Going the “Extra Mile” with the Orthotics Process

The main values of providing custom orthotics are the postural support, protection, and comfort they offer to your patients.  Another important aspect of the orthotics process, however, is the help you can give your patients in getting reimbursed for these products. 
Many patients hope that their orthotics will be considered a covered expense by their insurance companies.  For some policies that is true; but there are exceptions.  It is a good idea to suggest that patients read through the various policy documents they were given.  If there is no specific exclusion, it is very possible that some coverage is available.  Either way, it is often helpful if patients have something in writing which details the reasons you are recommending custom orthotics.  This makes them more excited and more willing to pay the cost, even if insurance denies the expense.  Sending a copy of this written explanation to the insurance company does seem to help with payment in many cases.
Figure 1 is an explanatory letter for custom-fitted orthotics.  I recommend you re-type this onto your letterhead, and use it whenever a patient, a family member, or an insurance adjustor needs to be educated regarding the need for orthotics. Of course, any specific information you can provide to make the explanation more customized for each individual patient will be very helpful.  Your patients will appreciate the “extra mile” you have gone to help them in their dealings with insurance companies. TAC

Dr. John 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 associate editor to the Journal of the Neuromusculoskeletal System and the Journal of Chiropractic Sports Injuries and Rehabilitation.  He has been in private practice in Massachusetts for 24 years. You may reaach Dr. Danchik at (617) 489-1220 or e-mail [email protected].

Marketing for Growth

New Patients are the lifeblood of any chiropractic practice.  New patients are critical for your expansion.  An important factor to consider when talking about expansion is the quality of care you offer your existing patients.  The primary reason to treat patients is to better their health.  By focusing on the health of your current patients and following some simple acquisition rules for new patients, your practice will do well and flourish. 
The most common new patient acquisition method is patient referrals.  Did you know that every patient you see in your office presents an opportunity for you to market to eleven new people? Eleven is the average number of relatives, friends and acquaintances that an individual would feel comfortable referring to you.  Everyone knows someone that is having a problem with headaches, backaches, stress or sleeping disorders.  It is important that you incorporate this philosophy into your everyday practice and learn how to ask for these referrals.  By doing so, you will be working smarter—not harder—and capitalizing on this opportunity.  This will successfully grow your practice. 
Another new patient acquisition method is marketing.  First, let’s describe the word “marketing”.  Marketing, by definition, is the function of getting the word out about your practice or business.  We must “market” in order for chiropractic to expand.  We must have an ongoing stream of new patients continuing to get well.  Even the most philosophical chiropractor, must realize that marketing is critical in order for the field of chiropractic to hit the percentage of the population necessary for us not to market. 
Talk to any one of your instructors back in school and they will tell you that chiropractors treat about 8-10% of the population.  In reality, what you will find in your investigation is that this percentage has remained relatively unchanged for the last 50 to 75 years.  This means that there has not been a dramatic change in the percentage of people seeking out chiropractic care over the years.  We are treating 8-10% of the population, currently.  We must get to a higher percentage, if chiropractic is going to become the number one health care choice. 
Chiropractic is currently not the number one health care choice.  This is because the public does not understand what we do as chiropractors.  They are not aware of the benefits we offer.  In order to change this, we have some work to do.  We have to create market penetration so the public understands chiropractic.  The only way for this to occur is with systematic application of tools introducing chiropractic to the public and the public’s accepting it. 
When discussing marketing, there are two major categories to work on in order to improve your new patient enrollment:  Internal Marketing and External Marketing.
Internal Marketing
is any activity you can do inside your practice to improve the number of new patients you receive on an ongoing basis.  This would include asking for referrals, conducting In-Office Workshops, holding Quality Control Consultations, and offering specialty programs.  Most internal marketing programs are simple to implement.  They, typically, follow a very systematic approach and are easy to duplicate.  If they are scheduled and held on a weekly basis, your practice will expand.  Unfortunately, the biggest obstacle to their effectiveness is the fact that they are not conducted on a consistent basis.  If they are scheduled, then cancelled or postponed, no growth benefits will be realized.
External Marketing activities are held outside your office.  Some examples of external marketing activities are screenings, lectures, Patient Appreciation Days, health fairs, direct mail, television commercials, radio advertising and print advertising.  Most of these activities require the doctor or staff member to physically leave the practice.  While there is generally an additional cost associated with external marketing, you usually reach a much wider audience with your message.  External marketing activities should be planned carefully so the cost of the activity does not outweigh the benefits you receive. 
It is important to realize that marketing a product like chiropractic, which is not well understood by a large percentage of the population, works better when you use a variety of tools to communicate your message.  There are many programs designed to help ease your level of work, while moving the concept of chiropractic into the public and helping overcome the fears that an individual might have about chiropractic care.  Choose your programs based on your patient needs and the needs of the community in which you practice.  This will help ensure that you grow your practice successfully. 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.  Dr. Pisciottano has become a noted authority on the topic of Chiropractic Analysis and Treatment Systems.  He travels the world over conducting speaking engagements on the topic.  Since graduating from the Palmer College of Chiropractic in 1989, Dr. Pisciottano has built a successful multiple office practice in Western Pennsylvania.  Dr. Pisciottano regularly teaches continuing education courses 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, 1-877-942-4284.

Financial Management for Future Freedom

Budgeting includes short- and long-term plans

Look beyond next year!

