With his appointment to the board, Dr. William Morgan continues building bridges for the chiropractic profession.

William Morgan, DC, has been appointed to the United States Navy’s Musculoskeletal Continuum of Care Advisory Board (MCCAB), an entity created to address the prevalent musculoskeletal injuries sustained by U.S. armed forces personnel during active-duty operations.

Dr. Morgan, who also serves on the spine subcommittee within MCCAB – members of which include orthopedic surgeons, sports medicine physicians, physical medicine and rehabilitation physicians and physical therapists – will serve as the sole chiropractic representative to MCCAB, the Bureau of Medicine and Surgery (BUMED) and the U.S. Navy. The spine committee will develop care algorithms for treating musculoskeletal and spinal conditions and in so doing, help determine the future of musculoskeletal management in the U.S. armed forces.

Addressing Musculoskeletal Health Issues in the Armed Forces

The leading cause of medical evacuation from forward-deployed units is musculoskeletal complaints, not combat wounds, with a high percentage of the complaints being back and neck pain. The MCCAB intends to develop guidelines for best practices in the management of musculoskeletal conditions through collaboration between professions, standardized metrics/outcome measurements, evidence-based practices and increased access to care.

William Morgan This is a big step for chiropractic in the armed forces. Never before has a chiropractor been on a military medical board that will have this level of strategic planning and implementation of ideas. This advisory board will make decisions about the future direction of health care within the Navy and the Marine Corps (the Navy provides the medical care for both the Navy and the Marines). The development of the board and Dr. Morgan’s appointment to it suggests the Navy’s open-mindedness in addressing the need for better management of musculoskeletal conditions.

Dr. Morgan’s Long Journey With Navy Health Care

Dr. Morgan has a long history in Navy medicine. Joining the Navy at age 17, he became a hospital corpsman, serving with Marine Corps Infantry and an elite Marine Recon Company. While in the Navy he was qualified in parachuting, military diving, submarine insertion, jungle warfare, combat swimming, explosives, mountaineering, winter warfare, and Arctic survival. He attended anti-terrorist training at the FBI academy. During a deployment to Southeast Asia, Morgan’s unit assisted in the rescue of Vietnamese refugees, whose ship had been attacked by pirates. Morgan provided medical care to the refugees.

After leaving active military service, Morgan began college and transferred to the Navy reserves. He served briefly with a dive and salvage unit and was one of the Navy divers who helped raise the USS Potomac from the San Francisco Bay after she sank in 1980. In 1982, Morgan transferred to a reserve Naval Special Warfare platoon as the unit’s primary hospital corpsman. He was sent to Special Operations Technician training, Coronado, Calif., to learn the principles and practice of dive medicine. For the next eight years he served as a dive medicine corpsman / combat swimmer for a platoon of Navy frogmen in Navy Special Warfare Unit One. (Dr. Morgan is quick to point out that while he served as an operator within a reserve SEAL platoon, his special warfare training took place in Marine Recon, not Navy BUDS.)

Dr. Morgan graduated from Palmer West in 1985 and practiced in California for 13 years. During that time, he pioneered chiropractic care within hospitals. He was credentialed and worked in two hospitals in central California. In 1998, after responding to an advertisement in Dynamic Chiropractic, he accepted a position at the Navy’s premier medical center, National Naval Medical Center (NNMC), Bethesda, Md.

Dr. Morgan has practiced in Bethesda for the past 13 years and works in Navy-supported executive health clinics in the Washington, D.C. region, caring for service members, high-level civilian government leaders, as well as Pentagon leadership. On occasion, Dr. Morgan will make “house calls” or travel with government officials.

While representing chiropractic to the command, Morgan has given scores of lectures to the medical staff. He also lectures on a regular basis to medical residencies and fellowships, and has worked as a consultant to the Veterans Administration and the U.S. Army. He is on faculty at the Uniformed Services University of Health Sciences’ Medical School, a professor for New York Chiropractic College, and has worked as adjunct faculty for Cleveland Chiropractic College, Palmer College, National University of Health Sciences and Texas Chiropractic College.

Interview by Daniel Redwood, DC

Dr. Lance Cohen on the job at the National Naval Medical Center in Bethesda.

Lance Cohen, a 2009 graduate of Cleveland Chiropractic College–Los Angeles (CCCLA), was the first chiropractic student to participate in one of the most prestigious health care fellowships in the nation, at the National Naval Medical Center (NNMC) in Bethesda, MD.

