Step-by-Step Rehab Center

About 83 million people in the U.S. (42% of the adult population) used at least one alternative therapy in 1997.  Usage among those 35-40-years-old is even higher, at 50%.

The estimated number of visits in 1997 to providers of “unconventional therapy”  (629 million) was greater than the number of visits to all primary care medical doctors nationwide (386 million).
Americans spent $21 billion out-of-pocket on visits to alternative practitioners in 1997 (an increase of 45% over 1990’s total).  This does not include money spent on retail products, such as herbal products ($5.1 billion), books, classes and equipment ($4.7 billion).  By comparison, out-of-pocket expenditures for physician visits were $29.3 billion and for hospitalizations were $9.1 billion.

We have to ask why 42.1 percent of U.S. citizens surveyed used at least one of sixteen alternative medicine practitioners, increasing from 427 million in 1990 to 629 million in 1997, exceeding the total visits to primary care physicians.  What is of greater interest is that these statistics have continued to increase—by 3.6% between the years of 2001 and 2002. 

None of these statistics, however, come close to the billions Americans spend on exercise and fitness.  Over 50% of the American population is overweight and the number is growing.  What does this all mean for the primary healthcare provider such as a DC?  The DC, basically, has to be prepared to diversify his/her services and, most of all, create a center where exercise and rehabilitative therapy are key components.
DC’s have always looked for ways to increase their income, often by learning new techniques or buying some expensive piece of diagnostic equipment.  While these can be valuable investments, they are not as effective as knowing how to establish, manage and/or promote a rehab center.

Following are the basic protocols, which have to be put into place to establish a rehab center. (See Table 1).

Table 1. basic protocols to establish a rehab center
1. Necessary Education:  Proficiency in sports medicine.
2. Professional Staff:  Exercise physiologist, physical therapist, physical therapist aide, and/or assistant, fitness trainer, massage therapist.
3. Equipment: Minimum equipment necessary is a full body station, treadmill, enlarged physical therapy table, various weights, stationary bike, exercise mats.  Miscellaneous:  towels, theraband, cold packs, etc.
Approximate initial cost of total equipment, between $10,000 to $15,000
Certification is a must for all professionals
Ideal size room, 800 sq. ft.

Table 2. Most Common Scenario Used in Rehab Facility
1. Doctor initial exam
2. X-Ray/ancillary services
3. Treatment protocol established and started
4. Diagnostic testing
5. Rehab with PT (4 weeks)
6. Re-exam to update or change diagnosis
7. Rehab with PT (4-8 weeks)
8. Discharge

Table 3. 10 Steps to Opening Date
1. Plan out (draw out) rehab room space
2. Interview and hire professional staff
3. Design marketing plan (newspaper ads, coupons, flyers, etc.) and allocate marketing budget ($3,000 to $5,000)
4. Purchase equipment (ask accountant if leasing is better option)
5. Understand billing codes and implement rehab form
(See Table 4)
6. Create appointment script for front desk
7. Train office staff
8. Send letter to all local businesses
9. Send announcement letter to all active patients
10.Have grand opening day (balloons, prizes, music…)

Expected Reimbursement in Rehab Exercise Facility
The above scenario is by far the most practical flow that will allow the highest reimbursement.  It is important to take into consideration that insurance companies do not approve “medical maintenance care”.  Insurance companies will pay for treatment, but not for exercise physiology and/or rehabilitative medicine when used to enhance a patient’s stamina or endurance.  Insurance companies are interested in treating patients and rehabilitating them, given serious practice medical diagnosis.

Table 4. reimbursements for rehab patients
Total reimbursements for rehab patients vary between $4,500 to $6,500. CPT codes most often used are as follows:
97535   Activities of Daily Living
97112   Neuromuscular Re-education of movement, balance, coordination, kinesthetic sense, Posture, and/or proprioception for sitting and/or standing activities
97110   Therapeutic procedure, each  15 min., therapeutic exercise to develop strength and endurance, range of motion and flexibility.
97530   Therapeutic activities, direct patient contact by the provider, each 15 min.
97799   Unlisted Physical Medicine/Rehab service or procedure
97139   Unlisted Therapeutic Procedure (specify)
97150   Therapeutic procedure(s), group (2 or more individuals)
97750   Physical Performance Test or Measurement w/report
97504   Orthotic(s) fitting and training, upper and lower extremities, each 15 min.
97520   Prosthetic Training, each 15 min.
97140   Manual Therapy techniques (Manual Traction), each 15 min.
97124   Massage Therapy, including effleurage, petrissage, and/or tapotement
97113   Aquatic Therapy with therapeutic exercises
97537   Community/Work Reintegration Training, direct contact, each 15 min.
97542   Wheelchair Management/Propulsion Training, each 15 min.
97703   Checkout for orthotic/prosthetic use established patient, each 15 min.
97545   Work Hardening/Conditioning (initial 2 hrs.)
97546   Each additional hour (list separately in addition to code for primary procedure).  (Use 97546 in conjunction with code 97545)
97116   Gait Training
95833   Total Evaluation of Body w/o Hands
95834   Total Evaluation of body w/ Hands
95851   ROM Measure w/Report, each extremity
95852   Hand w/ or w/o Comparison to Normal Side

Objective Testing That Can Be Used to Support Medical Necessity and Enhance Medical Records
1. X-Rays
2. Digitized Radiographic Mensurations
3. MRI
4. Neurological Diagnostic Testing

General Discussion
Overall, a rehabilitation center is a great addition for any practitioner.  Using diversified healthcare, the doctor has the ability to promote the best treatment protocol available.  The core problem in healthcare today lies in the fact that there are currently not significant entities that can provide quality care at sufficiently low prices on a large enough scale to service the overwhelming needs of the population.
By creating a rehab sport center, a clinic will provide a viable solution to the healthcare crisis, by integrating the skills of the chiropractor and various other healthcare practitioners, such as exercise physiologist, physical therapist, etc., leading to the development of a profitable venture.  This, by all means, is the wave of the future.

Dr. Daniel H. Dahan owned and operated one of the most successful clinics in Southern California.  As previous chairman of the West Coast Medical Advisory Board and writer/editor for the Sun’s Weekly Health Column, Dr. Dahan, the President of Practice Perfect, developed a successful management and consulting health care system for doctors throughout the United States.  His seminars are rated among the best and most proliferate lectures in the country.  Dr. Dahan has taught over 4700 doctors and integrated 800+ offices in 45 states.  He can be contacted at [email protected]For more information, go to www.dahan.com.

Diagnostics Used for Sports and Rehab Facilities

Having a sport and rehab facility demands great expertise and close attention to detail in treatment protocols.  In such settings, doctors often rely on objective findings of manual testing.  Nonetheless, given the explosive level of technology available today, it is ludicrous for any doctor to rely strictly on “manual findings.”  One of the greatest sources of objective findings available, to date, to all doctors but especially in rehab and sport facility settings is the use of diagnostic radiology.  Indeed, the information that can be gathered using diagnostic radiology is very impressive. 

