2 has been shown to and aerosols will travel in air. Respiratory droplets will un- replicate three times faster than SARS-CoV-1 and thus can dergo gravitational settling faster than they evaporate, con- rapidly spread to the pharynx from which it can be shed be- taminating surfaces and leading to contact transmission. fore the innate immune response becomes activated and Smaller aerosols (≤5 μm) will evaporate faster than they can produces symptoms. By the time symptoms occur, the pa- settle, are buoyant, and thus can be affected by air currents, tient has transmitted the virus without knowing. which can transport them over longer distances. Thus, there are two major respiratory virus transmission pathways: con- Identifying infected individuals to curb SARS-CoV-2 trans- tact (direct or indirect between people and with contami- mission is more challenging compared to SARS and other re- nated surfaces) and airborne inhalation. spiratory viruses because infected individuals can be highly contagious for several days, peaking on or before symptoms In addition to contributing to the extent of dispersal and occur. These “silent shedders” could be critical drivers of the mode of transmission, respiratory droplet size has been enhanced spread of SARS-CoV-2. In Wuhan, China, it has shown to affect the severity of disease. For example, influ- been estimated that undiagnosed cases of COVID-19 infec- enza virus is more commonly contained in aerosols with tion, who were presumably asymptomatic, were responsible sizes below 1 μm (submicron), which lead to more severe for up to 79% of viral infections. Therefore, regular, wide- infection. In the case of severe acute respiratory syndrome spread testing is essential to identify and isolate infected coronavirus 2 (SARS-CoV-2), it is possible that submicron vi- asymptomatic individuals. rus-containing aerosols are being transferred deep into the Click here to read the full article, published in Science, May 2020 by Kimberly A. Prather, Chia C. Wang and Robert T. Schooley.

Covid-19 can spread by traveling in small particles called aerosols

By now, we’re used to staying six feet from others, per so- cial-distancing recommendations. For months, public health experts have described the virus as being primarily trans- mitted through droplets from an infected person’s cough or sneeze to nearby people or surfaces. Lately, research and discussion has focused on airborne transmission over longer distances. Some scientists say covid-19 can spread by travel- ing in small particles called aerosols.

A recent study of an incident that took place at a restau- rant in China, where the virus originated, found nine people were infected with covid-19 by a diner sitting near an air- conditioning vent. A study of the transmission, published in a Centers for Disease Control and Prevention journal, showed how one diner infected diners at adjoining tables, as droplets containing the virus were apparently carried by the air conditioning. Four people at the person’s table later tested positive for covid-19, as well as five people at neigh- boring tables, some as far as 14 feet away.

Page 20 | The IACP News | June 2020 June 2020 | The IACP News | Page 21 Chiropractic College News

Plan to attend the 125th Founder’s Day Texas Chiropractic College Annual Convention celebration at the Chiropractic Fountainhead is moving online!

Chiropractic began with D.D. Palmer’s belief that spinal Now offering a mix of prerecorded and live webinars! Prere- alignment could lead to overall healing and well-being. In corded will be available starting July 23, 2020. Live webinars 1895, D.D. Palmer adjusted Harvey Lillard in downtown Dav- will be available Friday, July 24 and Saturday, July 25. Texas enport, Iowa, and the chiropractic profession was born. Chiropractic College’s Annual Convention offers DCs from around the U.S. professional development opportunities The chiropractic profession has come a long way since 1895, and dynamic sessions. The convention offers 8 hours of CE and 2020 will offer a worldwide celebration of all that chi- each day, including the 4 mandatory TBCE hours. ropractic offers: a world of unlimited health and potential. With more than 70,000 chiropractors in the U.S. alone, the Click here for more information or to register. profession has earned broad acceptance from the public and in national health-care systems for its conservative ap- proach to spinal care. Chiropractors make a difference in lives of veterans and active military members, sports profes- sionals and community members in all stages of life.

