My Day with Dr. Bill Morgan…and a Grateful Nation

:dropcap_open:I:dropcap_close: recently had an opportunity to visit the Chiropractic Department at Walter Reed National Military Medical Center (WRNMMC). As a component of the Physical Medicine and Rehabilitation Department, it was inspiring to see chiropractic integrated with multiple specialties. I was fascinated as I observed the dedication of a variety of professions applied to the revitalization of wounded warriors through sophisticated treatment protocols, technology, and the rebuilding of self-esteem. The miracles I witnessed there were important and moving, both personally and professionally. It was a thrill to see chiropractic and the tools of our trade used to improve the lives of so many wounded warriors.

 

This is an interesting time. It seems as if we are constantly urged by our national associations, the ACA and ICA, to contact our congressional representatives and senators to encourage them to cosponsor chiropractic legislation. The hot button right now is S. 422, or the Chiropractic Care Available to All Veterans Act. Personally, I have been a little confused by this for years. After all, didn’t Congress pass a bill more than ten years ago that put DCs in VA hospitals and on military bases? Sure they did, and it was H.R. 3447 (107th Congress): Department of Veterans Affairs Health Care Programs Enhancement Act of 2001. However, if it seems that the implementation has not been comprehensive, then here’s the bill’s requirement: “The Secretary shall designate at least one site for such program in each geographic service area of the Veterans Health Administration.”1  So, if you have thought that coverage is not thorough, now you know why. However, the new bill is a great enhancement to this, stating: “Chiropractic Care Available to All Veterans Act of 2013—Amends the Department of Veterans Affairs Health Care Programs Enhancement Act of 2001 to require a program under which the Secretary of Veterans Affairs provides chiropractic care and services to veterans through Department of Veterans Affairs (VA) medical centers and clinics to be carried out at: (1) no fewer than 75 medical centers by December 31, 2014, and (2) all medical centers by December 31, 2016.” 2

 

I  have enjoyed a full-time private chiropractic practice in northern Virginia since 1982. My office is only about 15 miles from the Pentagon, and is close to many other military and federal installations. I feel honored to have assisted the health of thousands of active and retired military and their dependents. One of my earliest practice memories was working with a colonel named Neil who had been a Vietnam prisoner of war for more than seven years. I will always treasure that learning experience. In chiropractic school, we are told that our patients will refer others like themselves, and from the beginning, I have always had military patients. However, even with their great sacrifices, they have not had chiropractic treatment as one of their well-earned benefits. Even with a few DCs on nearby bases, there simply is not enough coverage for all those in need. Passage of bills like S. 422 and others would enhance military access to our services. According to Harold Kudler, MD, of the VA, the most commonly reported health issue of returning soldiers is musculoskeletal.3 

 

With all of this in mind, I have developed a curiosity of what it might be like to visit an operating chiropractic department at a military facility. In March, at the National Chiropractic Legislative Conference in Washington, DC, I was fortunate enough to meet William Morgan, DC, chief of chiropractic services at Walter Reed National Military Medical Center. 

The unassuming Dr. Morgan, who prefers to be known as just Bill, was gracious enough to accept my request to visit him at the hospital. Keep in mind, I was expecting to see straightforward chiropractic, but what I saw far exceeded my expectations.

The purpose of my story is not to list Dr. Morgan’s (Bill’s) lengthy accolades. His CV is book length and his numerous awards are, if you ask me, “too many to count.” (If interested, visit: http://drmorgan.info/home.) What I want to convey, though, is that I experienced a very friendly, caring, energetic guy who is excited about his work, has an unselfish desire to share, and possesses a terrific command of the subject. Bill told me he is just an average chiropractor, but I beg to differ.

I drove to Walter Reed on a sunny Thursday afternoon and the capital-area traffic had not yet ramped up. Getting past security at the north gate was a little tricky, even though Bill had me put on the access list. They don’t let just anyone in to Walter Reed, but after explaining the purpose of my visit, I was allowed to enter. With parking my next challenge, I found a space high up in the garage next to the new hospital building, the America Building. Bill called me just as I parked and guided me to the clinic. Then he said, “Meet me at the piano.” Piano? I found that interesting, but I’ll get back to that later.