What is the benefit of diagnostic radiology?
After a thorough physical examination has been done and the need for the X-rays has been established, X-rays are sent to a specialized company which uses highly technical equipment and techniques to produce computerized enhancement of the radiographic plain films.  One of the enhancements is called digital radiographic mensuration.  The X-rays are scanned, and multiple landmarks are selected and stored in a location separate from the image.  The numbered data, “landmarks,” are later used to reconstruct a variety of biomechanical relationships and measurements that are useful to the doctor and the patient.  The diagnostic analyses, as well as biomechanical data, are extracted from these plain film radiographs and are then displayed on high-resolution monitors using comparative standards and technical procedures.  These visuals of radiographic imaging are used objectively to analyze the biomechanical properties of the spine.  At least fifty-nine biomechanical analyses for diagnostic purposes can be performed on such instruments.  (See Table 1 to for a list of a few examples)
Using highly technical equipment and techniques produces computerized enhancement of the radiographic plain films, that can then be used to perform at least fifty-nine biomechanical analyses for diagnostic purposes. Here are some Examples:

  • Atlas Skull Line
  • Stress Line 
  • Skull Line Baselines 
  • Thoracic Apex                          
  • Baseline Atlas                         
  • Stenosis
  • Spinal Length 
  • Occiput Angle  
  • Ferguson’s Angle 
  • Sacrum Angle
  • Penning’s Range of Motion 
  • Thoracic Kyphosis  
  • Jackson’s Angle 
  • Lumbar Instability  
  • Motion Segment Integrity 
  • Vertebral Offset 
  • George’s Line 
  • Atlas/Axis Angle  
  • Lumbar Gravity Line 
  • Vertebral Body Rotation 
  • Pelvic Rotation 
  • Lumbar Lordosis  
  • Cobb’s Angle 
  • Spondylolisthesis

It becomes medically necessary for a sports and rehab facility to fully assess the degree of injury and its effect on the patient’s health and future well-being.  Reports obtained from digital analysis include impairment ratings, per the American Medical Association (AMA) Guides to the Evaluation of Permanent Impairment. 

Defining “disability”
American Medical Association Guides evaluate Medical Disability as well as Permanent Impairment.  The term disability has historically referred to a broad category of individuals with diverse limitations and the ability to meet social or occupational demands.  However, it is more accurate to refer to the specific activity or role the “disabled” individual is unable to perform.  Several organizations are moving away from the term disability and, instead, are referring to specific activity limitations to encourage an emphasis on the specific activities the individual can perform and to identify how the environment can be altered to enable the individual to perform the activities associated with various social or occupational roles.  Nonetheless, Guides to the Evaluation of Permanent Impairment defines disability as “an alteration of an individual’s capacity to meet personal, social, or occupational demands or statutory or regulatory requirements because of an impairment”.  (American Medical Association. Guides to the Evaluation of Permanent Impairment. 5th  ed. Chicago, Ill: American Medical Association; 1993)

What are the benefits to the patients?
We live in an age when patients are particular about their health care needs and are demanding that their doctors under- u u stand not only the need for specific treatment, but also the findings of the objective testing.
Using diagnostic radiology will bring the following benefits to the patient:

  • Films read by a board certified radiologist 
  • Photographic reproduction of the patient’s film images, printed with complete measurements and displayed next to comparatively normal images, should be shown to the patient to explain the findings and insure patient retention.  If the healthcare practitioner has expertise and is well acquainted with the individual’s activities and needs, then he or she must express an opinion about the presence or absence of the specific disability and how this will impact the patient’s daily activities.

Benefits to a Rehab Center
Rehab centers are often made up of exercise physiologists, body trainers, physical therapists (Pt’s), Pt aids, Pt assistants, chiropractic practitioners and others.  These sports and rehabilitation oriented practitioners, although very knowledgeable in assessing a patient’s diagnosis, can greatly benefit by the highly technical, yet diversified, information which is gathered from diagnostic radiology.
Because every patient’s injury or disease is different and every patient responds differently to treatment, the information obtained from the digital analysis of radiographic images can prove or disprove the necessity for further treatment.  This information is then used to customize the most effective treatment protocol for the patient’s injury and/or disease and may cut down on or eliminate unnecessary treatment.
Biomechanical measurements are vital and are critical to the appropriate diagnosis analysis, treatment, and prognosis of the sports injury patient in a clinical environment.  With accurate measurements, a fundamental base line can be determined and can further be explored for an accurate and reliable assessment of the patient’s condition and outcome potential. 
There is also a financial benefit, since the referring doctor gets reimbursed u  u for the professional confirmatory component above and beyond the X-ray coding.

Below are a few samples of indications for diagnostic radiology.

  • Sprains/ Strains
  • Trauma
  • Motor vehicular accidents
  • Sports induced injuries
  • Work related injuries

On a side note, and as a fundamental basis, DC’s often deal with the dynamics of the musculoskeletal system, whether or not the clinical neurological components exist. 
Simply stated, the science of chiropractic is founded on the premise that adequate nerve supply is of prime importance in regulating body function.  Hence, radiographic measurements obtained from diagnostic radiology and utilized in a rehab facility can:

  • Increase Personal Injury referral
  • Enhance reputation
  • Increase patient compliance
  • Support insurance claims with scientific medical proof
  • Provide attorneys with professional documentation
  • Increase collections 

How to implement diagnostic radiology

  1. Determine need for X-rays.
  2. Take flexion/extension study of cervical or lumbar area (or both, if needed).
  3. Referring doctor reads films and gives brief impression to patient.
  4. Films are sent for digitization and for impression by Board Certified Radiologist (licensed in the state where patient is being treated).
  5. Analysis is done and returned to referring doctor.
  6. Treatment protocol is established and information is given over to patient.
  7. Service is billed for consultation to proper carrier.

In conclusion, other procedures (i.e., NCV, SSEP, MRI, US, Electromyography, etc.) should always be correlated to clinical history, physical examination and radiographic findings for a more comprehensive and complete picture of the patient’s status.  Digitized radiology has shown reliability, accuracy and benefit paralleled to this time in history with respect to spinal radiographic analysis.  In determining need for treatment, type of treatment to be administered, and/or monitoring of changes of treatment resulting from re-injury, for prognosis, digitized analysis for radiology is an effective outcome assessment device and methodology for chiropractic services in a rehab facility.

Aadam Quraishi, MD, was a clinical instructor at New York University Medical Center.  He is board certified in radi-ology and has additional fellowship trained qualifications.  He has seventeen years of medical practice experience.
Dr. Quraishi specializes in Vascular and Interventional Radiology MRI (Neuro and Musculosketal), MRA Mammography, Breast Localization, Nuclear Medicine CT and Ultrasound.  Dr. Quraishi has board certification in Diagnostic Radiology, and can be contacted at
[email protected]For more information and/or sample reports, go to www.aboutpdi.com.

Million Dollar Chiropractic: Interview with Tim Weir

Each article in the MILLION DOLLAR CHIROPRACTIC series (M$C) focuses on the top surveyed issues facing chiropractors today.  Recruiting new patients, retention, profitability, marketing and staffing are each a determining factor in the growth, potential and success of the practice.
The subject of this issue’s profile is Dr. Timothy Weir an extremely successful chiropractor who has practiced in North Carolina, for the past twenty-two years.
Originally from Eau Claire, Wisconsin, Tim Weir began working at a very early age in a freight salvage store owned by his parents.  “That,” he says, “bred into me a good work ethic.”
As a child, he also loved music and started playing the piano at age four.  When he was sixteen-years-old, he traveled the United States and Canada in a gospel singing group, subsequently cutting a solo gospel album in Nashville, Tennessee, and, touring the US giving concerts. 
And this was all BEFORE he got into chiropractic!
Then, newly married at the age of eighteen, Tim and his bride, Rose, were off to Davenport, Iowa, where he proceeded to attend Palmer College of Chiropractic, graduating in 1981.

In an interview with The American Chiropractor, Dr. Tim Weir answers our Million Dollar Chiropractic (M$C) questions about his successful multidisciplinary practice where their motto is, “Get Well, Have Fun.”

M$C:  What influenced you to become a chiropractor?
Weir:
  In 1956, my father was in a wheelchair suffering from Multiple Sclerosis.  The Mayo clinic had given up on him, and sent him home with six months to live.  Instead of taking him home to die, though, my mother took him to the Toftness Chiropractic Clinic in Cumberland, Wisconsin.  Within weeks, he was walking; within six months he was back at work; and he lived another thirty-two years. 
I had two brothers.  My older brother, Mike, who now practices in Monterey, California, was the first of us to become a chiropractor.  Mike has been a great mentor and friend;  but it was my other brother, Kevin, who just passed away after a short battle with liver cancer, and myself who went to Palmer at the same time.

