Chris DeBari:
A lot going on, up-and-coming, and as you can see for what I do for a living, certainly a lot of people, a lot of cars, and a lot of injuries that occur.
Dr. Dale Hanson:
Yeah. Traffic seems to get worse and worse and there’s a ton of construction, whether it’s here or Orlando, it’s just Florida’s growing.
Chris DeBari:
Sure, sure. It leads to a lot of situations where people find themselves in need of your services, and like you, I don’t cause accidents. I’m not happy that people get into accidents but the fact is they happen, and that’s why I’m here to provide my service. And one of my mottos is, “It’s personal to me because it’s personal to you,” and I try to live by that by providing excellent personal service to my clients. But one of my other mottos is, “Just because I gave you my business card doesn’t mean I want something bad to happen to you.” So obviously it’s going to happen whether we like it or not, but thank goodness there are practitioners like yourself that can help. So tell us a little bit about your approach to what you do.
Dr. Dale Hanson:
Okay. Well, especially in regards to motor vehicle accidents and trauma, my job is to get you back to pre-accident status or, if I can, better. So we’re not only talking about getting you out of pain, although that’s usually the first priority, but we’re talking about restoring you to function. So we’re wanting to get you back to where you can enjoy life and you have the mobility to pursue the things that you want to pursue.
Chris DeBari:
Oh, that’s great. Actually, we have a couple of guests stopping in. My mother is watching. Hey mom, how are you doing? Thank you for watching.
Dr. Dale Hanson:
I’ll have to send this to my parents, too.
Chris DeBari:
Absolutely, absolutely. So tell us what motivated you to become a chiropractor in the first place? I mean, I’m sure there are many of other things you could have done. Why did you choose chiropractic?
Dr. Dale Hanson:
It’s kind of an interesting story. This is funny that you asked me this because we haven’t spoken about this before. When I was an undergrad, I had to compare and contrast… I was going to go into the medical field. I always liked the health sciences. So I had to talk to a few different people whose basically mindset would be comparative but also contrasting a little bit. And there happened to be a neurosurgeon who lived across the street from me in my neighborhood, and there was also a chiropractor.
Dr. Dale Hanson:
So I went and talked to both of them, and they were both very intelligent, well-spoken people, but the chiropractor was more along the lines of getting people, instead of compartmentalizing the body, to talking about how it works and adjusting synergistically as a whole. Whereas in Western medicine, we tend to take things into compartmentalize like cardiologists only with the heart, pediatrists only with the foot, but the foot needs a blood supply, too. So being able to synergistically put everything together as a functioning whole, that made more sense to me.
Dr. Dale Hanson:
And then there was also the fact that I remember watching 60 Minutes, and there was a whole thing about an Alzheimer’s medication. There was different, basically, supplements that tended to work very well, but nobody would really market them because there wasn’t a whole lot of money to be made, even though they had less side effects. To me, that was just not really in keeping with what I wanted to do in the field of the healing arts. So if there’s a way to less-invasively and more naturally help somebody to heal, then that’s what I wanted to pursue.
Chris DeBari:
So the allopathic route, despite your degree in biology, you could have become pretty much anything with that, but you chose not allopathic but rather a holistic approach to healing people.
Dr. Dale Hanson:
Yeah. And I mean there’s a place for every part of medicine, whether it’s surgery or medicine. This just seemed to be more along the lines of what I wanted to pursue. I was also really into nutrition and then weightlifting and athletics. So there was always a chiropractor or physical therapist around. So I got more of a chance to talk to those guys, and that just kind of led me down this path.
Chris DeBari:
Sure. And in my experience, as a former athlete and a former injured athlete from time to time, I always seemed to get a lot more value out of the time I spent with my chiropractor and my physical therapist than I ever did with my M.D. And a lot of the things that were employed were really particularly effective at helping get back to playing, a lot of really great techniques. Now, as far as automobile accidents, and that’s mainly what I do in my practice, as far as those patients that you treat, what would you say the percentage of auto cases in your practice would be compared to, say, managed care or other things?
Dr. Dale Hanson:
It’s about half and half. We’ll work with anybody who wants to work with us, whether it’s insurance or accidents or cash patients. It doesn’t really matter where they come from. Try to assess them individually and do what we can to get them the results that they’re looking for. That’s why I spend a lot of time initially trying to figure out what it is that the patient’s trying to accomplish before we start developing a treatment plan for them.
