I was reading in the news today and read that a federal panel has a familiar prescription to reduce hypertension, something that has the potential to cause heart problems and raise health care costs in this country if untreated (http://www.latimes.com/news/nation-and-world/la-sci-hypertension23-2010feb23,0,4388789.story). They indicate the incidence of hypertension has increase by 25% in the last decade. Many packaged and restaurant foods use salt as a cheap way of adding flavor and as we rely on these types of meals, we exceed the recommended daily allowance of salt by at lease 50%. Many physicians are rushed because of our current health care systems reluctance to pay them for time spent, which has created the quick office visit and the receipt of a script for a drug that will help the kidneys lower your blood pressure artificially (thank you insurance industry for introducing this problematic paradigm - cost effective not!!!!!!!!!). Most physicians would love to spend more time with their patients and would except for the fact it would put them out of business which is why some no longer take insurance and instead charge a fair rate for their time and caring (a better paradigm IMHO).
To summerize, the panel advocates that you
1. Reduce your weight - has a positive effect on blood pressure.
2. Reduce your salt intake.
3. Eat more fruit, vegetables, lean protein.
I would add the following
1. Get evaluated by your chiropractor periodically - studies show problems in the spine will affect blood pressure and getting a periodic adjustment is helpful. Your bodies neurology is part of the equation.
2. Get regular exercise - your cardiovascular system will become more efficient.
Tuesday, February 23, 2010
Sunday, February 21, 2010
Adult Track and Field in Toms River NJ 2-21-10 - Check it out
Saturday, February 20, 2010
Avandia Diabetes Drug, another one bites the dust
The New York Times reported today that avandia (http://www.nytimes.com/2010/02/20/health/policy/20avandia.html) which has been given to those with type 2 diabetes is responsible for 500 heart attacks and 300 cases of heart failure monthly. So much for the drug paradigm under allopathic ideals being safe. Many doctors having seen the writing on the wall for this one have switched to other meds.
Meanwhile, there is a growing amount of evidence that the sweetner corn based fructose may have alot to do with obesity and many of the cases of diabetes that occur. The mayo clinic gives these recommendations (http://www.mayoclinic.com/health/type-2-diabetes/DS00585/DSECTION=treatments-and-drugs) however, their opinions are based on not the why but the management.
It is my opinion that there are larger issues at work to find out why people develop the disease and are there better ways to treat it other than medication on the horizon? I also believe that what you eat determines your health in a big way. There are alternative regimens that offer non drug alternatives to management (http://altmedicine.about.com/cs/conditionsatod/a/Diabetes.htm) which may have as much or more validity that the pharmaceutical model now accepted but is of questionable long term safety. Maybe we need to rethink what we do, what we eat and make those changes a cultural phenomenon.
I do not endorse the sites I posted here but do ask you read everything and form your own opinions.
Friday, February 19, 2010
Steroids for asthma and better alternatives through chiropractic
Today I had read in the NJ Star ledger about the problems with the current inhalers such as advair (see below)
"GlaxoSmithKline (GSK) shares are down about 1.5% after the U.S. Food and Drug Administration warned against long-term use of its asthma treatments, Advair and Serevent. Advair is the British pharmaceutical firm's best-selling product, but could now suffer a serious blow following regulators' call for further study of potential health risks. Advair had total sales of 1.366 billion euros ($1.859 billion) in the fourth quarter of 2009, of which more than half -- 704 million euros ($958 million) -- came out of the U.S.
The new label warning isn't limited to Glaxo's meds; Novartis's (NVS) Foradil and AstraZeneca's (AZN) Symbicort are affected as well. The four widely used asthma treatments belong to a class of drugs known as long-acting beta agonists (LABAs), which open airways. Other steroid-based meds control inflammation. The new label warns that LABAs "should never be used alone in the treatment of asthma in children or adults," and should be used only for the "shortest duration of time required to achieve control of asthma symptoms," then discontinued. These medicines can actually worsen asthma symptoms, the FDA said, "leading to hospitalization in both children and adults and death in some patients with asthma."
"GlaxoSmithKline (GSK) shares are down about 1.5% after the U.S. Food and Drug Administration warned against long-term use of its asthma treatments, Advair and Serevent. Advair is the British pharmaceutical firm's best-selling product, but could now suffer a serious blow following regulators' call for further study of potential health risks. Advair had total sales of 1.366 billion euros ($1.859 billion) in the fourth quarter of 2009, of which more than half -- 704 million euros ($958 million) -- came out of the U.S.
The new label warning isn't limited to Glaxo's meds; Novartis's (NVS) Foradil and AstraZeneca's (AZN) Symbicort are affected as well. The four widely used asthma treatments belong to a class of drugs known as long-acting beta agonists (LABAs), which open airways. Other steroid-based meds control inflammation. The new label warns that LABAs "should never be used alone in the treatment of asthma in children or adults," and should be used only for the "shortest duration of time required to achieve control of asthma symptoms," then discontinued. These medicines can actually worsen asthma symptoms, the FDA said, "leading to hospitalization in both children and adults and death in some patients with asthma."
One of the methods that has helped many asthma sufferers is chiropractic care. The reason I believe it is helpful is that the chiropractic adjustment normalizes the bodys neurological response and also makes rib movement improve with the adjustment. In order to properly breathe, the ribs must expand. Rib misalignments and muscular tightness from many attacks can be relieved by chiropractic intervention. The side effects are only some soreness after the adjustment which will typically dissapate quickly. Seeing a chiropractor is much safer and does not cause more attacks of asthma as these drugs do. Most medical providers should consider this as an alternative to the classic urge to recommend steroids for inhalation treatment. The other benefit is that since the musculoskeletal system is part of a system , so as this improves functionally, so do other body functions and mechanisms as well. For instance, it is not unusual for stomach problems to also improve from those same spinal treatments.
The more we hear about drugs and their side effects, the more I recommend people see a chiropractor and make this a larger part of their wellness strategy.
Tuesday, February 16, 2010
Health Care Reform, what is wrong with this picture
Health care reform was attempted by President Clinton and we know how that went. Along comes a new president who believes he has the conviction and the management style to get it done finally. I applaud him for this however there are problems that the current reforms fail to address.
1. Our current system is a monopoly with a drug biased ideology. It is based heavily on Allopathy which is very symptom based. In many areas of the world, there are many types of health care providers who feed the system, both drug and non drug based. In our country, the providers who feed the system (hospitals, specialists, etc are educated and inundated with the philosophy of drug based care supported by pharmaceutical interests. Since there is no true competition (there are provider groups like chiropractors and other complementary providers being used by the public in increasing numbers) to this system, it has become overpriced in many respects and bloated. Many of the preventative regimens are not preventative at all but are invasive and many of these ideas are pushed as part of preventative care. Unfortunately, many of these have not been proven to improve our quality of life long term, while it is of high cost and the social costs as well as the cost of treating the side effects of these interventions has been quite high. Many procedures done to resolve symptoms and many tests done to diagnose them are a result of our lack of understanding of the integrated systems that make up the body. In other words, the body dysfunctions in systems, and we are the sum of our functioning parts which is part of the whole. This differs from what health care has turned into which is overspecialization where doctors look at your parts rather than the hole. In parts of the country with fewer specialists and more primary care, the overall costs are lower and people do better under the healthcare system. Unfortunately, insurance companies have over reimbursed the specailsts and starved the primary care model causing patients to have visits that are more brief even if more time would yield better thought processes, less testing and better doctoring.
2. We need tort reform and we need better medical practices. Malpractice rates for chiropractic have always been very low based on safety and risk, however, many medical providers pay very high rates for their insurance because of lawsuits. Some of these are justified however, without limits and large pain and suffering rewards, it has pushed the rate of insurance upwards. Many doctors practice defensive medicine because they can be sued if they avoided a test or for another technicality. In many instances, it is justified, and in others, it is a product of the fact that physicians are penalized financially if they spend too much time with a patient and rewarded if they order or perform procedures. This is not only risky, but also has contributed to more doctors being sued and as we learned from the first section of the blog, it has been shown that less is more with regards to patient care. More specialists costs more but does not make them healthier which leads to further tests, etc. Some things like childbirth are risky and as long as the doctor did not violate community standards during a childbirth, they should not have to fear reprisals if they did everything right and the delivery did not. Most OB's have very expensive malpractice which has deterred many from delivering babies which sends the wrong message. In closing, we need better medical practices that are rewarded for results, not doing more and doctors should be reimbursed for their time, rather than for performing procedures that add further risk.