This article was written to help you on budgeting for your chiropractic practice.  We’re starting now to develop your practice’s 2003 budget.  It amazes me how many doctors spend more than they make.  We are fortunate to drive luxury cars, live in large homes, take great vacations.  But, we must do this only if it fits into our budgets.  Debt can create stress; and stress can cause us to make improper decisions.  By removing debt, we remove most of our practice stresses.  My father used to say that the key to being successful is to spend less money than you make.  Unfortunately, many doctors do not follow this age old wisdom.  Budgeting can make life less stressful, if done properly. 
A good budget encompasses all the financial details of running your practice.  Good budgeting goes further and projects how those details will help achieve your and your practice’s larger, long-term goals.  The dual purposes of operational and strategic planning lie at the core of this article. 

Look to the future

Chiropractic practice budgeting is more than a series of annual targets.  The effective planning process considers strategic issues for the coming five, or even ten years.  The first key is to remove or eliminate debt.  Before your accountant, your manager or administrator can “run the numbers,” you must decide where you want them to run to in the coming years.  If your budgeting and planning efforts don’t project beyond the coming year, schedule such planning sessions.  Otherwise, it’s like building a bridge from one riverbank, with no knowledge or concern for what’s lurking on the opposite shore.  That’s exploring, not planning.
Strategic questions like, “What do we want to be doing in five years?” produce natural operational questions like, “What will we do next year to put, or keep us on that path?”  My goal, as a consultant, is always to help my doctors grow, while keeping their prospective overheads under control.  You can grow your practice while maintaining a certain percentage overhead.
This strategic planning step involves questions about internal (physician goals) and external (competition and other market forces) factors like:

  • Do you want to make the practice larger?
  • If so, how?  Should you add physicians—physical therapist, nurse practitioners, massage therapist, another DC, an MD—or increase your geographic market, perhaps with an additional office?  Should the practice introduce new services you’ve referred out in the past?
  • What competitive threats exist—or are likely to develop?  How can you react to them, or eliminate them, by acting now?

Budget protocols

Next, begin the traditional budget mechanics.  Start using the budget framework to attach numbers to the agreed ideas and goals.  We’ll look at the different budget components in greater detail in the coming months:

  1. Revenue budget.  Looking at past data and projecting forward, how much revenue does the practice expect from cash payments?  And what about managed care plans, prepaid HMO contracts, patient co-pays and self-pays, receivables on the books and the prospective sale of any assets.  What about PI or Worker Compensation?  Well-researched revenue budgeting explores all likely income sources.
  2. Expense budget.  The health care services you render cost money to provide.  You must meet fixed, variable and “semi-fixed” expenses to keep the doors open and the revenue coming in.  One objective is for your overhead never to exceed 50%.  Have your accountant provide you with P/L’s on a regular basis.  Have each category earmarked by percentage.  (Example:  Advertising should comprise in the range of 6%, employees in the range of 25%, etc.)
  3. Capital budget.  Small and mid-size practices (even many larger ones) rarely develop capital budgets.  Nor should they.  If a practice doesn’t own its office (even though a related partnership often does) many traditional capital expenditures fall outside the practice budget.  Plus, by borrowing funds for capital purchases, like new clinical equipment, you essentially transfer them into regular budget items.  But, for larger practices, capital budgeting can be an important part of the overall process and an alternative to borrowing.  This should be part of your overall planning and should be done carefully, with your accountant, as part of your tax planning.
  4. Profit plan.  This integrates the revenue and expense budgets to show net income for the practice.  Some groups even start the budgeting process by deciding what take-home pay their doctors should receive, and then work back up the line to project the revenue needed to produce that profit.  One of my mentors, Dr. Larry Markson, taught me a long time ago, “Pay yourself first.”  I have always followed this philosophy.
  5. Cash budget.  The cash budget details the anticipated cash flowing through the practice.  Net charges and actual revenue don’t march in step.  Rarely do clinics collect what they bill out.  You need to calculate what your collection percentage ratio is.  I provide this to my clients on a monthly basis.  If your practice bills $500,000, and you collect $300,000, then you have a 60% collection ratio and a $300,000 practice.  Prepaid contracts, workers compensation, and outside referrals can create a significant short-term difference between what you’re due and what you actually receive.  And cash outflows, like malpractice premiums and meeting travel, may vary significantly from month to month.  By knowing what you anticipate as your collection percentage, this budget protocol helps you stay on top of your practice’s monthly cash needs.
  6. Balance sheet.  The balance sheet puts all the revenue and expense data together and projects the practice’s assets and liabilities—essentially, a snapshot of the practice’s financial health—at the end of the budget year.
  7. Review; revise.  After you put the collected information into an initial draft, the crucial review process begins.  Are the numbers accurate to the best of your forecasting ability?  Are the forecasted results good enough to support the practice and meet the needs of the physician/owner(s)?  If you project these numbers into the future, will the practice likely stay on track toward achieving its long-term goals?  Was anything inadvertently left out?