Chris DeBari:
Now, do many of the patients that you see, are they following up with you after an emergency room visit?
Dr. Dale Hanson:
Yeah, sometimes they’re coming here after the ER. Sometimes they realize they’re not bleeding to death and they’re just a little shaken up and they just want to go home. So it kind of depends on the person. I’ve seen people come in with more severe trauma who didn’t go to the hospital sometimes and people who had less severe trauma who did. So it really depends on how the person was. For instance, one of my friends, we became friends after I was treating him for a while. But he was more concerned about his dad who was in the car, who shattered his arm, needed nine pins in his arm, so he was more concerned about taking care of him. He took his dad to the hospital. He got no treatment himself until six months later. Then he’s like, “I’ve been living with this for six months. I never took care of myself.” Didn’t go to the hospital. Ended up having some pretty severe injuries. But, again, it kind of depends on the individual.
Chris DeBari:
Now, what are some of the tools that you’re able to rely upon to help you in diagnosing and treating patients that might be different from what, say, the hospital would do? Or how is your approach different from an ER physician’s toward getting people well?
Dr. Dale Hanson:
ER physicians are really good at making sure that you’re going to live. They’re really not geared towards physical therapy or making sure that you regain your mobility or regain your functionality or your strength. So that’s where we come in. We make sure that… On top of making sure nothing’s broken, and if they haven’t had x-rays, we’ll get x-rays if need be. And I like to take flexion extension x-rays, too, so I see how things are moving. And the other thing, too, is along the course of treatment, especially if they have pain that travels, we like to get an MRI so we can assess the soft tissue damage, how severe that is and to what extent we might have to either treat them differently here in-house, or maybe refer them out to an orthopedic surgeon or a neurosurgeon and make sure their care is managed appropriately amongst a group of people.
Dr. Dale Hanson:
So it’s nice that I have a lot of other doctors to work with, as well, after the triage and after we know that they’re not immediately going to die. Then to get them back to health, that usually takes a team effort and kind of a multi-stage approach. So we have multiple phases of care here where we can first get them out of pain. Second, make sure we know exactly what’s going on diagnostically with the proper imaging, and then get them exercising and mobile and get them back to where they were pre-accident.
Chris DeBari:
Now, I guess obviously it’s necessary sometimes to go to the emergency room, particularly when dealing with injuries to the neck and the head-
Dr. Dale Hanson:
Oh, absolutely.
Chris DeBari:
… I mean, and lungs and back and all that. But as far as the tools used in the ER, it’s generally going to be an x-ray and a CT scan, but those are really just… The CT is just an x-ray.
Dr. Dale Hanson:
Yeah, axial slices of an x-ray. I think part of the reason why they do that, too, is an MRI is magnetic. So if you have a patient who you can’t get a history on, because they’re not conscious, you don’t know if there’s anything metallic or anything that might be damaged by that magnetic field. So that’s just a, I think, pretty much standard of care. And it gives you a good image, but the gold standard for soft tissue is currently MRI.
Chris DeBari:
So yeah, the CT is not going to give you everything you need to see, but at least it’s what they know that they can do safely for the patient at that point in time.
Dr. Dale Hanson:
Safely, quickly, and it gives them a pretty comprehensive view to make sure that the patient is at least stable.
Chris DeBari:
Now, one of the more interesting and intricate areas of these types of injuries, and something we see frequently, is injury to the head. Closed head injury, sometimes traumatic brain injury, so basically I’m talking about what would you recognize as a concussion. So how do you approach concussions as opposed to what the emergency room physicians are able to do in the emergency room? How does it differ?
Dr. Dale Hanson:
Well, initially, you’re going to be looking for, whether it’s a fracture or an intercranial bleed, something that’s going to be an acute, immediate, life-threatening type of thing. So once they rule that out, there’s not a very good objective test for concussions, and you don’t even have to hit your head. The inside of your brain, actually, with a whiplash-type injury can just hit the front and back of your skull, and that can cause concussions as well. So some people don’t even realize they’ve had a traumatic brain injury because they didn’t hit their head. They just whipped their head forward fast enough.
Dr. Dale Hanson:
So what we do is, over time, we look for changes in behavior, changes in sleep patterns. A lot of times family will be first to notice this because you don’t always have the best view of yourself. Sometimes someone on the outside will give you a better opinion like, “Why are you behaving differently? Why are you…?” So we’ll talk to family members if we have permission, too, just to see how they’re getting along in their everyday life. That’s a really good indicator of… Especially sleep patterns, behavioral changes. These types of things are more of an indicator.
