Dr. Tom Rountree (00:01.632)
Well, welcome, Dr. Ding, to the podcast. Really great to have you here. How's your morning going?
Keith Denning (00:08.451)
Wonderful. Great to be here. Thanks for having me. Yes, very.
Dr. Tom Rountree (00:10.08)
Good, good. Pretty busy.
Yeah, that's right. So I know I kind of wanted to start out because I felt this was an interesting part of your past. You said that you were a TA at Purdue. And I think that's really important because it gives you a good kind of teaching background. And this was before you went to chiropractic school. Is that right?
Keith Denning (00:40.652)
Yep, in undergrad. Yep.
Dr. Tom Rountree (00:42.922)
And so what was it like being a TA there?
Keith Denning (00:47.5)
It was interesting. A lot of fun, met a lot of great people, great students. It was exciting. Honestly, I taught for a human anatomy and physiology course, was part of the prerequisites for nursing school. And then I also taught a biomechanics course, which is for the major of movement and sports science, exercise physiology, essentially. So I did both of those. I had
Dr. Tom Rountree (01:04.348)
nice.
Dr. Tom Rountree (01:14.208)
wow.
Keith Denning (01:17.208)
fantastic professors to rely on. And it was quite an experience. It definitely fueled my passion for educating patients, educating friends when they decide they want to ask for it. So it was a lot of fun. I really enjoyed it. It definitely, like say, fueled my passion for educating others.
Dr. Tom Rountree (01:30.282)
Mm -hmm.
Dr. Tom Rountree (01:39.624)
good, good, good. And so this was at your, if I understood at your undergrad.
Keith Denning (01:45.644)
Yes, yes, at my undergrad level.
Dr. Tom Rountree (01:48.392)
Okay, and then, and what degree were you pursuing? Or what degree did you get? Maybe they're different, I don't know.
Keith Denning (01:53.994)
Bye.
Yes, a degree of biomechanics.
Dr. Tom Rountree (01:59.026)
Okay, okay, nice. So that kind of set you up maybe to go and pursue a further like higher education in chiropractic care, is that right?
Keith Denning (02:12.822)
Yeah, I mean that I think was always the goal for me. Even at an early age in high school, my mom was a nurse for a cardiologist. So even at an early age, was kind of, with my mom being a nurse on top of it, was sort of led in that direction towards the healthcare field in some way or another. So yeah, was, it kind of helped me kind of push me into that direction, for
Dr. Tom Rountree (02:40.49)
Yeah, nurses are really special. They are the cornerstone of our health care. they're just. there you go. She probably keeps you in check. Just like my wife does. Yeah.
Keith Denning (02:43.722)
Absolutely. I married one as well, so I couldn't agree more.
Absolutely. My wife is a psych nurse actually. She has been for her entire career, 24 years, she really keeps me in check.
Dr. Tom Rountree (03:03.762)
wow. Yeah, there's literally no arguing with that. yeah. Yeah, yeah. I've shadowed some psych individuals. So that's really cool. And then afterwards, you went to chiropractic school, is that correct?
Keith Denning (03:07.695)
So you've been to my house, have you?
Keith Denning (03:27.79)
Correct, yes, I went right from Purdue undergrad, received my degree, my undergraduate degree, and then right into chiropractic school in South Carolina.
Dr. Tom Rountree (03:37.565)
nice, nice. Yeah, South Carolina. That's kind of a beautiful area.
Keith Denning (03:41.408)
Absolutely, if you like golf especially.
Dr. Tom Rountree (03:44.2)
Yeah, yeah, there is a lot of golf there. That's where my, my mom and in -laws live. it's a nice, nice area. And, and what was it like going to chiropractic school? Cause I'm actually interested in, you know, in that kind of aspect actually.
Keith Denning (03:47.19)
Yeah.
Keith Denning (03:53.388)
Yeah, it is.
Keith Denning (04:02.328)
So it was intense at first. The days, you know, in the first few trimesters were very long. It included human anatomy course, obviously cadaver lab, they call it. So there were some very, very long hours. was certainly, there was so much information, I think that there was a, it was a difficult transition from undergraduate where, you you as a junior and senior, you kind of had developed your game plan for studying and doing well.
And it wasn't nearly as intense as car practice school. it was, at first it was a shock, right, to the system, to get used to that and develop your own plan, a lot of long hours. But once you started getting the hang of it, was fantastic. It was very, very interesting. I find the human body and how it works fascinating, I always have. So it was absolutely fantastic. Met a lot of great people there and certainly,
was certainly surrounded by people obviously of like mind and our passion kind of just grew together from each other even so. You know and then what we were doing and how we were
Dr. Tom Rountree (05:17.91)
Did you find that the town kind of respected people from the school around there or was it? Cause I know it depends on the size of the town sometimes, but did you find that as well? Like, cause I found that when I went to med school, they would, they would say, hi, you go to the med school and stuff like
Keith Denning (05:35.234)
Yeah, I definitely think that the people in town were happy to have us there. At least that's the experience I had. They were afforded care at an incredibly reasonable rate. So that was really nice for them. So yeah, think there was a warm greeting, so to speak, from the townspeople in Spartanburg that they were appreciative of us being there. And they certainly saw that they were respectful.
Dr. Tom Rountree (05:49.93)
Mm -hmm.
Keith Denning (06:05.559)
Love
Dr. Tom Rountree (06:07.037)
Mm -hmm. And you said that they got treatment there too.
Keith Denning (06:12.046)
absolutely. Absolutely. We had an intern lab, if you will, a hospital, so to speak. so patients were, townsfolk were allowed to come in and get treated. It was by upper quarter students that were in their last few trimesters, and they were always guided by a licensed chiropractor the entire way through. So it was pretty interesting.