3. Medical Ethics. When is technology appropriate and when is it not and at what age do certain interventions have little benefit? This is a tough question because there are many babies that would not make it without an incubator and even with it may have horrible chronic problems during the rest of their lives. Other children with genetic malformations or disease processes who would otherwise not survive and kept alive but their quality of life is horrible until the inevitable end. These excesses are horribly expensive and have little benefit. Are we really helping by keeping a dying child alive further torturing the child, the family and financially draining them. This is an ethics question to be sure.
On the other end of the spectrum, when is enough care enough. At what age do cholesterol lowering drugs serve no benefit. Recently, a study suggested that men over 85 should no longer have PSA tests because many of them are positive, and the therapy or surgery caused more problems than they had before at great cost. At what point do we leave them alone? This is another ethics question.
4. Results orientated reimbursement - Now we have a more is better ethos and about 1/2 of our health care resources for a person gets used up in the last year of life with no change in the outcome. Doctors with better outcomes of all types should be rewarded. Cost effectiveness should be rewarded.
5. Paradigm Shift - We need to move from a disease and sickness model to a wellness model. We need to question the benefits of many tests that justify a drug but do not improve a patients quality of life or have a measurable improvement on ones lifespan. With all the information on cholesterol lowering drugs, the long term estimate is that these meds may improve life spans a year or two while having many side effects. Is this type of intervention worth it?
We need to get back to basics, where primary care handles many conditions cost effectively and allow other providers such as chiropractors, natropaths, napropaths, acupuncturists, nurse practitioners and others be point of first contact providers. In my own profession, we are terrific as first contact for musculoskeletal problems, weather in workers compensation or in general care of the population. Most medical providers are less comfortable with this but are more comfortable with diseases and hospital coordination. Provider Groups must work more hand in hand for better patient experiences.
6. Central data bases for health care records with less duplication and better care coordination. Having all patients medical records will allow for better coordination of care between providers of health care both local and across the country. Currently, many tests are duplicated because a provider cannot go into a national data base and pick out what they need. We are closing in on this slowly.
7. Sanity on in and out of network fees. Medicare actually started the upward spiral of medical costs by issuing a blank check in the 1970's when it was young. doctors sent in bills and Medicare paid it. Many medical/surgical fees are outrageous and are supported by the fact we have insurance. Coding for health care has become a game, manipulated by providers and by insurers which has helped health care costs march onward. Insurance carriers have made changes such as primary care doctors no longer being reimbursed for vsiting their patients in the hospital. Many have hired hospitalists who visit you for a minute, charge you handsomely and report to the doctor. Many doctor would prefer to visit their own patients but not if they do not get paid.
8. Insurance companies have blown managed care and instead of cost savings, they have squeezed consumers into more restrictive plans for their benefit, not the benefit of the patient. This yearly bait and switch has allowed insurance carriers to be very profitable and pay themselves and their investors instead of paying for care. They have become owners of parts of the market and the patients and physicians are merely pawns. We need a public option run by a non insurance entity who can help explore an evidence based paradigm for better care in the future. We also should have this paid for by a VAT (value added tax) so it is properly funded rather than our current recommendations which make us partners with the people who created the problem in the first place. It also makes it so if you lose your job, you still have insurance. Doctors should be paid fairly for their services, and their patients should be charged fairly for what is done in their best interest. This is different from the free for all money care we have now. It is also simpler to have one insurance with one set of rules rather than a medicaid (paid for partially by the states with low reimbursement), medicare (for seniors over 65 mostly, and has better reimbursement for most primary care and point of contact physicians ) and the regular insurance which is all over the place but generally pays poorly in network and way too handsomely out of network. How about one carrier, properly funded that works toward a model of preventative care that helps the puiblic.
These are some of my questions and thoughts. I know the problem is more complex but our paradigm is broken and is making people broke. If it does not get fixed (the current proposals do little to fix the paradigm but does address some of the problems of coverage and affordability), the costs will continue to balloon and we will all find ourselves paying cash for care. This will force the current model into a tailspin and many doctors will likely leave the profession if they cannot earn a living. If the current model does collapse, it could mean true reform of the painful kind. Hopefully, our government can come together after tuning out some of the noise and put together a better system for all of us. Health care dollars should go toward healthcare, not corporations and americans should not be drug addicts without realizing they are. Perhaps, we will find a better way.
1. Our current system is a monopoly with a drug biased ideology. It is based heavily on Allopathy which is very symptom based. In many areas of the world, there are many types of health care providers who feed the system, both drug and non drug based. In our country, the providers who feed the system (hospitals, specialists, etc are educated and inundated with the philosophy of drug based care supported by pharmaceutical interests. Since there is no true competition (there are provider groups like chiropractors and other complementary providers being used by the public in increasing numbers) to this system, it has become overpriced in many respects and bloated. Many of the preventative regimens are not preventative at all but are invasive and many of these ideas are pushed as part of preventative care. Unfortunately, many of these have not been proven to improve our quality of life long term, while it is of high cost and the social costs as well as the cost of treating the side effects of these interventions has been quite high. Many procedures done to resolve symptoms and many tests done to diagnose them are a result of our lack of understanding of the integrated systems that make up the body. In other words, the body dysfunctions in systems, and we are the sum of our functioning parts which is part of the whole. This differs from what health care has turned into which is overspecialization where doctors look at your parts rather than the hole. In parts of the country with fewer specialists and more primary care, the overall costs are lower and people do better under the healthcare system. Unfortunately, insurance companies have over reimbursed the specailsts and starved the primary care model causing patients to have visits that are more brief even if more time would yield better thought processes, less testing and better doctoring.
2. We need tort reform and we need better medical practices. Malpractice rates for chiropractic have always been very low based on safety and risk, however, many medical providers pay very high rates for their insurance because of lawsuits. Some of these are justified however, without limits and large pain and suffering rewards, it has pushed the rate of insurance upwards. Many doctors practice defensive medicine because they can be sued if they avoided a test or for another technicality. In many instances, it is justified, and in others, it is a product of the fact that physicians are penalized financially if they spend too much time with a patient and rewarded if they order or perform procedures. This is not only risky, but also has contributed to more doctors being sued and as we learned from the first section of the blog, it has been shown that less is more with regards to patient care. More specialists costs more but does not make them healthier which leads to further tests, etc. Some things like childbirth are risky and as long as the doctor did not violate community standards during a childbirth, they should not have to fear reprisals if they did everything right and the delivery did not. Most OB's have very expensive malpractice which has deterred many from delivering babies which sends the wrong message. In closing, we need better medical practices that are rewarded for results, not doing more and doctors should be reimbursed for their time, rather than for performing procedures that add further risk.
3. Medical Ethics. When is technology appropriate and when is it not and at what age do certain interventions have little benefit? This is a tough question because there are many babies that would not make it without an incubator and even with it may have horrible chronic problems during the rest of their lives. Other children with genetic malformations or disease processes who would otherwise not survive and kept alive but their quality of life is horrible until the inevitable end. These excesses are horribly expensive and have little benefit. Are we really helping by keeping a dying child alive further torturing the child, the family and financially draining them. This is an ethics question to be sure.
On the other end of the spectrum, when is enough care enough. At what age do cholesterol lowering drugs serve no benefit. Recently, a study suggested that men over 85 should no longer have PSA tests because many of them are positive, and the therapy or surgery caused more problems than they had before at great cost. At what point do we leave them alone? This is another ethics question.
4. Results orientated reimbursement - Now we have a more is better ethos and about 1/2 of our health care resources for a person gets used up in the last year of life with no change in the outcome. Doctors with better outcomes of all types should be rewarded. Cost effectiveness should be rewarded.