Chris DeBari:
Now, what are you able to do for those types of injuries that are not brain bleeds and do not involve skull fractures and things like that? I mean, obviously there’s a whole gamut of head and brain injury that’s sort of beneath that in severity, yet serious nonetheless. And how are you able to approach helping people with those problems?
Dr. Dale Hanson:
It’s going to depend on the severity. One of the things that I do is I want to make sure that I work closely with the neurosurgeon or a neurologist to see if you know that we’re in agreement as far as what the treatment plan is going to be for this person. One of the other things that really helps, too, is just getting somebody out of pain so that they can get back to a normal routine as far as sleep is concerned. That really helps your body to heal, just in general. So one of the first things we need to do is make sure that we get them out of pain. And one of the things that we do that’s different, chiropractically, is we try to do that without medications. They have their place, but you don’t have pain because of a lack of Tylenol. You don’t have pain because of lack of narcotics. So it’s usually something that masks the symptom as opposed to something that’s actually fixing the problem.
Dr. Dale Hanson:
So we try to make sure that we get them moving properly and sleeping properly. And this is one of the things that chiropractic does. Movement inhibits pain. So after an accident, people are a lot less likely to move normally, to move naturally. And without that natural motion your pain threshold will start to drop, and things that weren’t painful before, now they’re painful. So if we can just get those areas moving and get you stretching and even do things like some of the physical therapy that we have people do are low-impact mobility exercises, things like the elliptical machine. So what we’re trying to do is transition them to get out of pain, get moving, even though it’s passively at the beginning, and then to actively start moving themselves. So that gets them out of pain, hopefully without a whole lot of medication, because sometimes especially with traumatic brain injuries, a lot of medications will sometimes mask or alter the symptoms. So the more we can get them out of pain naturally, the clearer the picture is.
Chris DeBari:
Now doctor, one of the things I’ve learned… Excuse me, one second. I’m just going to plug in the computer here so I, I’m on the laptop, so I can make sure I’ve got sufficient power. There we go.
Chris DeBari:
One of the things in the practice of personal injury law I’ve been involved in, in fact over 20 years, is that chiropractic therapy, particularly in the beginning of the case, requires a greater amount of contact between the patient and the doctor. Why is that?
Dr. Dale Hanson:
It’s physical medicine. I can’t give them a bottle of adjustments to take home, and I can’t follow them to the gym and make sure that they exercise. So it’s more of a hands-on type thing. And nobody really seems to have an issue with it. If you want to go take a bottle of antibiotics, you go home and you take the whole thing as prescribed. You don’t take four days worth of it when you’re supposed to take 10 and go, “Uh, this isn’t working. I’m done with this.” You take it as prescribed. And since this is physical medicine, you actually have to be here physically, get the adjustment, do the exercise, do the mobilization. So there is a little bit more person to person contact just due to the nature of the fact that I’m going to have my hands on you.
Chris DeBari: It’s interesting. One of our… We’ve got a couple more people tuned in. Terry DeNika is here. Hey Terry, thanks for joining us. And also a good friend, a former client of mine, Juan Zemora is on as well. He asks an interesting question. I don’t know if that’s really a question for us, but he says, “Can you get MRIs in
areas with metal screws in them?” Not being an MRI tech, I would probably defer that question to an MRI specialist, tech, or somebody who performs MRIs or scripts them. Do you have any thoughts or insight on that, yourself?
Dr. Dale Hanson:
It kind of depends. Most of the newer surgical equipment is non-magnetizable. So a lot of it’s titanium and it’s safe, but you’re really going to want to talk with your radiology tech about that. And, if you can, bring in any details that you might have. If you’re talking about a screw, usually they’ll give you a little information about what type of surgery you had and what type of equipment you had placed in there. So based on the material that’s used, that may or may not be safe. So bring as much information as you can to your radiology tech, and being open and honest with that person, that’s going to be your safest route.
Chris DeBari:
Now, when you first see a patient, I’m talking on the very first visit when you conduct your examination and so forth, you conduct usually an x-ray at least? Don’t you?