M$C:   What type of practice do you have?
Weir:
  Our practice is a true “multi-disciplinary” practice.  We are basically a medical practice, with chiropractic and physical therapy incorporated into the practice.  I realized that patients needed chiropractic care, but I also realized that they needed some type of medical care at the same time.  I am quick to admit that I am a big baby when it comes to pain, and that, when I had a severe back problem, I took some type of pain relief.  My feeling was, if I need this, the patients in my town deserve to have the same thing:  the marriage of the healing arts…medicine, chiropractic, physical therapy and massage.

M$C:  Give us a physical description of your office facility.
Weir:
  First Choice Family Healthcare is right on one of the busiest streets in North Raleigh.  We have approximately 5,700 sq. ft.  We have a beautiful office and a great therapy suite, and are set up to do urgent care as well as physical medicine.  You have heard that the three success points of any business are location, location, location.  Well, our clinic is on the corner of two busy streets, right between Wendy’s and Burger King (great locators for people.)  It is also possible to be on a street that is too busy…as is the building two doors down from ours.  Our saving grace is a back entrance from a less busy street. 
Raleigh is the capital city of North Carolina, and is a wonderful city to live and practice in.

M$C:  What’s the income service   level that you provide annually?
Weir:
  I guess that I tend to look at our practice “pre-multidisciplinary.”  We actually started the multidisciplinary practice under the direction of a consultant.  But, it seemed like everything that he told us to do required some type of equipment to purchase from him.  We did well, but there were a lot of chiropractic practices in town that were doing just as well. 
Then we found Dr. Daniel Dahan of Practice Perfect.  He was able to help us get rid of some equipment, cut overhead and increase the practice all at the same time.  What I always considered a “pipedream” a couple of years ago—a million-dollar-per-year practice—is now a dream come true.

M$C:  Do you have a margin formula or set profit standard for the business?
Weir:
  I run our practice on goals.  We have an objective, and that is to be better this year than we were last year.  Our goal is to provide quality service to a greater amount of people.  I get our staff involved with this.  Every staff member knows what our goals are, where we stand every day of the week, and how far we have left to go.  Bob Proctor taught me that the important thing was to write my goal down, put it in my pocket and read it as often as I can.  My staff all have these goal cards, and the front desk person will walkie-talkie everyone to read their goal cards several times per day.

M$C:  Is there anyone in particular to whom you attribute your professional success?
Weir:
  I was raised with Judeo-Christian ethics.  I practiced WWJD (What Would Jesus Do?) long before bracelets. 
My wife is not only the love of my life and my best friend, but also my business partner.  She has believed in me, and our vision, more than anyone. 
But there are two people who have helped change my life.  First, in my professional career, there is my  consultant, Dr. Daniel Dahan.  I have never met a more caring, loving and ethical u        u man than this guy.  There is never a time that I have called on him that he has not helped me walk through a problem.  There are so many issues involved in a multidisciplinary clinic, and he has been there every step of the way—never a question of whether something should or should not be done but, rather, is it right or wrong—end of discussion.  He is filled with wisdom beyond his earthly years. 
Second of all, Bob Proctor has helped me in my success education.  He has helped me grasp the concepts that I needed to help me become wealthy.  Gaining wealth is easy; believing that you deserve it is the hard part.  He helped me realize that life is too short to waste it doing things I hate to do.  One of my favorite quotes from Bob is, “Most people are tiptoeing through life, hoping they safely make it to death.”  Just make the decision that you are going to have the best practice in your city, goal for that, and go for it.   Don’t just look to chiropractors for mentoring.  Success has nothing to do with how many patients you see, but it has to do with what thoughts go on between your ears!  Most of us need mental enemas!

M$C:  Tell us about your family.
Weir:
  My wife, Rose, and I have been married for twenty-seven years.  We have three beautiful children—Wendi, Nikki and Tyler—and they all work in our office.  Our daughter, Wendi, graduated from Oral Roberts University with a degree in marketing, and now has become a certified coder.  Nikki has taken over our front desk area, and is doing a tremendous job.  Tyler is six, and he has placed himself in as office manager.  We have been blessed with a wonderful family and marriage.
 
M$C:  What marketing strategies do you use to attract new patients and to keep current patients?
Weir:
  Of course, when you first start a practice, you have nothing to do but external marketing.  When we first started our chiropractic practice, I went door-to-door doing surveys, mall screenings and newspaper ads.  Now, most of our marketing is done internally. 
As you know, our office motto is “Get Well, Have Fun.”  When you realize that people give up over an hour, three-to-four times per week, it makes you appreciate them.  So, we try to make their visits enjoyable.  We are always looking at ways to have a party in our office. 
For example, our July program was “It’s Christmas in July at First Choice.”  We had our office decorated with Christmas decorations and we had our “12 Days of Christmas” Contest.  Everyday, for twelve days, we gave away a present.  Patients would get a ticket for keeping appointments, referring patients, etc., then, everyday, we drew a name for a prize.  All month we were aiming for July 31st, our Christmas party. 
We adopted the Wake County Foster Care Program.  We decided these kids needed to have a little Christmas, so our patients helped us collect book bags for these kids to go back to school with.  We collected over 150 book bags u  u filled with supplies.  On the 31st, we had games, prizes, snow cones, moonwalks and lots of food at our Christmas party.  These kids had a blast, and we did, too!  You would be amazed at how many people will help you reach your goal if you but ask.
Another key is to keep your name in front of your patients.  A couple of years ago, a patient came in with this tremendous story of how this surgeon had literally saved his life.  When I asked the surgeon’s name, the patient could not tell me.  That made me realize that, if I don’t keep my name in front of them…they won’t remember my name either. 
Everyday, our patients receive a positive thought e-mail from me and our clinic…it’s called the “Insight of the Day.”  It is done by a service called the 3% Club and, once our patient’s name is given to them, I don’t have to do a thing!  Everyday they get an uplifting positive message in a very short sentence.  Then it gives my name, and the clinic name.  It is an incredible marketing tool that is so inexpensive it is ludicrous! 
The key is good customer service.  We choose where we go to eat by their customer service.  One of my favorite restaurants in Raleigh is Winston’s Grille.  These people treat you like kings.  So, when we shop, or go out to eat, and if the customer service is great, we emulate that. 
We are known around the city as the clinic with fresh baked chocolate chip cookies.  We bought   a little convection oven, and we go to Sam’s Club and buy bulk dough.  It takes so little time and effort, but it makes a tremendous impact on patients.  I got this cookie idea from Dr. Bob Lupo in Tampa.  Use other people’s ideas!
We started to study the “Fish Philosphy” based on the books written about Seattle’s Pike Place Fish market. Again, it boils down to giving good customer service. It starts on day one, and ends with their release from care. At their release, it is announced over the walkie-talkies, “There’s a fish swimming away”. At this point, we give them a First Choice tee shirt, and take their picture with the staff. Within a week, they have a copy of this picture with a nice thank you card. If Nordstroms can send you a thank you card for a little $15.00 purchase, we figure that we can too!

M$C:  Obviously, every doctor, at some time or other in his practice, experiences problems with patient retention.  How do you handle such problems? 
Weir:
  Our patient retention is a staff endeavor!  From Day One, when they walk in the door, we are letting them know the importance of keeping up with their care.  I learned from Dr. Peter Fernandez several years ago to keep missed appointments under 10%.  We are very strict with our appointments.  Our patients know that it is a major infraction to miss an appointment in our office; it jeopardizes their care.
We instituted something from the game of baseball, “Three strikes and you’re OUT.”  On the first missed appointment, they get a big red sticker on their chart:  “Missed Appointment.”  Every person that they see that day, comments on the missed appointment.  Honestly, if a person misses their appointment, and no one notices it or says anything, they don’t believe that you think that it is all that important for them to keep either.  But, if everyone hits them with some type of remark, you can bet they are going to think twice about another miss.  The second miss is not as graciously acknowledged, and number u      u three is downright stern.  After that, they have become more of a liability than an asset. 
You must genuinely care.  People can tell.  If you have a fun, positive place to come to for care, it’s not hard to get people to come.  Again, question yourself!  Would you come to your office three times per week for twelve weeks?   Make the climate in your office fun and enjoyable, and they will come.
 