According to a 2016 Gallup-Palmer Report, 95% of past-year chiropractic users say it’s an effective form of pain relief. In the same year the Centers for Disease Control and Preven- tion released new guidelines for prescribing opioids that in- stead promote non-pharmacologic alternatives – including Logan launches Doxy chiropractic care – for the treatment of chronic pain. The telehealth technology for patient care American College of Physicians updated its guidelines for the treatment of acute and chronic low-back pain to recom- In the midst of the coronavirus pandemic, Logan University mend first using non-invasive, non-drug treatments like chi- is ensuring its Health Centers are able to deliver chiroprac- ropractic before resorting to drug therapies. tic care to patients while adhering to state mandates and guidelines from the Centers for Disease Control and Pre- Let’s leverage the 125th anniversary of the profession to vention. Logan has launched Doxy, a HIPAA-compliant tele- join forces and promote the benefits of chiropractic like health tool that allows chiropractic clinicians to meet with never before. Throughout 2020, share your stories of heal- patients via video conferencing. Using a mobile device or a ing, inspiration and celebration on social media and beyond, desktop computer, patients can ask questions to a clinician and be sure to use #chiropractic125.Everyone in the profes- without having to leave their home. sion is invited to attend the 125th Founder’s Day Celebration at Palmer College of Chiropractic held Sept. 17-19, 2020 in Telehealth was already on the rise in recent years, however the Quad Cities. The celebration will include speakers, social COVID-19 has accelerated the industry and its ability to pro- events, and continuing-education for current chiropractors. vide safe care to patients around the world. Find event schedules, sponsorship opportunities and the 125th celebration brand toolkit at www.palmer.edu/chiro- Vincent DeBono, DC, CSCS, vice provost of innovation and practic-125 new ventures at Logan, said telehealth does two things: It allows Logan’s chiropractic clinicians to continue to provide essential care and check the progress of a patient, andit gives patients greater access to chiropractic without risking their health and safety. So, how does telehealth work for chiropractic?

Page 22 | The IACP News | June 2020 “During a video conference, a clinician will ask you a series hours of Upper Extremities and 12 hours on Lower Extremi- of questions to get a better idea of the nature of your symp- ties. Extremities are one of the most treated areas on a pa- toms, and they may ask you to point to where on your neck tient. The Activator Extremity course is highly detailed, and or back you feel pain,” Dr. DeBono explains. “The clinician gives very practical information. Please contact your local may also ask you to move a body part or apply light pres- state board to find out if they accept online programs and sure to assess if these movements exacerbate or relieve the how many hours they allow. Each 12 hour module is only symptoms. This information will help the clinician - deter $399.00. mine if the patient should first attempt home therapy – such as applying ice or heat, performing directional movements Click here for more information. to reduce pain, or beginning a series of therapeutic exer- cises – or if the patient should arrange for a physical office New York Chiropractic College visit since the symptoms require further investigation or a to hold virtual open house July 17. hands-on treatment. While in general, chiropractic is more hands-on than other health care disciplines, in these times Due to the current pandemic situation, NYCC is unable to of social distancing the risk versus benefit of a physical office host any on campus open houses. However, there are sever- visit should be weighed against the many ways our clinicians al virtual opportunities in order to share information about can provide quality care and guidance via telehealth to offer our campus and NYCC’s Doctor of Chiropractic Program. Join temporary relief.” us for a Chiropractic Virtual Open House from 3:30 p.m. to 5 p.m. on July 17, 2020. Learn more and register today. Currently, Logan clinicians can use Doxy with any patient in Missouri. Monday through Friday from 10 a.m. to 5 p.m., pa- NYCC in-person/on-campus Doctor of Chiropractic Open tients can log onto Logan’s Health Center homepage and im- House will let you meet your future classmates and profes- mediately ask questions to an on-duty clinician (wait times sors; tour our beautiful campus in the heart of New York’s may vary based on patient call volume). During the video Finger Lakes; ask questions about applying, financial aid, conference, a clinician can upload documents and send vid- and registration; and get hands-on demonstrations in our eos to a patient, or invite another clinician into the video classrooms and labs. conference for consultation. Or you can join us from the comfort of your own computer While the tool addresses a timely concern of the pandemic, for an ONLINE Open House for our M.S. in Applied Clinical it also provides an opportunity to those who may be new to Nutrition and M.S. in Human Anatomy and Physiology In- chiropractic, says Dr. DeBono. “It gives patients the chance struction programs. These virtual events feature demonstra- to speak to and see a chiropractor before even coming in tions, time with NYCC students and faculty, question and for an appointment. Providing someone the ability to ask answer sessions, and more. Bonus: NYCC will hold a Virtual questions and get to know their chiropractic physician at the Doctor of Chiropractic Open House, too! start is so valuable in the doctor-patient relationship as we establish a foundation of trust.” Annual WAVE conference comes home to Life West August 21-23 Click here to learn more. Life West is continuing to prepare for the WAVE 20, which Logan postgrad offers online will have a new home this summer. The school’s premier chi- activator technique courses ropractic conference will take place on the Life West campus in Hayward, California from Aug. 21-23. Logan University Postgraduate Department is pleased to an- nounce it is offering the first in a series of online Interactive WAVE organizers are monitoring the COVID-19 pandemic, Virtual Training courses on the Activator Technique. There which prompted a “shelter in place” order for Northern Cali- are a total of 36 hours of CE credit, with each module being fornia’s Bay Area in early March. The Life West administra- 12 hours. tion is continuing to make plans for the WAVE while keeping an eye on public health mandates, which are changing fre- The first module is the Basic Scan Protocol of the Activator quently as we move through the pandemic. Method. The Basic Scan will take you on a tour of why Ac- tivator works, and how to perform adjustments across the “In this unprecedented time, it helps for us to look to the body. The next two 12 hour modules are on Extremities: 12 Continued on next page