Project some problems

Consider the financial implications of falling a little short—or a lot short.  Remember, a fall is a fall.  Falling, of any nature, is not a comfortable situation.  Yet, it happens.  That raises the issue of whether a budget should represent your best projection of what will likely happen, a “stretch” goal to strive for, or a near worst-case scenario that will still meet your needs. 
Regardless of the approach you choose, it is your responsibility to work with your accountant to run some good, bad and middle-of-the-road scenarios, so you know what to expect if the unexpected happens.  Computers break down, employees get sick, and even doctors can miss work.  You must plan for the unexpected.  Remember, if you carefully gather your information, project reasonably and don’t get blindsided by external changes, budgeting shouldn’t provide too many surprises.  And that’s the point of the entire process.
Your goal should be to maintain your overhead at 50%; every month you should evaluate your P/L.  Many doctors get into financial crisis because they do not have an effective budget or savings system.  I recommend to all my clients that they save 10% per week.  Call it, Tithing for Success.
The road to SUCCESS is always under construction.  Success is not our birthright; we must work and plan.  Throughout our journey there will be obstacles, so be prepared.  Periodically, you may make a wrong turn.  Get back on track.  Financial freedom takes time, energy, effort and, most of all, discipline.  With proper preparation you can build your future by starting today. 
Good luck; I’ll see you “At the Top”. TAC

Dr. Kaplan is the CEO of MBA, Inc., one of the nation’s largest multi-specialty consulting companies.  Dr. Kaplan ran and operated five  of his own clinics, seeing over 1000 patient visits per week.  He is the best-selling author of Dr. Kaplan’s Lifestyles of the Fit and Famous, endorsed by Donald Trump, Norman Vincent Peale and Mark Victor Hansen.  He was a recent commencement speaker at New York Chiropractic College and regularly speaks throughout the country.  For more information about Dr. Kaplan or MBA, call 561-626-3004.

Is Hormone Replacement “Therapy”?

During the third week in July of 2002, The Journal of the American Medical Association reported that a large scale clinical trial on hormone replacement therapy (HRT) had been halted five years into the study.1  Researchers at 40 clinics across the country had recruited 16,608 healthy volunteers, ages 59-79 (not at high risk for either heart problems OR breast cancer), and randomly assigned them to either Prempro or a placebo.  Chances of suffering a heart attack or pulmonary blood clot were elevated throughout the study, and stroke risk was high as early as the second year and remained high throughout the study.  That alone was not reason enough to halt the study, especially since hip fractures and colon cancer had decreased.  However, five years into the trial, it was clear that the development of invasive breast cancer was increasing and, combined with the cardiovascular outcomes, “It became very clear that the risks of treatment exceeded the benefit.”2

Estrogen Dominance

The female organs produce estrogen and progesterone in what sometimes seems to be a “tug of war”—during a woman’s cycle, concentrations of each hormone fluctuate at different times.  Since estrogen prevails for most of the cycle, it creates a condition commonly referred to as “estrogen dominance”.  This imbalance happens both in PMS and in menopause, when estrogen replacement therapy (ERT) is given.  Symptoms of estrogen dominance include, “water retention, breast swelling, fibrocystic breasts, pre-menstrual mood swings and depression, loss of sex drive, heavy or irregular periods, uterine fibroids, craving for sweets, and fat deposition in the hips and thighs”.3  Progesterone is an important hormone that balances estrogen.  When synthetic progesterone is given with ERT, it is called hormone replacement therapy (HRT); however, the synthetic version cannot be attributed with the beneficial effects of the natural progesterone.
Synthetic progesterone has been likened by Dr. John Lee, who has researched and written a book on natural progesterone, to a cook who needs eggs for a recipe and is given cheese—the effects just aren’t the same!

The Good News about Natural Support:
Natural Progesterone

“A growing number of doctors believe that if natural products were used, medical risks and side effects would be considerably lessened.  Research using hormones from natural sources have the benefits of synthetics, but fewer side effects.  A significant finding showed that the adverse effects of the synthetic progestins on blood-fats and cholesterol levels were eliminated with natural progesterone.”4


Plant phytoestrogens do not carry the risks of estrogen replacement therapy, and yet they have the ability to exert a weak estrogenic activity when they bind to estrogen receptors.  Phytoestrogens are found in some 300 foods, (including flaxseeds, tofu, cabbage, alfalfa, and fennel) and in some herbs, such as dong quai, red raspberry, black cohosh, chaste-tree berries (vitex), red clover, wild yam and licorice root. (*Dong Quai, black cohosh, and several other female herbs are contraindicated during pregnancy.)  Since the plant hormones have weak estrogenic activity, they are able to eliminate some of the symptoms of menopause and decrease the risk of osteoporosis that is associated with a lack of estrogen.  Used together synergistically, they are even more powerful.5
If plant estrogens provide weak activity where there was none before, does that increase risk for breast cancer?  There is no conclusive evidence that they do.  That could be due to the natural quality of the estrogen and, also, the fact that the plant estrogens may be exerting other beneficial effects.  For instance, these plant estrogens bind to an enzyme called estrogen synthetase, thus inhibiting production of the estrogen in the body, and offering additional protection in this manner.6
It is interesting to note that estrone, which is the main estrogen produced by the body after menopause, has been shown to be carcinogenic.  Estrone is one of three estrogens produced by the body.  Estriol is a weaker form (major hormone of pregnancy) that has not been proven to be carcinogenic, but is not used in HRT.  Estradiol (twelve times more potent than estrone, and eighty times more potent than estriol) is used in HRT, and is also correlated to cancers—the blocking of this estrogen by the phytoestrogens may explain the supposed protection that the phytoestrogens offer in premenopausal years.
It is also possible that, by binding the receptors, plant estrogens prevent the binding of xenoestrogens, highly toxic and carcinogenic substances in our environment suspected of causing breast cancer.  Xenoestrogens not only bind the receptors, but negatively affect the DNA of the cell.  In 1978, Israel banned several chemicals determined to be correlated with breast cancer—the incidence of breast cancer dropped 30% in women under 44 years old, even though it rose 4% overall worldwide.7  In contrast, the phytoestrogen-receptor complex that is formed does not bind to DNA as strongly as human estrogen.8  Additionally, phytoestrogens exhibit antioxidant, radical scavenging, hypolipidemic and serum cholesterol lowering properties.9