Dr. Tom Rountree (06:39.77)
that's good, that's good. And I assume you still have friends from your school, is that right?
Keith Denning (06:44.792)
absolutely, absolutely to this day. Yep, I've got some very close friends all spread out all over the country in practice.
Dr. Tom Rountree (06:53.225)
Good, good, good. And so after chiropractic school, you kind of went, did you join like a corporation or were you with a certain group?
Keith Denning (07:05.848)
So right after school, I actually at the time was married to another chiropractor and we opened practice together right off the bat. She actually worked for another chiropractor, did an externship for about six months or so. And then we jumped in with both feet, so to speak, and decided to open the doors on a new practice right from scratch in Howell, Michigan.
Dr. Tom Rountree (07:33.262)
nice. interesting. Okay, okay. He said, how Michigan? okay, nice. And I know that did you have a certain or did you form kind of an interest for a certain aspect of chiropractic care? Like, in other words, maybe focusing on more like a sports area or, you know, stuff like
Keith Denning (08:01.004)
Yeah, I think that was it was just sort of natural for me to go right into that sports and slash performance. You know Avenue of care. I was an athlete my entire life. Huge sports fan, you know baseball bat all of them and so I think it was just natural for me to sort of go into that arena in sports and performance care. Absolutely, so was definitely the direction that I headed from the beginning.
Dr. Tom Rountree (08:26.048)
Yeah, it did.
good, good, good. So there's kind of a little bit of a vision kind of where you want it to end up almost.
Keith Denning (08:35.662)
Certainly, certainly.
Dr. Tom Rountree (08:37.768)
And did you did you play sports when you're younger?
Keith Denning (08:41.612)
I did. did. Mostly soccer. was sort of the passion of mine. But baseball and football as well. But soccer was really where my heart was at, for sure.
Dr. Tom Rountree (08:52.14)
good. Good. It's a fun sport. I broke one of my big toes playing it. Yeah, it was really good.
Keith Denning (08:55.982)
Yeah, it is. It's a great sport. doesn't have as much popularity here in the US as it does abroad, but it's growing for certain. Some of the international stars have been infiltrating the American MLS league, so it's certainly growing for sure.
Dr. Tom Rountree (09:12.586)
Mm -hmm.
Yeah, I remember in Texas where I grew up, there's a big Mexican population. so they, like the older gentlemen would be out there, you know, and they would just be killing it out there. And they would end up with, know, sprained ankles and, you know, broken bones and they would get healed and they'd be like, well, I guess it's time to go back and do it again.
Keith Denning (09:30.061)
Ha ha ha.
Keith Denning (09:37.976)
Yep.
Keith Denning (09:41.846)
Absolutely. It's very intense passion for soccer. Absolutely.
Dr. Tom Rountree (09:45.516)
Yes, yeah, yeah, yeah. And the games were just as wild, know, throwing water, getting water thrown on your head and all that stuff.
Keith Denning (09:51.173)
yeah. Very intense.
Keith Denning (09:56.722)
Yeah, very intense.
Dr. Tom Rountree (10:00.07)
But I know that you had told me that you want to visit all of the MLB parks in the US.
Keith Denning (10:10.156)
Yes. So, as much as I loved soccer, you know, when I was younger, I did play baseball, loved it. my passion for baseball grew as I grew older. I actually have retired now. but even as recently as a couple of years ago in my late forties, I was playing in the men's Detroit league, in hardball baseball. So, just love the sport. We're a baseball family. All of our boys, all four of our boys, you know, play baseball or have played baseball.
Dr. Tom Rountree (10:28.901)
wow.
Keith Denning (10:39.918)
The other ones are in college now, but so yeah, it's always been a big passion of ours. And so my wife and I started this quest to visit every major league park. All right, so we're, I was ahead of her by a good eight to 10 parks that we had to revisit because she hadn't visited them yet. But we're doing well. We're probably about 40 % of the way there now on our quest, every park. So it's a lot of fun.
Dr. Tom Rountree (10:57.588)
Yeah, Yeah, yeah, yeah.
Dr. Tom Rountree (11:05.103)
cool. That's fantastic.
Keith Denning (11:08.436)
We take a vacation or two each year and you know especially in the summertime obviously and visit a couple parks at least every
Dr. Tom Rountree (11:15.686)
good, good, good, good. And I know on your website, you actually have the Notre Dame, you had a Notre Dame baseball pitcher, David Lally Jr.? Is that right?
Keith Denning (11:25.966)
Junior. So yes, he's since he's since entered the portal and actually now has transferred. He's actually at University of Michigan. So he is local to us now, which is pretty cool. So he's correct. Correct. Great kid. Throws some serious heat. He hits 97 tops out at 97, 98. So.
Dr. Tom Rountree (11:37.351)
wow, okay.
Dr. Tom Rountree (11:42.026)
nice, nice. And he was one of your patients, is that right?
Dr. Tom Rountree (11:48.288)
Very nice.
Dr. Tom Rountree (11:55.157)
Really? Wow.
Keith Denning (11:55.468)
He's, yeah, he's, I think he, I think he was drafted in the fourth round. but at that point he had decided that he was going to school for, for certain. And I think that was probably why he dropped as far as he did, but he is incredibly talented. Yeah. That's a great young man. Good hand on shoulders on top of
Dr. Tom Rountree (12:10.259)
Mm -hmm.
Good, good, you need that, you need that when you're popular. So what do you find, like when somebody's playing baseball, do you find certain injuries that are kind of repetitive or certain wear and tear that they come into your office with?