June 2020 | The IACP News | Page 23 Chiropractic College News

Continued from last page luncheon on Saturday, Aug. 22. The luncheon will take place in the Life West library. future and keep some normalcy in our lives,” said Life West President Ron Oberstein, DC, in an email sent to Life West Mark your calendars for the WAVE 20, Aug. 21-23. Follow alumni and friends. “The WAVE is the perfect vehicle to cel- us on Facebook and Life West’s other social channels for ebrate our great profession and its 125th birthday. Moving updates, and visit wave.lifewest.edu for more information our profession to new heights can only be done together. closer to the event. Join me at the WAVE so we can learn, share and rejoice with one another.” Amy Spoelstra, DC, receives Distinguished Service Award from Sherman College of Life West’s staff is already hard at work, planning and pre- Chiropractic paring to roll out on-campus improvements ahead of the WAVE. Construction is set to begin this summer, and the Coeur d’Alene , ID, chiropractor pending expansion will allow the Life West gymnasium to be Amy Spoelstra, D.C., has been reshaped into the WAVE’s exhibit hall with improved capaci- honored with the Distinguished ty in that area. Speakers will present in the Standard Process Service Award from Sherman Assembly Hall, and additional educational sessions will take College of Chiropractic in Spar- place in other large classrooms on campus. tanburg, SC. This award is given to Sherman graduates who have The program of WAVE events offers a wide range of educa- distinguished themselves with tional and inspirational opportunities for chiropractors. The service to the community, the Life West stage will host two full days of presentations from profession, and Sherman College. world-class chiropractors Aug. 21-22, and the school will also host an X-ray program led by faculty members Jamie Dr. Amy Spoelstra graduated from Sherman College of Chi- Motley, DC, DACBR, and Bryan Gatterman, DC, DACBR, on ropractic cum laude in 2008. She is creator of the Focus Sunday, Aug. 23. Chiropractors can earn up to 20 CE hours, program, a multi-pillared approach to neuro-deflective be- with 18 coming from WAVE seminars and two more from haviors associated with developmental, behavioral, social- online sessions. ization, and learning challenges in children and adults. She is founder of the Neuro-Deflective Retraining Method, Fo- Friday night’s festivities will include a block party held to cus Educational Seminars, Focus AcademyTM and the Brain honor the memory of Jeanne Ohm, DC. Dr. Ohm, a member Blossom ProgramTM. She is also the founder of Focus Edu- of the Life West Board of Regents, passed on in late 2019. cational Services, where she trains and consults other doc- She was also a past president of the International Chiro- tors around the country in the Focus model and how to lead practic Pediatric Association. Returning alumni will also with brain development making the case for chiropractic. have several events to attend. Life West will hold its annual alumni reunion on Thursday, Aug. 20, as well as an alumni Dr. Spoelstra co-founded Navigate Your Healing, an online platform designed to assist parents and families affected through the overwhelming and often isolating effects of neurodevelopmental disorders in children. She created the FOCUS program in her practice in 2011, and since that time has been helping children and adults with neurodevelop- mental disorders in Coeur d’Alene, ID, and throughout the northwest.