Phytoestrogen Support…

Dong quai is a Chinese herb high in phytoestrogens; it relieves hot flashes, vaginal dryness, and depression.10  “Scientific investigation has shown that dong quai produces a balancing effect on estrogen activity and a tonic effect on the uterus.” 11
Black Cohosh has a high phyto-estrogen content, and is recommended frequently for support of all female ailments.  In some clinical trials, black cohosh has been shown to be equally as effective as synthetic estrogen replacement therapy.12  It lowers blood pressure,13 and a review of eight human clinical trials found black cohosh to be “a safe, effective alternative to estrogen replacement therapy”.14
Wild Yam Root is a good source of phytoestrogens, and sterol compounds similar to progesterone.  It contains a natural steroid called dehydroepiandosterone (DHEA).  The root is used in the treatment of menopause-related symptoms.  It helps relax muscle spasms and is said to be beneficial for many female disorders, helping to relieve mood swings, depression, irritability, insomnia, headaches, and cramps.
Chaste Tree (or Vitex) has hormone balancing effects, helps alleviate hot flashes, and is used in the treatment of fibroids in uterine tissue, fibrocystic breasts, and endometriosis.
Red raspberry is full of phyto-estrogens, and is helpful in treating menopause, and associated symptoms such as hot flashes.15  It is one of the safest herbs and can be taken during pregnancy.
Red Clover has phytoestrogens and is also a rich source of bioflavonoids, isoflavonoids, folic acid, biotin, choline, inositol, pantothenic acid, vitamins A, B1, B2, B3, B6, B12, C, and minerals such as copper, magnesium, manganese, selenium, and zinc.
Flaxseed is mildly estrogenic (contains phytoestrogens) and is rich in minerals needed by postmenopausal women.  Flaxseed is also high in essential fatty acids (EFA’s)—deficiency of EFA’s is partly responsible for skin, hair, and vaginal dryness, as well as the dryness of other mucous membranes. 
Other female nutrients helpful in menopause include burdock root, motherwort, damiana, gotu kola, Panax ginseng, and avena sativa.
Bioflavonoids and vitamin C:
  In a clinical trial, subjects received a supplement containing a hesperidin bioflavonoid combination with  vitamin C.  “The bioflavonoids were markedly superior to the other preparation’s relief of the hot flashes.  Bioflavonoids appear to restore the endothelium to a normal structure and help reduce the hot flashes and vasodilation.”16  Additionally, bioflavonoids are high in the phytoestrogens that can relieve symptoms.

Natural Support for Osteoporosis

One of the reasons that the large scale trial was not halted earlier was because hip fractures were decreased with estrogen.  Both phytoestrogens and natural progesterone can support healthy bones.  The bioactivity of several phytoestrogens in preventing bone loss “has been demonstrated in a well-recognized model of postmenopausal bone loss”.17
Jerilynn Prior, MD, of the Endocrinology and Metabolism Division of the University of British Columbia, notes that, “Progesterone acts on bone, even though estrogen activity is low or absent.  Because progesterone appears to work on the osteoblasts to increase bone formation, it would complement the actions of estrogen.” (Estrogen decreases bone breakdown.)  Another MD notes that osteoporosis has been reversed in women as much as 16 years past menopause, using natural progesterone in combination with other dietary factors and exercise.18
Phytoestrogens and natural progesterone cream can offer a lot in the way of support for women, both pre- and post-menopausally.  Over 16,000 women have been studied and have blasted the theory that HRT is a wonder drug for women in menopause.  The natural alternatives certainly do not carry the risks that come along with the medical hormone replacement, and more and more women these days want a healthier alternative. TAC


  1. JAMA July 17, 2002
  2. Marcia  Stefanick, chair of the Women’s Health Initiative’s Steering committee; Newsweek July 22, 2002:38-41
  3. Null, G. The Woman’s Encyclopedia of Natural Healing.  Seven Stories Press, NY, NY. 1996
  4. Hargrove J et al., Menopausal Hormone Replacement Therapy with Continuous Daily Oral Micronized Estradiol and Progesterone. Obstetrics and Gynecology. 1989;73:606, as cited in:  Ojeda, Linda, PhD.  Menopause without Medicine.  Hunter House Publ., Alameda Ca. 1989, p. 107
  5. Murray, M. Menopause. Prima Publ. Rocklin, Ca. 1994
  6. Lark, S. Fibroid Tumors & Endometriosis. Celestrial Arts, Berkeley, Ca. 1995;  p.125  
  7. Westin J & Richter E. Ann NY Acad Sci 1990;609:269-279
  8. Draper CR et al. J Nutr. 1997;127:1795-99
  9. Franke et al. 1994
  10. Balch, J.F., M.D. and Balch, P.A., C.N.C.  Prescription for Nutritional Healing.  1990.  Avery Publishing, Garden City Park, NY, p. 241
  11. Murray, M.T., N.D.  Natural Alternatives to Over-the-Counter and Prescription Drugs.  1994.  William Morrow and Company, Inc.  NY, NY
  12. Zen BL Gynakol 110-61, 1998
  13. Mowrey, DB. The Scientific Validation of Herbal Medicine.  Cormorant Books, 1986
  14. as cited by Lieberman, Shari, Journal of Women’s Health. 1998;7(5):525-529
  15. Balch, J.F., M.D. and Balch, P.A., C.N.C.  Prescription for Nutritional Healing.  1990.  Avery Publishing, Garden City Park, NY, p. 241.
  16. Smith, CJ, MD. Non-hormonal control of vaso-motor flushing in menopausal patients, Chicago Medicine, March 7, 1964
  17. J Nutr 1997;127:1795-99.
  18. Christiane Northrup, MD.  Women’s Bodies, Women’s Wisdom.