Keith Denning (12:15.682)
Yes, absolutely.
Keith Denning (12:31.404)
Yeah, absolutely. mean, one of the biggest is, you know, forearm sprain strains and elbow, potentially elbow ligament damage. Another one with some of the older baseball athletes, if you will, you find a lot of adhesive capsulitis, you know, as well, which we perform MUA's on with some fantastic results.
Dr. Tom Rountree (12:49.28)
Mm -hmm. Mm -hmm.
Dr. Tom Rountree (12:56.436)
Yeah, yeah, that was, I was getting to that actually. So, which is really cool. So I think you you said MUA, which is manipulation under anesthesia, right? And it's a very cool thing because a lot of times when somebody comes into my office with adhesive capsulitis or commonly called frozen shoulder, I can only go so far, right?
Keith Denning (13:08.677)
Yes.
Dr. Tom Rountree (13:25.18)
and I have to have them back a lot of times sometimes to keep manipulating it and fix it. But you take it one step extra, which is kind of cool. You manipulate it under anesthesia. can you tell me, like, do you have a story around that that kind of maybe changed a patient's life?
Keith Denning (13:42.904)
Yes.
Keith Denning (13:51.244)
absolutely. So I had a patient that's probably the good, probably seven, eight, nine years ago. I was practicing in Flint and had a patient that had been in a car accident. And he was, he tried every sort of procedure known to man with zero results. The only thing he hadn't done at that point was surgery and just sort of at his wits end.
Kind of went into a depressive state. It was just miserable. It could not function, you know, anything close to where he was before the accident. He came in, treated with us for a while. After, I want to say, he's probably about a four -month period of treatment. Had seen some positive results, some permanent change, just not enough. And so I suggested to him that maybe we try an MUA and see if that was something
Dr. Tom Rountree (14:31.702)
Mm.
Keith Denning (14:50.36)
you know, might help him. And it was life changing for him. I mean, he within one procedure was able to go back to work, was able to help around the house. Obviously because of this, his mood improved dramatically. I mean, just changed his life. it are a company that I work for actually did a YouTube video and put it up on the YouTube where he describes his situation.
Dr. Tom Rountree (15:07.305)
Mm -hmm.
Keith Denning (15:19.214)
what he had gone through and how this had completely changed his life. Yeah, it was pretty amazing to watch somebody go through that, you know, that kind of adversity and one simple procedure turned his life around completely.
Dr. Tom Rountree (15:25.6)
wow.
Dr. Tom Rountree (15:36.874)
Yeah, yeah, yeah. you know, I seen it where I seen both things where you manipulate under anesthesia and I've seen the arthroscopic version of it where they go in there and they kind of shave the shoulder a little bit and they cut the adhesions, you know, on there. So it got me thinking about, what's kind of the best way to maybe handle it or what's the most maybe cost effective? And I found a really cool study called the UK Frost.
like frozen shoulder frost. And it was a multi -center randomized trial. There was like 914 people and they compared regular physiotherapy with manipulation under anesthesia, as well as the arthroscopic, like the orthopedic surgeon coming in. And the MUA, the manipulation under anesthesia had the highest probability of being most cost effective.
Keith Denning (16:26.797)
Yeah.
Dr. Tom Rountree (16:35.984)
And I was like, wow, that's really cool. So it was, you know, it was a really robust study that found that if you're doing manipulation under anesthesia, that probably saves the patient the most money. And they probably don't, one, they don't have to keep coming back to the office all the time. And two, they're not paying for the orthopedic cost of like the arthroscopy and the tools and all that stuff. And I think you told me you, you,
Keith Denning (17:00.772)
Correct.
Dr. Tom Rountree (17:03.872)
told me a little bit about this when I was talking to you before.
Keith Denning (17:07.398)
Yeah, so the MUA procedure is, like to feel like they think that it's new, but it's actually been around for close to about 100 years now. It's something that was informed by osteopaths and orthopedic docs back in the 30s. It gained some popularity. And I think it started, popularity started to die off for a couple of different reasons. I think the general anesthesia was a little much maybe for
level of procedure, I think was probably something that helped that decline. And then, you know, the invention of advancements in surgical procedures obviously made a huge improvement in that in pharmaceuticals as well. And that was a route that was obviously became more popular. But then back in the 1990s, I think it gained popularity again with chiropractors. I mean, obviously we're, you know, we are the manipulation experts, if you will.
Dr. Tom Rountree (18:04.406)
Mm -hmm.
Keith Denning (18:04.438)
So I think it gained some popularity with maybe some more traumatic cases that weren't responding the way that we had hoped they would respond with traditional in -office care. So I think that was part of the reason as to why it started gaining some popularity to be used again. And again, the cost effectiveness, like you say, like you mentioned in that study, is a huge factor. One or two procedures, they don't even come close to the cost in time
financial to some of the other options.
Dr. Tom Rountree (18:40.005)
Mm hmm. Yeah, yeah, definitely. Can you can you walk us through that type of procedure?
Keith Denning (18:48.344)
Yeah, absolutely. So as far as our perspective, you know, it's similar to other procedures that you would have any sort of anesthesia for. There's an anesthesiologist on site, potentially a CRNA as well, nursing staff. So they're getting that patient prepped and ready for the procedure. far as from our perspective, doing the procedure, the docs that come in, it's depending on how many areas that we're doing,
So roughly a 15 to 20 minute procedure. And there's protocols for obviously every single area that you do, whether it's a knee, a shoulder, the spine, hips, what have you. But there's a routine that we go through. There's a lot of intense stretching and seeing what a patient's actual true range of motion is versus what they can do when they're awake and pain starts to stop their range of motion.
