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April 1, 2009

BehindTheMedspeak: MUA (Manipulation under anesthesia)

Above, a video of the procedure.

Once again I must've missed the lecture 'cause I'd never heard of MUA until I read Bob LaMendola's March 22, 2009 Orlando Sentinel story, which follows.


Family speaks out about controversial medical procedure

He's 33, a father to three, a bit heavy, with diabetes and sore legs. And now he lies unresponsive in a hospital, his brain damaged in a controversial outpatient procedure that critics say is often done needlessly and billed excessively.

Lauderdale Lakes security-firm manager Dale Whyte had a cardiac arrest during "manipulation under anesthesia," his family and records say, a procedure in which doctors and chiropractors sedate patients and vigorously flex the body to treat pain and stiffness.

Supporters of MUA say most patients improve dramatically. But many medical officials say some practitioners and surgery centers view it as a profit center, performing it far too often and at times on high-risk patients, and billing insurers as much as $50,000 for an hour of therapy over three days.

While no one tracks MUA deaths and complications, medical groups have linked the procedure to strokes and to damage in blood vessels, the spine and nerves in some patients. Critics also say MUA has been done on patients with obesity, high blood pressure and other conditions that raise their risk for heart attacks and bad reactions to anesthesia.

"It's absolutely unconscionable. They are doing it on almost anyone. It has really just become a method of billing for income," said Charles A. Bender, former president of the New Jersey chiropractic board and a critic of MUA.

At least four dozen outpatient centers in South Florida and 145 in the state perform MUA, and the number is growing. Some appeal for patients by putting them up in hotels and sending chauffeurs to pick them up for the procedure.

Even the leading supporter of MUA, Robert C. Gordon, a former Miramar chiropractor who travels the nation teaching the procedure, estimated that 20 percent to 40 percent of cases are unnecessary, overbilled or done wrong.

"There are a lot of people out there abusing this procedure," Gordon said. "Those of us who do this right are terribly, terribly upset with this. They make it hard for the rest of us."

The procedure has been deemed effective for a few uses, such as breaking up scar tissue that causes frozen shoulders and jammed knees. Many insurers cover MUA only for those cases.

Two practitioners — usually one a chiropractor — stretch the tendons and muscles of an unconscious patient farther than he or she otherwise could tolerate. They do this for three straight days, Gordon said, to make a gradual change. Gordon said he charges no more than $1,000 per day.

"MUA has been nothing less than miraculous for my patients," said Helen Bartosek, a Boca Raton chiropractor who has been doing MUA for 15 years.

Not so for Whyte. His family said he had had no serious pain before his MUA, just aches. Before a chauffeur came to bring him to Atlantic Surgical Center in Pompano Beach on Dec. 4, Whyte had said his doctor, Basil Mangra, just wanted to test his legs.

But at the Pompano Beachcenter, anesthesiologist Thomas Rodenberg sedated him and two practitioners identified as "Dr. Brown and Dr. Petryk" manipulated Whyte's legs, hips, spine, shoulders and arms, according to records from the center and paramedics provided by the family's attorney. Mangra and five people learning MUA looked on.

Moments after doctors stretched Whyte's neck, his heart rate plunged, the records show. No one knows why. That started a chain of events in which he was deprived of oxygen and lost brain function. He now lies unresponsive in North Broward Medical Center.

"I feel like if he didn't have insurance, they would not have done all they did on him. It was just so they could make the insurance money," his fiancee, Tina McGee, said while at his bedside. "Our 2-year-old, Christa, cries for him every day: 'Where's daddy?' They took him away from us."

His mother, Carol Whyte, is overseeing his care. She has hired an attorney and said she talks openly about her son's case hoping to educate other people about the potential risks of MUA.

State health officials last month barred Atlantic from seeing patients in response to Whyte's case, citing improper oxygen procedures and other violations. Atlantic administrator Andrew Byers and the involved practitioners declined to comment.

Specialists say MUA should be done only if a patient's injuries do not respond to eight weeks of physical therapy and medication, and the patient is cleared as fit for surgery. That's a tiny fraction of patients, said Gordon.

But a few South Florida clinics have made MUA a high-volume specialty.

Sanctuary Surgical Center in Boca Raton performed 2,205 of the 5,210 MUAs done in Florida in 2007, and billed insurers $11.6 million, according to a state database that tracks most centers. That's $15,600 per patient, not counting thousands billed by each practitioner.

Sanctuary's owner, plastic surgeon Arthur Handal, said the numbers are misleading because insurers may pay only a portion of the bill. Also, he said Sanctuary's MUA business is down because of aggressive new competitors.

"Medically, we would never have done anything just for the sake of making money," said Handal, who does not perform MUA.

The procedure has been around for 70 years. And in recent years, it was revived after changes in insurance rules made insurers in some states cover it more often for car crash victims, said Frank Brennan, a New Jersey attorney who studied MUA.

Gordon and others helped expand MUA nationally, and now use it for all joints, the spine, muscles and painful conditions such as fibromyalgia. Many insurers reject those bills, but some pay tens of thousands.