Dr. Dale Hanson:
Well, it depends. A lot of the times when we get patients coming in after an accident, more often than not, we’ll request their hospital records to make sure we don’t duplicate tests. Not that there’s a lot of radiation in an x-ray, but there’s no reason to spend their time and irradiate them again if they’ve already had a CT in that region. So first things first, we get the tests that they’ve already had done, and we compare that to their complaints that they come in with.
Chris DeBari:
Now, are there any things that you would observe on an objective test, an x-ray or CT, that might counter-indicate a chiropractic adjustment?
Dr. Dale Hanson:
Yeah, that’s why we always go through a pretty thorough initial exam, not only looking over their hospital records but asking them if they’ve had surgical interventions, if they have altered anatomy, if there are areas that are immobilized and there’s no adjusting those areas so we have to work around that. Old scar tissue, old surgeries, areas of instability, osteoporosis. We asked them what kind of medications they’re on, what other treatments they’re undergoing. So we try to get rid of all the reasons why we shouldn’t adjust them before we do, but most people respond pretty well to being adjusted. There’s different techniques that are less aggressive that will still help to mobilize joints and get people out of pain.
Chris DeBari:
Now, in addition to obviously chiropractic adjustment, what are some of the other modalities that you offer that can help? Because, I mean, obviously the type of injury that we’re going to be dealing with most of the time, not that we don’t have serious injuries from time to time, God forbid, but most of the time you see what the insurance industry would classify as soft tissue injuries, things that really can’t be imaged on an x-ray exactly. So what’s your approach dealing with the soft tissue type of injury?
Dr. Dale Hanson:
It’s more functional. Are you able to do the things that you want to do? Are you able to sleep the entire night? Are you able to reach up above your head? Are you able to wash your hair with both hands? Activities of daily living that sometimes soft tissue injuries can compromise very severely. So what we’re trying to do is get them back to pre-injury status, and, if I have the opportunity to, maybe even get them stronger or get them in better cardiovascular shape. That’s my goal. I know the insurance companies just want the pre-accident condition, but if I have the opportunity to get you a little stronger, a little more flexible, a little bit more heart-healthy, I’ll give it my best shot.
Chris DeBari:
Well, and not only that, that would probably prevent somebody from having the same predisposition to injury in the future that they might have prior to the accident, if you leave them better than you found them.
Dr. Dale Hanson:
Yeah. That’s usually the goal. And you’re right, too. A lot of the times with soft tissue injuries… Unlike a bone. A bone is going to heal back together usually the way it was, functionally. With soft tissue injuries, a lot of times it’s replaced with adhesions and fibrotic scar tissue, and that limits range of motion and that decreases strength. And depending on what you do every day, that can really affect your life. If you’re an athlete, I mean… Even with me, I have two sons. I love to throw the football around with them. I had a pretty traumatic, severe shoulder injury. Luckily I had a great surgeon who was able to repair everything because he told me, “We can treat it like this, or we can treat it like this and let it scar in.” I said, “No, I don’t want it to scar in.”
Dr. Dale Hanson:
At the time, my sons were pretty young. I’m like, “I’m going to have to be all throw softball and a baseball and football. And I work with my hands and shoulders. So what would you do if I was Peyton Manning in my prime?” And he was like, “Well, we’d do this.” And I said, “Well, we’re doing that.” So that’s usually the approach that I take with my patients is we’re going to try to get you back to the way you were pre-accident so you have the strength, you have the functionality, you have the mobility, you have the flexibility. Because scar tissue’s just not the same as healthy ligaments, joints, tendons, muscles. It’s compromised.
Chris DeBari:
If you could take a second to just maybe discuss with us the dynamics of the anatomy of the spine, in particular with regard to ligamentous laxity, that seems to be the thing that is the most difficult thing to detect objectively but accounts for a lot of people’s woes when they’ve been injured in whiplash-type injuries.
Dr. Dale Hanson: Yeah. And we can do and have done, actually I’ve done quite a bit of, flexion extension x-rays where we measure the amount of translation. Because, ligaments, they hold bone to bone. And generally when they’re stretched, usually that’s by some sort of traumatic force, they heal… Not like a rubber band. They don’t snap back into position. They’ll heal at new length. So if there’s translation now that’s allowable, you have laxity where there’s more angulation or there’s more translation now where the bone can travel a distance that it really wasn’t able to travel before. And that can predispose somebody to being injured more seriously if something like that was to happen to them again. So if someone has ligament laxity and now they’re in another accident, they can be injured much more severely in that second accident than they would have been able to had they had a ligament that was holding things in place the way it originally was.