So, and again, while it's called manipulation under anesthesia, a large majority, probably 80 to 85 % of the actual seizure involves intense stretching, trying to break up tissue adhesions, whether they're in the joints, muscular, what have you. So there's a lot of stretching, a lot of intense massage by the doctor, then eventually the manipulation of the whatever joints or joint, joint or joints we may be doing that day.
Dr. Tom Rountree (20:14.75)
And I think it's maybe important to describe on the inside what an adhesion kind of looks like. And to me, when I would see it in the camera, it looks kind of like a Spider -Man spider web. It's kind of like connected. Yeah, it's like connected on there. And because you think adhesion, like, is it like a flat thing? No, it looks like Spider -Man spider webs. Like he just went in there and just, you know, went to town and, know,
Keith Denning (20:29.122)
I think that's a perfect description.
Dr. Tom Rountree (20:44.35)
And so that's what's stopping them moving that that kind of range of motion there. And I think, am I right? It's full anesthesia, right? Like it's not like a twilight level. It's it's I think it's pretty deep, isn't
Keith Denning (20:59.266)
No, actually, I think that was sort of what they were using a while back for the procedure, but now it's more of, I think the most common anesthetizing agent is propofol is what they're using. So it is more of a twilight state sedation. There's quite often my patients under that particular anesthesia will moan a little bit, they'll even say a couple
Dr. Tom Rountree (21:13.597)
Mm -hmm. Mm -hmm.
Keith Denning (21:27.862)
nonsensical words at times, even move a little bit or resist us. So that's when the anesthesia professional obviously will administer a little bit more to put them into a deeper sleep.
Dr. Tom Rountree (21:43.038)
Yeah, yeah, the same thing happens during a colonoscopy. Go figure. I don't know. So can you, I know on your website you have other things that you offer too. Like you offer the joint pain assessment and treatment and you have stem wave regenerative therapy. Can you talk a little bit about
Keith Denning (21:47.18)
I'm
Keith Denning (22:00.322)
Hmm?
Keith Denning (22:06.971)
Yeah, stem wave and shockwave both are sort of newer technologies. It's a focused shockwave, essentially what it is. And to break it down into layman's terms, it's imagine like a miniaturized lithotripsy machine is essentially sort of what we're dealing with. And so you're penetrating deeper into tissue. So when they say regenerative, it helps.
Dr. Tom Rountree (22:24.192)
Mm -hmm.
Keith Denning (22:35.054)
stem cells become more active in that area. So you're adding stem cells or producing stem cells, obviously, but you're helping that process move along. And so the results have been fantastic. A massive reduction in inflammation in joint areas and muscle tissue in one treatment. I believe the company states a 91 % reduction
I haven't read the study myself to see the particulars on it, but that is what they claim. So, yes, we've had some fantastic cells with it
Dr. Tom Rountree (23:07.946)
Mm -hmm.
Dr. Tom Rountree (23:15.572)
And if I remember, it's kind of like you're using an ultrasound probe looking thing.
Keith Denning (23:21.902)
Very similar, yes, very similar. When you hold the device it almost looks like a microphone if you will. It's administered for just about a five to eight minute period on a particular joint area that the patient might be a problem with. the treatment is fairly quick but it has some fantastic results.
Dr. Tom Rountree (23:42.589)
good. Good. And another interesting thing you had was an orthopedic telehealth console. Is that right?
Keith Denning (23:50.348)
Yes, so we utilize something called MDT, Mechanical Diagnosis and Treatment. It's part of McKenzie method. Robin McKenzie was a physiotherapist from the New Zealand area who developed this particular method quite a few decades ago. And so it allows the practitioner who's certified in the procedure to evaluate and assess patients.
based on their motion. And in doing so, you find what they call a directional preference for the patient. And repeated motion in that directional preference winds up essentially getting rid of pain and helping that person move better, have better mobility, and then as well as giving them the tools to help themselves into the future. Even has a couple of books produced
paperback books, pretty thin books, but pretty profound, how to treat your neck and how to treat your back. Again, giving the patients the tools to help themselves into the future.
Dr. Tom Rountree (25:03.294)
Yeah, it's interesting, you you say the thin books, usually people who are experts can say a lot more with a lot less, that's what it is. Yeah, exactly. Yeah, the McKinsey Method, I looked it up a few years ago, actually, and it's actually one of the most proven methods for back pain treatment. I know a lot of patients that I had coming through my office at the time,
Keith Denning (25:11.18)
Yeah, use your words wisely.
Dr. Tom Rountree (25:30.142)
I would send them to get this McKinsey method treatment and they would say that it worked extremely well. And so I'm really glad to hear that you use it because it's actually very well proven and actually works really well.
Keith Denning (25:47.587)
It does. The results are amazing.
Dr. Tom Rountree (25:53.092)
And so I know you've been practicing for a while and given the flow of the chiropractic industry and initially you had said that you started out with an insurance -based practice, is that right?
and now you're kind of doing, you're a little bit of a rebel.
Keith Denning (26:19.918)
Yeah, I don't know about that. I don't know about REVL. I think cash -based practices are certainly not the norm in chiropractic, but they're certainly growing in popularity. And cash practices have been around for quite a while. And I think, especially in this profession, insurance wasn't always something that was even an option for chiropractors. A lot of insurances didn't even cover chiropractic care.
Dr. Tom Rountree (26:20.553)
Yeah.
Keith Denning (26:49.876)
So I cash was sort of the only option at that point. So, but yet it's, again, I don't know if I want to say rebel, it's certainly not the norm yet.
