All Things a Poison. Plus: Silicon, an Overlooked Trace Mineral?

If you are recommending trace minerals to your patients, chances are you are recommending toxic substances.  The strange paradox is, many of these toxic minerals are also essential for life!  With the recent popularity of coral calcium, colloidal mineral cocktails, and other supplements containing seventy or more trace minerals, the question of how toxic elements, such as arsenic, cadmium, antimony, and vanadium, can be safe needs to be addressed.  Truth is, each of these minerals is deemed an “essential mineral” by the National Research Council (NRC)–that is, essential for human or animal life and only available to the body by ingestion of foods.

Human bodies contain 60 minerals, but our soil is only replenished with 3

Take arsenic for example.  This well known deadly poison is also required for life (NRC, 1989).  The average human being has 20 mg of arsenic distributed throughout the body.1  Studies on rats have shown a deficiency of arsenic is associated with retarded growth, Similar information is available on all 25 essential minerals–each is necessary, yet they will all have severe adverse effects in large quantities. The famous Swiss physician, Paracelsus, summarized this phenomenon in the 1400’s when he said, “All substances are poisons; there is none which is not a poison.  The right dose differentiates a poison and a remedy.”  Even oxygen and water, taken in extreme amounts, can prove toxic. 

But, which minerals are considered essential?  One hundred years ago, only fourteen elements were thought to be essential.  In 1950, copper, manganese, zinc and cobalt were added.  Late in the 1950’s, selenium was included.  1975 saw the inclusion of fluorine and silicon.  A few years later, boron was added.  Today, twenty-five are classified as essential!  The rest are not considered essential or ruled as non-essential.  It should be noted that sixty trace minerals are found in human milk, including aluminum, bromine, vanadium and nickel, which were previously considered unimportant, so we may eventually learn that up to sixty are essential or important minerals. 

It is interesting that we know of at least twenty-five essential minerals and, yet, our soil is only replenished with the big three:  nitrogen, phosphorous and potassium (NPK).  Many trace minerals have become entirely absent in the land growing feed for their cattle, so farmers have begun supplementing their beef and dairy herds, because it makes economic sense–it is more profitable to buy trace mineral supplements and feed it to their cows than to suffer losses from trace mineral deficiency diseases.  Heifers on trace mineral programs produced 3.7 pounds per day more milk compared to non-supplemented groups, conception rates improved significantly, weaning weights in calves were higher and overall herd health improved.2

Not only cattle benefit from adding trace minerals to their diets.  A two-year study raising meat chickens using Brazilian coral minerals, as compared to birds on growth hormone, was conducted at University of Vila Velha, Brazil.  The result showed similar growth rates, but the chickens on coral were more energetic and, hence, produced a leaner, higher protein, lower fat bird.3

Think about that.  Farmers find it cost effective to buy trace minerals and add them to animals’ foods because the animals are not getting these elements from the produce of the fields.  Humans eat from those same depleted fields and, yet, many of us do not think about supplementing ourselves.  Perhaps it is time to reassess our fears of “toxic” trace minerals.  Trace minerals can be toxic in large quantities but equally damaging to health, and more prevalent, is their absence.

References
1. Halstead B, Fossil Stony Coral Minerals p. 64.
2. Feedlot, Volume 8, number 2, March 2000.
3. University of Vila Velha Study on Chickens,
www.brazilcoral.com.

Silicon, an Overlooked Trace Mineral?

Fiber rich foods, such as cereals, oats, wheat bran and vegetables, have high silicon concentration, as does coral from Brazil, available only through professionals

Even silicon, a trace mineral that is abundant in nature, can produce tremendous results far beyond the commonly known benefits for hair, nails and skin, when taken as a supplement.  Here are some of the latest studies on this unsung hero:

Silicon has an important role in preventing osteoporosis.  Bone loss occurs, generally, with aging, but accelerates during menopause with its resultant estrogen deficiency.  Studies with animals indicate that silicon supplementation reduces the number of osteoclast cells, partially preventing bone resorption and bone loss.1  On the other hand, Keeting, et al., demonstrated that silicon stimulates DNA synthesis in osteoblast-like cells.2  Animal models for osteoporosis using estrogen deficient rats show silicon supplementation preventing bone loss.3  In a 1993 study of fifty-three osteoporotic women, silicon supplementation was associated with a significant increase in mineral bone density of the femur.4

In addition to connective tissue and bone health, several other health benefits, such as protection of arterial tissue and defense against aluminum toxicity, derive from silicon.

It is believed that silicon bonds with aluminum in food and, in so doing, reduces gastrointestinal absorption of aluminum.  In rat studies, silicon was found to prevent the accumulation of aluminum in the brain.5  The protective role of silicon on aluminum was confirmed in a French study of elderly subjects.  High levels of aluminum in drinking water had a deleterious effect upon cognitive function when the silicon concentration level was low.  When the silicon concentration was high, exposure to aluminum appeared less likely to impair cognitive function.6
Experiments with rabbits eating a high cholesterol diet demonstrate silicon’s benefit as a defense against atherosclerosis.7

Silicon in your diet
Silicon is used by plants for structural support; hence, fiber rich foods, such as cereals, oats, wheat bran and vegetables, have high silicon concentration.  Another source of organic silicon available only through medical professionals is coral from Brazil.  On average, it contains 1320 ppm, along with seventy-two other trace minerals.  There are currently no established guidelines for silicon intake in humans, but there is evidence that supplementation is valuable. – by Mark Percival, D.C., N.D.

References
1. Hott M, et al.  Short term effects of organic silicon on trabecular bone in mature ovariectomized rats.  Calcif Tissue Int 1993 53:174-179
2. Keeting, et al.  Zeolite A increases proliferation, differentiation, and transforming growth factor beta production in normal adult human osteoblast-like cells in vitro.  J Bone and Miner Res 1992, 7 (11):1281-1289
3. Rico H, et al.  Effect of silicon supplement on osteopenia induced by ovarianectomy in rats.  Calcif Tissue Int 1999, 66:53-55
4. Eislinger J, Clariet D.  Effects of silicon, fluoride, etidronate and magnesium on bone mineral density: a retrospective study.  Magnesium Research 1993, 6(3):247-249
5. Carlisle EM, Curran MJ.  Effect of dietary silicon and aluminum on silicon and aluminum levels in rat brain.  Alzheimer Dis Assoc Disord 1987, 1:83-89
6. Jacmin-Gadda H, et al. Silic and aluminium in drinking water and cognitive impairment of elderly.  Epidemiology 1996, 7:281-285.
7. Loeper J, et al.  The antiatheromatous action of silicon.  Atherosclerosis 1979, 22:397-408.

Important Multivitamin and Magnesium Update

Multivitamins
Only until recently, has the use of supplements been generally accepted by the mainstream healthcare community.  Naturally, there remain pockets of resistance, and that is likely to last forever; however, we just need to recall the comments made in an article in the Journal of the American Medical Association last year:1

“In the absence of specific predisposing conditions, a usual North American diet is sufficient to prevent overt vitamin deficiency diseases….  However, insufficient vitamin intake is apparently a cause of chronic diseases….  A large proportion of the general population is apparently at increased risk for this reason….  Most people do not consume an optimal amount of all vitamins by diet alone….  We recommend that all adults take a multivitamin daily.”