Sherman College named its 2020 award recipients as part of Lyceum, a homecoming and continuing education event -at

Page 24 | The IACP News | June 2020 tended by hundreds of chiropractors and students through- of-the-art learning and study environment. out the U.S. and internationally. Lyceum is held each May Learning Commons Exterior and involves three days of seminars, special events and oth- er programs; this year’s Lyceum was held as a live-streaming “Chiropractic has become an integral part of health-care event for the first time ever to preserve this crucial continu- teams, causing significant job growth for the profession ing education opportunity for Doctors of Chiropractic. More and an increased demand for high-quality chiropractic edu- than 700 people participated. cation,” said Dennis Marchiori, D.C., Ph.D., chancellor and CEO, Palmer College of Chiropractic. “This grant will allow Life University wins communicator award Palmer to continue to carry out its tradition of delivering the leading educational experience for future chiropractors.” The Life University (LIFE) Marketing Department is among the winners of the 26th Annual Communicator Awards, Over the past decade, Palmer College has invested more than which recognize “big ideas in marketing and communica- $50 million in capital improvements on its main campus in tions.” LIFE was honored with an Award of Distinction in the Davenport, Iowa. Palmer is focused on student success and category of Social Responsibility for its video about the Uni- has additional capital improvement projects planned over versity’s guiding principle, Lasting Purpose. The two-minute the next five years that will ensure Palmer graduates can video, produced by Lavender Digital, highlights some of change lives as successful chiropractors all over the world. LIFE’s key departments, including Athletics and the Center for Compassion, Integrity and Secular Ethics (CCISE). More than 900 students are enrolled at Palmer’s main campus, and with planned campus enhancement projects You can view the award-winning video here. the College estimates that enrollment will increase to 1,200 students in the coming years. Life University is a health sciences institution most known for its Doctor of Chiropractic program, the largest single- campus chiropractic program in the world. LIFE also offers 15 undergraduate degrees as well as a pre-chiropractic, degree-seeking pathway. Three graduate degrees are avail- able, encompassing areas of sport health science, clinical nu- trition and positive psychology. Some degree programs are offered to distance learners through the College of Online Education. LIFE’s campus in Marietta, Georgia, just north- west of Atlanta, is home to more than 2,700 undergraduate, graduate and professional students who come from all 50 United States and more than 45 countries. An exterior rendering of the proposed Learning Commons, show- The Communicator Awards are sanctioned and judged by ing the view looking south from Brady Street. the Academy of Interactive & Visual Arts, an invitation-only group consisting of top-tier professionals from acclaimed media, communications, advertising, creative and market- ing firms. The awards, which receive more than 6,000 en- tries, are one of the largest competitions in the world. The IACP News Palmer College of Chiropractic accepts press releases and news items! awarded $100,000 development grant Please send your news to: A $100,000 grant awarded to Palmer College of Chiropractic by the Regional Development Authority (RDA) will support Steve at C&S Publishing, campus enhancement plans that will help ensure current and future students have a top-of-the-line learning experi- [email protected] ence. This is the largest grant ever awarded to Palmer by the RDA. One of the first major projects to be undertaken is a Learning Commons which will provide students with a state-

June 2020 | The IACP News | Page 25 Office Posters We have created a FREE printable PDF of the Go outside and get the benefits of vitamin D poster on the following page, and the following posters are available online:

Ways to keep moving with join pain Basic Coronavirus protective measures The drug-free approach to pain reduction Get up and move! STRETCHING for better joint health Yoga and pilates may help with chronic back pain Were you pain free this morning when you got out of bed? Tips for safe stretches Don’t let pain keep you from enjoying life Sleep like a baby for better health 7 simple steps to a longer, healthier life 7 ways to reduce stress and keep blood pressure low

Please feel free to print out and use any or all of the flyers. Or, make them available as handouts to your patients. They are available on the website, www.IACPnews.com in an easy to print format. Each has the following tagline:

This healthy living information is provided by your Doctor of Chiropractic and the Idaho Association of Chiropractic Physicians (IACP) .