Dr. Tom Rountree (27:04.03)
Yes, yeah, yeah. And yeah, because I remember when insurance did not pay for chiropractic care. And then it's been a few years since I looked at chiropractic care and I met you and I was like, that's interesting. They're kind of going through the same revolution that primary care doctors are, that we're saying that, well, insurance is not congruent with our principles to treat patients.
You know, and not only that, but it significantly interferes with our own ability to cognitively handle the medical problem load and the interaction with patients. So did you find that kind of same thing where the insurance would just interfere with your treatment and daily activities?
Keith Denning (27:56.606)
Yeah, I'd say so. say so. I think physicians start to see that the patient and themselves are no longer in charge of patient care when the doctor is worried about what he is or is not able to do based on the patient's finances. So then, not directly, but indirectly, the insurance company is now dictating what kind of care a patient will get.
Dr. Tom Rountree (28:09.867)
Mm -hmm.
Keith Denning (28:25.718)
at the end of the day, physicians that own their own practice are worried about their bottom line and are they able to treat patients and actually make a profit and have a living? So you combine that with the squeeze of the insurance company, well, they will and will not allow. I think doctors wind up and patients both wind up getting underserved because of that, because of not really being in actual control of their own care.
Dr. Tom Rountree (28:56.252)
Mm -hmm, mm -hmm, yeah. And the other thing is that we have to hire more people to handle the insurance itself. So then your overhead gets massive. I mean, for me, I would have to hire like three people extra if I took insurance. And so it's definitely something that needs to change. I mean, at least I think so.
Keith Denning (29:20.438)
Absolutely. Absolutely. There's a lot of hoops that you have to jump through to even bill insurance. hiring a lot of staff is an absolute necessity.
Dr. Tom Rountree (29:31.498)
Yeah, yeah. So, and now you don't take insurance at all in this current practice, is that right? Okay. So, and how does that feel now to you?
Keith Denning (29:49.454)
Oh, I mean, there are pros and cons for certain. Initially, think there's, I mean, you come from an insurance -based practice for the last 20 plus years. There's going to be some fear. Absolutely. You know, is this going to be something that's accepted? You know, so I think that's the first sensation that you get and the first emotion you get is fear of the unknown and then what it's going to be like. But we, you know, we've pushed ahead and
Dr. Tom Rountree (30:10.614)
Yeah.
Keith Denning (30:18.872)
fought and we're growing. we're definitely, bases are more accepting and I think they're more understanding of, you know, the fact that it requires some intervention on their part essentially, if you will, to maintain good health.
Dr. Tom Rountree (30:37.354)
Yeah, yeah. And since you started this kind of new endeavor, has your has your family life changed at
Keith Denning (30:49.078)
Yes, I'd say to be anything it's moved in a positive direction. I think I'm just less stressed. You know, just a happier person to be around. I think my patients can see that as well. Patients that have followed me from an old practice, you know, to here. I think that I'm just able to deliver and focus on patient care more so than I ever have been because of
Dr. Tom Rountree (31:02.447)
No.
Keith Denning (31:18.99)
because I know that I'm able to concern myself 100 % with that patient's case and what they need and deliver that care without any concerns or worries about insurance or what the patient can afford, you know, because their insurance isn't going to pay or something along those lines or racking up a large bill or anything like
Dr. Tom Rountree (31:19.296)
Mm -hmm.
Dr. Tom Rountree (31:43.72)
Yeah, and the patient, I assume they know the cost. So they're at a little bit more comfortable level too, because they don't get any surprise bills afterwards.
Keith Denning (31:51.32)
Absurd.
Keith Denning (31:55.712)
Absolutely, I think that's a huge part for the patient is just upfront hear the costs and they know walking in before they even step foot into our office if they want to find out what they are going to be expected to pay.
Dr. Tom Rountree (32:09.768)
Mm -hmm. Mm -hmm. Yeah, that transparency, I mean, is key. And it just seems like it'd be something natural in the healthcare industry, but transparency isn't always there because you have this obscurity of the insurance, you know, in the background there. And what's that? Yeah, yeah.
Keith Denning (32:27.904)
Absolutely. It's the man behind the wall. You don't know what's going on. And it says like the man behind the wall. You're not really sure what's going
Dr. Tom Rountree (32:36.582)
Yeah, exactly. Like the Wizard of Oz, like the wizards behind the the cape there and you know, the and you're like, who is that guy? And he never comes out. And you said that you were going back a little bit. You were chief of staff at a chiropractic at a large hospital, which is interesting. I've never I've never heard that myself. Can you kind of talk about that a little bit and what you did there?
Keith Denning (32:38.612)
Exactly.
Keith Denning (33:02.702)
Yeah, Insight is the company that I used to work for. started out as a neurosurgery group based out of Flint. And in the last, I want to say, five to six years, they've acquired several hospitals and grown their practice from neurosurgery into essentially just about every specialty you can think of. And approximately, say it was the end of 2015.
beginning of 2016, they hired me to run their chiropractic, physical therapy, and occupational therapy department and the Flint office. And then at that point we grew and acquired several different hospitals, one in Warren, there's a surgical hospital in Warren, they have a large outpatient clinic in Dearborn. A couple years ago, let's say three years ago, they purchased what used to be Mercy Hospital on the south side of Chicago.
And since then, they've also purchased a hospital in, I believe it's Keogh Cuck, Iowa. And I think recently they were trying to buy a hospital in Los Angeles as well. So after all the purchases of those hospitals, each time they did, they would open up every department that they had in the Flint office, which included chiropractic, PT, and OT.