M$C:  We all know that an efficient staff is a crucial com-ponent of a successful practice.  Tell us about your staff  (how  you find them, train them, what qualities you look for).
Weir:
  In a multidisciplinary team, the key has to be this:  Nobody is the big cheese!  We are all important to the patient’s getting well.  I look for people who are friendly, people loving people.  I also understand that, although I am an extrovert, not everyone is, and there are a lot of things that I don’t like to do; and so, to get those things done, I best not hire an extrovert like me!  I try to surround myself with people who will balance me out. 
I was once taught that I need to find my weaknesses and get stronger in those areas.  What a mistake.  The key is to find your strengths, get stronger in those areas, and hire other people to do your “weak areas”.  Regardless of whether you are an introvert, or an extrovert, you still need to love and care for people.
We have a great team, and when I hire new people, I let them know that my main goal is to protect my team and that the rest of the team has to approve.

M$C:  Do you enjoy your work?  How do you feel about going to work in the morning?  
Weir:
  I am not a morning person!  I have had to learn to be a morning person.  Chiropractors are special birds!  They really are.  It takes someone special to do what we do.  We are healers, business people, entrepreneurs and in sales, all in one package.  It is really amazing how much more you love going to work when you are earning a great income, seeing great patients and have a loving staff.  All of those things are things you have control over!  If you don’t love going to work, you need to take inventory of your life, find out what is out of sync and fix it.  As Bob Proctor says, I think that the only people who are working are those people who are doing what they don’t love to do!  If you go to a place and do what you love to do, that is not work!  It is fulfilling your destiny and purpose.  What you do should give you life…not sap life from you!

M$C: With your practice being multidisciplinary, can you give our readers your advice about setting up and maintaining such a practice in today’s healthcare system? 
Weir:
  If you decide that you want to build a multidisciplinary practice, you must realize that you cannot do it alone.  This is not the kind of practice that your great-grandfather had!  You must partner with a management consultant who knows the multidisciplinary practice from A to Z.  You must also have a good healthcare attorney and a good accountant.  I am amazed by people who will go to stockbrokers who drive thirty-year-old cars and live in apartments over hardware stores!  I also do not understand how doctors can go to other doctors who are failures in practice and ask for their advice.  If you want advice on how to put in a Jacuzzi, don’t ask your mailman! 
Solomon once said that there is wisdom in the council of many.  Surround yourself with people who believe in you and your vision.  Immerse yourself in the knowledge you need to succeed.
 
M$C:  Other than traditional chiropractic care, do you include any other type of services or products in your clinic which further help your patients as well as bring in additional revenue to your practice? 
Weir:
  We provide urgent care in our practice.  Our MD is in the office from the early morning huddle until the door is locked at night.  She loves to do sutures and injections.  We are getting ready to expand into trigger point injections and possibly prolotherapy. 
I wrote a book a couple of years ago on fibromyalgia, You’re Not Crazy, an Overcomers Guide to Fibromyalgia.  We do a couple of things for fibromyalgia.  One is nutritional counseling.   We also use the Synaptic Electronic Nerve Block.  Ninety-five percent of the time, if a patient comes in with a migraine, they leave without it.  If you are going to treat fibromyalgia, get a “toolkit” for these patients to use.  One product that you want to make sure that you include is stopain® Professional Strenght Cryotherapy  Spray.  This is a pain relieving spray that contains MSM.  It is a part of the puzzle.  We also use it for any type of muscle pain.

M$C:  Any final words for our readers? 
Weir:
  Yes.  Never, never, never give up.  It seems like there are so many people who are on the brink of success, and they give in to temporary defeat.  Success is not based on how many times you fall, but on how many times you get up!  You are a part of a great profession.  People who believe that there is a power that animates the living world, and you help people come in contact with that power every day!  Forget about going to an office to practice chiropractic!  Turn your office into a healing center, a filling station for the power of life!  Have the mind that you are going to have a blast doing the very thing that you love to do:  getting sick people well—spirit, soul and body.
You may contact Dr. Weir at 919-954-0050 or visit him at
www.DrTimWeir.com.

Our sincere thanks to Dr. Weir and his staff at First Choice Family Healthcare, P.C., of North Raleigh, North Carolina.

Editor’s Note:  Do you have a million dollar practice that you’d like TAC to highlight in our Million Dollar Chiropractic column?  Contact TAC’s editor Jaclyn Busch Touzard by phone/fax: 1-305-716-9212 or email: [email protected].  We want your inspiring story!  Contact us today!

Degeneration Introduction of Decompressive Traction

In my last article, I covered a general introduction and description of decompressive traction (spinal decompression) and its move into the chiropractic market.  In this article, I’m going to discuss the research literature and our clinical experience as it relates to both proper patient selection and reasonable outcome expectation.  The elimination of pain is typically the main priority in a chiropractic practice. It is how we, collectively, have built our reputation.  However, like all things in life, there is no 100% successful procedure, and it is simply dogmatic to believe that we are now doing all that ever needs to be done.  If we are rational in our approach, we regularly search for new or expanded means of offering an improved, cost effective outcome.  That is exactly what spinal decompressive traction can offer your practice.  Like all procedures, though, choosing the right equipment and understanding proper patient selection are the first steps.

The traction literature offers us numerous and varied protocols and procedures and that, perhaps more than anything else, contributes to its subsequent inconsistent performance and poor reputation.  Add to that the antiquated equipment of the past and enthusiasm for this modality diminishes.  We need to separate mechanized traction as just another mobilizing technique, whose outcomes are often more amenable to hands-on procedures, and focus on the specific job of decompression of the disc, whose outcome is improbable without mechanical means.  Decompression of the disc aims to create an enhanced diffusion, fibroblast activity and blood supply contact.  It is these phasic effects that are consistently mentioned as a source of healing. 

Ultimately, the inherent systemic health and healing ability of the individual is what is revealed with therapeutic intervention, and time.  As Byron said, “Circumstances don’t make the man, they reveal the man.”  This is an important, yet paradoxical, point to chiropractic and health care in general.  If a patient fails to improve, is it an inherent property of their constitution or the misapplication (or lack of application) of the proper therapy?  I have discovered that it is more a misapplication of the appropriate therapy and, in many cases, misapplication goes hand in hand with adequate product design.  Fortunately, today the research and subsequent product design has raised decompressive traction to a previously unseen efficiency and ease of application.  Not to mention that it doesn’t require a second mortgage to deliver it.
Decompressive Traction Systems are available to any chiropractor today for a fraction of the cost of previous devices.  By implementing and incorporating a specific, limited number of parameters, outcomes have been improved dramatically with a relatively short learning curve and modest equipment costs.

 

 Specific parameters of Decompressive Traction Therapy include:
 1)  a non-slipping, circumferential harness allowing the best possible focus of force application, as opposed to side-to-side harnesses, wrap-overs or ankle straps. 
 2)  The pull vector needs to be adjustable in angle and pull pattern must be graduated and stepped to elicit no an-ticipatory muscle guarding.

 

The pull pattern cannot be taken lightly. We are basically sneaking up on the body, with the intention of creating segmental separation without awakening the muscle-guarding giant that stands ready to limit our every move.  The equipment must be designed to incorporate all of the utilitarian functions that increase the probability of separating the spinal segments.  It appears, from numerous studies and reviews, that sufficient vertebral distraction is a key to creating decompression.  Thus, a focused restraint and specific positioning with slow, graduated force application limiting muscle guarding are key factors.