Bruce Ames, a famous researcher at the University of California at Berkeley, tells us that a deficiency in even one vitamin/mineral, including folic acid, vitamin B12, vitamin B6, niacin, vitamin C, vitamin E, iron, or zinc, is capable of mimicking the cellular damage caused by ionizing radiation, and that we should compare vitamin/mineral deficiencies to radiation damage to gain perspective on how crucial it is to ensure adequate nutrient intake.2  Ames tells us that remedying such deficiencies with supplementation should lead to a major improvement in health and an increase in longevity at a low cost.

In August of 2003, a study on multivitamin supplementation was published in the Journal of Nutrition.3   Researchers examined the relationship between multivitamin intake and myocardial infarction (MI) in adults living in Sweden, a country in which fruit and vegetable consumption is relatively low and foods are not fortified with folic acid.  The study found multivitamin supplementation is inversely associated with MI risk in men and women, and this is after healthy lifestyle habits were taken into consideration.

Multivitamin supplements are extremely reasonable.  All of our patients should be taking them.  Who knows what nasty disease we may prevent by making this simple healthy addition to our diet?  As people are often very resistant to changing their diets, adding a multi can act as an intermediate step, offering health protection, while patients struggle to get their diets in order.
 
Magnesium
In the January 29, 2003, issue of TAC, I wrote an article about magnesium and its many benefits for our patients.  Consider briefly that magnesium adequacy can help prevent the development of many diseases, including osteoporosis, muscle dysfunction, depression, apathy, cardiac arrythmias, hypertension, atherosclerosis, and even stress and aging.

Researchers suggest that for every 2.2 pounds of body weight, which is equivalent to one kilogram (kg), we should be ingesting six mg of magnesium.  Accordingly, a 150-pound man (70 kg) would require 420 mg/day, while a 200-pound man (90 kg) requires 540 mg/day.  This needs to be considered in light of the 420 mg/d RDA for males; clearly it does not necessarily apply to men who weigh more than 150 pounds.  The RDA for women is 320 mg/d; however, if you weigh 140 lbs, you will need 380 mg/d.  In other words the RDA only applies to woman who weigh 117 pounds.

A recent study examined magnesium intake among white, black, and Mexican males and females. The results are quite shocking.  (see Table 1)

Table 1. Average intake of magnesium 

It should not be a surprise to any of us that we suffer from diseases related to magnesium deficiency.  The majority of our population is likely to be deficient in magnesium.  Fortunately, magnesium supplements are reasonably priced and, therefore, remediation is quite easy to realize. TAC

References

  1. Fletcher RH, Fairfield KM. Vitamins for chronic disease prevention in adults: clinical applications. JAMA. 2002; 287(23):3127-9
  2. Ames BN. DNA damage from micronutrient deficiencies is likely to be a major cause of cancer. Mutat Res. 2001; 475(1-2):7-20
  3. Holmquist C, Larsson S, Wolk A, de Fair U. Multivitamin supplements are inversely associated with risk of myocardial infarction in men and women—Stockholm Heart Epidemiology Program (SHEEP). J Nutr 2003; 133:2650-54
  4. Ford ES, Mokdad AH. Dietary magnesim intake in a national sample of US adults. J Nutr 2003; 133:2879-82

Dr. Seaman is the Clinical Chiropractic Consultant for Anabolic Laboratories, one of the first supplement manufacturers to service the chiropractic profession.  He is on the faculty of Palmer College of Chiropractic Florida and on the postgraduate faculties of several other chiropractic colleges, providing nutrition seminars that focus on the needs of the chiropractic patient.  Dr. Seaman believes that chiropractors should be thinking like chiropractors, while providing nutritional recommendations.  Doctors and patients who follow his programs report improved feelings of well-being, weight loss, dramatic increases in energy, and significant pain reduction. 
Dr. Seaman can be reached by e-mail at
[email protected].

The Webster Technique – A Chiropractic Analysis and Adjustment for Pregnant Women

More and more women are seeking the benefits of chiropractic care in pregnancy.  Many birth care providers are becoming aware of the efficacy of care throughout pregnancy and encouraging their patients/clients to find doctors of chiropractic who are interested in caring for pregnant women.  As with any specialty group within the population, there are specific types of spinal analysis and adjustment which are adapted to the best care for that population.

The Webster Technique is a specific analysis and adjustment whose appeal, necessity and popularity are increasing in both the professional and public sectors.  Discovered by Dr. Larry Webster, this technique was first taught as a sacral adjustment which allowed a baby in a breech presentation to turn to the vertex position.  As founder of the International Chiropractic Pediatric Association (ICPA) and Pediatric Instructor at Life College, Dr Webster had the venue to share this technique with many students and doctors of chiropractic.  These practitioners brought this technique into their communities and, according to Dr. Webster’s instructions, offered it to mothers who presented with breech presentations in their last tri-mester.  Success with this specific adjustment to alleviate “breech presentations” became known by birthing practitioners (primarily midwives) and it became known as the Webster Breech Turning Technique.

When Dr. Anrig was compiling the extensive materials for her textbook, Chiropractic Pediatrics, the name of the technique was revised to the Webster In-Utero-Constraint Technique.  This title reflected a more accurate description of the technique, as it identified the physiological relationship between the sacral subluxation and intrauterine constraint.

After Dr Webster’s passing in 1997, the technique continued to be taught by instructors of the ICPA’s 120-hour certification program.  With its increased exposure and use, more women experienced the benefits of the technique and more practitioners expressed greater interest in defining the physiological aspects of this particular analysis and adjustment.  A look into the physiology of the woman’s pelvis, particularly the suspension ligaments of the uterus and their biomechanical relationship with the sacrum, revealed a deeper understanding of how the administration of this technique could affect the positioning of the developing fetus.  In February 2000, the ICPA approved and incorporated a Technique Proficiency class to update and expose doctors to the, now understood, physiology of the technique.  The technique, itself, became termed the “Webster Technique.”

This more sophisticated understanding led to an evolution in the technique protocols.  Whereas the technique was previously used on women presenting breech in their last trimester only, it is now understood that this specific sacral analysis and adjustment is an asset to the pregnant woman throughout pregnancy as a means of preventing or limiting the potential of intrauterine constraint.

Intrauterine constraint is a condition where fetal movement is restricted, resulting in potential adverse effects to its development throughout pregnancy.  Furthermore, limited movement and space in the uterus can lead to malpresentation in various forms: breech, transverse, posterior, as well as ascynclitic presentations.  Malpresentation at the time of birth is one of the four leading causes of dystocia (difficult labor).  Dystocia is the primary reason for medical intervention.  Medical intervention almost always leads to further intervention and, frequently, results in a more traumatic birth for both the mother and baby.

It is a wonderful thing to offer a service and help create an environment that allows a baby to go from breech to vertex.  Breech presentations, however, occur in only 4% of the population.  Many, many more women experience dystocia in labor, leading to excessive interventions and trauma.  When it comes to birth, the obstetric profession readily refers to difficult labor and its cause by admitting that, “Such complications, however, are not determined by birth weight alone, but by a poorly understood relationship between fetal and maternal anatomy and other factors.”  In Williams Obstetrics’ chapter on dystocia, the authors also admit that they have a limited understanding of the natural, physiological process of birth.

As doctors of chiropractic, our perspective on physiology offers significant insight into intrauterine constraint, its effects, and the difficult labors it creates.  The Webster Technique is a significant analysis and adjustment to be utilized throughout pregnancy for the prevention of dystocia.  