Chris DeBari:
So the bones could actually articulate greater motion-
Dr. Dale Hanson:
Yeah.
Chris DeBari:
… when they’re not as contained as they were before.
Dr. Dale Hanson:
Not just greater motion but just aberrant motion. Motion that really the joints weren’t designed to translate, to have that kind of play. So we’ll put that in our final narrative, whether it’s going to the orthopedic doctor or going to you, letting you guys know that this scar tissue now has translation that wasn’t there before.
Chris DeBari:
Yeah. There’s a certain amount of degeneration that occurs in all people once you reach a certain age, just from living life, I guess. Discs become dark and thin and dehydrated, they may press on some of those delicate structures in your spine. Is this something that, that having lax ligaments could accelerate?
Dr. Dale Hanson:
Yeah, it’s just more delicate tissue, and fibrotic scar tissue just doesn’t heal with the same strength that healthy tissue once had. So it’s easier to be damaged, and because it has less motion, whether it’s a joint or a muscle, you don’t use it, you lose it. Over time, the less motion, the quicker it decays, essentially. So that’s one of the reasons why our goal is to help you maintain flexibility, maintain motion, because whether it’s a ligament or whether it’s a muscle or whether it’s any kind of soft tissue, you need mobility to keep that type of tissue healthy, and scar tissue just doesn’t tend to have that sort of mobility.
Chris DeBari:
What do they say, “That a body in motion is more likely to stay in motion?”
Dr. Dale Hanson:
Yeah, pretty much. That’s pretty good way to look at it, really.
Chris DeBari: You don’t want to just take pills and fall asleep. You want to really be active about your treatment and so forth to the extent that you’re able to be. And as we know in the state of Florida, in particular, you’ve only got 14 days to initiate treatment before your no-fault benefits are in jeopardy. So, yeah, that’s one of the interesting things that I’m sure that you want clients to treat right away. Now what if a person has an accident and they’re not feeling anything significant or too, too much in the beginning, but knowing that they have only 14 days to show up for treatment or they waive the possibility of having no-fault benefits pay for their treatment, how do you recommend people address that situation? Is it better to just get checked out?
Dr. Dale Hanson:
Yeah, absolutely. It’s unfortunate that that’s the way the statutes are set up, because yeah, a lot of times people figure, “I’m going to tough it out, take some Motrin, and I’ll sleep it off. I’ll shake it off. I’ll be all right.” But because things are locked up and because there’s less motion and because they’re not sleeping, the pain tends to… And even the people who pick you up. When an ambulance picks up, the guys there will usually say, or whoever it is who gives you your immediate attention will say, “This is probably going to hurt worse tomorrow or over the next week.” And it does. As the inflammation ramps up, the pain goes up. So a lot of times you have patients come in and they’re like, “It wasn’t too bad in the beginning when the adrenaline was pumping, and the next day it was worse and the next day it was worse. And I tried to take meds and then a couple weeks later.”
Dr. Dale Hanson:
And so my advice, and I’m sure it’s the same as you, just go get checked out. It’s not going to hurt you to just go get an exam and just see what’s going on. And don’t try to be a soldier about it and tough it out. If there’s something that doesn’t feel right, let somebody know.
Chris DeBari:
Yeah. And that’s something we see all too often and what we do… And yeah, the only legal requirement that’s placed on an injured person is getting better, not letting themselves become worse and becoming a burden on society. Obviously that’s an evil that should be avoided. It’s one of the reasons the PIP statute was passed in the first place so that people could have immediate access to care without the necessity of admission of liability by an at-fault party. So we’re required as attorneys and as doctors to be familiar and up on all the PIP laws, and that’s really great. Well, doctor, thank you very much for joining us this evening. This has really been a great conversation. It’s been very, very enlightening, I’m sure. And I know guests have, have been very happy with some of the information that we’ve been able to discuss this evening.
Chris DeBari:
So folks, thank you very much. And this is Dr. Dale Hanson with Florida Central Chiropractic. His office is in Lutz, and if you are involved in a motor vehicle accident, he is a great guy to go to see to treat you. He’s very experienced and obviously very knowledgeable as you can see, and a very pleasant fellow to deal with. So we thank him for being on the show and folks, thank you.
Dr. Dale Hanson:
Thanks for having me. Chris DeBari:
For more information please call
Chris DeBari
727-656-7852
or Email
Chris@CDBinjurylaw.com