A second generation chiropractor (his father is CCCLA alumnus Dr. Nathan Cohen), Dr. Cohen had the opportunity to work under Dr. Bill Morgan at NNMC, providing care for injured veterans (many of them from the conflicts in Iraq and Afghanistan) at the nation’s premier tertiary care hospital. This experience afforded him unparalleled learning opportunities, which he describes in this Health Insights Today interview. Dr. Cohen now practices in Tahoe City and La Jolla, California.

What first kindled your interest in chiropractic?

My father was a chiropractor for nearly 3 years prior to my birth; chiropractic has always been part of my life. I was one of those kids whose mother received chiropractic care while she was carrying me and I received my first adjustment shortly thereafter. Throughout my younger years I was very active and played lots of sports, so I very quickly became aware of the benefits that chiropractic offered. I clearly remember seeing how grateful my father’s patients were for the improved quality that chiropractic afforded them. That was the deciding factor for me. I remember being about 5 or 6 years old; some children wanted to be firemen, astronauts, or maybe the president of the United States, and I knew that I wanted to be a chiropractor. I wanted to someday be able to emulate my father’s ability to assist others in regaining their health and improving their quality of life.

What is the procedure for determining which chiropractic student is chosen for the fellowship at National Naval Medical Center, Bethesda?

This is a question that I asked many times prior to applying for the program, a question which I still do not know the answer to. I know that the process differs from school to school with regards to candidate selection. After that I’m not sure how the final decision is reached. At Cleveland we were making it up as we went, because the college had never submitted a candidate for consideration. It was my understanding that the program had not been established previously at the college and there had not been a student demand for it in previous years.

That all changed when I made it my mission to create the student demand for the program after hearing one of Dr. Morgan’s interns speak about the program at the National Chiropractic Legislative Conference in Washington, DC. I wasn’t even sure if I wanted to apply for the program, but my father had graduated from CCCLA in 1980 and I felt a great deal of pride as a legacy at the college. I thought that the college was obligated to offer programs like this to students in order to provide a competitive product in today’s market of education. That is when I brought the issue up with Dr. Cleveland III (the college’s President), Dr. Globe (then the Dean/Provost), and Dr. Henry (Clinic Director).

Drs. William Morgan (l.) and Lance Cohen (r.), with canine companion at the National Naval Medical Center

The process of establishing the agreement between the Navy and the college was not easy and took over a year from when I brought up the project. I was unrelenting, steadfast and committed to seeing this project through even if I was not going to participate in it. I was convinced that someone at our college (either in Kansas City or Los Angeles) should have the opportunity to at least apply. I was very fortunate to have such a hard working team of faculty and staff at the school; if it wasn’t for their dedication and help this project would have never been brought to fruition.

What were your emotions when you first received word that you had been chosen?

I was in the intern lounge of the college clinic catching up on some paperwork while waiting for a new patient, who was late and I later learned didn’t show up for their appointment, when my mobile phone began to vibrate in my pocket. As I picked it up I didn’t recognize the number or even the area code. I answered the call and to my surprise Dr. Morgan was on the other end. My initial thoughts were that he wanted to ask me some questions about my application. After exchanging salutations and some small talk he asked if I was okay. I responded that I was, and apparently he could sense the surprise and bewilderment in my voice over the phone line.

He then proceeded to tell me that I was highly qualified and that I had studied under some of the greats in our profession and he hoped that I would not be disappointed while working with him at Bethesda. He offered me the position if I wanted to accept and he wanted to know how soon I could begin. I almost fell out of my chair, literally. I am sure that I will not be able to adequately put into words how I felt at that moment, but it was the shock and realization that I had achieved a goal that I had been working for tirelessly for several years. Immediately after that I was overcome with the excitement of the unknown. I knew that my future would have in store some truly incredible experiences during this program, but I couldn’t even begin to remotely conceive what they might be.

What advice would you offer to current students who are considering applying for this fellowship at NNMC?

Talk to your administration and faculty early on in your student career, find out about the program and see if it is something that you would be interested in. Declare your intentions early. This is not the sort of program that you sign up for a couple months in advance. Interns and fellows are usually selected 6 months prior to their start date. Contact interns or fellows who are currently at NNMC and talk to them about their experience, build rapport with Dr. Morgan or Dr. Kearney (both are chiropractors at NNMC). Make arrangements to visit the chiropractic clinic at NNMC. An opportune time to do this is while attending the National Chiropractic Legislative Conference.