5. Paradigm Shift - We need to move from a disease and sickness model to a wellness model. We need to question the benefits of many tests that justify a drug but do not improve a patients quality of life or have a measurable improvement on ones lifespan. With all the information on cholesterol lowering drugs, the long term estimate is that these meds may improve life spans a year or two while having many side effects. Is this type of intervention worth it?
We need to get back to basics, where primary care handles many conditions cost effectively and allow other providers such as chiropractors, natropaths, napropaths, acupuncturists, nurse practitioners and others be point of first contact providers. In my own profession, we are terrific as first contact for musculoskeletal problems, weather in workers compensation or in general care of the population. Most medical providers are less comfortable with this but are more comfortable with diseases and hospital coordination. Provider Groups must work more hand in hand for better patient experiences.
6. Central data bases for health care records with less duplication and better care coordination. Having all patients medical records will allow for better coordination of care between providers of health care both local and across the country. Currently, many tests are duplicated because a provider cannot go into a national data base and pick out what they need. We are closing in on this slowly.
7. Sanity on in and out of network fees. Medicare actually started the upward spiral of medical costs by issuing a blank check in the 1970's when it was young. doctors sent in bills and Medicare paid it. Many medical/surgical fees are outrageous and are supported by the fact we have insurance. Coding for health care has become a game, manipulated by providers and by insurers which has helped health care costs march onward. Insurance carriers have made changes such as primary care doctors no longer being reimbursed for vsiting their patients in the hospital. Many have hired hospitalists who visit you for a minute, charge you handsomely and report to the doctor. Many doctor would prefer to visit their own patients but not if they do not get paid.
8. Insurance companies have blown managed care and instead of cost savings, they have squeezed consumers into more restrictive plans for their benefit, not the benefit of the patient. This yearly bait and switch has allowed insurance carriers to be very profitable and pay themselves and their investors instead of paying for care. They have become owners of parts of the market and the patients and physicians are merely pawns. We need a public option run by a non insurance entity who can help explore an evidence based paradigm for better care in the future. We also should have this paid for by a VAT (value added tax) so it is properly funded rather than our current recommendations which make us partners with the people who created the problem in the first place. It also makes it so if you lose your job, you still have insurance. Doctors should be paid fairly for their services, and their patients should be charged fairly for what is done in their best interest. This is different from the free for all money care we have now. It is also simpler to have one insurance with one set of rules rather than a medicaid (paid for partially by the states with low reimbursement), medicare (for seniors over 65 mostly, and has better reimbursement for most primary care and point of contact physicians ) and the regular insurance which is all over the place but generally pays poorly in network and way too handsomely out of network. How about one carrier, properly funded that works toward a model of preventative care that helps the puiblic.
These are some of my questions and thoughts. I know the problem is more complex but our paradigm is broken and is making people broke. If it does not get fixed (the current proposals do little to fix the paradigm but does address some of the problems of coverage and affordability), the costs will continue to balloon and we will all find ourselves paying cash for care. This will force the current model into a tailspin and many doctors will likely leave the profession if they cannot earn a living. If the current model does collapse, it could mean true reform of the painful kind. Hopefully, our government can come together after tuning out some of the noise and put together a better system for all of us. Health care dollars should go toward healthcare, not corporations and americans should not be drug addicts without realizing they are. Perhaps, we will find a better way.
Tuesday, February 09, 2010
Snow and how to move it safely.
1. Use a fencers stance when pushing or lifting snow. It will help you protect your lower back.
2. If the temperature is in the low 20's the snow will be powder like and light. If the temperature is closer to 30, the snow flakes will be larger, wetter and heavier. Push and lift accordingly.
3. Snow that has been pushed against your driveway by the plow is always heavier. Dig , push and lift with caution.
4. If you are getting out of breath and are older, take frequent breaks. People suffer heart attacks moving snow and you do not want to be a statistic.
5. If you are sore and it is getting worse after shoveling, call us.
Sunday, February 07, 2010
The Ultimate Cold Fighting Regimen
There are many people who have colds, and I am one of them. You can however, get more control over how you feel and how long these symptoms persist with my simple plan that I have outlined below. Most people who have colds can benefit from this regimen.
1. Echinacea (helps fight cold viruses as the body is being attacked)
2. Amino Lysine 400 IU
3. 5000 mg vitamin c powder - one level tsp taken with orange juice
Take this as follows
At the onset of symptoms, take a tablet of Echinacea per ever two hours for 3-4 doses total. Echinacea is only effective at the onset. If you are well into the symptoms, don't barther.
Vitamin C powder - take ever two hours. If you begin to get diahrea or feel gassy, stop taking it. This means you have saturated your body. Vitamin C powder acidifies your system and gives it a fighting chance. Typically, colds make your body basic. If you are on medications that are altering your body chemistry, check with your pharmacist first. You can then take doses of this periodically as the symptoms begin to abate.
Amino Lysine is anti viral and can be taken with the vitamin C powder.
This regimen will shorten colds, get you feeling better faster. If you have a really nasty virus, you may find that it takes many doses of vitamin C to get to the point of diahrea or gassiness. If it is mild, you may reach this with one or two doses.
1. Echinacea (helps fight cold viruses as the body is being attacked)
2. Amino Lysine 400 IU
3. 5000 mg vitamin c powder - one level tsp taken with orange juice
Take this as follows
At the onset of symptoms, take a tablet of Echinacea per ever two hours for 3-4 doses total. Echinacea is only effective at the onset. If you are well into the symptoms, don't barther.
Vitamin C powder - take ever two hours. If you begin to get diahrea or feel gassy, stop taking it. This means you have saturated your body. Vitamin C powder acidifies your system and gives it a fighting chance. Typically, colds make your body basic. If you are on medications that are altering your body chemistry, check with your pharmacist first. You can then take doses of this periodically as the symptoms begin to abate.
Amino Lysine is anti viral and can be taken with the vitamin C powder.
This regimen will shorten colds, get you feeling better faster. If you have a really nasty virus, you may find that it takes many doses of vitamin C to get to the point of diahrea or gassiness. If it is mild, you may reach this with one or two doses.
Wednesday, February 03, 2010
Jerry Rice and Chiropractic - A Top NFL Receiver Credits Much of His Success to Chiropractic Care
Former NFL wide-receiver Jerry Rice says, ""If I had everything in alignment, I knew I could play my best football." His training routine included twice-weekly chiropractic adjustments, which helped his body recover from all the hard hits and countless tackles. Because he firmly believed in the benefits of chiropractic, his teammates began to favor this natural care over the medications that trainers traditionally give. "I wanted to set the standard within football," said Rice. "I knew if chiropractic helped me put up outstanding numbers, it could help my teammates do the same."
Read more at: http://www.chiroeco.com/chiropractic/news/8892/52/jerry-rice-reveals-secrets-to-long-healthy-career-/
Read more at: http://www.chiroeco.com/chiropractic/news/8892/52/jerry-rice-reveals-secrets-to-long-healthy-career-/
Sunday, January 31, 2010
Track and Field event today in Lakewood NJ
Today I attended a track and field event in Lakewood NJ. As many of you know, I am the medical director for USATF NJ and I am responsible for chiropractic coverage for their sponsored events. This event today featured athletes 18 and under. I was mentoring a chiropractor from southern NJ, Fred Mayer DC who had never attended one of these events before. Together, we saw a number of competitors who needed help and he learned about the different types of events and what to look for when runners are having problems. I will be attending additional events toward the end of February, 2010
Thursday, January 28, 2010
Patients in Medicare Demonstration Project Give Chiropractors High Marks
For those who are in Medicare or are about to be enrolled, this is a great thing. The history of chiropractic inclusion in Medicare is that the limited benefit was negotiated in the 1970's before chiropractic had the widespread acceptance it has now as the top complementary health care profession in the country, if not the world. It is safe, effective and cost effective and studies support these statements. Unfortunately, in Medicare, chiropractic is only covered for manipulation and nothing else. Seniors are required to pay for their own evaluations, x rays and therapies done even though these procedures are paid for when they visit other providers. Many seniors value chiropractic as the best way to limit their exposure to harmful medications and stay out of pain and active.