Chen, et al., showed that a decrease in disc pressure was related to distraction distance.  Paradoxically, in their study of forty-seven prolapsed discs, prior to therapeutic traction application, 62% had negative pressure and only 19% had positive pressure.  64% showed a further reduction with traction.  Ramos and Martin showed initial pressures in three surgical candidates to be +60 to +70 mmHg,, which reduced to negative ranges when a threshold traction tension was reached (about 60 lbs.).

Proper patient selection is paramount.  A patient’s poor fitness/posture, loss of local muscle control, and past trauma added to pain sensitization deep into the disc ultimately spell a clinical nightmare!  Certainly, these patients warrant a multifaceted approach.  And, obviously, we must know when our intervention will be of limited value and referral is necessary.  Improving signs and symptoms from a reasonable trial of the two most potent mechanical spinal treatments, manipulation and decompression, can help us determine this. 

We are basically sneaking up on the body, with the intention of creating segmental separation. Sufficient vertebral distraction is a key to creating decompression.

The so-called sub-ligamentous, single level protrusion/ hernia, with limited degeneration, will show the best outcome.  The greater the annular damage or extrusion of the nucleus, the more nebulous the outcome.  Additionally, extensive degenerative changes and diffuse, central bulges—especially multiple levels—tend to reduce success.  Of course, the safety (first do no harm), ease of use and comfort to the patient make decompressive traction a viable passive therapy to try even in difficult cases.  As a chiropractor, I am convinced (as were Cyriax, Farfan, and Mathews, among others) decompressive traction should be seen as an obvious companion to manipulation and, in cases of sciatica, often the more reasonable approach. 

Henrik Weber, MD, writing on the natural history of disc herniation (Spine (19) 1994) points out the lack of concise answers for back and leg pain.  However, he points to research that suggests the evolution of a hernia (compressed disc) is associated with clinical symptoms, and the decrease in size is seen in many of the successfully treated patients.  Over 90% of patients have satisfactory outcomes from herniation at one-year follow-up with conservative treatment including traction.  Deyo, et al., suggest, from their review, traditional type traction is of limited value except that sciatic patients treated with it had a greater chance of avoiding surgery.  (Not an inconsequential outcome!)  Could you imagine what the outcomes could have been if they had access to the much improved products that are now available.  Minimize the misapplication and your results will improve exponentially.

As stated earlier the literature tends to paint a poor picture of traction methods.  We’re attempting to change that.  I contend that when done in a codified manner, with clear intent and indications, decompressive traction is a vital addition to a chiropractor interested in that multi-faceted approach.  Few therapies can lay claim to the direct, phasic effects of axial decompression, both physiologically and neurologically.  I have used it for years as a diagnostic tool to judge potential outcomes.  Leg pain patients typically “centralize”; patients intolerant, or unresponsive to manipulation can still be offered a viable treatment option, prone or supine; and, of course, much of this relates to the cervical spine as well.  Today there is no excuse why decompressive traction shouldn’t be part of your chiropractic artillery.  With dramatic product improvements and a price within reason, the most powerful adjunct in your arsenal is often available for the price of a good adjusting table.

Dr. Jay Kennedy has been practicing Chiropractic Biophysics (CBP) in Western Pennsylvania since graduating Palmer College in 1987.  In the last eight years, he has owned and operated several decompression systems treating over 2000 patients on them in his multi-disciplinary clinics.  He lectures extensively and has authored various articles on axial decompression. You may contact him by e-mail at [email protected]

Proven Safety of Homeopathy Pregnancy, Birth, Nursing, and Infancy

For centuries, homeopathy has been safely and successfully used to treat a plethora of common conditions associated with pregnant and nursing women.  Not only does homeopathy assist in treating the mother during pregnancy or nursing, but it also enhances the health of the unborn or nursing child as well.  I have let my pregnant and nursing patients know that we are actually treating two for the price of one!
Homeopathy is a therapy that works gently and safely, yet is restorative in its deep-working actions.  It has proven to be highly effective for many of the common health conditions of pregnancy, including:

  • Morning sickness,
  • Miscarriage prevention,
  • Toxemia,
  • Varicose veins,
  • Hemorrhoids,
  • Assistance with a safer, healthier, and faster delivery, and 
  • Assistance with a safer, healthier and faster recovery.

Dr. James Tyler Kent, the father of American homeopathy, said, “A pregnant woman is more sensitive to the indicated (homeopathic) remedy than at any other time….  The physiological functions are more active and, because great changes are occurring throughout the whole organism, the remedy has a much better opportunity to do its work.”

The amazing truth is that the very best possible time to treat a woman homeopathically is during pregnancy.  It appears as though the new life growing within her brings out unique symptomatic communication patterns to express a woman’s specific needs for certain homeopathic remedies to maximize her health as well as the health of her baby.

Pregnancy has become known as a time predictions are useless and all the rules change.  Interestingly, though, the significant changes observed in the pregnant mother are often key indicators for the treatment of her developing infant’s needs.

Like chiropractic, homeopathy activates the appropriate, innate communications of the body, and is more strategically related to chiropractic than any other protocol.  In fact, homeopathy corrects nerve interferences throughout the whole nervous system where the hands of the chiropractor cannot reach.

Miscarriages

Homeopathy has been remarkably effective in the correction and prevention of miscarriage.  If a patient displays symptoms of a potential miscarriage, homeopathy should be quickly implemented with dosages as often as every half-hour during the symptomatic stage.  This patient should be seen frequently, and reflex response tests employed as a key to discover the correct remedies, administer optimal dosages, and maximize results.  Actually, the best time for treatment of a patient with a history of miscarriage(s) is before she tries to become pregnant.  This is a good time for a proactive approach to begin working with related homeopathic remedies.  Remedies to be considered and tested will include:

  • All detoxification and drainage remedies
  • Constitutional remedies
  • Female reproductive related remedies
  • Any symptomatic specific related remedies

Miscarriage is a very sensitive and traumatic experience for parents—especially the mother.  Working as an adjunct with standard medical procedures—even though they often have very little to offer in most cases—is always helpful.

Children and Newborns

Again, homeopathy has the proven safety profile for confidently and effectively treating both children and newborns.  Pure water-based homeopathic products provide the purest base for the purest form of medicine—homeopathy.  Newborn babies and children are much more safely treated homeopathically, without the traditional stabilizers of alcohol-, sugar-, or glycerin-based products.

People on multiple medications

This issue of conflicting medications has become a primary problem for healthcare providers, as well as a major concern to patients.  Homeopathy is the only health protocol that has demonstrated through its time-tested record to have no known negative drug interactions.  The practice of homeopathy is the only approach that can make this claim.  It is, literally, the safest healthcare practice on the planet!

Proven Safety of Homeopathy

Homeopathic medicines are made from official homeopathic ingredients monographed in the Homeopathic Pharmacopoeia of the United States.  This is the official US governmental compendium that recognizes homeopathy as being the only 100% safe therapeutic product.  All ingredients have been reviewed for efficacy, toxicology, adverse effects and clinical use.
For over 200 years, the safety and therapeutic potential of homeopathy has been widely acknowledged and accepted in the vast global perspective.  In fact, the World Health Organization (WHO) reports homeopathy as the second most widely used medical modality for primary healthcare worldwide, allopathic medicine as a distant fourth.

The FDA drug monitoring process does not reveal any significant instances of problems with homeopathic drug products, thus establishing a positive safety profile.  The historic time-tested safety records and results of homeopathy are unprecedented in the history of all medicine.

In over 200 years of clinical use, homeopathy has had no recorded side effects, no known negative drug interactions, no contraindications of any kind, and is also proven to be non-habit forming.  This time-tested safety profile applies to pregnant and nursing woman, children and newborns, as well as people on multiple medications.