Most importantly, be active during your student career, get involved with student associations and organizations, become a leader and actively seek mentorship. Dr. Morgan is not looking to mentor chiropractic students who are going to just go out and be successful. Success in practice should be expected. He is looking to mentor students who will leave NNMC and use what they have learned to change the world, change the way in which chiropractic is integrated and utilized in health care on a national or international level.

Please describe a typical day when you were at NNMC.

During my time at NNMC I would see patients in the chiropractic clinic Monday, Wednesday, and Friday. Typical clinic hours were from 0730 to 1600 hours. Tuesdays and Thursdays I would be on rotations either at NNMC or at Walter Reed Army Medical Center (WRAMC) while Dr. Morgan was staffing the health care clinic at the US Capitol. The hours for my hospital rotations were variable and dependent on the schedule of the respective department that I was assigned to. Some days I would report as early as 0400 hours in order to scrub in on a surgery and there were days when I stayed as late as 2000 hours helping out in the postsurgical wards.

On Wednesday afternoons Dr. Morgan and I would travel to Annapolis to the United States Naval Academy in order to care for the Naval Academy football team and some of the other athletes. This was a very memorable experience. I admired seeing the heart the Naval Academy football team displayed. Most always, their opponents were taller and outweighed them due to military height and weight regulations. The Midshipmen would compensate for this by superior physical conditioning, speed, and determination or heart. It was really a privilege to be a small part of that program.

What did you find most satisfying about your fellowship?

The most satisfying part of the internship was having the honor and privilege to be part of the team that administered care to the brave men and women who have sacrificed so much for our great nation. It was also a great honor to represent the chiropractic profession at the world’s most advanced tertiary care facility. Every time I interacted with another health care provider, legislator, or key government leader I took into account that my actions, interactions and responses were not only viewed as my own but were on behalf of the profession that I was there representing. Most of these people have not had much experience with chiropractors in a professional/clinical setting and I was there to dazzle them. I wanted to be able to answer the questions asked in rounds that the other fellows, residents, intern and med students fell silent on, and many times I did.

What surprised you most while you were there?

I was taken aback by the patients at the hospital and their families, who maintained such positive attitudes during the course of their treatment at the hospital. Some of these brave young men and women suffered what I would consider beyond devastating battle injuries, and through it all they kept hope and maintained high morale and the unrelenting desire to fight a new battle, the battle toward their recovery. This was testament to the undying, unrelenting American spirit upon which our country was founded.

What was the most difficult part of your work there?

The most difficult part of the experience was leaving. I really enjoyed my time at NNMC under the tutelage of Dr. Morgan and some of the country’s finest health care providers. During my time there, I didn’t even think about the difficulty of my charge because I was focused on doing the best job that I was capable of doing. There were long hours and challenges to overcome, yet every night I would find myself lying in bed just before falling asleep reflecting on how incredible and horizon-expanding that particular day had been. This occurred every night that I was at Bethesda.

Looking back, were there things you learned at Bethesda that you would have been unlikely to learn elsewhere?

I could write tomes on this question. Nearly a year after the completion of my time at Bethesda, I am still realizing the extent of what I learned during my time at NNMC. Conservatively, I would venture to say that I gained experiences during my fellowship that one could go several careers or lifetimes without accumulating. The vastness of the experience and knowledge available was unparalleled and I am certain that there is no program that even comes close to offering such experiences.

During your stay in Washington, were there aspects of life there (people you met, places you visited) that were meaningful for you, aside from your work at NNMC?

With regards to the people that I met during my time in Washington, by far the most interesting were people that I met at the hospital. I very much enjoyed hearing their stories. I took some time to visit many of the museums, national monuments and the White House. The most memorable of these was my tour to the top of the Washington Monument and a visit to Mount Vernon, George Washington’s estate.

How well are the chiropractors at NNMC integrated into the overall staff structure? Is there a spirit of cooperation and collaboration?

There are two staff chiropractors at NNMC, Dr. Morgan and Dr. Kearney, and at any given time each of them usually has one intern. There is usually some overlap time to aid in the training process. In the history of the program there have been only two fellows, including myself.

I feel that the chiropractic department is well integrated into the hospital. It is my opinion that this is a result of Dr. Morgan’s effort as the department head seeking out and building relationships with other providers in the hospital who refer patients to the chiropractic clinic. There is, of course, some room for improvement as there is always a constant flow of new providers, some of whom are not yet familiar with chiropractic and are hesitant to refer patients to the service. In the military, every patient is assigned to a Primary Care Manager (PCM). These doctors act as central hubs and coordinate the patient’s care. In order for a patient to see any specialist, including a chiropractor, the patient has to go through their PCM. Likewise, if a specialist wants to refer the patient to another specialty, the provider will communicate that to the PCM and the PCM will make the referral. This system may seem a bit convoluted but is helpful in tracking the overall care of a particular patient.