Two years ago, after much chiropractic lobbying, Medicare was forced to create a chiropractic demonstration project in a few markets. The purpose of this was to see if chiropractic would add to the cost, lower the cost or be budget neutral. The good news is that chiropractic in most areas was chosen instead of other interventions without higher costs and the better news was the level of satisfaction most seniors reported.
What this all means - The American Chiropractic Assn. now has an opportunity to change the Medicare problem forever which means if you are enrolled in Medicare, you will be covered for everything just as you are when you visit other doctors and it will end the discrimination against chiropractic patients under Medicare. This is in the public's best interests and they should have the right to choose chiropractic as their intervention for their health care issues.
If you have seen the nonsense that went on as health care debated, you should realize that full inclusion for chiropractic is an uphill battle. Last night pres Obama scolded congress for not doing their job and he is right. They are not there to get elected. They are there to pass laws to help you and I. Hopefully, chiropractic will be finally fully covered.
Here is the ACA press release for your reading
Two years ago, after much chiropractic lobbying, Medicare was forced to create a chiropractic demonstration project in a few markets. The purpose of this was to see if chiropractic would add to the cost, lower the cost or be budget neutral. The good news is that chiropractic in most areas was chosen instead of other interventions without higher costs and the better news was the level of satisfaction most seniors reported.
What this all means - The American Chiropractic Assn. now has an opportunity to change the Medicare problem forever which means if you are enrolled in Medicare, you will be covered for everything just as you are when you visit other doctors and it will end the discrimination against chiropractic patients under Medicare. This is in the public's best interests and they should have the right to choose chiropractic as their intervention for their health care issues.
If you have seen the nonsense that went on as health care debated, you should realize that full inclusion for chiropractic is an uphill battle. Last night pres Obama scolded congress for not doing their job and he is right. They are not there to get elected. They are there to pass laws to help you and I. Hopefully, chiropractic will be finally fully covered.
Here is the ACA press release for your reading
Patients in Medicare Demonstration Project Give Chiropractors High Marks
According to long-awaited results from a congressionally mandated pilot project testing the feasibility of expanding chiropractic services in the Medicare program, patients have a high rate of satisfaction with the care they receive from doctors of chiropractic.
When asked to rate their satisfaction on a 10-point scale, 87 percent of patients in the study gave their doctor of chiropractic a level of 8 or higher. What’s more, 56 percent of those patients rated their chiropractor with a perfect 10.
Contributing to that satisfaction was the attention given to patients’ needs and the accessibility of chiropractic care. Patients reported that doctors of chiropractic listened to them carefully and spent sufficient time with them. Some 95 percent said they had to wait no longer than one week for appointments.
“Doctors of chiropractic everywhere should feel pride in these patient satisfaction results and in being part of a profession that still sees the great need for spending time with patients and truly listening to them,” said Dr. Rick McMichael, president of the American Chiropractic Association (ACA). “It’s clear that patients deeply value the time their chiropractic providers spend with them and the expert care that DCs offer.”
The pilot, known as a “demonstration project” in Congress, was conducted from April 2005 to March 2007 throughout the states of Maine and New Mexico, and also in Scott County, Iowa, 26 counties comprising the Chicago metropolitan area, and 17 counties in central Virginia.
Current chiropractic coverage under Medicare is limited to spinal manipulation. Under the demonstration project, however, chiropractic care was expanded to include diagnostic and other services, such as X-rays, examinations, physical therapy and rehabilitation services.
The final report to Congress also includes information on the costs of expanding chiropractic services in the demonstration sites. The report indicates that in all but one of the demonstration sites, patients’ health care costs were not significantly changed by expanding coverage of chiropractic services. In contrast, a cost increase was found in the Chicago metropolitan area. Further research into the reasons why the results in Chicago differ from the rest of the demonstration project sites is needed to better understand these findings.
“We already know that Medicare costs in general tend to be higher in Chicago than other similar areas of the country. We must find the underlying cause of the cost difference found in the chiropractic demonstration project and determine whether it had anything at all to do with the expansion of chiropractic services,” Dr. McMichael noted.
According to long-awaited results from a congressionally mandated pilot project testing the feasibility of expanding chiropractic services in the Medicare program, patients have a high rate of satisfaction with the care they receive from doctors of chiropractic.
When asked to rate their satisfaction on a 10-point scale, 87 percent of patients in the study gave their doctor of chiropractic a level of 8 or higher. What’s more, 56 percent of those patients rated their chiropractor with a perfect 10.
Contributing to that satisfaction was the attention given to patients’ needs and the accessibility of chiropractic care. Patients reported that doctors of chiropractic listened to them carefully and spent sufficient time with them. Some 95 percent said they had to wait no longer than one week for appointments.
“Doctors of chiropractic everywhere should feel pride in these patient satisfaction results and in being part of a profession that still sees the great need for spending time with patients and truly listening to them,” said Dr. Rick McMichael, president of the American Chiropractic Association (ACA). “It’s clear that patients deeply value the time their chiropractic providers spend with them and the expert care that DCs offer.”
The pilot, known as a “demonstration project” in Congress, was conducted from April 2005 to March 2007 throughout the states of Maine and New Mexico, and also in Scott County, Iowa, 26 counties comprising the Chicago metropolitan area, and 17 counties in central Virginia.
Current chiropractic coverage under Medicare is limited to spinal manipulation. Under the demonstration project, however, chiropractic care was expanded to include diagnostic and other services, such as X-rays, examinations, physical therapy and rehabilitation services.
The final report to Congress also includes information on the costs of expanding chiropractic services in the demonstration sites. The report indicates that in all but one of the demonstration sites, patients’ health care costs were not significantly changed by expanding coverage of chiropractic services. In contrast, a cost increase was found in the Chicago metropolitan area. Further research into the reasons why the results in Chicago differ from the rest of the demonstration project sites is needed to better understand these findings.
“We already know that Medicare costs in general tend to be higher in Chicago than other similar areas of the country. We must find the underlying cause of the cost difference found in the chiropractic demonstration project and determine whether it had anything at all to do with the expansion of chiropractic services,” Dr. McMichael noted.
To further analyze the results of the demonstration project, ACA is creating a taskforce of Medicare experts and researchers who will review the report and develop a response for the
Centers of Medicare and Medicaid Services.
To view the report online, visit www.acatoday.org/pdf/demo_report.pdf.
To view the report online, visit www.acatoday.org/pdf/demo_report.pdf.
Monday, January 18, 2010
Signing of the Chiropractic Practice Act for New Jersey
I just received word that we should have our scope of practice signed into law by Gov Corzine today. It has been a long road to get to this point. Stay tuned for more stuff.
Saturday, January 16, 2010
Chiropractor in NJ have a new scope of practice finally
Five years in the making to get our legislature to approve a new chiropractic scope of practice bill. We had many people who did not want this to happen, even though our previous scope has not been changed since 1953 and was antiquated and one of the worst in the nation. With the new scope of practice (parameters under which I can function as a chiropractor), I can now fully council patients on nutrition (before I had my hands tied), perform extremity work without relating it to the spine (I was fined years ago for those semantics) and practice the way most chiropractors are taught to in school. The bill also has continuing education requirements that were not required previously, although I had to get continuing ed for my sports certification. This one requirement is necessary to protect the public and to improve the chiropractor. Check out this press release:
Bill expands what New Jersey's chiropractors can do
Bill expands what New Jersey's chiropractors can do
Chiropractors in New Jersey are going beyond the back.
Thanks to a measure that passed in both the state Senate and Assembly on Monday, state-licensed chiropractors would be able to treat extremities, prescribe medical tests and give nutritional advice as well as sell nutritional supplements in their offices.
The bill brings New Jersey in line with many other states that have similar regulations.
For example, under New Jersey’s current standards, a chiropractor can treat problems in the extremities such as hands and feet only if they directly relate to problems in the spine, according to Dr. James P. Farrell, a chiropractic physician at Farrell Chiropractic and Rehabilitation in Cape May Court House.