Action of the uterine ligaments: Like guy ropes, they anchor the upper uterine segment and prevent it from pulling up above the presenting partThe ICPA Technique Committee has put out an official definition of the Webster Technique, and encourages all doctors to remain consistent with this definition when referring to this technique.  The term “breech turning” is physiologically, legally and philosophically incorrect.  The definition is as follows:  “The Webster Technique is a specific chiropractic analysis and adjustment which reduces interference to the nervous system, improves the function of the pelvic muscles and ligaments, which in turn, removes constraint of the woman’s uterus, and allows the baby to get into the best possible position for birth.”

The ICPA Research Department is involved in several large scale studies to demonstrate the efficacy of the Webster Technique for safer, easier births.  Members of the ICPA are being invited to participate in these exciting projects.

Since ICPA’s initiation of the Webster Proficiency series in Feb 2000, over 2,000 practitioners have become certified.  They are now aware of the physiology behind the technique and the far reaching implications it has on the future of safe and natural birthing.  If you are already certified, kudos to you and the women in your community!  If you learned the technique years ago, update your knowledge and understanding of its application.  Your ability to adequately explain its efficacy to both women and birth care providers establishes your credibility.  The way you represent this technique in your community has ramifications for the entire profession.  If you do not know this technique, you owe it to the women in your community to become proficient and lead them towards safer, easier births.

It is a true teacher’s dream to see his or her work grow and evolve to be of even greater service and value.  When I think back on our founder and teacher, Dr. Larry Webster, I know he would be pleased that his technique is now offering a significant contribution to safer, easier births for all pregnant women.

References
The Webster Technique: A Chiropractic Analysis and Adjustment for Pregnant Women
By Jeanne Ohm, D.C.
For references, e-mail:
[email protected] or visit: www.icpa4kids.com.

Dr. Jeanne Ohm has practiced in a family practice with her husband, Dr. Tom, since 1981.  They have six children who were all born at home.  Dr. Ohm has lectured internationally on the topic Chiropractic Care in Pregnancy and Infancy for many years and is an instructor for the ICPA’s Certification Diplomate Program.  Currently, Dr. Ohm is the Executive Coordinator of the International Chiropractic Pediatric Association, the oldest and largest organization of its kind.  For additional information about the ICPA or their classes, please visit www.icpa4kids.com or call 610 565-2360.

Software & Technology

When selecting a software package for your office, take your time and know exactly what you are looking for.  There are many applications on the market today to choose from and the search can be intimidating for someone who is not savvy on the latest technologies.  However, without having the technical knowledge, there are ways that you can make good decisions.

Obviously, technology is the way of the world now and we must join in or be left behind.  After researching many products out there, the most important feature to a software application is the ease at which data may be entered and the ability to adapt to your own office workflows.  Many times, end users will manipulate the software in ways to fit an office workflow that may actually make data entry more difficult, rather than easy and efficient.

Software and Technology Windows based applications are the appropriate choice today.  If you are not familiar with the latest technologies in hardware, networking, and internet connectivity, you should consider hiring a technical person to guide you in making those decisions.  Selecting the right hardware and networking system for your software is critical.

To begin your search for software, first make a wish list of what you would like to have in your system.  Review your current practice systems and imagine ways that would enhance your overall ability to render service, if certain processes could be automated.  Create a list of the current reports that you use on a regular basis.  Identify information that you are not able to obtain and would like to have in order to better manage your business.  Knowing exactly what your needs are gives you power and confidence to begin your search.   

Contact other providers and find out which software packages they are currently using.  Ask the doctor and staff what their likes and dislikes are with regard to their system.  After, you have identified the various packages to consider, contact each company and request a demo of their product.  During the demo, have prepared a list of questions of desired functionality that you would like to see.  A good way to find out how a system would work for your office is to create scenarios that you would like to see handled with that software.  For instance, request that the vendor demonstrate entering a new patient that has both a primary and secondary insurance and has a 20% co-pay.  Ask them to demonstrate charge entry and entering a patient payment. 

Create scenarios that would encompass your entire system, from entering a new patient, and scheduling multiple appointments, to ledger functionality.  Pay close attention to the number of screens and flow of the data entry through each scenario.  Make sure that the system is not too difficult or cumbersome to handle the easiest tasks.
Reporting is a very important feature in a system.  You want to look for a system that has good reporting capabilities.  Many vendors have integrated the technology for Open Database Connectivity (ODBC), which allows the user to capture their data and implement other reporting software in order to create custom reports.  This technology is also important for cleaning up data, if necessary, and fixing problems without having to contact technical-support.

A software application should be one that you can expand and grow with.  Many packages offer “bells and whistles” that you may not think are necessary for your practice.  Our industry is one that is constantly changing and, as your practice grows, these features may become important to you later down the road.  Choosing a basic package to begin with may result in more expense later when your needs begin to expand. 
When choosing the right company to enter into this important relationship with, you must understand the aspects of this company that will affect you.  First, every company has a support department.  Find out if the support is 24/7. 

How many times per month, can you call for help?  In addition, many companies offer different levels of support from very costly to relatively inexpensive.  Your first year with a new software company is a time of growth and, sometimes, frustration.  Good technical support is important and should be readily available.  Many companies will also tailor a support contract that fits your budget.  Support contracts normally include updates to the product that add additional features free. 

Training is another major aspect when selecting a new software company.  Most companies offer different packages for training that include onsite or modem training.  Investing in extensive training will save money in the long run and relieves staff anxiety during the implementation phase. 

Components to Practice Management Software:
Scheduler:
  When looking at automating your scheduling, make sure that the software is flexible.  The software should be able to handle multiple work hours for multiple providers, with different days and times.  The ability to create your own appointment types and set specific time limits to each can be important.  Scheduling a patient should be simple and fast.  A nice feature in a scheduler is the ability to block book multiple appointments and or cancel multiple appointments with out having to switch from day to day to enter each appointment.  The ability to customize the views is also a plus.  The system should allow you to create views that will display multiple doctors, single doctors, and daily and weekly views.
A good scheduler program should also possess the functionality to flag appointments to track cancellations and reschedules, print patient’s appointments, and generate statistics.

Billing:  The most important part of the billing system is the ability to generate clean patient statements, enter charges easily and accurately, and post payments per line item.  Make sure that the system maintains a payor history for the patient and can handle multiple injuries or incidents for each without having to create separate patient accounts.  When posting payments, make sure that you have the flexibility to create appropriate write- offs or adjustments.  Payments should be able to link back to the specific payor who made the payment.  All accounting reports are generated from the patient ledgers and, many times, how the reports are created can be confusing.  During training, be sure that you understand exactly how the information is reported, to insure that you are getting accurate figures.
Make sure that the system has the capability to file electronically.  Even if you are not currently filing claims this way today, it is likely to happen in the future.  When generating bills, either electronically or on paper, the system should have a process to review all claims and check for missing information before sending out the claim.  The process for fixing those errors should be user friendly.  In addition, there should be a good way to track collection attempts and add notes to the system for follow up information. 

Documentation:  It is recommended that the software have both a practice management package and a fully integrated documentation package.  As hard as it is to get rid of those paper charts, it is almost becoming a necessity with today’s requirements for providers to prove medical necessity.  An all-in-one package saves everyone time and money.  There are very good systems with touch screen and voice recognition to simplify this process.  Handheld devices have also improved this process for reasonably low costs.
Security:  This is a very important factor in today’s world with the HIPAA regulations.  Advanced security features can add value to any system.  The ability to control and user-functionality is extremely important.  In addition, with electronic documentation, most systems can track who and when accessed any record.  This feature is especially important to compliance with the new regulations. 