Page 26 | The IACP News | June 2020 Go outside and get the benefits of Vitamin D

Vitamin D is sometimes called the “sunshine vitamin” because it’s produced in your skin in response to sunlight. Sunlight is the most important source of vitamin D. It’s a fat-soluble vitamin in a family of compounds that includes vitamins D-1, D-2, and D-3. Your body produces vitamin D naturally when it’s directly exposed to sunlight. Vitamin D has several important functions. Perhaps the most vital are regulating the absorption of calcium and phosphorus, and facilitating normal immune system function. Getting a sufficient amount of vitamin D is important for normal growth and development of bones and teeth, as well as improved resistance against certain diseases. If your body doesn’t get enough vitamin D, you’re at risk of developing bone abnormalities such as soft bones (osteomalacia) or fragile bones (osteoporosis). Here are three benefits of vitamin D:

1. Vitamin D fights disease In addition to its primary benefits, research suggests that vitamin D may also play a role in: • reducing your risk of multiple sclerosis, according to a 2006 study published in the Journal of the American Medical Association; • decreasing your chance of developing heart disease, according to 2008 findings published in Circulation; • helping to reduce your likelihood of developing the flu, according to 2010 research published in the American Journal of Clinical Nutrition.

2. Vitamin D reduces depression Research shows that vitamin D might play an important role in regulating mood and warding off depression. In one study, scientists found that people with depression who received vitamin D supplements noticed an improvement in their symptoms. In another study of people with fibromyalgia, researchers found vitamin D deficiency was more common in those who were also experiencing anxiety and depression.

3. Vitamin D boosts weight loss Consider adding vitamin D supplements to your diet if you’re trying to lose weight or prevent heart disease. Some scientists say the calcium and vitamin D have an appetite-suppressing effect. In one study, overweight people who took a daily vitamin D supplement improved their heart disease risk markers. Better yet, go outside into the sunshine and take a daily walk. You will be surprised at how good you feel.

This healthy living information is provided by your Doctor of Chiropractic and the Idaho Association of Chiropractic Physicians (IACP) . June 2020 | The IACP News | Page 27 The Idaho Association of Chiropractic Physicians The IACP News Display Advertising Policy, Rates and Information

The Idaho Association of Chiropractic Physician’s IACP News is a full-color digital newsletter, published monthly and distributed to member doctors of chiropractic across Idaho as well as out-of-state members and student members. Format: The IACP News is produced in a state-of-the-art digital format. It can be opened and viewed online from both the IACP website at https://iacp.wildapricot.org/ and also from the publication site: www.IACPnews.com. The publication site has both current and back issues ofThe IACP News. Questions about the digital format, the website, or display advertising should be directed to C&S Publishing at [email protected]. Classified Ads:IACP accepts classified ads. They are published without cost for IACP members, but can also be purchased for $100 by non-members. For additional information about placing a classifed ad, contact Caroline Merritt, IACP Executive Director at (208) 515-6263 or [email protected].

Ad Sizes and Rates: IACP reserves the right to determine position and placement of all advertising. Special positioning may be purchased for an additional 20% if space is available. Inside Cover and Back Cover are charged additional 20% for special positioning. 15% off these rates for IACP Members.

Ad Type Ad Size 1 run 3 runs 6 runs 12 runs

Full page (bleed) 8 5/8” wide by 11 1/4” tall $450 $414 $378 $330 Full page (boxed) 8” wide by 9 3/4” tall $450 $414 $378 $330 Half page 8” wide by 4 3/4” tall $267 $264 $224 $190 One Third (V) 2 3/8” wide by 9 3/4” tall $190 $174 $159 $140 One Third (H) 8” wide by 3 1/8” tall $190 $174 $159 $140 Quarter Page 3 7/8” wide by 4 3/4” tall $160 $146 $134 $115 One Sixth 3 5/8” wide by 2 7/8” tall $105 $97 $88 $75

Rates are for full color ads per insertion. Ads published under a multi-run contract can be changed for each issue at no additional cost. Flash animation (.swf files), animations (.gif format) and video clips can be added to any ad. There is no extra charge for video clips or multi-media in ads unless “assembly” of the ad is required. Some file size limitations apply. For details contact [email protected]. Email camera-ready ads in high resolution Adobe Acrobat (.pdf) format to: [email protected]. Ad creation and graphic design services are available through C&S Publishing at no additional cost. Acceptance of Advertising: IACP reserves the right to refuse any advertisement with or without reason or explaination including any ad that, in the opinion of IACP, is unethical, makes extravagant claims, misrepresents, is unfair or harmful to other advertisers; violates postal, anti-trust or U.S. currency regulations; or is deemed inconsistent with the objectives of the IACP.

The IACP News is produced for the IACP by C&S Publishing Phone: 916-729-5432 • Email: [email protected] Page 28 | The IACP News | June 2020