“If someone came into my office with carpal tunnel syndrome, I would have to relate it to the spine or I couldn’t treat it,” Farrell said.
Farrell explained that patients such as athletes, who might need immediate treatment, would be in a difficult position if the injury they sustained wasn’t along the spine.
“There’s only so much time in the day to be writing notes to the insurance companies,” Farrell said.
Farrell said today’s chiropractors are trained to treat beyond the spine, and that includes giving nutrition advice to their patients.
“It brings us into the 21st century,” said Dr. Robert Olivieri, a chiropractic orthopedist at Olivieri Chiropractic and Rehabilitation Center in Rio Grande.
Olivieri said chiropractors are trained to consult patients about nutrition — for example, skeletal pain might not be the result of an injury; it could be related to a vitamin D deficiency, which can lead to bone problems such as rickets and osteomalacia.
Under the new legislation, chiropractors still would not be able to write prescriptions for medications, but they would be able to recommend them.
“Your body’s not lacking Lipitor,” Olivieri said. “But it might be lacking in vitamin D.”
Some opponents of the legislation argued that since chiropractors could sell nutritional supplements in their offices, it could create a conflict of interest.
“We prohibit physicians from selling prescription drugs because if they sell they have a profit motive,” said Assemblyman Sam Thompson, R-Monmouth. “The same would apply to chiropractors.”
Local chiropractors disagree with that argument.
“We sell pillows and other supplies in our practice, and no one has said anything against that,” Farrell said.
Another argument some legislators presented against the bill was one concerning a chiropractor’s ability to perform pre-employment screenings, since they could apply to conditions related to the brain or heart and not to injuries or the spine.
Farrell said that chiropractors are more qualified to give the screenings than nurse practitioners who are currently allowed to give the same pre-employment screenings in the state.
While the bill expands the definition of a chiropractor’s duties in New Jersey, it also requires chiropractors to participate in continuing education programs.
Chiropractors have to complete 30 additional credits of annual training, while those who want to give out nutritional advice must participate in 45 hours in a nutritional study program.
The Assembly passed the bill 64-4 with eight people declining to vote. The Senate voted 23-11. Gov. Jon S. Corzine has to sign the bill for it to become law.
2009 was a tough year for many people. It looks like things in NJ are about to improve markedly for chiropractors and the patients they treat
Horizon Blue Cross Blue Shield must pay for all chiropractic services
For many years, Horizon Blue Cross Blue Shield has not paid for chiropractic evaluations on their patients and the other services practically all insurance carriers provide. A few years ago, they also reduced chiropractic reimbursements by over 30 percent as well making chiropractors suffer financially. Many, like myself would basically eat the cost of evaluations and the time we spent because of our ethos (chiropractors are all about the patients they serve). A couple of years ago, we had no choice but to charge our patients for their examinations since their policies, combined with other carriers may have made being a practicing chiropractor financially impossible.
On October 7th, 2009, an administrative action we had taken a number of years ago had finally found by the Department of Banking and Insurance ( DOBI) that they had indeed abused their stature and that they must now cover all services performed by chiropractors.
On 1/15/10, all chiropractors will receive the following letter
Horizon Letter:
January 15, 2010
Dear Chiropractor:
Pursuant to the New Jersey Department of Banking and Insurance (DOBI) Decision and
Order pertaining to Order Number A09-113, Horizon Blue Cross Blue Shield of New Jersey
is revising our policy regarding the consideration of Evaluation and Management (E&M)
services and physical therapy modalities for reimbursement separate from the reimbursement
of Chiropractic Manipulative Therapy (CMT) codes.
Horizon BCBSNJ is in the process of implementing Order Number A09-113, which requires
that we evaluate whether E&M and/or physical therapy modality services billed by you are
separately compensable from the CMT and other services billed by you.
Horizon BCBSNJ will engage the services of an external vendor to help us implement this
Order. We will advise you of further details regarding this vendor in the next 30 days.
Our goal is to implement this Order with the least amount of administrative burden and/or
inconvenience to your office and to our members.
Please be advised that any claims that have been processed for dates of service on or after
October 7, 2009 that are not in compliance with this Order, as well as any appeals that have
been received by Horizon BCBSNJ relating to dates of service on or after October 7, 2009,
will be evaluated for consideration within the next 90 days. Any additional reimbursement
amounts will be paid with interest, in accordance with New Jersey Law, based upon the
receipt date of the original claim.
The evaluation of E&M services and physical therapy modalities may require the submission
of portions of your patients’ medical records to support the appropriateness of the services
being billed.
Further communications outlining the details will be forthcoming.
Sincerely,
James F. Albano - Vice President
Healthcare Services
Of course, there was no apology since they clearly knew what they did over the years was wrong. In the end, justice was served for the chiropractic profession and the patients they treat. Perhaps now, I can afford to replace my worn carpeting and touch up the trim in my office.
Dr. C
Sunday, August 12, 2007
Effectiveness and empowering the public
I am often frustrated by most people and the problems they face with their back, neck shoulders, knees and other parts of their body that appear to be breaking down as they age. Part of the problem is that our healthcare system has become so specialized, that nobody looks at the person. For example, if you have knee pain, your primary doctor will likely either give you medication or send you to either a therapist or an orthopedic doctor. For some reason, the rarely consider the chiropractor. The person they refer to treats the supposedly injured part and the results are often mixed, leading to more medications or sometimes high tech tests or surgery. On another occasion, this same person, may have a lower back episode. This is likely treated with more pills and if they dont relieve the pain, the patient is referred to either a therapist, orthopedist and sometimes is lucky enough to be given a chiropractic referral. On another occasion, this same person develops shoulder pain. The same thing ensues and they either get pills, therapy, a shot and rarely a chiropractor. During these episodes, the patient sometimes will get relief and that relief may often be short lived.
There is a common thread that runs through all of this. Problems with someones gait (the way they walk which is by the way inherited) will predispose the patient to all of the above types of problems. If we just look at the area of pain, are we missing what is really wrong with the person.
This is where our practice is different. We look at people, then get a list of their symptoms and then try to make sense of what we are seeing. This then leads to more appropriate and effective therapy. Most gait issues are caused by body assymetries that create strain on one side of the body causing chronically painful conditions. The medical literature if you look deep enough actually shows this to be the case.
My point is that as physicians, we are trained in the medical symptom model, not the mechanical function/malfunction model. I often tell people I work in a different paradigm than many of my collegues. The great thing is I help solve many difficult chronic long term pain cases, many that were called myofascial pain syndrome of fibromyalgia.
Our office gets predictable results with neck pain, shoulder problems, knee, hip and back pain for most patients unless there is a more severe problem that requires advanced diagnostics. The good news is that most people do not require advanced diagnostics and we save the system tons of money by avoiding unnecessary tests, MRI's and instead, use that insurance money toward getting the patient better.
I am currently writing a consumer level book discussing our model, why many conditions can get better with the right thought process and debunking myths of many conditions patients often tolerate off and on all their lives and never get resolved. I hope to have the book completed early next year and will be looking for a publisher who wants to have a book of the general public that helps them understand why people are in pain and how to find someone who really understands how to get them out of pain without drugs or surgery.
Stay tuned...
There is a common thread that runs through all of this. Problems with someones gait (the way they walk which is by the way inherited) will predispose the patient to all of the above types of problems. If we just look at the area of pain, are we missing what is really wrong with the person.
This is where our practice is different. We look at people, then get a list of their symptoms and then try to make sense of what we are seeing. This then leads to more appropriate and effective therapy. Most gait issues are caused by body assymetries that create strain on one side of the body causing chronically painful conditions. The medical literature if you look deep enough actually shows this to be the case.
My point is that as physicians, we are trained in the medical symptom model, not the mechanical function/malfunction model. I often tell people I work in a different paradigm than many of my collegues. The great thing is I help solve many difficult chronic long term pain cases, many that were called myofascial pain syndrome of fibromyalgia.
Our office gets predictable results with neck pain, shoulder problems, knee, hip and back pain for most patients unless there is a more severe problem that requires advanced diagnostics. The good news is that most people do not require advanced diagnostics and we save the system tons of money by avoiding unnecessary tests, MRI's and instead, use that insurance money toward getting the patient better.