Due to the strong and rightful warnings from the Surgeon General and the medical profession, expectant mothers are obviously concerned about consuming substances during pregnancy that could harm the developing baby.  While homeopathy has distinguished itself by becoming the first to ascend to the status of an all-natural drug product registered with the FDA, homeopathic products are required to use the standard over-the-counter warnings required for allopathic products on their label.  These warnings are aimed primarily at alcohol, coffee, and drugs, but they encompass herbal and nutritional supplements and homeopathic products as well.  Pregnant or nursing women are encouraged to seek the advice of a healthcare professional before usage.  Fortunately, as a healthcare professional, a chiropractor can confirm the safety of using homeopathic products during pregnancy and nursing.

Dispelling Common Concerns

Why is homeopathy so safe compared to other natural products like nutrition and herbs?  Nutrition, herbs, and drugs work from a bio-chemical perspective.  Homeopathy, with its serial dilutions and successions commonly beyond the molecular level, works more from a bio-energetic perspective. Homeopathy functions subtly, but deeply, within the inner energetic control mechanisms of the body to correct interferences.  And, although more corrective and curative, it does not force itself upon the body as a bio-chemical substance that must be dealt with.  A subtle energetic substance can be either accepted or rejected by the body.  For example, the cellular, satellite, radio, and TV waves in our atmosphere have no function within us; only those things programmed to accept these wavelengths will receive them.

Can a homeopathic medicine hurt you?  Some people may notice certain temporary symptoms from taking a homeopathic.  I call these symptoms good symptoms—evidence that your body is working to eliminate certain toxins that may be causing health problems.  Homeopathy functions to express our natural health potentials rather than to suppress symptoms.

New Testing Procedures

The use of bio-response tests (kinesiology, leg length, electro-acupuncture testing, etc.) provides confirmation as to which homeopathic products are needed or not needed by the individual.  With the highly individualized healing art of homeopathy, these tools are of paramount importance for the practitioner to take homeopathy to a more effective treatment level and proactive level of prevention. 

Frank J. King, Jr., is a nationally recognized researcher, author and lecturer on homeopathy.  In addition, Dr. King is the founder and director of King Bio Pharmaceuticals, a registered homeopathic manufacturing company dedicated to completing chiropractic destiny with the marriage of homeopathy.  Dr. King offers, complimentary to all Doctors of Chiropractic, his turnkey procedural system for the high volume practice called, The Chiropractic Enhancer systemÔ (CES).  It is so easy to use that you can successfully apply homeopathy in your practice using any company’s products in one day. Call King Bio Pharma-ceuticals, Asheville, N.C. 1-800-543-3245 or e-mail: [email protected].

NATIONAL ASSOCIATIONS News Update

American Chiropractic Association

DC’s Across the Country Continue to Reap Benefits of ACA Legal Action 

The aggressive legal posture of the ACA in protecting the rights of doctors of chiropractic and their patients continues to pay dividends for the chiropractic profession.  The United States Office of Personnel Management has determined that doctors of chiropractic will be reimbursed for providing physical therapy services under the national Blue Cross Blue Shield Association’s (BCBSA) Federal Employee Program (FEP), if such services lie within the doctor’s state scope of licensure.  The BCBSA FEP is the largest privately underwritten health insurance contract in the world, enrolling 4 million federal government employees, dependents and retirees.
“ACA is delighted to announce another tangible benefit of our ongoing legal action,” said Daryl D. Wills, DC, President of the ACA.  “This policy change not only has obvious financial implications for the chiropractic profession but it also demonstrates the ever-growing respect and recognition our profession enjoys.”

ACA is sponsoring Spinal Health Month this October!

The purpose of this annual observance is to bring about public awareness of chiropractic care and its relationship with the neuromusculoskeletal system and to promote the many health benefits of chiropractic care. 
ACA members can create a Spinal Health Month campaign in their own communities by using the tool kit on ACA’s Web site (www.acatoday.com).  The toolkit contains an official Spinal Health Month proclamation, a sample press release to send to your local newspaper, a sample radio ad spot and a sample Spinal Health Month newspaper ad slick.

International Chiropractors Association

Dr. Dan Murphy is ICA’s New Vice President

World-renowned educator and spinal trauma expert Dr. Daniel J. Murphy has been elected to fill the position of ICA Vice President by the Board of Directors of the International Chiropractors Association.  This senior leadership position was left vacant by the recent loss of Dr. Fred H. Barge, and was filled during a special meeting of the ICA Board in mid-August. 
Dr. Murphy is a 1978 graduate of Western States Chiropractic College and, since 1982, has been on the faculty of Life Chiropractic College West.  He also maintains a busy practice in Auburn, California.  One of chiropractic’s most articulate and effective spokesmen, Dr. Murphy appears on platforms around the world speaking before chiropractic as well as other professional groups.  Dr. Murphy pioneered the postgraduate education process for chiropractic management of spinal trauma.  He has given over 800 12-hour seminars on this vitally important clinical subject and is universally acknowledged as the chiropractic profession’s expert on this topic.  Dr. Murphy has also written extensively and served as an expert witness in defense of chiropractors on countless occasions.
Dr. Murphy has been actively involved in ICA’s programs for nearly twenty years and has been repeatedly recognized for his service on behalf of the ICA, including “Chiropractic Educator of the Year” in 1987 and 1991, and “Researcher of the Year” in 1995. He has also been recognized through numerous “Clinical Science Faculty Awards” from Life Chiropractic College West and as the 1997 “Carl S. Cleveland Jr. Educator of the Year” by the International Chiropractors Association of California (ICAC). 

World Chiropractic Alliance

ICA, FSCO to Join WCA for Summit Legislative Day

In 2004, for the first time in history, three major chiropractic organizations–the World Chiropractic Alliance (WCA), International Chiropractors Association (ICA), and Federation of Straight Chiropractors and Organizations (FSCO)–will gather together for a demonstration of chiropractic unity and influence.
The historic assembly will take place on Thursday, April 29, 2004, as the kick-off event of the World Chiropractic Alliance International Summit 2004.  Members from all three organizations will take part in a one-hour political “pep rally” before meeting with Senators and Representatives either singly or in state-wide contingents.

WCA Lobbies for Federal Research Grants

The WCA has retained Michael Fulton, Executive Vice President of Golin/Harris International, to help secure federal funding for a multi-year chiropractic research study that will further validate the need to expand the role of chiropractic in the US healthcare system.  The WCA campaign included giving testimony at the US Senate Appropriations Committee hearings on “Health Care Access and Cost Containment Strategies.”
Following the hearing, Committee staff members were given draft language that was later incorporated into the final report to the Fiscal Year 2004 spending bill funding the US Department of Health and Human Services.  Fulton said the testimony and report language are part of a comprehensive campaign building a case for $1.4 million in federal funding for the research study.
For more information on the World Chiropractic Alliance, visit www.worldchiropracticalliance.org.

Orthitics for Work Boots

Many people wear special footwear at work.  Occupational health guidelines and employers often require the use of protective work boots.  When fitting patients for orthotics, ask what type of footwear is worn throughout the workday, as well as during recreation and relaxation periods.  An orthotic designed for work boots can be very helpful.  While generic insoles and off-the-shelf foot supports provide some comfort, workers appreciate a custom-made orthotic designed specifically for work boots.

Protection from Injury

Work boots protect the feet and ankles from work-related injuries.  This category of footwear contains primarily ankle-high boots made from thick, sturdy materials.  Most have a special sole, which varies depending on the work conditions (slip-resistant rubber, large lugs for traction, non-conductive to electricity, etc.).  Many also have steel, non-crushable protection for the toes.  These boots are often quite heavy.  Because weight on the feet leads to fatigue, a lightweight orthotic is appreciated.  Check the weight of the orthotics you recommend for work boots.

Support for Ankles and Arches

Better work boots provide excellent external support and help hold the foot and ankle in alignment during strenuous activities.  However, the insole must fit the many different shapes of feet that wear that same size.  Therefore, the internal support is generic, with a strong shank under the arches, but no specific support.  Foot and ankle fatigue increases as the workday progresses, especially for workers with non-standard feet, whether flat or high-arched.  A custom-made orthotic improves foot and ankle function during strenuous work activities.  It must cause little or no interference in the proprioceptive feedback system, and the foot and ankle must be kept in good balance.  This means controlling the amount of pronation during gait, preventing excessive ankle and calcaneal eversion, and supporting the three-arch complex.