We were in Bill’s office for only a couple of minutes. It was a fairly typical chiropractic treatment room: diagnostic equipment, elevating Leander table with auto flexion, hydrocolator tank, ultrasound unit, cold laser, etc., all strategically placed around the room. Bill also explained that this room was also his office; there was a desk, a computer for documentation and research, and an extra monitor to view imaging. Given space limitations, Bill chose to have an additional treatment room over a private office. Before I knew it, we were out of the office and starting the tour.

The Chiropractic Department shares a front desk with three other clinics: Occupational Therapy, Orthotics/Prosthetics, and Physical Medicine and Rehabilitation. It was the beginning of a discovery of integration as it should be.

:dropcap_open:Ross is a firearms instructor who trains recovering soldiers to fire weapons using their newly fitted prostheses.:quoteleft_close:

Our first stop was the Department of Occupational Therapy in Rehabilitative Services, where I met salty retired Navy SEAL, Recreational Therapist Ross Colquhoun. Ross is a firearms instructor who trains recovering soldiers to fire weapons using their newly fitted prostheses. It is a “can-do” atmosphere that I perceived to be far more about the reestablishment of self-esteem and confidence than the newly developed dexterity required to regain proficiency with firearms. After working with a large variety of soldiers’ injuries over the years, Ross has become tremendously creative toward finding ways to teach positional adaptation to fitted prostheses. More importantly, though, Ross establishes the concept that a soldier will regain his belief that he is capable to return to his previous level of ability.

Additionally, Ross is the outdoor “field and stream” manager. It is one thing to be cooped up in a state of the art rehabilitation center, but he also manages to get many guys out into the great outdoors and do something fun and physical. Hunting and fishing is very popular, including an annual event on the Eastern Shore during “Waterfowl Weekend.” Those interested get to enjoy four days of “hunting, freedom, and honor” hosted by American Legion Post 18. It is not only for experienced hunters, but also for others who discover they really can be capable once again. Here they have an opportunity to enjoy their newly developed arms proficiency without being in combat. Soldiers who had seen their young lives flash before them are reinvigorated by success found through fishing, hunting, crossbow, or biking. The newfound confidence in their physical capability is just as important as rehabilitating wounded soldiers’ mangled limbs. Inside or out, Ross Colquhoun’s contributions are great!

Next stop was the CAREN-Lab, which stands for Computer Assisted Rehabilitation Environment. This is a 9’ x 9’ high-tech motion platform with an embedded treadmill with force plates. The platform can move in every direction as well as rotate. It is suspended in front of a large curved screen on which virtual application scenes are projected along with surround sound, making it all seem very real. Nine motion capture cameras record the movements of the subject on the platform. Patients are harnessed on the platform and learn to improve and rehab gait and balance by following the path of the projected scene. Everything is recorded by the cameras and the force plates. Data is collected, computer analyzed, and progress is regularly evaluated.

The CAREN-Lab is used for amputees and those with traumatic brain injuries, vision impairment, and neurological diseases that cause ambulatory deficits. The soldiers referred by their physicians to the lab are highly motivated to be as they were prior to injury, or better. This safe, controlled place challenges the physicality of rehabilitation while expediting and improving the rehab process. In my discussions with both Bill and the lab techs, I heard a consistent theme: “It’s all about the best possible care for our wounded warriors.”

It is becoming evident that Bill is intrigued by the use of high technology to aid in advancing the quality of care. I think his favorite stop was at the GAIT lab. This large interesting room is actually the Biomechanics Laboratory and it has 23 motion-capture cameras strategically positioned to record the complex coordinated interactions between the lower limbs and the body during walking and running. Through computerized analysis, objective details of joint movement and associated forces help aid and develop clinical decision making to optimize treatment plans and correct prosthetic alignment.

The technology of the GAIT Lab largely contributed to Bill’s development of a trial study for the Fifth Joint National Capital Region Research Competition Symposium at Walter Reed. It was called “Reduction of Elective Amputations: Restoration of Function through Manual Extremity Manipulation.” At the time of my visit, 70 “case report posters” had been submitted and Bill’s Chiropractic Department’s entry was one of six finalists in the “staff and fellow” category. Stephanie Johnson, DC, now in practice in Alexandria, Virginia and a recent program intern who worked with Bill on the study, let me know that they placed second in the competition.