Dr. Toohey received her Ph.D. in nutrition from Colorado State University in Ft. Collins, CO.  She has lectured to chiropractors and other health professionals across the country and also in Canada and Europe.  She has been invited by the Canadian MS Society to be a guest speaker at their annual convention in Vancouver (Nov.  16th).  Various lecture engagements have included speaking for the International College of Applied Kinesiology, the United Chiropractors of New Mexico, and the Florida Chiropractic Association.  You may reach Dr. Toohey by e-mail at [email protected].

Why magnesium for the chiropractic patient?

Back in 1992, Elin referred to mag-nesium as the fifth, but forgotten, electrolyte.1  This is not surprising, as magnesium’s importance is rarely mentioned, perhaps due to our culture’s obsession with calcium.   One would never know that magnesium plays a crucial role in bone metabolism, for it is never mentioned.  Even certain researchers do not consider magnesium when studying osteoporosis.  Alexandersen, et al., state that, “It is not a general practice to include a magnesium supplement in osteoporosis studies.”2  Such sentiments are inconsistent with well-known facts about calcium and magnesium metabolism.  A basic endocrinology book explains that magnesium deficiency creates a deficiency in calcium that cannot be corrected until magnesium levels are restored.3  In fact, magnesium supplementation has been used in the research setting in the treatment of osteoporosis. 
In a group of postmenopausal women in Israel suffering from osteoporosis who received magnesium supplements in the range of 250-750 mg/day for 24 months, in 87% of the cases, either trabecular bone density increased up to 8% or bone loss was arrested; in some cases, both an increase in bone density and arrested bone loss occurred.  Untreated controls, on the other hand, lost bone density at an average of 1% a year.4   In another study, postmenopausal osteoporotic women in Czechoslovakia received magnesium at levels ranging from 1500-3000 mg of magnesium lactate per day for two years.  Nearly 65% were classified totally free of pain and with no further deformity of vertebrae, with the condition in the remainder either arrested or slightly improved.4
Magnesium is not limited to improving bone health.  There are some three hundred bodily enzymes that require magnesium, which suggests that magnesium is vital for most cells and tissues of the body.  Deficiency in magnesium can have far reaching effects on many different tissues, to the point that a leading magnesium researcher wrote an article entitled, “Magnesium deficiency:  A cause of heterogeneous disease in humans”.5  Numerous conditions and symptoms can be promoted by magnesium deficiency, including osteoporosis, muscle dysfunction, depression, apathy, cardiac arrythmias, hypertension, atherosclerosis, and even stress and aging.5,6  
Literally no bodily system can escape without being insulted by magnesium deficiency, even the human genome.  In fact, magnesium is thought to promote genomic stability, such that DNA synthesis and repair depends on magnesium.7
Consider how the muscular component of subluxation may by driven by magnesium deficiency.  In particular, magnesium is required for ATP synthesis, which is needed for normal patterns of muscle contraction and relaxation.  Consider that ATP is needed to pump calcium back into the sarcoplasmic reticulum after muscle contraction.  Inadequate magnesium intake is likely to promote increased muscle tension.  Indeed, Rude explains this relationship quite concisely:  “The mechanism by which Mg affects the neuromuscular system relates to the fact that Mg stabilizes the nerve axon, as well as influences the release of neurotransmitters at the myoneural junction….  In Mg deficiency, there is a lower threshold for axonal stimulation and increased nerve conduction velocity, as well as increased quantity of neurotransmitter released.  Mg is also involved in calcium handling by the muscle cell.  With low intracellular Mg, calcium is more readily released from the sarcoplasmic reticulum and is reaccumulated more slowly….  This results in a muscle that is more readily contractible to a given stimulus and is less able to recover from contraction, i.e., tetany prone.”
With the above in mind, one can only hope that he is getting adequate magnesium in his diet.  Regretfully, this is not the case.  Marginal magnesium deficiencies are very common.  At the turn of the century (1900), magnesium intake was estimated to be 475-500 mg per day,8 which is substantially higher than today’s RDA’s.  The current US RDA for magnesium is 320 mg for women and 420 mg for men.  Intakes below the RDA are common, if not the norm, for the people of many countries, including the United States.7,8  While we cannot attribute this lowered intake to be the cause of the conditions and diseases mentioned above, it certainly makes sense to increase magnesium ingestion to at least the RDA. 
Researchers suggest that for every 2.2 pounds of body weight, which is equivalent to 1 kilogram (kg), we should be ingesting six mg of magnesium.  Accordingly, a 150-pound man (70 kg) would require 420 mg/day, while a 200-pound man (90 kg) requires 540 mg/day. 
As most in the US are deficient, it is suggested that we supplement five mg per kg of body weight to replenish what has been lost.6  Researchers have observed that between 950-1020 mg of magnesium per day is required to create a positive magnesium balance.7
For those taking calcium supplements, it is very important to add a magnesium supplement to the regimen.  The current accepted balance of calcium/magnesium intake is 2:1.  At present, the average intake of calcium in the US is thought to be about 1000 mg/day or greater (which includes supplements and fortified foods) and only about 250-350 mg of magnesium.  This imbalance, i.e., about a 4:1 ratio of calcium/magnesium, is thought to reduce magnesium absorption and further enhance magnesium deficiency.4
I suggest we give patients a nutritional adjustment by supplementing with magnesium.  Take magnesium about thirty minutes before eating a meal.  Divide your magnesium supplementation throughout the day if you are taking more than 300 mg, which will help to avoid the only side-effect to taking magnesium, that being loose stools. TAC