Support for the Pelvis and Spine

The best work boot orthotic also ensures proper alignment of the pelvis and spine.  Biomechanical asymmetries transmit abnormal forces into these areas, resulting in persistent subluxations and susceptibility for back injuries.  The integration of a pronation wedge or heel lift, when needed, can greatly improve the function of the pelvis, sacroiliac joints, and spine.1  Many chronic back conditions associated with work postures resolve when custom-made orthotics are worn in work boots.

Shock Absorption

Long-term standing on concrete and other rigid materials can lead to back problems.  The best modern orthotics are designed to reduce shock waves generated up the leg into the knee, hip, and spine.  The best materials for work boot orthotics are the viscoelastic polymers (such as Zorbacel® and Poron®), a group of materials created to enhance the body’s ability to dissipate shock stress to sensitive and easily damaged tissues.2
Viscoelastic shoe inserts can significantly reduce reported pain levels in patients with low back pain.3  A report on soccer referees participating in a five-day tournament found, “The incidence of soreness in Achilles tendon, calf, and back were significantly reduced by the use of shock absorbing heel inserts.”4  Orthotics made for work boots should take full advantage of the newer viscoelastic materials.

Moisture Control

The sturdy construction of work boots often causes substantial heat accumulation, especially when working indoors, or during the summer.  Sweat often builds up, which can result in foot odors and fungal infections.  The feet can excrete as much as half a pint of moisture daily.5  Orthotics for work boots should incorporate special materials that pull sweat away from the foot surface.  Such an orthotic is able to control most cases of hyperhidrosis, and even normal foot moisture is handled efficiently.

Additional Orthotic Concerns

Comfort.  A good orthotic must be easy to fit into the work boot, with a minimum of modification.  There should be no sensation of “something in my shoe,” which would distract from work performance.  The newer materials tend to be more comfortable and less intrusive.  The break-in period is usually much shorter, and workers quickly become accustomed to custom-made orthotics designed with viscoelastic polymers.  An orthotic used during work must be supportive, yet flexible, so that it doesn’t hinder natural biomechanical performance.  Longitudinal flexibility (especially at the forefoot) is a major indicator of a comfortable orthotic for work boots.
Durability.  Since many work activities produce high forces and stresses on an orthotic, it must be capable of sustaining repetitive physical insults, with no perceptible decrease in support, performance, or shock absorption.  Moisture and heat must not cause significant degradation of any of the above factors.  Once again, the newer materials are usually the most durable, and their physical characteristics can be maintained the longest.

Conclusion

Orthotics need to be specifically selected for use in work boots.  They should support the arches and spine, be lightweight, and offer shock absorption, moisture control, comfort, and durability.  Patients with properly fitted and selected orthotics for their employment have noticeably less work-related fatigue. TAC

Dr. John J. Danchik is the seventh inductee to the American Chiropractic Association Sports Hall of Fame.  He is the current chairperson of the United States Olympic Committee’s Chiropractic Selection Program.  He lectures extensively in the United States and abroad on current trends in sports chiropractic and rehabilitation.  Dr. Danchik is an associate editor of the Journal of the Neuromusculoskeletal System and the Journal of Chiropractic Sports Injuries and Rehabilitation.  He has been in private practice in Massachusetts for twenty-six years.

Chaos vs. Control Are You Organized for Success?

Organization is a large word that can have a great impact on the success of your practice.  Without a systematic way of organizing your practice, chaos and havoc will rule with no guidelines to help sort out the confusion.  In a chiropractic practice there are three components to building a successful organization:  Policies, procedures and systems.
Policies, procedures and systems add the structure that is necessary to run a successful practice.  It is helpful to understand the difference between these components and why each is important for your success.

Policies

Policies are the rules and regulations of running your practice relative to your staff and your patients.  Policies are written in order to help your practice run smoothly.  Each and every chiropractic office should have a General Policy Manual that is followed by all staff members (regardless of position or seniority.)

Chaos vs Control - Are You Organized for Success?

A General Policy Manual will minimize and eventually eliminate staffing problems.  When all staff members are following the written policies, there are fewer issues for staff members to discuss or dispute.  Once the rules and regulations are in place, correcting a staff member also becomes easier.  Most staff or practice problems are in equal proportion to the doctor’s willingness to confront the staff member.  Having a well-written and proven set of policies supports the discussion and resolution of the problem.
When a new staff member is hired, it is imperative that you introduce them to the General Policy Manual and make sure they understand and agree with your policies.  Have them complete a “Check-Off Form” to ensure they do not miss any important policies.  Also, have them write several essays during their probation period on their understanding of your policies.  This will eliminate any misunderstandings and potential staffing problems down the road.
You can change the way your practice operates by following these few simple suggestions.  Policies allow you exponential growth in your practice, regardless if you have one, five, fifteen or thirty staff members.  Policies are critical.

Procedures

A procedure is a specific course of action that can be repeated in order to achieve a certain response.  Procedures are the step-by-step processes that you utilize in your practice.  Your procedures take place from the moment a patient walks through your front door, until the time they are released onto maintenance care.
Procedures are critical for a chiropractic practice to continue to expand.  Once you have developed your procedures, you should write them down or put them on audio or videotapes.  By doing so, you are making them available to everyone to learn from and incorporate into your daily operation.  The more specifically your procedures are defined, the smoother your practice will operate.
The anxiety level over hiring new staff members will significantly diminish when you have proper procedures in place.  It will be easier for a staff to duplicate a position when the procedures are already defined for that position.  You will find that you will have more compliant staff members and a greater willingness to replace non-compliant staff members with the appropriate procedures in place.  Procedures are vital.

Systems

A system is a functionally related group of elements that interact harmoniously.  Systems need to be put into place in order to have your practice function overall.  A system incorporates your policies and procedures into a workable and consistent structure that will succeed regardless of the personalities involved.
For example, you would have a “new patient” system that would handle all aspects of serving a new patient, from the time they walk in the door until they are put on a maintenance program.  The system would specify the exact way to handle setting up the first appointment, how to greet the patient upon arrival, paperwork procedures to follow, etc.   With a system, nothing is left to chance.
Systems are incorporated into a practice for a number of different reasons.  Regardless of the specific end result of the system, it is only considered effective if it will work for anyone, in any town, in any practice, at any time of year.  A system is bulletproof, and put into place in order to help your practice function more effectively.  Increase your systems, increase your productivity and increase your opportunity for growth. Systems are essential.
Organize your practice for success.  Eliminate chaos and embrace control.  Write your policies and procedures and put your systems in place.  You will be setting the stage for success in an organized and expanding practice! TAC

Dr. Maurice A. Pisciottano, CEO and founder of Pro-Solutions for Chiropractic, is a practicing chiropractor, noted lecturer, author, producer and research and development technologist.  He is well known for his practice management expertise, as well as new patient development programs.  He has devoted the past twelve years to the development of the instrumentation and the computerization of chiropractic treatment and documentation.  Dr. Pisciottano regularly lectures at Palmer College of Chiropractic in Davenport, IA, and at Logan College of Chiropractic in St. Louis, MO.  He can be reached at Pro-Solutions for Chiropractic in Pittsburgh, PA, at 1-877-942-4284.

Coral Calcium–Debunking the Debunking!