Customization:  Customization is the ability to change the program to meet your practice needs.  When purchasing software, inquire about the flexibility for customization on both the practice management package and documentation package.  Be aware that customization will result in additional fees. 

Pricing and Costs:  Software applications usually price the software with a base price that includes one-to-five users.  Additional user licenses will add to the cost of the software.  Purchase the amount of users you currently have and add a couple more to leave room for growth.  Purchasing licenses later can result in higher costs, so it is better to plan now than pay later.  Support contracts can vary.  Structure a support contract that works for you.  Make sure that there is a true value to their contract, such as upgrades.  Training is one area that you do not want to skimp on.  The more training your staff has, the better they will adapt to a new way of doing things.  New systems can be very intimidating to staff who are not comfortable with change.
In summary, when selecting a new software vendor, choose a reputable company and gather references.  Know what you want and educate yourself on all of the many options available.  Make sure that the software is user friendly.  Always remember to purchase a software that will grow with your practice and enhance your overall service delivery and profitability.

Ms. Munroe was an Executive Director and Practice Manager for a successful multidisciplinary practice for over 6 years.  Her experience and proficiency lead her to the position of Implementation Manager with a large practice management software company for 5 years.  She is currently the Vice President of Development Services at Practice Perfect.  Contact her at [email protected].

Trigenics Myoneural Medicine

As a chiropractor, I have been focusing on the human nervous system and correction of related neuromusculoskeletal dysfunction for over twenty years. Although chiropractic adjustments constantly produce tremendous results, the holding elements and soft tissue components of the subluxation complex and biomechanical dysfunctions have been largely undervalued. Trigenics is a form of manual medicine that provides a solution to correcting soft tissue dysfunction and neuromuscular/neuro-energetic imbalance.Dr. Austin applying a Trigenics performance enhancement treatment to Ted McIntyre at Angus Glen A treatment such as this fits in perfectly with current chiropractic paradigms. The Trigenics Institute of Myoneural Medicine has been teaching Trigenics seminars in Canada and Australia for a number of years. The response from many notable chiropractors that have undertaken its study has been that of high acclaim. The Registered Trigenics Practitioner program and RTP designation were recently introduced to the United States. As such, this article will serve as a brief introduction.Trigenics is an interactive, neurologically based soft tissue assessment and manipulative treatment system that symbiotically combines aspects of both Eastern and Western manual medicines.

The three main components are:
It involves the simultaneous application of three components for a cumulative synergistic effect.
1) Autogenics

2) Myogenics

3) Neurogenics

Trigenics main therapeutic applications revolve around neurologically modifying muscle tone and somatic function, as well as restoring and balancing functional sensorimotor biomechanics. Although each of the three originating components in Trigenics (“genics”) could basically be used as a stand-alone therapy, the synergistic effect of combining three in a specific way provides results that are profound. This is further supported by a recent study done by Masakado Y (2001), who demonstrated that inhibition on a target muscle is significantly increased when the two stimuli (stimulation of the peripheral nervous system and central nervous system) were given together, rather than separately. Ikai (1996) also suggested that inhibition of antagonist muscles may occur at the cortical and spinal cord levels. One of the key concepts of Trigenics is to “trick” the central nervous system into super-inhibiting the target muscle. Once the muscle is put into a temporary unloaded state, it can easily and rapidly be strengthened or lengthened, using various manipulative procedures.

There are three main treatment procedures in this system:
(meridian muscle manipulation) (reflex neurology)

1) Trigenics Strengthening (TS)

2) Trigenics Lengthening (TL)

3) Trigenics Manipulation (TM)

 

Vladimir Janda has clearly delineated that many muscular and biomechanical problems develop as a result of muscle imbalance that is created by either shortened or weakened (inhibited) muscles. Imbalanced development or, more clinically, aberrant alignment and disruption of the kinetic chain integrity will inevitably lead to injuries. Traditionally, doctors and therapists have been prescribing stretching exercises for the shortened muscles and isotonic/isometric resistive exercises to strengthen weakened muscles. Although these exercises have been widely utilized, however, it takes a few months to achieve results. It will take at least the initial four-six weeks just to regain the proper neural recruitment (Moritani and Devaries, 1979; Sale, 1992). In addition, these exercises do not necessarily correct muscle spindle dysfunction. They can even be counterproductive, if a greater state of imbalance is created due to aberrant neurological input to the heavily innervated sensorimotor system. Trigenics assessment procedures provide delineated methods of locating and objectively mapping out patterns of weakness and shortening. A second key concept is the active-assisted-resisted training and interactive involvement of the patient. The patient is an active participant, rather than a passive recipient, as they actually exercise their muscles simultaneously during the treatment. This allows early training of neural recruitment to improve muscle strength, and shortens the total time for rehabilitation training. It also serves as an early stimulation of the joint mechanoreceptors and proprioception training, as well as stimulation of the muscles’ strength-building elements.

Following assessment, Trigenics TS and TL treatment procedures enable the practitioner to alter the muscle’s neurological firing pattern for a cumulative tonal “resetting” effect. (With the advent of digital muscle testing devices, such as the MicroFET III, objective results are easily recorded and shown to the patient pre- and post-treatment.) Only after the muscles’ aberrant firing patterns have been normalized will rehabilitative exercises work to enable the musculature to respond in such a way that the resetting will be held. Muscles will then respond to exercise in a way that creates balanced growth and development.

Trigenics essentially has a cumulative synergistic effect on the nervous systemTrigenics is, generally, not hard on the doctor or the patient. It is much easier for the doctor to apply and easier for the patient to receive than regular mechanically based soft tissue techniques. The patient usually does not experience appreciable pain during the treatment, and rarely has any delayed onset of post-treatment soreness. In collectively facilitating the patient’s nervous system to reduce pain signals and inhibit the target muscle, the protocol allows for much easier and even deeper access than would otherwise be achievable.

The Trigenics Practitioner, or Trigenist, may use manual or instrument contact in the application of the treatment.  Contact is made with the tissue in such a way as to distort the fibres to stimulate local mechanoreceptor activity, and to increase the mechanical load on the tissue in order to stimulate proliferation of fibroblasts at a cellular level (Eastwood, 1998 & Galen, 1999).  This form of manual contact is referred to as Proprioceptive Distortional Myomanipulation (PDM).  (Direct ischemic compression pressure and longitudinal traction pressure are not to be used with Trigenics, as they are often painful to the patients, causing reflexogenic contraction of the muscle.)  The application of PDM often results in a Myoneural Reduction (MNR), wherein a muscular or articular cavitation is notably felt.

Processes involved in a Trigenics treatment:

nitial cerebral pathways induce voluntary muscle contraction activity of specific vector forces to cause firing of pre-programmed proprioceptive and sensorimotor feedback signals from within the
muscle or tissue.

+

The controlled generation and convergent neurologic bombardment of existing and recently uncovered, reflex feedback mechanisms such as the inverse resistance loading reflex (aka “The Austin Response”*), generate sustainable changes in the firing pattern of the targeted musculature.
(*Application of a measured light resistance load to the agonist will facilitate an increased level of reciprocal innervation to the antagonist.)

+

Localized monosynaptic pathways are further generated and added to the converging neural signal pool via simultaneous distortional manipulation of the tissue mechanoreceptors during muscle exercise activity.

=

A cumulative “myoneural” response that is significantly greater on multiple levels than one could attain with application of mechanically based techniques.