I am currently writing a consumer level book discussing our model, why many conditions can get better with the right thought process and debunking myths of many conditions patients often tolerate off and on all their lives and never get resolved. I hope to have the book completed early next year and will be looking for a publisher who wants to have a book of the general public that helps them understand why people are in pain and how to find someone who really understands how to get them out of pain without drugs or surgery.
Stay tuned...
Friday, June 22, 2007
Self, the stroke threat and other groundless magazine articles
It has been upsetting to me lately to read some of the sensational scare tactic articles that are hitting the news stands. One that came to mind was an article in Self Magazine. The article brought up the issue of the chiropractic adjustment to the neck and the threat of stroke.
That scare unfortunately has hurt many who would have benefitted from chiropractic care and stayed away because of this concern. Reality check...
Chiropractors have among the lowest malpractice rates in the country. Ours is about $1300 annually. Since this is based on risk, and since our rates are about 90 percent less than your family practice doctor pays, one can only assume that what we do in our offices is quite safe.
The article below that you can download talks about the true risks. The truth is that having a stroke at the hands of your chiropractor is a chance of less than 1 in one million adjustments. Considering many patients neck problems are actually in their mid back and lower back regions, especially in our office, we do not manipulate the neck unless absolutely necessary. We take all precautions and prescreen patients for any possible problems. When compared to tylenol which can have serious consequences in as few as 1 in 7500 people taking the drug, chiropractic is a no brainer.
http://www.acatoday.org/membersonly/ChiroRisks_Lauretti_06.pdf
Don't be put off by the scare tactics and sensational headlines that others seek. When compared to medical methods, chiropractic has proven itself over and over to be safe and effective and our patients know we deliver the goods in the absense of drugs and surgery.
I find it funny that athletes cannot get enough of us. Recently, the Mets hired a team chiropractor. I guess it is still up to our patients judgement as to whom they will use for the care of their frame and musculoskeletal system.
Our patients know we are effective and we have research to back it up. For many of us though, our bodies are our own labs. While chiropractic care may not fix all problems over night, our patients not only get relief but are in overall better health with a true sense of wellbeing, not a drug induced facsimile.
That scare unfortunately has hurt many who would have benefitted from chiropractic care and stayed away because of this concern. Reality check...
Chiropractors have among the lowest malpractice rates in the country. Ours is about $1300 annually. Since this is based on risk, and since our rates are about 90 percent less than your family practice doctor pays, one can only assume that what we do in our offices is quite safe.
The article below that you can download talks about the true risks. The truth is that having a stroke at the hands of your chiropractor is a chance of less than 1 in one million adjustments. Considering many patients neck problems are actually in their mid back and lower back regions, especially in our office, we do not manipulate the neck unless absolutely necessary. We take all precautions and prescreen patients for any possible problems. When compared to tylenol which can have serious consequences in as few as 1 in 7500 people taking the drug, chiropractic is a no brainer.
http://www.acatoday.org/membersonly/ChiroRisks_Lauretti_06.pdf
Don't be put off by the scare tactics and sensational headlines that others seek. When compared to medical methods, chiropractic has proven itself over and over to be safe and effective and our patients know we deliver the goods in the absense of drugs and surgery.
I find it funny that athletes cannot get enough of us. Recently, the Mets hired a team chiropractor. I guess it is still up to our patients judgement as to whom they will use for the care of their frame and musculoskeletal system.
Our patients know we are effective and we have research to back it up. For many of us though, our bodies are our own labs. While chiropractic care may not fix all problems over night, our patients not only get relief but are in overall better health with a true sense of wellbeing, not a drug induced facsimile.
Hurting our patients and our profession by Judicial means
Many of our patients are appalled that our right to adjust extremities (arms, legs, wrists, elbows, fingers and other such articulations that relate to movement) had been taken away by an appellate court decision. It has hurt all chiropractors and their patients, especially since they are the only ones really qualified universally in NJ to perform these services. Although a chiropractor may still work on these areas, actual adjustments to these joints to reestablish normal movement and free patients of pain has been a mainstay of chiropractic practice for decades.
Our scope of practice had been interpreted by our state chiropractic regulatory board to include the practice which is used across the country, allowing chiropractors a unique solution to many joint problems.
This decision was made during a malpractice case that was won by the chiropractor in question. The attorneys on the other side queried the appellate court as to weather we as a profession can adjust extremities. Of course, they were shown only what the attorneys wanted them to see causing a bad judgement which took away our interpreted practice law since 1991. They over rode our own chiropractic board. Unfortunately, we all fall victims since this was all about legal strategies and trying to win a lost case.
The profession is attempting to overturn this poor decision but also is trying to use the opportunity to also put forth a new scope of practice, which will update NJ's which is from 1954 and it quite restrictive, when compared to other states.
Unfortunately, our attempts to get this passed yesterday, 6/22/07 failed in the hands of the senate. We will again attempt this in September and hopefully, not only will we prevail for the sake of the profession and our patients, but will emerge with a modern practice act which allows us to perform what we learned in school including nutrition.
I will keep you posted
Dr C
Our scope of practice had been interpreted by our state chiropractic regulatory board to include the practice which is used across the country, allowing chiropractors a unique solution to many joint problems.
This decision was made during a malpractice case that was won by the chiropractor in question. The attorneys on the other side queried the appellate court as to weather we as a profession can adjust extremities. Of course, they were shown only what the attorneys wanted them to see causing a bad judgement which took away our interpreted practice law since 1991. They over rode our own chiropractic board. Unfortunately, we all fall victims since this was all about legal strategies and trying to win a lost case.
The profession is attempting to overturn this poor decision but also is trying to use the opportunity to also put forth a new scope of practice, which will update NJ's which is from 1954 and it quite restrictive, when compared to other states.
Unfortunately, our attempts to get this passed yesterday, 6/22/07 failed in the hands of the senate. We will again attempt this in September and hopefully, not only will we prevail for the sake of the profession and our patients, but will emerge with a modern practice act which allows us to perform what we learned in school including nutrition.
I will keep you posted
Dr C
Monday, January 29, 2007
Thoughts for the New Year 2007
Well, it is almost the end of January. This was a strange winter. Not too cold so far, and some unseasonably warm weather. Because of increased demand, we have added Tuesday mornings to our Scotch Plains schedule.
A big concern of mine this year is the way insurance companies have abused our patients and are not giving us what we have paid for. Most of us have been continually subjected to higher co payments which is blurring the line between weather to go in or out of network. The truth is, out of network doctors are out of network because the insurance companies are paying them less and less, while charging us more and more. In our case, we are no longer in United Healthcare. There were a number of reasons this happened, but we are finding out that with the higher co payments, the paperwork our patients were required to fill out and the nasty things they were doing to us, and to our patients and to the relationships we have with those patients, out of network was better for everyone. The benefits are as follows: The paperwork has gone away. That is correct, no precert forms anymore. With the loss of participation will be the loss of wondering if they misinformed us about precert, as they did last year and then withheld our reimbursements. Although we in good faith tried to straighten it out and get paid after providing proof, this was ignored and more United Healthcare excuses were given. It turns out many medical doctors felt the same way and more are opting out daily.
Many people have been brainwashed to believe that out of network is unaffordable. The reality is that although some doctors price themselves that way, most of us are priced reasonably and have ways for patients to comfortably afford care. Sure, you may not have the 40 dollar co pay which is becoming more common, but for $55, you can get the care you need, without the referral, the hassle, the angst and everyone is happier.
We have tried to stay in network with most plans, for the benefit of our patients. Most doctors would like to. Today, I met with a medical doctor I am friendly with who just terminated Horizon Blue Cross after many years because they continue to pay him less and less, while his overhead continues to escalate. He was quite upset by this especially when he contacted the representative to question her about their policy and the answer was simple, here is how you can resign from the plan. Here is a well respected physician who is caught between whether to do an appropriate EKG on a patient that he is not being paid for anymore. He told me the allergist friend of his has to fight with a clerk to give a non generic medication.