With the FTC filing law suit against Bob Barefoot for false and misleading advertising, and the discovery of lead in one coral calcium brand both happening in June, coral calcium has been severely wounded.  Others jumped on the anti-coral bandwagon and suggested coral was no different from cheap calcium carbonate or limestone–that it was just an overpriced calcium supplement. 
The $64,000 question is whether the bad rap is justified or are we throwing the baby out with the bath water?  Okay, everyone agrees Mr. Barefoot exaggerated coral’s benefits to sell product, and having his infomercial forced off the air was fair treatment; but should we dismiss coral entirely or does it deserve a closer look? 
Whatever your beliefs, be prepared for another round of advertising.  Several new infomercials, including one with a well-known country singer, are in production to be launched this fall/winter, filling the void left by the removal of Robert Barefoot’s show.  These television promotions are likely to rekindle broad interest and you will soon, once again, be answering patients’ questions about the merits of coral calcium products.  Here are the pitfalls to watch for.

Load of Bunk #1—“Lead in Coral Calcium”
Let’s get some perspective.  ConsumerLabs, a watchdog group, did find a higher than Proposition 65 lead level in one bottle, from one batch, from one brand, of coral calcium.  With over 300 brands of coral calcium in a market experiencing vertical growth, it is not surprising that one bad apple has emerged.  The vast majority of coral comes from two suppliers who test every batch and offer third party lab results showing Proposition Compliant lead levels.  The news that was not published is that almost every other coral brand has been tested by ConsumerLabs, or one of the many other labs around the country, with passing scores.

Steaming Pile of Bunk #2–“Coral calcium is the same as calcium carbonate.”
An initial inquiry revealed that calcium from coral is, indeed, in a carbon-based form, but that is where the similarities end.  Even a cursory glance at the electron microscope photo below indicates differing properties.
Coral contains seventy-three minerals not found in calcium carbonate supplements.  According to the National Research Council, 25 of the 73 are essential minerals, and 60 of these minerals are naturally found in human milk and blood, indicating that they have unknown functions.  It is widely recognized that these trace minerals are often missing entirely from our soils and food in some locations, so it makes sense to supplement.
One recent coral entry is a live harvested coral from Brazil which is particularly high in trace minerals–about twelve times more than Okinawan varieties, which are long dead and somewhat depleted. (
www.brazilcoral.com)  This Brazilian coral is actually an algae and, hence, has vegetable proteins to which the minerals can chelate.  Heat treatment is avoided so the non-mineral marine nutrients stay in tact with this particular form of coral. 
We also know that the minerals in coral are found in an organic rather than elemental form.  Organic minerals are complexes which contain two or more chemical bonds with the metal (mineral) atom, resulting in higher absorption rates from the intestine and greater biological activity in the tissues.1  To compare a product loaded with organic essential and trace minerals to calcium carbonate is fallacious.

Absorption—The Big Non-Issue
Anti-coral groups have tried to focus the attention on calcium absorption from coral versus from calcium carbonate, saying coral has similar bio-availability, but is more expensive.  The only peer-reviewed, published studies available show calcium from coral has superior absorption compared to calcium carbonate.  In a small, but well controlled study, Dr. Kunihiko Ishitani reports superior absorption of calcium from coral in food compared to calcium carbonate.2  Other carefully controlled feeding studies performed at the Universities of Rukuyuku and Okinawa have shown calcium absorption from coral calcium in experimental animals was better than absorption of calcium from milk, hydroxiapatite or calcium carbonate.3  Even if calcium absorption from coral were the same as from calcium carbonate, it would still be seventy-two minerals ahead.
The key to coral calcium is its mineral balance, which assists calcium’s effectiveness.  With regard to the fight against osteoporosis, for example, Straise L., et al., showed that a group receiving calcium together with trace minerals arrested bone loss, compared to a control group which took calcium alone.4  A good body of science shows calcium is more effective when taken with other minerals so as to provide a mineral balance.  (Heaney, Becker, and Weaver, 1990; Huliz, 1990; Beal and Scofield, 1995; Harvey, 1988)
Other well-conducted, controlled studies performed at the Futaba Nutrition School at the Kagawa Nutrition University in Japan were instructive with regard to coral calcium specifically.  They showed the benefit of the multi-mineral coral calcium combined with exercise in improving bone mineral density.  This research study was presented at the 52nd Japanese Society of Nutrition and Food Science, in April 1998.
Clearly absorption of calcium is a red herring–it is like comparing a vitamin E supplement to a multi-vitamin containing the same Vitamin E and saying the multi-vitamin is overpriced.  It is really apples versus oranges…or in this case, apples versus a whole basket of assorted fruits.  We would expect the fruit basket to cost a little more than an apple! 
To summarize, yes, lead was found in one sample of coral; and, yes, Mr. Barefoot has made exaggerated claims.  Yes, coral is a form of carbonate, but closer inspection shows coral is one of the most promising organic multi-minerals available. 

Dr. Mark Percival achieved a doctorate in naturopathic medicine upon finishing his chiropractic degree. Dr. Percival pioneers the use and study of Coral Calcium and is currently the Medical Advisor to CFU for Brazilian Fresh Harvest Coral™. For more information contact 888-293-9875 or visit www.brazilcoral.com

Time to Tune Up Your Body’s Engine

Patient compliance is an issue for all doctors.   And, let’s face it, when we feel well, we often cheat on our exercise or diet plans.  After all, we are only human.  This short article provides some great ammunition to motivate us—and our patients—to follow-through with good nutritional practices. 

Recently Dr. Bruce Ames, a famous toxicologist from the University of California, at Berkeley, explained that nutrient needs vary with age and genetic constitution, and supplementation with micronutrients and metabolites, would tune up metabolism and give a marked increase in health, particularly for the poor and elderly.1  Consider that 80% of children and adolescents and 68% of adults do not eat the recommended total of five portions of fruits and vegetables per day, which I think is low anyway.  Ames points out that such habits are known to promote cancer and other degenerative diseases.  We chiropractors have warned our patients about such issues for many years, and now it is becoming a much more popular perspective to have.

How serious are such deficiencies?

Consider telling your patients the following information that was written by Ames, a leading researcher in the field.  It is now known that deficiencies in key nutrients will mimic the damage that occurs to cells when they are exposed to radiation.  That’s right; micronutrient deficiencies and radiation damage have similar affects on cells.  Ames focuses on vitamins B-12, B-6, niacin, C and E, and the minerals iron and zinc.  Evidence suggests that at least half the US population is deficient in at least one of these micronutrients.  Tell your patients to be smart and take at least a multi.  The only way you will discover if you have a subclinical deficiency is when you get cancer or some other serious degenerative disease.  Not a good thing to happen if you plan on living a long life. 

Infertility?  This may also be driven by deficiencies.  In a recent study, twenty-four subfertile men took a daily supplement that contained both 66 mg. of zinc and 5 mg. of folic acid for twenty-six weeks and experienced a 74% increase in total normal sperm count.  Consider the countless millions that could be saved if people would just take a multiple vitamin.

Need to drop a few pounds?  Ames and his group believe that micronutrient deficiencies drive obesity.  This is because energy-rich, but nutrient-poor, diets will create a state that drives us to eat more to obtain adequate nutrients.  In other words, the overweight and obese are constantly hungry, because they are deficient in key nutrients.

Aging too quickly?  Our mitochondria make free radicals when they make ATP (adenosine triphosphate) for cell energy.  Free radicals can damage tissue and cause premature aging.  What should you do?  Ames and his group have worked with lipoic acid and acetyl carnitine and found that they reduce free radicals and as I discussed in a previous issue of The American Chiropractor (Volume 25, Issue 1).2  Magnesium is also important for mitochondria function, so make sure to get enough magnesium and consider supplementing with 400-1000 mg. per day.

There is no need to place oneself at risk for cancer, heart disease, other degenerative diseases, infertility, obesity, and premature aging.  Give yourself a nutritional adjustment and drop the inflammatory grains, replacing them with fruits and vegetables.  If you want a starch, have a potato.  Also, make sure to take a multi, magnesium, perhaps calcium, fish oil, and coenzyme Q10.  These represent easy ways to prevent chronic disease from developing, and give every-body a chance to live longer and healthier lives.

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].