Bill explained that there are cases where injured patients with salvaged limbs ultimately opt for elective amputation if they don’t reach their level of functional expectations. He has found that failure can be related to limited range of motion caused by scar tissue adhesions, though. These are circumstances where chiropractic extremity procedures have been found to reach an effective level of increased function, thereby eliminating the contemplation of ultimate elective amputation. The GAIT Lab was a great place to objectively measure and record before and after progress made via chiropractic procedures.

Major Tammy Phipps is the lead driving instructor at Walter Reed. Her main objective is helping multiple amputees drive again. What is prioritized, though, is not so much about driver training or simulators; it is more about giving these wounded warriors, who have sacrificed and lost so much, the opportunity to regain personal dignity. There is a clear philosophy in this department: “Driving revives self-esteem and speeds recovery.”

Major Phipps explained to me that all effort is made on an individual, case-by-case basis to develop a vehicle adaptable to their prostheses and limitations. If a wounded warrior wants to drive, they will find a way to fit a vehicle to his needs. The gains in confidence and mental health are worth the time and cost. Additionally, there is supplemental funding available to amputees to assist in the modification of a vehicle for use in civilian life.

Back at the Chiropractic Department, Bill introduced me to another staff DC, Dr. Terence Kearney, along with longtime chiropractic assistants Rosie and Sharlene. Each treatment room is well equipped. Along with terrific integration with the other physical medicine departments, they do what we love to do: chiropractic. They treat a variety of patients, with the most challenging being, of course, the seriously “wounded warriors.” But like you and me, they also see the whole gamut of spine-related things we see every day as they treat active military, including high-ranking officers and VIPs. Just before we headed out, a young intern dropped by, Jeff Smee from NYCC. Another great thing about this operation is the opportunity some students get to work with Bill as an intern. I have met a few, including Jeff and Stephanie Johnson, who worked on the Gait Lab trial. Bill attracts highly qualified students who leave the intern program benefiting from a terrific learning experience, which is great for our profession.

Bill helped me find my way back to the parking garage. As we approached the large main entrance again, a young soldier beautifully playing the piano mesmerized me. Everyone present stopped what they were doing and just listened. Bill explained that this was not unusual. The arts remain extremely important here and it is just another way to feel normal through recovery. On top of that, well-known performers might just stop by and play a few tunes. I couldn’t help but imagine Billy Joel or Elton John rocking out at Walter Reed.

As I thanked Bill for a fun tour and interesting day, I commented that I was quite taken by all the great people I had met, the camaraderie, and the cooperative attitude of all the departments. I was also impressed especially by the overriding concept of what this hospital is willing to do to revive our wounded warriors, not only physically and functionally, but also mentally. Everywhere I went the theme seemed to be: rebuild the confidence, the self-esteem, the self-worth. To this, Bill responded, “Our nation is indebted to those who have placed themselves in harm’s way on our behalf. We strive to show every wounded hero the depths of our nation’s gratitude.”

He went on to explain that arrival at Walter Reed from combat operations is a very emotional scene. Typically, they are greeted by the admiral in charge of the hospital and an ICU contingent. Frequently, family members are present, and even more importantly, other wounded warriors. They drive home the point that not long ago, they too were mangled. With hard work ahead, though, new patients can count on healing, pulling their lives back together, and once again feeling functional and vital. The mentor side of it is just as important as the treatment. Most importantly, Bill said, they are received with a hero’s welcome.

Reference:

1. 107th Congress, 2001–2002. Text as of Jan 04, 2002 (Passed Congress/Enrolled Bill)
2. The Library of Congress, Thomas, Bill Summary & Status 113th Congress (2013 – 2014) S.422.
3. Source “Painting a Moving Train” ,Harold Kudler, M.D., Department of Veterans Affairs, and LCDR Erin Simmons, United States Navy, February, 2010.

David B. Dolberg, DC is a 1981 graduate of NYCC and has been in private practice in Springfield, Virginia since 1982. He is the 2012 Unified Virginia Chiropractic Association Chiropractor of the Year and has served as its Treasurer since 2008. He also recently became the ACA State Delegate for Virginia.