Dr. Tom Rountree (34:10.848)
Mmm.
Keith Denning (34:30.594)
orthopedic surgery and so on. And so we would open a department of Cairo PT &OT in each one of those locations. It was my responsibility to staff and make sure that those departments were running well.
Dr. Tom Rountree (34:46.504)
okay, nice, nice. you, it sounds difficult. I mean, it sounds like there's a lot of responsibility there and a lot of emails coming in.
Keith Denning (34:55.467)
It was. It was a lot of work. I mean it certainly cut out some patient treatment time which was unfortunate right so I spent some time treating patients but I spent a lot of time on administrative things reviewing cases obviously about the doctors that worked for me speaking with all the individual managers of each location discussing and fixing problems.
watching obviously the financials for each location and how those were going. yeah, there's a lot of administrative work, not as much clinical as I would have
Dr. Tom Rountree (35:33.3)
Yeah, yeah, seems like that, like, as an organization gets bigger and you have that role, you lose a little bit clinical contact there. But now it's like you, it, I mean, I assume you have a lot more now.
Keith Denning (35:49.836)
absolutely. it's, I mean obviously owning your own practice there's always going to be some administrative responsibilities but it's not nearly what it what it used to be and with just one location most of most all of my time is focused on the patient care.
Dr. Tom Rountree (36:07.082)
Yeah, yeah, you're in, the name of your practice is restorative spine and pain, and you're in Troy, Michigan, right?
Keith Denning (36:15.928)
Yes, yes, Troy.
Dr. Tom Rountree (36:19.826)
And so I know we've talked a little bit about the change of the industry and things like that. Is there anything else that you think with a chiropractic industry that maybe needs to change a little bit or maybe become more in touch with the current problems in today's world?
Keith Denning (36:43.102)
I would say absolutely. would say probably one of the most important aspects in my opinion would be the need for the profession to come together to promote what it is that we do. Right. I don't think there's a very congruent unified voice in chiropractic to promote what it is that we do. And that I think leads us to where we are now with a lot of misconceptions about chiropractic care
a lack of understanding of what it is that we truly do. When you let rumors and what have you decide what the public thinks of you, you're doing yourself a disservice. So I think us coming together as a profession and promoting ourselves, like dentists do, just like anybody else would do, right? Whether it's commercial marketing or what have you, just getting the word out on how important it
Dr. Tom Rountree (37:33.994)
Mm -hmm.
Keith Denning (37:41.176)
to just see regular checkups, right? To get your spine checked with some regularity and make sure that you're taking care of yourself and your mobility as you age. I think just like I say, a unified voice would be paramount to us promoting our profession and getting the correct word out, if you will.
Dr. Tom Rountree (38:02.036)
Yeah, it sounds like that it's something that you might need to start.
Keith Denning (38:06.702)
Certainly possible, can add that to my plate. Whatever it takes. You would think. Yeah. Yes, easy. That's the word I would use.
Dr. Tom Rountree (38:08.012)
It should be easy, right? To get everybody, get the cats corralled together.
Yeah, yeah. Yeah, you know, we we face that in the direct primary care association that, you know, getting us all aligned on one topic is it can be difficult, extremely difficult. But yeah, I think getting people to know, you know, what you do and your stories and and things like that, I think it's going to be very, very important. And the other thing I was going to talk about was
You know, in the osteopathic world, we have certain techniques that we do. Like we will do like the HVLA, the high velocity, low amplitude, which is like the neck cracking and the back cracking. And in some of that to me, at least when I would do it before, it seemed to be almost like a psychological relief.
versus a mechanical relief, if that's making sense, or like a muscle manipulation relief. What are your thoughts on
Keith Denning (39:29.518)
So I certainly think that there is something to be said about the psychosomatic factor, if you will, of the noise being heard by a patient, right? did that go, did that move as if the noise is the thing that tells us whether the joint has moved or not, which obviously is not true. So there's definitely a large part of that. And I
Dr. Tom Rountree (39:42.703)
Mm -hmm.
Dr. Tom Rountree (39:54.571)
Mm -hmm.
Keith Denning (39:58.818)
the response, the actual physical response that a patient may feel can vary quite a bit based on that noise. Now, as far as that particular adjustment type of a manipulation, it has its place just like anything else, I would say. To me, it's all about the correct diagnosis, right? If we go on a thorough assessment of that patient to determine what's appropriate, right? We have a ton of tools in our tool bag.
you know, in the chiropractic world that you can manipulate a joint with. And many of them don't produce that cavitation, that sound. So I think at the end of the day, it's just proper assessment and what is the best method for this patient to get the best possible outcome. And whether that is a high velocity, low amplitude manipulation, which, you know, potentially could include rotation or not, is really just based on
good thorough assessment. For example, if I have a patient that comes in and they've got radicular symptoms into the arms and hands and they've got some disc degeneration after x -ray, see some disc degeneration in the cervical spine, the very last thing that I'm going to do is a high velocity, low amplitude, rotary adjustment, right? We've got electric impulse tools that fliver, very light force specific adjustments.
Dr. Tom Rountree (41:19.094)
Mm -hmm.