Many doctors who have studied Trigenics have commented that Trigenics “puts it all together”.  They see it as an effective treatment formulation, which includes key aspects of many singular treatment and exercise modalities already known to be effective.  The Trigenics treatment combination, with the incorporation of recently researched neurophysiological reflexes, provides results that are not linear, but exponential.
Trigenics treatment protocols can be used in close succession for optimal results with multiple treatment plans.  Adjunctive laser applications and topical post-treatment homeoceuticals such as Trigel® are also used in certain cases.  (Trigenics treatments average ten-to-twenty minutes, with fees standardized at $75-$150/tx.)  There are four application levels for the TS and TL procedures, with four types of PDM techniques, depending upon muscle size and design.

before and after

Examples of Conditions, Protocols, and Application Levels

1. Ultra-light application (UA)
· Acute inflammatory conditions (TS, TM)
· Acute sprain/strain injuries (TS, TM)
· Pediatrics (i.e., infantile torticollis, hip dysplasia) (TS)
·  Severe fibromyalgia, severe osteoporotic patients (TS, TM)

2. Light Application (LA)
· Acute torticollis (TL), disc herniation and canal stenosis (TS), fibromyalgia (TS, TL), geriatrics patients (TS, TL, TM)
· Major neurological impairment from conditions such as trigeminal neuralgia, cerebral palsy, multiple sclerosis, Bell’s palsy (TS)
· Patients with conditions in which integrity of the vasculature is in question, such as chronic diabetic and rheumatoid arthritis patients (TS)

3. Moderate Application (MA) &
4. Heavy Application (HA)
· Most musculoskeletal or musculotendinous conditions, such as: tendinitis/tenosynovitis/tendonosis, frozen shoulder, sciatica, headaches, chondromalacia patella, plantar fasciitis, disc protrusion (TS, TL, TM)
· Post-surgical/post-joint-replacement rehabilitation (TS, TL)
· Athletic strength and power augmentation (TS, TL)
· Neurological conditions, such as cerebral palsy & stroke (TS, TL).

Canadian-Estonian Chiropractor, Dr. Allan Gary Oolo Austin is the originator of Trigenics. He is a Certified Chiropractic Sports Physician, Certified Chiropractic Rehabilitation Doctor, Doctor of Natural Medicine, Doctor of Acupuncture, Fellow of the International Academy of Medical Acupuncture, and Fellow of the Trigenics Institute of Myoneural Medicine. Dr Austin began developing Trigenics in the early 1980s.  In 1994, Dr. Austin began to write the current procedural and theory manuals and commenced upon forming The Trigenics Institute. In 2004, Dr. Austin will be speaking about Trigenics at the ABCSP Sports Symposium and the SWIS Symposium.
For more information, contact the Trigenics Institute of Myoneural Medicine, toll free at 1-888-514-9355 or by email:
[email protected],or visit www.trigenicsinstitute.com.

Chiropractic Marketing 101

It is simplistic in appearance. Many may say that it is even naïve. Yet “hidden” in the simplicity may be just what you were looking for: a low stress, high return approach to marketing. It is a chance to build a practice that is consistent and dependable in an economy that is anything but.

On the surface, marketing is far more art than science. I have read—and continue to read—the bestselling marketing books that crop up each year. I do it because I, probably much like you, want to know the “answer” or the “solution”. In spite of my chiropractic beliefs, I still find myself looking for the magic pill. Yet, too often, I read books back-to-back, each written by an expert with impressive credentials, each story told with unshakable confidence, and each completely contradicts the other. Direct mail is in. Direct mail is out. Telemarketing is in. Telemarketing is out. Big yellow page ad in. Big yellow page ad out.

Whenever I get hit with these opposing “truths”, I am haunted with echoes in the recesses of my brain—areas not touched since college economics: “This is true as long as everything else remains the same.” The reality is this: Nothing remains the same. What works in Atlanta may not work in Albuquerque. What works in Davenport may not work in Denver. What works in Timbuktu may not work in your neighborhood. And that is just looking at geographic differences. What about demographics? What about technique? What about socioeconomic differences? Listen to the experts, if you want. I do. They have great ideas. But keep this in mind: It is not the art of marketing that is efficient or successful. It is the science. And how does this relate in any way to chiropractic software? I’m glad you asked.

For years and years advertising was the king of the marketing hill. You spent money. You waited for new business. You spent money. And waited for business. The problem was—and is—trying to determine how effectively you spent your marketing dollars. Direct marketing—either by mail or phone—was the answer to many peoples’ marketing prayers, because it gave a direct and measurable return. The value here is having the ability to test different approaches. People are fickle. People are finicky. Try what you think will work…and measure to see if it does. It is in this process that you will quickly discover where to spend your marketing dollars…and where you are just wasting your money. Repeat what works. Discard what fails. The challenge that most chiropractors have is collecting accurate numbers with which to make these decisions. So, before you drop next year’s Annual City [fill in community event of choice] Screening, make sure you are looking at the proper numbers. It’s easy to keep track of how much you spend and how many new patients it generated, but is that really the whole picture?

Lets say you are trying to prepare a marketing budget for next year. You sit down with all the numbers to figure out what worked and what didn’t over the course of the year. You see that Spinal Screening A cost $450, generated 9 new patients, and you ultimately collected $6000. Looking at Spinal Screening B you see that it also cost $450, but it only generated 2 new patients and $1800. If forced to choose one screening over the other, the logical choice with the available data appears to be Screening A. But, again, is that the whole picture?

Patient referrals should play a tremendous role in the growth and health of your business. Yet, how many offices take them into consideration when analyzing the return on investment of their marketing efforts? Let’s take the previous example. What if the two people from Screening B were business owners, or community leaders, or medical doctors, or attorneys? What if those two referred five, and those five referred twenty-three, and so on and so forth? Looking below the surface and including the money collected from the referred patients, we may find that Screening B ultimately brought in $30,000 or $40,000. Trying to judge one marketing effort from another without all of the facts can be a costly mistake. This is where most office systems fail; they don’t report patient referral information completely. This leaves you to make business decisions without some of the most critical information about your practice: The complete effects of patient referrals.

Though the task of collecting this information may seem daunting, a software tool called the Cascading Referral Analysis™ has recently become available to do it for you. It allows doctors to calculate their Return on Investment (ROI) on any marketing effort—including patient referrals resulting from that source. The Cascading Referral Analysis™ gives you the exact number of patients and the collected dollar amounts for each event, plus those generated by their referrals. You can also look at that information per patient. If you are a visual thinker, you can even see the connections on screen and step through them one at a time. This detailed information is not only fun or interesting to look at; it can be critical in allocating your marketing dollars.

The science of marketing can be a powerful tool. Yet there is one component to the Cascading Referral Analysis™ that falls more into the mystical art side of the marketing equation. B. J. Palmer stated that, “You never know how far reaching something you may think, say, or do today will effect the lives of millions tomorrow.” With a tool like this, you can demonstrate for your existing patients how important it is to refer other people. It is a powerful thing to actually see the far-reaching effect…to know that referring one person was the catalyst that cascaded into a group of twenty or thirty people. Maybe next time they think about sharing the chiropractic story, they will realize that the health and well being of many others is counting on them as well.

David and DeDe Van Riper of InPhase Technologies Group have worked in the chiropractic profession at many levels for more than a decade. InPhase Technologies Group is a company dedicated to providing a comprehensive approach to chiropractic office systems.