Out of network does not look so bad after his stories. As a doctor, I am torn between great care, a lousy health plan, can I afford to stay in network and trying to stay in network so more people can access us more easily.
What would you do if you were me? For those that know me, I always go the extra mile for my patients. I will do whatever it takes to help them resolve a problem. As a patient, you need to begin to demand your plan becomes accountable and your doctor needs to be treated with respect, and paid at a level that allows him to feed his family as well. Just my thoughts...
A big concern of mine this year is the way insurance companies have abused our patients and are not giving us what we have paid for. Most of us have been continually subjected to higher co payments which is blurring the line between weather to go in or out of network. The truth is, out of network doctors are out of network because the insurance companies are paying them less and less, while charging us more and more. In our case, we are no longer in United Healthcare. There were a number of reasons this happened, but we are finding out that with the higher co payments, the paperwork our patients were required to fill out and the nasty things they were doing to us, and to our patients and to the relationships we have with those patients, out of network was better for everyone. The benefits are as follows: The paperwork has gone away. That is correct, no precert forms anymore. With the loss of participation will be the loss of wondering if they misinformed us about precert, as they did last year and then withheld our reimbursements. Although we in good faith tried to straighten it out and get paid after providing proof, this was ignored and more United Healthcare excuses were given. It turns out many medical doctors felt the same way and more are opting out daily.
Many people have been brainwashed to believe that out of network is unaffordable. The reality is that although some doctors price themselves that way, most of us are priced reasonably and have ways for patients to comfortably afford care. Sure, you may not have the 40 dollar co pay which is becoming more common, but for $55, you can get the care you need, without the referral, the hassle, the angst and everyone is happier.
We have tried to stay in network with most plans, for the benefit of our patients. Most doctors would like to. Today, I met with a medical doctor I am friendly with who just terminated Horizon Blue Cross after many years because they continue to pay him less and less, while his overhead continues to escalate. He was quite upset by this especially when he contacted the representative to question her about their policy and the answer was simple, here is how you can resign from the plan. Here is a well respected physician who is caught between whether to do an appropriate EKG on a patient that he is not being paid for anymore. He told me the allergist friend of his has to fight with a clerk to give a non generic medication.
Out of network does not look so bad after his stories. As a doctor, I am torn between great care, a lousy health plan, can I afford to stay in network and trying to stay in network so more people can access us more easily.
What would you do if you were me? For those that know me, I always go the extra mile for my patients. I will do whatever it takes to help them resolve a problem. As a patient, you need to begin to demand your plan becomes accountable and your doctor needs to be treated with respect, and paid at a level that allows him to feed his family as well. Just my thoughts...
Friday, December 22, 2006
The holidays 2006
We just finished the week prior to x-mas and I am looking forward to two four day weekends. As usual, our patient volume changes during the holidays and I took advantage of the extra in office time to totally redo the web site. Check it out at backfixer1.com. I am very proud of this web site, which has been a great resource for both our patients and those who are considering joining our practice family. I am sure I will see the usual emergencies in Scotch Plains, those who waited to the last minute or did not prioritize their bodies needs. For those who have waited to the last minute, I am awaiting your call over the holidays. For those who are more in tune and are taking care of themselves, I will see your next week.
Everyone, have a great holiday and a terrific New Year. Make some resolutions and be true to yourself and follow though.
Yours in health,
Dr C
Everyone, have a great holiday and a terrific New Year. Make some resolutions and be true to yourself and follow though.
Yours in health,
Dr C
Sunday, December 10, 2006
Doctor for New Brunswick Football team
Some of you have heard about my experience last week. If not, let me tell you what happened.
I have been teaching the local High School Athletic Trainers (Atc's) about how they can perform myofascial release and advanced diagnostics of the body, body styles and how foot problems cause many of the issues they see daily.
The trainer of New Brunswick had their best wide receiver out on an injury and had a game in three days that would determine either the end of their season or weather they make it to the championship game. I was asked the following day to look at the injured player, worked on him in the school and he felt improved. The following two days, he was seen in our office and on Saturday, I was told he was running really fast and led his team to victory.
The ATC asked me if I would like to be the on the field doctor for the school for the championship game to be played at Rutgers stadium against Livingston High. I had my portable table on the field, had an on the field pass, was in the locker room with the team and for all intensive purposes, was a member of the team's staff. I even go to attend the halftime locker room pep talk, seen in many movies.
I must tell you this was fun (alittle cold though) and I had the best seats in the house (by the sideline of the field). I was rewarded when the player I helped caught the winning pass and New Brunswick won the game. I saw him proudly dance around the field showing off their schools trophy.
This was one of those times being a doctor was a blast. As many of you know, I regularly donate my time to athletic events. This past year I was fortunate enough to be invited to help at the Pro Bowlers Tour (I worked on a number of bowlers, I later found out are top professionals on the tour), many Track and field events and even a Grapplers Tournament. This football game was the most fun I had at an event all year.
I have been teaching the local High School Athletic Trainers (Atc's) about how they can perform myofascial release and advanced diagnostics of the body, body styles and how foot problems cause many of the issues they see daily.
The trainer of New Brunswick had their best wide receiver out on an injury and had a game in three days that would determine either the end of their season or weather they make it to the championship game. I was asked the following day to look at the injured player, worked on him in the school and he felt improved. The following two days, he was seen in our office and on Saturday, I was told he was running really fast and led his team to victory.
The ATC asked me if I would like to be the on the field doctor for the school for the championship game to be played at Rutgers stadium against Livingston High. I had my portable table on the field, had an on the field pass, was in the locker room with the team and for all intensive purposes, was a member of the team's staff. I even go to attend the halftime locker room pep talk, seen in many movies.
I must tell you this was fun (alittle cold though) and I had the best seats in the house (by the sideline of the field). I was rewarded when the player I helped caught the winning pass and New Brunswick won the game. I saw him proudly dance around the field showing off their schools trophy.
This was one of those times being a doctor was a blast. As many of you know, I regularly donate my time to athletic events. This past year I was fortunate enough to be invited to help at the Pro Bowlers Tour (I worked on a number of bowlers, I later found out are top professionals on the tour), many Track and field events and even a Grapplers Tournament. This football game was the most fun I had at an event all year.
Monday, November 20, 2006
Redefining Lower back pain, Sciatic Pain and other Symptoms in the lower kinetic chain, a mechanical definition
Lower back pain is a condition that costs Billions per year to treat, yet, treatment has been inconsistent at best, it misunderstood at worst and has been treated with varying levels of success. One of the most studied groups with the most consistent results has been chiropractors, followed by Physical Therapists, followed by medical treatment which includes surgeries and medication.
The problem with back pain definitions to this point is that the symptoms are what are defined, and then treatment is based on the symptoms. Unfortunately, back pain, sciatica and even knee pain are caused by malfunction of the lower kinetic chain (the series of joints including the ankle, knee and hip, with secondary effects on the shoulder, elbow and wrist), asymmetry and inherited traits which allow for either efficient or inefficient mechanics resulting eventually in breakdown we see as pain, sciatica, arthritis, worn out knee or hip joints and secondary effects into the upper body in the neck, shoulder, elbow.
Poor mechanical function results in muscular breakdown, poor firing patterns (groups of muscles that work together to achieve movement around a joint. A poor firing pattern results from shortened and weakened muscles that do not generate enough force to move as joint properly, requiring the body to recruit surrounding muscles into the action, causing an area to tighten). It is the author’s opinion that most herniated discs in the lower back and neck, are caused by asymmetry in the way the joints are moving when a person is built asymmetrically. This type of body style will impart shearing forces to these joints creating a process called creep (take a piece of plastic, keep on bending it until it begins to break is what we call creep). Creep will cause discs to fail and degenerate due to abnormal wear and tear. Promotion of symmetry will help avoid this process.
Many researchers such as Vladmir Janda, Brian Rothbart and many others have worked with kinetic chains, function or malfunction. Rothbart had shown in his engineering model how the body implodes or rolls anteriorly the more the feet flare out (overpronation of the feet). Many of my own articles discussed a concept called the basic pronation accommodation pattern that explains what happens with this implosion effect to the muscles and ligamenture.