  1. Elin R. Magnesm: the fifth but forgotten electrolyte. Am J Clin Path 1994; 102:616-22
  2. Alexandersen P, Riis B. Ipriflavone and osteoporosis. JAMA. 2001; 286(15):1836-7
  3. Besser GM et al. Clinical Endocrinology. 2nd ed. London: Times Mirror; 1994: p. 18.10
  4. Dreosti IE. Magnesium status and health. Nutr Rev 1995; 53(9):S23-S27
  5. Rude RE. Magnesium deficiency: a cause of heterogeneous disease in humans. J Bone Mineral Res  1998; 13:74-958
  6. Durlach J, Bac P, Durlach V, Rayssiguier Y, Bara M, Guiet-Bara A. Magnesium status and ageing: an update. Mag Res 1997; 11:25-42
  7. Hartwig A. Role of magnesium in genomic stability. Mutation Res 2001; 475:113-21
  8. Saris NL, Mervaala E, Karppanen   H, Khawaja JA, Lewenstam A. Magnesium: an update on physiological, clinical and analytical concepts. Clin Chim Acta 2000; 294:1-26

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 postgraduate faculties of several chiropractic colleges, providing nutrition seminars that focus on the needs of the chiropractic patient.   Dr. Seaman can be reached by e-mail at [email protected].

The Graston Technique: Changing the Treatment of Soft Tissue Injuries

A clinically researched, innovative treatment modality is changing the way chiropractors are treating soft tissue injuries—including the most difficult repetitive stress diagnoses.  The mode of treatment, the Graston Technique, offers expanded options for treating all chronic and acute disorders.

In less than a year since its introduction to the profession  (November 2001), more than 300 chiropractors nationwide have been trained in the technique.  National University of Health Sciences academians and clinicians have given the modality their blessing by adding the Graston Technique to the curriculum this fall.

The technique has made advocates out of skeptics.  “I never believed that the sensitivity of my hands could be enhanced.  I do now,” says renowned soft tissue expert Warren I. Hammer, MS, DC, DABCO.  Hammer, author of Functional Soft Tissue Examination and Treatment by Manual Methods, finds the Graston Technique “indispensable in his approach to soft tissue problems.”

Internationally-known sports chiropractor Thomas E. Hyde, DC, DABSP, says the Graston Technique is “one of the most innovative soft tissue forms of treatment to come along in many years.”  In addition to improving patient outcomes, Hyde believes that “doctors can add longevity to their careers by using the Graston Technique.”

The cornerstone of the patented Technique, developed more than ten years ago, is a set of six stainless steel instruments.  Use of these specially-designed instruments is a key element of the treatment protocol.  Skillfully trained clinicians use the Graston Technique to help prevent acute soft tissue injuries from becoming chronic, including conditions such as low-back strain, neck, wrist and foot pain.  The technique helps the clinician identify, evaluate and treat injured tissue better and more thoroughly, thus returning the patient to normal function sooner.  The instruments also eliminate nearly all stress on the clinician’s hands and upper extremities.

It is true that necessity is the mother of invention, as the instrument development bears out.  David Graston sustained a knee injury while trick skiing in 1987.   Surgery left him with very limited range of motion that conventional therapies failed to resolve.  Together with Andre Hall, an elite collegiate athlete, the two combined their knowledge of the musculoskeletal system with Graston’s experience in the tool and die industry to create the first instruments.  They, along with businessman Michael I. Arnolt, formed TherapyCare Resources, Inc., and an outpatient clinic in 1994.  Arnolt is president of the company, which today focuses on teaching, training and licensing the Graston Technique.

Initial research of the Graston Technique was conducted at Ball Memorial Hospital and Ball State University in Muncie, Indiana, in 1991-92.  Clinical data gathered from outpatient clinics, over seven years substantiated that more than 80% of soft tissue conditions treated resulted in attaining increased function and decreased pain.  Douglas G. Perry, Ph.D., at the Indiana University School of Informatics, conducted the study.

“The results of the study were significant,” according to M. Terry Carey, MS, PT, MTC, Assistant Clinical Professor, Indiana University School of Allied Sciences.  Many of the subjects were treated with other modalities, according to Carey, “but nothing worked as well as the Graston Technique.”  Carey has been treating patients and training instructors in the technique for eight years.

Currently, the Graston Technique is the subject of three independent randomized controlled clinical studies—including studies at Texas Back Institute and New York Chiropractic College.  Results of these clinical trials should be completed within the next year.