For more information contact [email protected]  or 800-490-3780.

Marketing, Retention, and Patient Base

What are the common points in the strategies employed by growing successful practices?

In the first few weeks of this year, a series of surveys caught my eye. The new statistics coincided from one survey to another on the topmost issues on chiropractor’s minds…Patient Retention and New Patient Recruitment. No big surprise there, yet it hangs around like a chronic sore back, refusing to go away. Patient turnover is at an all time high and competition for new patients is a fierce, ever-escalating contest. Recruiting new patients can be a costly, drawn out affair, filled with frustration and uncertain results.

Aside from throwing advertising and gimmick money at the problem, which only lowers your ROI (Return on Investment), there are simple, motivating factors that any practice can find with a little introspection. Further looks into the cause and effect of the situation will provide some information to work with. Every clinic and every patient is different, and what may be your Achilles heel may not be the same for another practice across town.

We know from experience that the best and cheapest form of advertising is word-of-mouth. The trick is nurturing a strong patient base that believes your vision of health. If you don’t already have one, your first step is to launch a customer service campaign to earn their hearts and loyalty. Once again, you need to know what will positively work for your practice and your patients.

What would make a person not return…or start going to someone else? Why would they not say anything? Why would they want to put themselves in the hands of a stranger? What went wrong?

A little research into past patients will uncover the most common reasons for patient exodus. There’s always a reason.

Let’s take a look at some of the more prevalent remarks from ex-patients.

  • Moved to another city or state. 
  • No progress in my recovery.
  • Therapy too painful. 
  • Was not a covered expense.
  • Too expensive.
  • Had no way to get there anymore. 
  • Didn’t listen to what I said.
  • They wanted me to buy stuff I didn’t want.
  • Clinic didn’t seem to care.
  • They changed my doctor
  • Never gave me a new appointment.
  • People only wanted my money. 
  • Their people weren’t very nice.
  • Never called to see how I was doing.

If any of these sounds familiar, you have plenty of company. Unfortunately, this happens even to the best. The good news is that you can reduce it to an acceptable level. The great majority of the above kinks are created by inadequate communication. The solutions can only follow after we find out what the problems are.

Highly underutilized in practices, surveys can provide a gold mine of information which is actionable and inexpensive. Not only will these surveys help you with your current clientele, they may unearth strong phrases to use in your advertising. Once you’ve gotten strong agreement on recurring answers from patients or public, you can begin to take action.

Being human, we may falter in our resolve to change things around and discontinue programs, features or services that should have stayed in place. Fortunately your practice software, if it is one of the good ones, can help you stay on track. It can make absolutely sure that you never send anyone out of the office without their next appointment. It can remind you of that one patient that always forgets her appointment, or Mrs. Johnson’s birthday, or that she prefers Dr. Bill. Software can help you track the effectiveness of your promotional activities and provide statistics to gauge response. In short, most of what you need to correct a decline or accelerate growth is within your reach today.

Depending on what your survey turns up in the form of needed changes (survey your patients twice a year minimum), you can implement a five- to-ten point service campaign that preserves your current roster of clients, while you concentrate on marketing/advertising to bring in new patients. What could the five or ten points to your campaign include? It will all come out in the survey…more communication, temperature of the rooms, ask if hurts, a birthday card, reminders, shorter waits, free pick-up at the home, mints…almost anything.

Even the best-thought-out promotional strategy, including letters, cards, phone calls, service awards for staff, package discounts, newsletters, ads, radio/TV, articles, seminars, earned free services and a host of internet and web applications, will be for naught, if they do not connect with the emotional triggers that patients or the public may have. Find out!

As for the growth of your patient base, chances are that, if your patients are happy with you, they’ll bring all their friends with them. And how can you use this to market to the broader public? Let them tell you. Surveys, once again, are the cornerstones of the future. Surveys, planning, a warm, caring staff and the correct software will keep your practice growing, profitable and full!

Derek Greenwood is Chairman of EON Systems, Inc., manufacturers of TPS 2000, a software program for practice management.  For additional information, please call (800) 955-6448.

Diagnostic Tools in Chiropractic

Diagnosis, the basis for determination of treatment, is defined as “the art or act of recognizing the presence of disease from its signs or symptoms”. Diagnostic tools help you uncover or establish the characteristics of the disease(s) or condition(s). Chiropractors have a wide range of diagnostic tools available to them today …from the old stand by’s to newer technologies. New procedures, tests and technologies continue to be developed, some complementing diagnostic tools of long standing and some replacing them.

The most advantage is gained in determining the appropriate procedure when you know the type of information to expect. Additional benefits come from the documentation of the findings and application to the treatment plan…the ultimate goal of diagnosis.

X-Ray’s: The plain film radiograph of the spine is still considered the simplest and most common diagnostic tool used by doctors to evaluate skeletal problems. X-rays can gather an astonishing amount of necessary information about the patient. Above and beyond ruling out pathologies and possible fractures, X-rays can be used to show mensuration lines that can be used to determine and document specific structural impairments. X-ray’s are the basis for documentation of structural and spinal abnormalities.

MRI: Developed in the 1980’s, Magnetic Resonance Imaging (MRI) produces images of the anatomy without the use of radiation, as in X-ray and CT scanning. An MRI scan, with its enhanced image resolution, can be an extremely accurate method of disease detection throughout the body and is most particularly useful when considering problems associated with the vertebrae or intervertebral discs of the spine. An additional benefit is that an MRI is a non-invasive procedure, and there are no known side- or after-effects.

Typical MRI results of the spine can provide information such as spinal alignment, disc height and hydration, configuration of vertebral bodies, the appearance of intervertebral discs—normal, bulging, herniated, dehydrated or degenerated, the size and appearance of the spinal canal—compression of cord or nerve root, and other abnormalities or inflammation. An MRI cannot distinguish between painful and non-painful anatomical problems in the spine. The patient’s physical exam and symptoms must be correlated with the MRI findings to arrive at a clinical diagnosis.

CT Scan: Computerized (Axial) Tomography, often referred to as “CAT” scans, has been described as a fancy X-ray that can take cross-section (axial) images of the body. They are extremely useful for assessing fractures, because of the bony detail provided. Nerve roots, however, are not clearly shown and smaller disc herniations can be missed. The highly invasive combination procedure of a CT scan combined with a myelogram is a very sensitive test for nerve impingement. A CT scan is a diagnostic alternative for patients who are not candidates for an MRI because of the presence of a pacemaker, metal slivers in eye, aneurysm clip in brain, etc.

Musculoskeletal Ultrasound: Musculoskeletal ultrasound scans of the spine and extremities can provide differentiation of soft tissue, including ligaments, tendons, nerve root area, facet area, costovertebral junction and muscle spasms, for evaluation and documentation. Extremities, such as shoulders, knees, ankles, hips, wrists and elbows, can be imaged and reviewed. Ultrasound allows for real-time scanning of moving and static soft-tissue structures, an important consideration in injuries such as rotator cuff. One limitation is that ultrasound does not pass through bone, so some soft tissue areas cannot be imaged. It is excellent, however, for imaging soft tissue and documenting trauma to tendons, tendonitis, tears, inflammation and ruptures, ligament strains and tears; injury or rupture of muscles, bursitis, capsulitis, neuromas, fibromas and cysts. Musculoskeletal ultrasound is a very “patient friendly” procedure, and there are no known side- or after-effects to its use.