Buried in all this information that has been published over the years is a most appropriate definition which is of a mechanical nature.
Back pain, Sciatica, Knee Pain, Lumbar Disc problems are a function of gait. The more efficient and symmetrical this persons body style is, the more likely they will experience chronic back, leg, knee and hip pain and secondary problems in the upper body.
The more the foot flares out, the more the knee rolls in (see http://members.aol.com/Backfixer/bkpain.html). If you have one leg that either turns out or in as compared to the other, the leg that flares out will create a functional short leg and will act as if it is shorter than the other leg. This causes an effect called pelvic unleveling. The side that flares out will also tighten up over time, with most of the muscles in the lower kinetic chain involved. This will cause movement of that side to become inefficient and this leg will eventually tighten in the back, creating tightness into the hamstring. The body will compensate with the quadriceps and psoas muscle (main mover of hip and strongest muscle in the body) to tighten on this side. This torque on the pelvis will lead to lower back pain, inflexibility of the legs which will in turn reduce the flexibility of the person who has this type of mechanics and sacro iliac or garden variety back pain. The pain is caused by the side of overpronation locking up and the opposite side straining. Typically, the side of strain is the side of pain in sacroiliac pain syndromes. The longer this persists, the tighter the quadratus, erector and multifidii muscles get creating further reduced mobility and upper kinetic chain malfunction which is why tight hip flexors will cause neck pain as this condition locks up and in the worst cases rotates the rib cage to the side of overpronation, often producing pain in the shoulder blade on the opposite side.
As you can see, body style produces lower back pain and many other problems chiropractors have successfully treated.
Intelligent treatment of gait issues begins at the feet. This includes eliminating flat shoes and wearing foot orthotics which have proven beneficial in improving the efficiency of body mechanics. A good doctor will look at body style, evaluate the symptoms and have an understanding of cause and effect. Treatment shall include myofascial release or similar method to improve muscular efficiency, improve firing patterns and promote body symmetry. Exercises should be performed to enhance the effect of myofascial treatment and strengthen released tissues. The role of orthotics should be explained in layman’s terms to the patient, and they need to recognize that these inserts need to be part of their lifestyle. Secondary effects of treating body style issues will be improvement in the way the upper body functions, fewer problems in the upper kinetic chain (shoulder, elbow and wrist) and improved ability to move their neck.
Herniated discs are a function of this system going bad. Since the body does not tolerate asymmetries, asymmetries in gait will cause shearing forces in the gait cycle resulting in a process called creep. Creep is structural fatigue (not dissimilar to taking a piece of plastic and bending it until it develops cracks). Since asymmetries will cause excess motion and wear and tear at the joints, eventually, the material (annulus fibrosus) can fail and cause the disc material to either bump out (bulge), herniated (break through inner but not outer fibers, extrude (break through the outer surface) or become an extruded segment (disc material in the spinal canal requiring surgical intervention).
Improving body mechanics using intelligent treatment will likely decrease ones likelihood for herniated discs, knee problems, sciatica and many upper back conditions.
While this is not your standard definition, it will lead to more intelligent treatment. Since back pain is a gait issue as I have shown, treating it as such yields more reliable results. Perhaps, this is why some chiropractors are able to yield better outcomes for the condition (most studies support this).
The problem with back pain definitions to this point is that the symptoms are what are defined, and then treatment is based on the symptoms. Unfortunately, back pain, sciatica and even knee pain are caused by malfunction of the lower kinetic chain (the series of joints including the ankle, knee and hip, with secondary effects on the shoulder, elbow and wrist), asymmetry and inherited traits which allow for either efficient or inefficient mechanics resulting eventually in breakdown we see as pain, sciatica, arthritis, worn out knee or hip joints and secondary effects into the upper body in the neck, shoulder, elbow.
Poor mechanical function results in muscular breakdown, poor firing patterns (groups of muscles that work together to achieve movement around a joint. A poor firing pattern results from shortened and weakened muscles that do not generate enough force to move as joint properly, requiring the body to recruit surrounding muscles into the action, causing an area to tighten). It is the author’s opinion that most herniated discs in the lower back and neck, are caused by asymmetry in the way the joints are moving when a person is built asymmetrically. This type of body style will impart shearing forces to these joints creating a process called creep (take a piece of plastic, keep on bending it until it begins to break is what we call creep). Creep will cause discs to fail and degenerate due to abnormal wear and tear. Promotion of symmetry will help avoid this process.
Many researchers such as Vladmir Janda, Brian Rothbart and many others have worked with kinetic chains, function or malfunction. Rothbart had shown in his engineering model how the body implodes or rolls anteriorly the more the feet flare out (overpronation of the feet). Many of my own articles discussed a concept called the basic pronation accommodation pattern that explains what happens with this implosion effect to the muscles and ligamenture.
Buried in all this information that has been published over the years is a most appropriate definition which is of a mechanical nature.
Back pain, Sciatica, Knee Pain, Lumbar Disc problems are a function of gait. The more efficient and symmetrical this persons body style is, the more likely they will experience chronic back, leg, knee and hip pain and secondary problems in the upper body.
The more the foot flares out, the more the knee rolls in (see http://members.aol.com/Backfixer/bkpain.html). If you have one leg that either turns out or in as compared to the other, the leg that flares out will create a functional short leg and will act as if it is shorter than the other leg. This causes an effect called pelvic unleveling. The side that flares out will also tighten up over time, with most of the muscles in the lower kinetic chain involved. This will cause movement of that side to become inefficient and this leg will eventually tighten in the back, creating tightness into the hamstring. The body will compensate with the quadriceps and psoas muscle (main mover of hip and strongest muscle in the body) to tighten on this side. This torque on the pelvis will lead to lower back pain, inflexibility of the legs which will in turn reduce the flexibility of the person who has this type of mechanics and sacro iliac or garden variety back pain. The pain is caused by the side of overpronation locking up and the opposite side straining. Typically, the side of strain is the side of pain in sacroiliac pain syndromes. The longer this persists, the tighter the quadratus, erector and multifidii muscles get creating further reduced mobility and upper kinetic chain malfunction which is why tight hip flexors will cause neck pain as this condition locks up and in the worst cases rotates the rib cage to the side of overpronation, often producing pain in the shoulder blade on the opposite side.
As you can see, body style produces lower back pain and many other problems chiropractors have successfully treated.
Intelligent treatment of gait issues begins at the feet. This includes eliminating flat shoes and wearing foot orthotics which have proven beneficial in improving the efficiency of body mechanics. A good doctor will look at body style, evaluate the symptoms and have an understanding of cause and effect. Treatment shall include myofascial release or similar method to improve muscular efficiency, improve firing patterns and promote body symmetry. Exercises should be performed to enhance the effect of myofascial treatment and strengthen released tissues. The role of orthotics should be explained in layman’s terms to the patient, and they need to recognize that these inserts need to be part of their lifestyle. Secondary effects of treating body style issues will be improvement in the way the upper body functions, fewer problems in the upper kinetic chain (shoulder, elbow and wrist) and improved ability to move their neck.
Herniated discs are a function of this system going bad. Since the body does not tolerate asymmetries, asymmetries in gait will cause shearing forces in the gait cycle resulting in a process called creep. Creep is structural fatigue (not dissimilar to taking a piece of plastic and bending it until it develops cracks). Since asymmetries will cause excess motion and wear and tear at the joints, eventually, the material (annulus fibrosus) can fail and cause the disc material to either bump out (bulge), herniated (break through inner but not outer fibers, extrude (break through the outer surface) or become an extruded segment (disc material in the spinal canal requiring surgical intervention).
Improving body mechanics using intelligent treatment will likely decrease ones likelihood for herniated discs, knee problems, sciatica and many upper back conditions.
While this is not your standard definition, it will lead to more intelligent treatment. Since back pain is a gait issue as I have shown, treating it as such yields more reliable results. Perhaps, this is why some chiropractors are able to yield better outcomes for the condition (most studies support this).
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