The Graston Technique is an interdisciplinary treatment that has a wide following in the outpatient market, and in industrial, academic, professional and collegiate sports arenas.  Included in the network of Graston Technique-licensed organizations are Community Hospitals of Indianapolis and more than twenty professional sports teams, among them the Seattle Supersonics, Philadelphia 76ers, St. Louis Cardinals, Milwaukee Bucks, Colorado Avalanche and the Miami Heat.  Nationally, many universities use the technique, including the University of Michigan, Indiana University, University of Wisconsin and the University of Illinois.  Major corporations, including Subaru-Isuzu Automotive, Navistar and SuperValu, use the Graston Technique to keep employee insurance claims and lost productivity to a minimum. TAC

The Graston Technique website, www.grastontechnique.com, is an excellent resource for additional information and research on the applications and success of the technique.  Information can also be obtained by calling toll-free 866-926-2828.

Protecting your R.O.I.

You hear it discussed on the radio.  You see it discussed on TV.  You read about it in the newspapers.  What’s the best investment?  Where can you put your money and get the best return?  What is safe and what is not?  How can you ensure your own survival during bad economic times?  The answer may be closer and simpler than you think.
Let’s start off by defining a commonly used abbreviation: ROI=Return On Investment.  This is a pretty simple concept.  You invest $100 and that investment makes $10 over the next year.  This would be a 10% annual ROI.  Of course, this assumes that the original $100 is safe and still worth $100.  When you invest your money into a bank savings account there is a pretty low ROI.  Investors have turned to CD’s, stocks, and bonds, to name a few.  Generally, the investment systems that offer higher return potential also include a greater risk factor.  You could do very well or you could lose your investment altogether.  The state of the economy and the general lack of confidence in Wall Street only add to this risk.  What used to be a simple decision, to invest in real estate, stocks, bonds, futures, etc., isn’t so simple anymore.  To some, it’s a little scary and possibly dangerous.  Enron used to look like a great investment.
So what do you do?  Well, let’s take a look at this.  We want to invest securely and net a nice return, free from corporate “slight of hand” economics.  It would be great if we could trust financial reports and the men in charge of running the company.  How refreshing it would be, to see the bigwigs of the company working as hard as we do.  Hey, wait a minute.  There IS an idea.  What would happen if we invested in our own clinic?  What if we spent the money on expanding our own business?  What if we had the money to invest in that which would yield us greater efficiency and productivity?  Could we then reduce our overhead, increase customer base, expand service, grow sales and double our collections by investing wisely? 
You’d be surprised to know how many people will invest in some obscure corporation for a possibly small return rather than invest in themselves for a potentially larger, more sustained return.  Where did they make the money in the first place?  From their own clinic, of course.  Why not strengthen your primary source of income in the first place?  When the economy is shaky wouldn’t you rather invest in a proven company?  Then invest in yours!
Where, in your own clinic, can you invest to get a good return?  You could buy equipment, such as tables, various machines or even X-ray equipment.  The question is, will any of this new equipment make more money for you than your current equipment?  Will it provide a good return on your investment?
Marketing and advertising efforts, such as radio, TV, fliers, brochures, newspaper ads, screenings, coupons, mailings, etc., all help to bring in new patients. They’ll work, if they are reaching the public with the right message. 
Do you have enough demographic and socio-economic information about your market to generate a substantial response in terms of new patients?  If you don’t feel like you have enough information, you are not alone.  Most office staffs have trouble keeping abreast of  the payments-for-services equation, let alone run a successful marketing campaign.
So, if marketing and advertising won’t blow the doors off your practice, where can you invest to get a guaranteed return?  The answer is Office Management Software.  If you’ve said to yourself, “All software is alike,” then you haven’t looked lately.  Software has gone way beyond billing and appointments. I’m not talking about billing programs pretending to be management software.  The new programs not only do billing, they have sophisticated centers for insurance follow-up, interoffice messaging, patient messaging, management statistics, full financial reporting, patient appointment management, narratives, SOAP’s, inventory management, proper patient accounting, on-line this and that, and even the ability to run multiple clinics from one software package.  The savings in time and manpower alone can swing the budget around impressively.
Some of the ways you obtain a return on your investment with software may be obvious, but some are not.  A new software package can reduce the amount of time spent on processing patient paperwork, writing notes, writing narratives, generating reports and statistics, sending out rebills and tracers, following up on insurance companies and posting payments.  Properly designed software packages can reduce data input errors, which tend to tie up the staff. 
I recently did an investigation in an office that was running at a fast clip of 200 patient-visits a week.  They had been operating with a mix of older software and manual paperwork, for which the efficiency was quite low.  Sixty-six man-hours were used to perform the various functions around the clinic.  I then made a calculation using modern, full-featured practice management software.  The difference was staggering!  A mere five-and-a-half hours was all that was required using the new software.  As you can see, investment in one of the new, comprehensive management software packages could produce a high return and significantly reduce wasted staff time.  It can pay for itself in as little as a week, in some cases.
Proper software can accelerate payments and increase the rate of collection.  The first office where I installed practice management software saw an incredible increase in their collection percent.  They collected 102% of services rendered for the next year.  Having enough information, properly organized and appropriately stated, facilitated collecting the monies they were owed.  This is not an isolated case. I’ve witnessed similar results time and again.
Patient retention is another way to get a return on your investment.  With a properly designed computerized appointment book, you will know who showed up and who didn’t.  You will know who left the office without a future appointment.  You will even know whom to call today, as they seem to always miss their appointments.  How many times have you come out of an adjusting room and said to your staff, “Hey, what ever happened to Irene?”  With a computerized appointment book this occurrence is not likely.
What is the most common mistake an office can make following its new management software purchase?  Virtually 90% of all software installation failures come from one simple but horribly overlooked fact:  no training!  Saving money by not including professional training can be disastrous and counterproductive!  Modern software packages are quite large in scope.  There’s a lot to learn. None of it is particularly hard, but a modern office is complex with hundreds or even thousands of different tasks to perform.  Equally, a full office software product has a myriad of functions at which to become proficient.  Unlicensed drivers!  You wouldn’t let someone loose on the highway or drive industrial equipment without proper operators’ training.  Why would you expect the average office worker, as pleasant and dedicated as he or she may be, to learn a full office software program to perfection all on his own?  The training dollars you invest may well be the wisest spent.
In a nutshell, to invest securely, all one has to do is look in the mirror.  This is simplicity at its best.  How do I know this to be true? You wouldn’t have money to invest if you weren’t already a winner.  You invested years and a small fortune in college tuition to get where you are.  Now, all you need is dependable, full-featured office management software as outlined above.  The factor that will translate this fine piece of equipment into a weapon of success is…training .  The software will be meaningless if the staff can’t apply all its virtues.  No matter how “user friendly” the software is, it still needs to be known and used to its fullest.  This means training and, with it, your staff will magically go about cutting time, effort and cost, while enhancing service and efficiency.
By all means, go ahead and invest.  But look at what has been the most successful and what helps the most people.  The decision will then be easy. TAC