Videofluoroscopy (VF): The American Chiropractic College of Radiology has stated that videofluoroscopy is a useful imaging modality for the demonstration of spinal intersegmental joint dysfunction. VF can display the abnormal motion of the cervical spine, showing the point in motion the hypermobility or aberrant motion occurs. VF is valuable in detecting instability in flexion and extension not otherwise visualized or detected on plain films. VF can be used to document hypermobility, hypomobility, aberrant motion, instability, aberrant coupling, paradoxical motion and evaluation of spinal arthrodesis. Videofluoroscopy is an X-ray procedure and, as such, is contraindicated during pregnancy. Some other contraindications are when motion would be detrimental to the patient; restrictive muscle spasm, dislocations, recent fractures and severe neurological deficit.

Consultation & Physical Exam: The most important diagnostic tool available in your practice is you. Diagnostic tests and procedures can provide targeted information about anatomical regions, physiological systems and more. Your training, and the examination and diagnostic skills you employ enable you, as a chiropractor, to take the best advantage of the data produced by these other tools. Your expertise is required to correlate the assembled findings and determine the best course of treatment for your patient.

Ms. Plank has an extensive background in medical and facilities management.  Before making the transition to healthcare, for over 10 years she was the Practice Manager for a large veterinary hospital and a “first of its kind” commercial veterinary blood analysis laboratory.  During the past 15 years, Ms. Plank has provided technical and management services to healthcare providers, specializing in radiology and neurology.  She is currently the Vice President of Corporate Services for Practice Perfect.  Contact her at [email protected].

C2 to C3 Congenital Block Vertebra

Description. When two adjacent vertebrae are osseously fused from birth, this joined unit is called a congenital block vertebra. Embryologically, this is the result of failure of the normal segmentation process of the somites during the period of differentiation at 3-to-8 fetal weeks.1 The block vertebra, by itself, is clinically insignificant. As there is no motion allowed at the fused level, there is no potential for degenerative disease of the disc or posterior apophyseal joints. The foramina at the blocked level may be smaller than normal, normally sized, or enlarged, but have not been shown to cause nerve compression. However, because of the lack of a motion segment, the free articulations above and below the block segment are stressed and usually result in premature degenerative discogenic spondylosis and arthrosis at the fully articulated levels, especially below the fusion site. Fusions are partial (i.e., do not completely involve the anterior and posterior spinal units) and may result in abnormal spinal curvature, usually scoliosis, because of a unilateral bar. Block vertebrae are most commonly found at C5-C6, C2-C3, T12-L1, and L4-L5, in decreasing order of incidence.1,2 C2-C3 Congenital Block Vertebra

A recent report suggests that long-standing congenital or acquired fusion of upper cervical vertebrae may lead to stretching and laxity of the ligaments between the occiput and the atlas, resulting in excessive motion and brainstem or cord compression.2

Radiologic Features. A typical congenital block vertebra will demonstrate the following roentgen signs: a diminished AP diameter of the vertebral body; a hypoplastic or rudimentary disc space that may show faint calcification; possible fusion of the apophyseal joints (50% of cases); and possible malformation or fusion of the spinous processes.

The anterior margins of the involved vertebrae form a concave surface, because of the decreased AP diameter at the fusion that is visible on plain film and MRI. This “wasp waist”3,5 or “C” shape can serve as a mnemonic device, to indicate that this fusion is “congenital.” Another helpful sign of this congenital anomaly is osseous fusion of the neural arches, that is almost never associated with infectious, traumatic processes or other causes of block vertebrae. 4,5 TAC

Dr. Terry R. Yochum is a second-generation chiropractor and a cum laude graduate of the National College of Chiropractic, where he subsequently completed his radiology specialty. He is currently Director of the Rocky Mountain Chiropractic Radiological Center, in Denver, CO, an Adjunct Professor of Radiology at the Los Angeles College of Chiropractic, as well as an instructor of Skeletal Radiology at the University of Colorado School of Medicine, Denver, CO. Dr. Yochum is, also, a consultant to Health Care Manufacturing Company that offers a Stored Energy system. For more information, Dr. Yochum can be reached at: 303-940-9400 or by e-mail at [email protected]. Magna Cum Laude graduate of National College of Chiropractic.

Dr. Chad Maola is a 1999

Magna Cum Laude graduate of National College of Chiropractic.

Chiropractic News Around the World

Chiropractic Physician Sues Insurance Giant and Gets Verdict on Behalf of Patient

MISSOURI: Dr. Anthony W. Calandro, a Crestwood, MO, chiropractic physician, was “fed up” with insurance company tactics. So, on behalf of his patient, he a Mr. Mitch Jacobs, attorney-at-law with over fifteen years of trial experience, filed a lawsuit against Safeco Automobile Insurance Co.
The suit claims Safeco cheated the patient out of benefits, which had been rightfully bought. Safeco allegedly uses a common tactic called “consultant review” where a so-called “doctor” reviews a file without ever seeing the injured patient, thereby rendering a bogus cut in benefits, thus cheating patients out of the benefits which they paid for to cover their health care costs.
The trial lasted over two hours, and two days later the verdict was in favor of Dr. Calandro. The judgment award was for over $4000, which included the amount denied, interest, and all attorney and court costs.
Dr. Calandro recommends that other doctors and patients faced with this tactic stand up for their rights and prove that, when paying high premiums for benefits, they should be rightfully reimbursed accordingly, to insure good health care.

Lawmakers Vote to Limit Physical Therapy and Chiropractic Care

CALIFORNIA: In the final day of the state legislature’s regular session, California legislators voted to make revisions to their state’s worker’s compensation insurance system, with the intent of reducing premiums and overall costs associated with the system.
Along with provisions regarding prescription drugs, fee schedules and fraud-related fine caps, the legislature also approved provisions that will limit chiropractic and physical therapy treatment for injured employees to no more than 24 treatments per claim. In addition, the legislature also voted to stop the state’s vocational rehabilitation program in favor of educational grants for retraining injured employees.
If signed into the law, the new worker’s compensation provisions will also establish medical guidelines for governing how injuries are treated and allow for an administrative review of previous worker’s compensation cases to prevent future over-treatment.
While these cost-saving measures may help ease the pains of the states’s worker’s compensation program for the worker with an injury resulting from an ergonomics-related issue, it may also cut into the effectiveness and viability of some of the more popular current forms of injury treatment, including chiropractic care and physical therapy.
With the highest premiums in the US, California’s worker’s compensation system has come under fire by insurance providers, businesses and lawmakers. The state’s governor, Grey Davis, has vowed to sign the recently approved workers compensation reform package into law.
Sacramento Bee: Insurance Journal

Chance Parker, Grandson of Dr. Jim Parker,
Dies at Age 38

TEXAS: Michael Chance Parker (age 38), affectionately known as Chance, grandson of the founder of Parker College, Dr. James W. Parker, and son of seminar leader and Past-President of Parker College, Dr. W. Karl Parker, passed away at his home in Burleson, TX, July 31, 2003.
Parker discovered he had renal cell carcinoma when his right kidney failed in 1997. About a year later, he discovered it had metastasized to the bones in his right arm, followed by his left arm, his neck, sacrum and pelvis and, later, to his adrenal and lungs. He was originally given a death sentence of about six months from the onset of the disease, but with the help of natural health care, chiropractic and prayer, he remarkably survived an additional six years.
Parker was well known and loved by many in the profession, as he was a staff member of the Parker Seminars and Share International for many years, moving up the ranks until he was promoted to be president of the forty-year-old Parker Products company.
He is survived by over twenty-five members of the Parker family including seven chiropractors, his father, brothers and uncles.
“Chance really had a knack of making friends with everyone,” his father, Dr. Karl Parker said of him. “His positive uplifting attitude was never dampened by his condition and the pain he was suffering, even up to the very end. He was a model for many others in loving life, family and friends, regardless of life’s circumstances.”
Parker passed away peacefully with his father, mother, wife, children and numerous friends at his side. A memorial was held at his church, Crestmont Baptist in Burleson, which was filled with family and friends. His life’s pride and joy were his wife, Diane, and two children, Jordan (10) and Cole (8). Parker requested no flowers and that any gifts be sent to a fund he established to help with his children’s education. Send to Diane Parker at 2360 Charles Ave, Burleson, TX, 76028.

