It's not easy to say which “one in a” Elizabeth Caplan is.
She might be one in 100,000. Or maybe 20,000. Or maybe 80,000.
For Caplan herself, it's not about proving which statistic she is. It's about telling what happens when you are the “one” who has a stroke during a visit to the chiropractor.
“I think the tragedy of this has been that people like me are silenced, for the most part, if they're alive, or they're relegated to some invented statistic of it being so one-in-a-million that it's not worth empirically documenting,” Caplan said.
Each year, thousands of people go to chiropractors, seeking pain relief that doesn't involve pharmaceutical drugs.
And each year, an unknown and hotly debated number of people have strokes as a result of injury suffered while getting their necks cracked, also known as manipulation of the cervical spine.
Life changes in an instant
At first, there was a gray haze, and then she went blind.
Caplan lay disoriented on the table after the neck adjustment. The room was spinning. And soon, the retired nurse practitioner realized she was having a stroke.
“Of course, there's the shock because nobody thinks (at) 44, ‘I'm having a stroke,' let alone here on the chiropractic table,” Caplan said.
The type of stroke that Caplan experienced in October 2010 while at the chiropractor is not something that's easy to quantify. There is no official estimate from any one entity, but the issue has been studied in several medical journals.
Caplan said she suffered a stroke as a result of vertebral arterial dissection, which occurs when blood enters the wall of the vertebral artery, usually through a small tear in its innermost coat, according to Dartmouth Medical School and U.S. National Library of Medicine.
Research published in 2008 in the European Spine Journal found that vertebral artery dissection is overall a rare event, and the increased risks of these types of stroke associated with chiropractic and primary care physician visits “is likely due to patients with headache and neck pain from VBA dissection seeking care before their stroke.”
But a journal article published in 2008 in a Korean neurosurgical journal quoted the likelihood of spinal manipulations causing stroke to be 1 in 20,000.
Dr. Bill Kinsinger has spent 23 years arguing that the risk is too high, regardless of what it is.
Since 1989, the Oklahoma City anesthesiologist has worked as what he calls a victim's advocate and, at one time, ran the website Neck911USA.com.
Kinsinger has traveled across North America, advocating for legislation that would require chiropractors to provide informed consent before performing cervical spine manipulation.
“Informed consent meaning — when they're going to twist somebody's neck, that they tell them not only of the benefits, of which, in my opinion, there are virtually none to twisting the neck,” Kinsinger said. “And without question let them know there is a risk of stroke and potentially death before they twist their neck. That's the first thing I want, and I don't think that's asking too much.”
There's good evidence that the manipulation of the lower back that chiropractors provide, under certain criteria, could have benefits, Kinsinger said.
“I wish they would decide what they want to be is back pain specialists. If they did that ... I would not only back off my crusade against them — I would endorse them because that's something they could do,” Kinsinger said.
Is there a real risk?
Dorothy Cloutet, of Edmond, has been going to a chiropractor on and off since she was 18.
Cloutet suffers from temporomandibular joint dysfunction, or TMJ, which causes jaw pain. She has found relief in her jaw because of the treatment her chiropractor has provided her.