I was very impressed by how patients were co-managed in the multidisciplinary setting of NNMC. One day I was on rotations in the outpatient physical therapy department and the therapist that I was shadowing performed an exam on a patient who we discovered to have what seemed to be a classic presentation of an S1 radiculopathy. She then asked me to examine the patient so that she could see how a chiropractic exam would differ. Most of what we did was very similar with the exception of the motion palpation and some additional neurologic and orthopedic tests that I performed.

The physical therapist and I both agreed on the diagnosis and both agreed that the patient’s L5 vertebra was fixated. The only main difference was that I was able to determine what particular ranges of motion the L5 segment was limited in. After that the physical therapist laid out the exercises that she recommended that the patient do and asked me if I would do anything else to treat the patient. I was surprised that to learn that the exercises were no different than what I was taught in school and then I said that if I were treating the patient, I would adjust the L5 segment to restore normal motion. At this point she said, “Let’s head across the hall to the chiropractic clinic.” I performed the chiropractic adjustment and we sent the patient on his way. I had never seen this sort of collaboration between physical therapists and chiropractors.

The chiropractic clinic had very close ties with the neurosurgery clinic. Many times they would schedule a patient for surgery and then refer them to us. If the patient was able to show improvement from chiropractic care prior to the surgical date, then they would cancel the surgery. I really enjoyed working with the neurosurgeons in co-managing difficult cases. Members of the chiropractic clinic regularly attended the neurosurgery morning report.

Did you have an opportunity to meet and to work with medical and other students who also had fellowship at NNMC?

I had the privilege to work with a number of med students, PT students, residents, interns and fellows. I felt that I was well received by the majority of the abovementioned personnel, especially in physical therapy clinic a the pain clinic. I still keep in touch with some of these connections.

What are you doing these days and what are your plans for the future?

Answer this question:

If I sneeze, and there is a car accident across the street,
have we discovered the *cause* of car accidents?

The scientific method would propose that we sneeze a hundred times, and count the car accidents.

That’s how you begin to determine if there is an actual relationship between one event (like drinking milk) and it’s potential consequences (like developing cancer).

The Bone and Joint Decade Task Force was appointed by the World Health Organization (WHO) to look at the causes of, and treatments for neck pain, and after years of review, they published their results in the prestigious Spine Journal. One of the most relevant articles (to this conversation) was titled:

“Risk of Vertebrobasilar Stroke and Chiropractic Care: Results of a Population-based Case-control and Case-crossover Study”
Spine 2008 (Feb 15); 33 (4 Suppl): S176–183

CONCLUSION: VBA stroke is a very rare event in the population. The increased risks of VBA stroke associated with chiropractic and PCP visits is likely due to patients with headache and neck pain from VBA dissection seeking care before their stroke. We found no evidence of excess risk of VBA stroke associated chiropractic care compared to primary care.

There was an association between chiropractic services and subsequent vertebrobasilar artery stroke in persons under 45 years of age, but a similar association was also observed among patients receiving general practitioner services. This is likely explained by patients with vertebrobasilar artery dissection-related neck pain or headache seeking care before having their stroke.

This Blog (and our website in general) has published regularly on this topic:

Podcast Interview with J. David Cassidy: No Increased Risk of Stroke With Chiropractic
http://www.chiro.org/wordpress/?p=4963

This interview, with author, researcher and epidemiologist J David Cassidy, DC, DrMedSc, PhD, should quell the fears of even the most vehement critics who would normally carry on on by mis-quoting, ignoring, or twisting the existing scientific literature to suit their pre-conceived notions and biases.

The Stroke and Chiropractic Page has been online since early 1996, compiling the literature which documents how chiropractic care has been mis-labeled as the “proximal event” in reported cases of vertebral artery injury.

Most telling is Terrett’s seminal work Misuse of the Literature by Medical Authors in Discussing Spinal Manipulative Therapy Injury, which clearly demonstrates that many of the reported injuries ascribed to chiropractic actually occurred following care provided by MDs, PTs and even hair-dressers, even though the authors of those works knew the truth. Where I come from, that’s called bald-faced lying, not *misuse*.

The unadorned FACT is that there is ZERO scientific evidence that a chiropractic adjustment has EVER *caused* a stroke. None.