For more information, contact Derek Greenwood, CEO and Designer of The Practice Solution 2000, EON Systems, Inc., or call, toll free, 800-955-6448.

The Rules For A Stress-Free Partnership With Technology From A “Techno-Geek”

I’ll admit it.  I’m a techno-geek.  I have internet access on my Pocket PC, two cell phones, four notebook computers, internet access on my boat, and anyone who has asked me to solve a computer problem knows that I know what I am doing.  I love technology; and, just like your passion is the spine, my passion, and the passion of my company is to keep ahead of the technology curve, so you do not have to.  With twenty-one years’ experience in the “Silicon Valley”, including research at NASA and IBM’s ergonomics labs, I have learned quite a bit about technology and making it easy for people to use, e.g., people like doctors, who need to spend time with patients, not fixing computers.
If you want to utilize technology in the most stress-free manner, here are  “David’s Rules”:

  1. Never purchase any technology unless it has been around for at least six months.  The reason IBM is rated the highest in reliability is because they do not release technology until others have worked the bugs out first.  I believe in this philosophy fully, and it shows in my product designs.
  2. Always purchase “name brand” computer hardware.  There is a significant difference in reliability with an IBM, Dell or Gateway, as compared to a “clone” which was custom built with all the quirks that brings.
  3. Purchase high quality printers and displays.  The public is more likely to be drawn to a doctor that is higher tech.  There is nothing worse than doing a screening with a slow printer.
  4. If upgrading from Windows 98 to Windows 2000 or XP, have a professional do the installation.  You may never figure out how to get it to work properly.
  5. Purchase quality backup hardware (tape drive, or backup drive).  Use five backup disks (media), one for each day of the workweek.  Take the tapes off site daily in case of fire or theft.

When evaluating which chiropractic software and hardware/instrumentation products, always ask technologically savvy friends in your profession, who own AND USE a technology you are interested in, the following questions:

  1. Does the software crash?  How often does it crash?  If Tech. Support has not been able to resolve crashes, avoid the product.
  2. Is the instrument reproducible?  Have a “well-trained” friend perform two tests in a row.  Print them out for an objective comparison, if the software does not do overlays.  Don’t worry about hurting the feelings of the owner.  If the product is not reproducible, this will affect your credibility with your patients and your community.
  3. How reliable is the product?  How often has it required repair?  How is the technical support?  Having a great concept for a product is great, but avoid products that have poor reliability or technical support.
  4. Do you have to purchase specialized supplies from the manufacturer?  If the supplies are available from multiple suppliers, it means cost savings for you. 
  5. Is the software fast, easy to use, and simple?  Simplicity is the hallmark of a great product.
  6. Is your machine capable of performing the types of test you need?  For example, if the cervical spine is of interest to you, make certain your machine is capable of doing a complete cervical measure.  If you are interested in Standing Neutral SEMG tests to correlate with your X-ray, and follow in the tradition of chiropractic itself, find a product which uses a button press on the probe.  The button press is optimal, as it allows you to stand in a neutral posture when testing.  If possible, test a system prior to purchasing it.
  7. Does the technical support include the ability to remotely access your computer, via modem, for problem resolution?  It is the next best thing to having a technician right in your office, and a service you won’t want to live without once you experience it. 
  8. What are the details of the warranty?  Get the warranty statement in writing so you can see the limitations.  If, for instance, you get a three-year warranty, does it include all components?  Less comprehensive warranties may cost you thousands in repairs.

Technology can be your best friend or worst enemy.  By finding the best product and support for your needs, you will have a great partner in building your practice.  Follow the simple guidelines above, and you will enjoy all the advantages of technology without the stress. TAC

The author, David Marcarian, MA, is founder and president of Precision Biometrics, supplier of the MyoVision SEMG  and Thermoglide systems.  He has worked for NASA, and was awarded a $450,000.00 grant from the NIH for developing the MyoVision.  He lectures for Palmer College of Chiropractic and his course is endorsed by all U.S. chiropractic associations that mandate SEMG training.  He has personally instructed more than 6,000 chiropractors on proper SEMG use.  Mr. Marcarian can be reached at 800-969-6961 and via email at: [email protected], or visit his company’s website at www.myovision.com.