If I may draw from personal practice, I will be brief with this. I will give you an example of a 65-year-old woman who came into my office about two years ago with general bone pain. She was also diabetic. She hadn't had a bone density test in almost ten years. We phoned up the physician. She had been lax with her medical care. We got her in, and sure enough we found greatly advanced osteoporosis.
That obviously affects the manner in which one is treated. We got her referred to a good exercise practitioner who could help her develop a safe program and a nutritionist who could help her with a program for bone health.
Down the road, however, she mentioned her granddaughter, who was about 15 at the time and who was having headaches at around eleven most mornings. She brought her granddaughter in, and her granddaughter was moderately obese and was a single child of a single parent. She tended to not eat her breakfast. Of course, by eleven in the morning she was hypoglycemic and would go out and have pop. She drank a lot of pop, maybe five or six cans a day, as an awful lot of kids do. Pop has phosphoric acid, which leaches calcium out of bones. Here you have a child with the red flags in her family of diabetes and osteoporosis. You have a diet low in dairy, high in phosphoric acid, along with lack of activity in the young girl, and she is pre-diabetic and will probably be a candidate for osteoporosis down the road, if not other conditions.
That is a good example of how primary care practitioners—and in particular, chiropractors for musculoskeletal things—will take a look and ask where they can collaborate with other professions and how they can get this person well looked after.
Good access to laboratory and imaging material is essential to all primary care practitioners. That is one hurdle we have. It varies from province to province. These situations allow for education of a patient as well as early intervention and prevention. It allows us to increase activity. It allows for consultation with other practitioners. Again, the message has to be ubiquitous and universal. All practitioners need to be speaking the same way.
You mentioned barriers. Barriers for us are often differences between provincial jurisdictions. Having now worked federally, I see how different it is from province to province for not only coverage of care, but also the access to lab and imaging materials. An easy consultation and referral base with medics in the community is on the whole so much better than it used to be, but still there are some barriers. We've implemented a huge amount of effort into research in the last ten years, and that is helping greatly. But we need more, and we need more interdisciplinary research. Those would be some of the highlights.