Keith Denning (41:28.204)
with no rotation, so there's a lot of options that we have. MDT, again, which is pretty much, for the most part, not completely, can be a hands -off modality for us to use. So there's a lot of options that we have. So while that manipulation is certainly one of the tools in our tool bag, it certainly isn't the only
Dr. Tom Rountree (41:50.304)
Yeah, that's good. And I think that that goes along with, you know, kind of exploring the chiropractic story, right? Like a lot of people think simply because on social media, you'll see that cracking, you know, everybody's cracking, right? You know, and but I think there's a there's a lot more to what you can do, like you were saying. And you said MDT, can you expound on that just a little
Keith Denning (42:17.324)
Yeah, the MDT like we've talked about before is McKenzie method. It's mechanical diagnosis and treatment. And yeah, that's that's sort of like we were talking about before at. I think even the instructors that work for the McKenzie Institute will tell you that at its core MDT is is really just a fantastic assessment and analysis tool. So the the therapy that comes afterwards again
Dr. Tom Rountree (42:25.16)
Okay,
Keith Denning (42:47.04)
is excellent. get me wrong, it again, it gives patients the tools to correct their issues into the future, right? It gives them the power. But at its core, that I think that is the most important part of McKenzie is that an accurate diagnosis and accurate assessment of what is going on with the patient.
Dr. Tom Rountree (43:06.856)
Yeah, it's kind of like a step by step like method to analyze what's going on. that is that right?
Keith Denning (43:14.092)
Yeah, it's very thorough and you find like I said, we call it directional preference of the patient and repetitive motions into that plane quite often, very often results in positive patient outcomes.
Dr. Tom Rountree (43:32.586)
And so now that you have more time with your family, what does a dad of four boys do to make sure they don't destroy everything?
Keith Denning (43:45.115)
Well, so three of our boys are a bit older. Two of them are at Michigan State, one's entering his last year, and the one's at Cleary College.
Frozen cons, we see them mostly in the summertime. And then when they need money, of course, we see them then. But then we have a 10 year old as well. you know, it's funny. You miss them when they're gone and you're waiting for them to leave when they're here sort of thing sometimes. When they're home for the summer, like now, we spend a lot of money on groceries, for sure, a lot more than normal.
Dr. Tom Rountree (43:59.316)
You made it.
Good.
Dr. Tom Rountree (44:07.923)
Mm -hmm.
Dr. Tom Rountree (44:20.499)
Yeah, yeah.
Keith Denning (44:28.792)
But no, we, again, we're a sports -oriented family, so we're constantly outdoors, whether it's playing a pickup family game of basketball, volleyball, swimming, whatever it might be, going to see baseball games. We spend a ton of time outside and staying active. That's, think, the key. And we spend a lot of time together. We enjoy each other's company a lot. It's fantastic.
Dr. Tom Rountree (44:59.018)
That's great. That's really great. mean, that's what, you know, as a family getting outside, there's nothing, there's nothing almost better. There's nothing than getting outside, enjoying the outdoors and moving. Right.
Keith Denning (45:14.634)
Absolutely. There's a saying in the musculoskeletal world, whether it's physical therapy or Cairo or somewhere the same like motion is medicine. It's actually part of a slogan that we have. And it's true. It really is. It is a form.
Dr. Tom Rountree (45:35.914)
Yeah, yeah, definitely. Yeah, there's a saying we have that also food is medicine. I think, yeah, and I think they kind of go hand in hand, definitely there. Well, I know we're kind of getting to the end of our journey here. And I was wondering if there's anything else you wanted to talk about or anything else you wanted to mention?
Keith Denning (45:45.358)
100 percent.
Keith Denning (46:04.494)
I wouldn't mind diving into that slogan that you just mentioned, the food is medicine. We could take a long time and talk about that.
Dr. Tom Rountree (46:11.498)
Yeah, yeah,
Dr. Tom Rountree (46:16.2)
Yes, yeah, I think so. think so. Yeah, go ahead. Let's talk for a few minutes on
Keith Denning (46:23.582)
So, you know, I think you had even mentioned in an email about US food industry and some of the things that they maybe have been a policy or something that they've been letting the public know is good for them or what have you over the last couple of decades. And if you look at like the food pyramid, right, that's that's awfully scary to look
Right? You look at the bottom of the pyramid and breads and grains and pastas, you know, are the largest part of that pyramid. And it's kind of terrifying to be quite honest that that we're consuming that kind of level of grain. Even 80 years ago when 90 years ago, whenever it was that grains were not over and sprayed with incredible amount of chemicals, herbicides, pesticides, and what have you.
I don't know that that was an appropriate thing for us to be consuming on such a large quantity. So I'd love to know your thoughts on
Dr. Tom Rountree (47:31.528)
Yeah, yeah, it's true. think a very interesting thing is one of my family members used to have a farm and we used to run from the plane. Like we'd be getting groceries out of the car and we'd see the plane come into spray and we like, okay, let's go get out of here. But yeah, I think the food pyramid, there's a few things, know, one that the concentration of the grains and breads at the bottom.
I think that needs to be reversed a little bit. Definitely taking down a few notches. And the other thing is that what a lot of people don't know is that corporations have the ability to input into this food pyramid. So if you look at the Canadian guidelines versus the American guidelines, they're very different.
you know, Canadian shows just a small portion of bread with a bunch of vegetables on the plate and a bunch of fruit and a little bit of meat up over here. And, you know, and, and the American diet does not, the recommendations do not, they don't show that. So I think that, it's good to know that that is not at least what we know from the American college of lifestyle medicine, that that's not a very healthy diet. And they, they call it
Keith Denning (48:42.306)
No.
Dr. Tom Rountree (48:57.014)
Sometimes the sad diet or the standard American diets, I think it's not good where it currently is.
Keith Denning (49:04.524)
No, absolutely. Absolutely not. And I don't even know that many people even know what the recommendations are, right? I think maybe a bigger concern is what passes for food these days. were, you know, I mean, I to use the quotes, right? But what passes for food is alarming. You you start reading ingredient labels and it's scary what we're putting inside of ourselves.