Medicare Announces Plan to Accept HIPAA Non-Compliant Electronic Transactions After the Compliance Deadline

WASHINGTON:  The Centers for Medicare & Medicaid Services (CMS) has announced that it will soften up on its October 16, 2003, deadline with a contingency plan designed to accept noncompliant electronic transactions submitted after that deadline has passed.  This will ensure continued processing of claims from thousands of providers who are unable to meet the deadline and would have had their Medicare claims rejected were it not for this late-hour reprieve.
“Implementing this contingency plan moves us toward the dual goals of achieving HIPAA compliance, while not disrupting providers’ cash flow and operations,” CMS Administrator Tom Scully states, ”so that beneficiaries can continue to get the health care services they need.”
CMS came to this decision after reviewing statistics showing unacceptably low numbers of compliant claims being submitted.
Rehab Wire

“Non-doctors” Excluded from $540 Million Dollar CIGNA Settlement

FLORIDA:  A federal judge gave preliminary approval, in early September, to an agreement requiring Cigna Corp. to spend $540 million to settle claims that the insurance company chronically skimped on payments to the nation’s 700,000 doctors.
Cigna joins Aetna in settling racketeering lawsuits against managed care industry leaders.  Both companies have agreed to pay refunds to doctors and change procedures for reviewing and processing doctors’ claims for services.
Cigna agreed to spend $400 million on internal changes, at least $70 million to doctors on claims up to 12 years old, $55 million on attorneys’ fees and $15 million to create a health care foundation.
Doctors expect to see $300 million in savings, mostly on overhead for handling claims and appeals.
Chiropractors, podiatrists, optometrists, therapists, mental health counselors and others were excluded from the agreement and will not be able to recover money for claims that were improperly denied or services for which they were shortchanged, lawyers on the case said.
“We’re pursuing separate litigation,” said Alan H. Rolnick, a Miami attorney who is among several attorneys seeking to gain a court victory or a settlement for health-care providers not covered by the pact reached with physicians. Those lawyers told Moreno they hope to negotiate with Cigna, but neither side would suggest a date for a status conference.
The lawsuit upon which the “non-doctors” are building is a case which was filed early this year by Allen Knecht, a Portland, OR, chiropractor.  The suit was transferred to Moreno because he has been designated to handle all similar class actions.
Rolnick said his team does not know the number of health professionals who would fit into the class, and that lawyers are “trying to determine that now.”  When Moreno proposed negotiations between the two sides, Cigna lawyers said they didn’t anticipate any immediately because they are trying to put final touches on the physicians’ settlement.
Hoover’s Online

 

Quackpot Barrett Crushed in Federal Court—Again…

CALIFORNIA:  Some people never learn.  Stephen Barrett (quackwatch.com) seems to be one of those.
Despite loss after loss, and humiliation on top of humiliation, self styled “quackbuster,” Stephen Barrett trudges on to the next embarrassment.  
Like a bug in the fast lane, Barrett is doomed to be wiped off the windshield of the North American Health Freedom Movement time after time, it appears.
This time, Barrett, apparently stung from defeats in other arenas, and perhaps trying to reclaim some dignity from a world becoming accustomed to laughing at his anti-health antics, sued the attorney he’s come to associate with his steady downfall in the politics of health care, Carlos Negrete. 
It’s not clear what the subject of Barrett’s suit against Negrete in Federal Court in San Diego was all about.  Barrett submits volumes of whiney material in his court actions, none of which, seems to be acquainted with reality.  But, what is known is that Barrett used, as his own attorney, one Morse Mehrban, listed as the general counsel of the National Council Against Health Fraud (NCAHF).   It was Mehrban who was quoted in the LA Law Journal as saying, “I consider suicide daily.”
“Suicide daily?”  
Negrete flattened them both—without breaking a sweat.  Another victory for GOOD, in the battle against EVIL.
Of course, Barrett also sued, in the same lawsuit, world-renowned health-humanitarian Hulda Regehr Clark PhD, ND.  Barrett can’t seem to talk, or write, these days, without bringing up Clark’s name in some way.  So, it’s not surprising he put Clark’s name in the lawsuit.  He describes her as an “Unlicensed Naturopath, Hulda Clark,” in his writing.  His hatred and resentment of her accomplishments, compared to his, are obvious.  He lost to Clark, too.…
Barrett had to allegedly “retire” from the medical profession, giving up his license in 1993, when he was in his mid-50’s.  He admits that he didn’t have enough medical practice income in 1993 to even pay the required malpractice insurance premiums.  Barrett, who claims to be a retired psychiatrist, was forced to admit in court documents (forced by Negrete) that he only had nine patients all year, each year, for several years, before he supposedly “retired.”  Psychiatrists get their patients from referrals from other MD’s.  Doctors in the LeHigh Valley of Pennsylvania just weren’t sending him any business.  Anybody wonder why?
And now Barrett is failing as a “quackbuster.”
By the way—Barrett lost in an anti-SLAPP motion, which means he gets to pay Negrete, and Clark’s, attorney fees.…
 Tim Bolen—Consumer Advocate website
http://www.quackpotwatch.org/default.htm 

FLORIDA:  The Florida Office of Insurance Regulation (OIR) is moving ahead with developing guidelines designed to tighten personal injury protection (PIP) rules in the state, and the National Association of Independent Insurers (NAII) expressed confidence that the reforms will help combat fraud in that state.
“The industry, the department and medical representatives are working to formulate a list of excluded tests that everyone can agree on,” said James S. Taylor, southeastern regional manager for the NAII.
The State Board of Medicine held a workshop recently to discuss excluded diagnostic procedures, with insurance industry and medical associations in attendance.  Insurers agreed that a number of tests should no longer be covered by PIP, including procedures on a list created by New Jersey in its auto reform efforts.  Such tests include diagnostic spinal ultrasound, nerve conduction velocity tests, reflexology and digital range of motion studies.
After receiving input from medical associations and the Board of Chiropractic Medicine, the State Board of Medicine found that the groups see no medical necessity or value for many common PIP diagnostic tests.
In other action, the Office of Insurance Regulation has developed a revised PIP sworn disclosure form that requires a signature from patients stating that they have actually received the medical services being claimed.
”Although the details are still being developed, we are confident that these methods will help reduce the problem of PIP fraud in Florida,” Taylor noted.
Insurancejournal.com

 

Pass  on the information to warn other D.C.’s about events that are really happening to chiropractors. When you see a “ yellow page” article in your local, regional, or national newspaper about chiropractic or a  fellow chiropractor, fax, e-mail or mail it to us at TAC.  For further information, fax: 1-305-716-9212 or see page 4 for our mailing address.