Bender, the New Jersey chiropractor, said unscrupulous practitioners look for patients with insurance that covers MUA — often PPOs — and steer patients to have it. Also, the procedure has been adopted by some organized rings that stage car crashes to bilk insurance, said James Quiggle, a spokesman for the Coalition Against Insurance Fraud.

Professional groups are skeptical of MUA. The American Society of Anesthesiologists warned its doctors in 2005 to be cautious doing MUAs because of the risks. The Florida Board of Chiropractic Medicine is looking into complaints of abuses, said Chairman Ronald Wellikoff, of Plantation.

Dania Beach bus driver Tim Murphy, 63, is upset about a full-body MUA he underwent for neck pain at Atlantic.

He told a doctor recommended by the center that he was having recurring chest pains but the doctor cleared him for the procedure. Also, Murphy said the center's anesthesiologist told him he had an irregular heartbeat during his first MUA session, but the MUA practitioners reassured him and completed two more sessions. Two weeks later, Murphy said, he was rushed to a hospital for a heart attack requiring surgery. The surgeon told him the MUA endangered him, raising doubts in his mind.

"I think their real goal," Murphy said, "was just to make a lot of money, not take care of me."


I watched the video up top with horrified fascination.

The procedure has two of the elements I most dislike about a procedure involving anesthesia:

1. No assured airway. The patient is receiving oxygen by mask, possibly along with inhaled anesthetic agent(s).

2. Change of position during the procedure. Always a headache because of increased difficulty of maintaining the airway, along with keeping the IV running, monitors attached and limbs and pressure points out of harm's way.

Combining 1. and 2. above = a nightmare. The fact the woman responsible for the airway in the video doesn't seem at all on edge makes me fear for the patient — I'd be sweating down my back if I were in charge of that patient's airway.

Not once did I see the airway manager look at her monitors to see if the EKG and O2 saturation were normal. She'd probably reply that she could hear the beeps and was focusing on the patient's airway. In fairness, that could've been the case: the background music during the video might have drowned out the machine sounds.

And though the patient's head and body were moved repeatedly during the procedure, her eyes were not taped shut to protect against corneal abrasions/foreign material. Once again, in fairness, perhaps protective ointment had been placed in the patient's eyes prior to beginning the MUA procedure. But I'd bet that wasn't the case.

Aetna Insurance published a Clinical Policy Bulletin on MUA this year which begins, "Aetna considers spinal manipulation under anesthesia (MUA) experimental and investigational."

A search for MUA at quackwatch.com turned up three results.

The American Society of Anesthesiologists reviewed the procedure in 2005, concluding its report with two words: "Doctors beware."

Substitute "patients" for doctors and that about sums it up.

You can learn more about the controversial procedure on the website of the National Academy of MUA Physicians.

I probably won't be getting an invite after this post, what?

April 1, 2009 at 04:01 PM | Permalink | Comments (8) | TrackBack

Chalkboard Candle


"Hand-poured in Los Angeles with 100% unscented soy wax."



Comes with a pack of chalk.

7.5 oz.



April 1, 2009 at 03:01 PM | Permalink | Comments (1) | TrackBack

Roz Chast on Bernard Madoff


Word — by my favorite cartoonist in the whole wide world.

April 1, 2009 at 02:01 PM | Permalink | Comments (1) | TrackBack

Oreo Fun Stix


"Straw-shaped Oreos that can be used to drink milk."

Put me down for a box.

It is bedtime yet?


April 1, 2009 at 01:01 PM | Permalink | Comments (3) | TrackBack

A shout-out to TypePad's comment spam filter


Goodness knows I'm no TypePad apologist: more than once I've grumbled out loud here about this or that problem.

But this morning I happened on something TypePad that's astounding and wonderful.

In the process of un-deleting a comment as spam that I'd mistakenly allocated to the trash heap (note to self: no comment management before second cup of coffee from now on), I had to go through six screens of spam like the one pictured above — all dated April 1, 2009 — before I got to the first of yesterday's comment spam.

And that was before 10 a.m. today.

Let's do the math (where's my calculator?): 6 (pages) x 20 (spam comments/page) = 120 in the first 10 hours of the day = 12/hour = 288/day.

Seeing as I'm only having maybe 4-6 a day get through now, such that I have to manually search and destroy them, that's a spam filter efficiency rate of 98%.

Very impressive.

April 1, 2009 at 12:01 PM | Permalink | Comments (4) | TrackBack

Bird on a wire clothes pins


Eight 3.5"-tall swallow clips in 8 colors.



April 1, 2009 at 11:01 AM | Permalink | Comments (1) | TrackBack

Jack Kerouac reads from 'On The Road' (1959)

On "The Steve Allen Show."

[via Jerry Young]

April 1, 2009 at 10:01 AM | Permalink | Comments (0) | TrackBack

Bunny Dollar Bill


From the website: "Our fun dollar bill is genuine legal tender, featuring the Easter Bunny himself — a removable decal placed over George Washington."

I guess a removable decal doesn't fall under Title 18, Part 1, Chapter 17, Section 333 of the United States Code.



April 1, 2009 at 09:01 AM | Permalink | Comments (3) | TrackBack

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