Dr. Tom Rountree (49:14.027)
Mm -hmm.
Keith Denning (49:33.378)
be honest, especially our children.
Dr. Tom Rountree (49:35.986)
Yeah, it is. And the other thing is that it's sometimes a very difficult to keep your child from noticing these things in the grocery store because they use our ancestral response to bright colors for danger. And they sit in the child will look at it and they'll be like, I want that, you know, and you have to constantly remind them this is this is not good. know, vegetables and fruit are what's good, you know, over there.
Keith Denning (50:04.718)
That's very tough task. Very tough.
Dr. Tom Rountree (50:08.616)
Mm -hmm. Yeah, our four -year -old finds them out, you
Keith Denning (50:10.072)
Constant battle.
Keith Denning (50:13.878)
Yes, they have a great habit of that.
Dr. Tom Rountree (50:17.56)
Mm -hmm, mm -hmm. The other thing is that very interesting when you look at Japan, as soon as they get into school, they have a nutritionist right there. And that nutritionist is teaching them that, what is it that, you know, what should we be eating? And when the kids get surveyed and they get polled, they will say like, what's your favorite food? And they'll be like broccoli.
know, broccoli's my favorite food. And even though when they ask the question repetitively, the kid will stick to his guns and be like, broccoli, you know? It's not Frito -Lays.
Keith Denning (50:55.543)
I think you might have to search long and hard to find an American child whose favorite food was broccoli.
Dr. Tom Rountree (51:03.432)
Mm -hmm. Mm -hmm. Yeah. Yeah, do you ever talk to your patients about this type of, you know, food problem?
Keith Denning (51:14.574)
Absolutely. Patients are always recommending or asking for recommendations for what they should be eating. It's pretty consistent that they do that. know, my advice to most of them is to consume a lot of organic fruits and vegetables. Make that pretty much the staple, you know, of your diet. Avoid
heavy grain use, heavy dairy use, lean organic meats, and in smaller portions are fine as well. And that is a decent summary of most of the advice that I give them. yeah, the patients are usually asking for what to eat. They're just not sure. I mean, with so many fad diets and whatever, they're being bombarded consistently with that stuff.
Dr. Tom Rountree (52:08.02)
Mm -hmm.
Keith Denning (52:12.31)
it's hard to get some actual good information.
Dr. Tom Rountree (52:16.202)
Yeah, yeah, it's, it's it is, it's, it's very hard because they're looking at all of these different things when it's, I mean, and from our point of view, it's very simple, you know, does it look like a whole food or, or doesn't it? And, you know, it's, it's kind of funny because the Mediterranean diet is, is one of them that seems like a
fan diet, but it's just simply our whole foods and our vegetables and our fruits. And it's very hard to show them the proof of it when they're bombarded by all of these messages outside. Yeah, you know, it even carries over into the hospital food sometimes. You know, and it's hard to it's hard to fight that too.
Keith Denning (52:57.378)
Yes. Yes.
Dr. Tom Rountree (53:09.352)
It's hard to fight, because I know the American College of Lifestyle Medicine, part of their goal is to reverse that inside the hospitals. But you have to literally go to the very top and work your way down. So you can't like I remember I asked one of them, I tested it out. I went in there and I asked one of the staff members, said, can you just maybe just put some olive oil in just regular olive oil with no additives, nothing else, right?
And they're like, I don't think we can do that. like, I said, it's just olive oil, you know.
Keith Denning (53:40.814)
Yeah, it's scary. I unfortunately have been spending a lot of time in a hospital. My father -in -law has been suffering from end -stage renal disease. My stepfather had a massive heart attack last week. And so I've witnessed firsthand the food choices that patients are given.
Dr. Tom Rountree (53:57.205)
Mmm.
Dr. Tom Rountree (54:03.323)
wow.
Keith Denning (54:10.862)
You would think that after suffering a massive heart attack, diet would be vitally important. But the food that my stepfather was given was something like would, 16 year old would eat on a regular basis, right? Fried foods and heavy gravies and what have you. And I'm thinking, my goodness, that guy just had a massive heart attack. I think maybe a more appropriate diet is in order here. So no,
It's definitely systemic. It's worldwide.
Dr. Tom Rountree (54:43.956)
Yeah, yeah, yeah, it really is. Well, hopefully we can use this message and then combine it with other people and really, we have to lobby for it, I think. I think that's one of the goals to start. So I'll get you on a plane over to Washington, DC and get you in that office over there.
Keith Denning (55:01.376)
Absolutely.
Keith Denning (55:09.134)
I'll pack my bags. Just tell me when. Let's go. It's worth it. You know what? It's worth fighting
Dr. Tom Rountree (55:13.854)
Yeah, exactly. Well, it is. is. Yeah, you're right. You're completely right. It's a staple that we need to nail down, basically. Well, I really appreciate you talking with me. This is a great ending, I think. I think it really shows what good principles you have and what patients can kind of expect and just how,
good of an all -around person you
Keith Denning (55:47.214)
Appreciate that. Thanks for having me on. I had a great time.
Dr. Tom Rountree (55:57.172)
Yeah, maybe we can do a part two sometime.
Keith Denning (55:57.324)
and
That would be fantastic.
Dr. Tom Rountree (56:04.662)
Well, thanks so much for talking with me and we'll definitely follow up with another one.
Keith Denning (56:05.057)
I'll enjoy
Keith Denning (56:14.242)
Sounds great. Thanks, Doc. I appreciate it. Take care. Bye.
Dr. Tom Rountree (56:15.722)
Alright, thanks a lot.