Surviving the Squeeze of the Sandwich Generation

bankretirement:dropcap_open:A:dropcap_close:s if saving for retirement isn’t challenging enough, add to it the financial and emotional responsibility of helping your kids and attending to the needs of elderly parents, and you’re officially a member of the Sandwich Generation.

Buzz about the Sandwich Generation emerged several years back as the bulk of Baby Boomers reached age 50. While at the peak of their careers, many Boomers met this milestone with big financial obligations looming – funding their retirement, paying for their kids’ college, and caring for aging parents. Now, as more settle into their 60s, members of this demographic set face a new array of challenges.

Changing needs of aging parents

Watching your parents’ health deteriorate with age is something most of us anticipate having to cope with as we approach middle age. Adding to the pain for many Baby Boomers is the bad economy’s impact on their parents’ finances. In many families, the nest egg Mom and Dad relied on to fund their late-in-life needs has been eroded by declining investments and a sunken housing market.

Depending on the extent of their losses, the situation may require that their adult children step in and help. While their parents may have once thought they would live independently for their remaining years, that may no longer be a reality. What’s more, medical advancements have allowed people to live longer than ever before, putting extra strain on their retirement savings and their Sandwich Generation children.

Boomerang kids stay dependent longer

On the other side of the sandwich are young adult children who aren’t able to reach financial independence.  Graduating from college once meant getting a ‘real’ job and living on your own.  With today’s soft job market, many recent graduates are realizing they can’t live independently and are finding shelter under mom and dad’s roof once again – thus being dubbed boomerang kids.

Finding a solution

While the Sandwich Generation faces some issues foreign to past generations, there are ways to help lower your stress level and ease your financial burden if you are feeling the squeeze.  Consider these suggestions:

Update your financial goals regularly.  As your family situation evolves, you may need to reassess your target retirement date and the amount of savings you are planning to amass for retirement.  Dependent parents and children may translate into financial obligations for you, and the sooner you plan for them, the better.

:dropcap_open:As your family situation evolves, you may need to reassess your target retirement date:quoteleft_close:

Maintain control of debt.  Saying that you’ll eliminate debt from your life may not be a realistic goal.  A more achievable bogie may be to steer clear of new debt.  With uncertainty approaching, you may want to avoid the lure of your dream home in lieu of a more secure future for your family.  Consider what you really need rather than what you want when making major buying decisions requiring long-term financial commitments.

Discuss care options with your parents.  It may be difficult to approach your parents with this topic, but planning early can pay off both financially and emotionally.  If you explore possibilities while your parents are still healthy, more options may be available – plus, your parents can help you work toward mutually desired goals.

Protect your assets with insurance.  Revisit your disability and life insurance coverage to make sure your family is protected in case you are no longer able to work or suffer an untimely death.  Long-term care insurance for you or your parents may also be an option to help offset the asset-draining cost of nursing home or home health care.

Put yourself first.  As you count down to the end of your career, make sure your retirement plan remains a high priority among your financial obligations.  While you can finance many things in life, it’s hard to put retirement on a credit card.  Don’t be a Sandwich Generation martyr by putting your own needs after those of your adult children or aging parents.  You’ll be a much more valuable parent and child with your own financial house in order.

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Be sure to ask your sales representative about the insurance policy’s features, benefits and fees, and whether the insurance is appropriate for you, based upon your financial situation and objectives.

Brokerage, investment and financial advisory services are made available through Ameriprise Financial Services, Inc. Member FINRA and SIPC. Some products and services may not be available in all jurisdictions or to all clients.

 

Rich Van Loan is a specialist in retirement, as well as a Senior Financial Advisor at Ameriprise Financial Services, Inc., in Boston MA.  He may be contacted at [email protected]

Commercial Motor Vehicle Physicals—Your Unique Practice Option

truckmarch:dropcap_open:F:dropcap_close:or the first time in our profession’s history, we are soon to be placed on a level playing field with our M.D., D.O., Nurse Practitioner and Physician Assistant peers.  Soon, the National Registry of Certified Medical Examiners will become final rule for the Federal Motor Carrier Safety Administration. What this means is that Chiropractic Physicians will be on the front lines, keeping our roads safe for truck and school bus drivers. But what does all this really mean for each of us?

FMCSA estimates there are 200,000 examiners in the United States performing CMV exams. When the NRCME is implemented, each examiner will be required to complete certification training and successfully pass a Federal written examination. FMCSA estimates the numbers of examiners will drop to 40,000 examiners. This is for nearly 12 million drivers in the United States. These numbers reveal that opportunity abounds for examiners obtaining the training and certification.

FMCSA is concerned that the numbers of examiners will be too low. So what can you do now? Get trained. Though there is no certification training out there yet, there are companies developing these programs in anticipation of the final rule.  These drivers are forced to come to your office for these exams. No other program in your practice mandates anyone to come to your office. When these drivers see your pleasant surroundings, meet your staff and see you are very professional, the possibilities are limitless.

All of this requires minimal investment on the D.C.’s part. Basic exam equipment to include would be a stethescope, otoscope, opthalmoscope, urine dip sticks, a Snellen chart and a broad base of knowledge of DOT rules, regulations and recommendations, along with some core pharmacology knowledge requirements—this will put you in the forefront of performing these examinations.

:dropcap_open:Once you have the basics and are able to apply DOT rules and regulations to your clinical findings, you will be in the top tier of CMV driver examiners in the country.:quoteleft_close:

Typical reimbursement is not insurance driven. No doctor-patient relationship is created and does not require managed care inclusion or intervention. These are cash exams either paid for by the drivers themselves or the company for which they work. Most exams are between $50 and $75 per evaluation. However, once NRCME is implemented, most exams will increase to around $100 until the service pool of NRCME examiners increases to force competition, and this will take some time.  An average exam takes around 20 minutes, but staff handling paperwork, blood pressure, and urine sampling can reduce the doctor’s contact to around 8 minutes for a normal, healthy driver. Of course, complicating factors such as co-morbiditities (diabetes, hypertension, smoking, seizures, etc.) will require more investigation, thus taking more time. However, the majority of CMV driver exams are straightforward and drivers are usually easily certifiable for the two year DOT maximum certification period.

So how do you begin performing these exams? Again, get trained. Once you have the basics and are able to apply DOT rules and regulations to your clinical findings, and do it consistently without wavering, you will be in the top tier of CMV driver examiners in the country. When the official training comes out, take that in a didactic lecture format or online (both will be allowed by the FMCSA) and then take the examination. There are pre-release training programs active at this time. Proposed rules state that a potential examiner should not have to drive a long distance to take the examination.  Beta testing that was administered in July of 2009 was proctored at H&R Block businesses around the country. We estimate this will be the contractor of choice for examiner candidates in this program.

Many have asked about the other required testing for CMV drivers, which include breath alcohol and urine drug testing. These two will enhance your practice and make it attractive to local companies that would like it all in one place.  Now, many companies have to go to three different clinics to get physicals, drug screens and breath alcohol testing performed.

Training consists of numerous modules presented in a slide show format. You will need to take notes and study for this exam.  No examiners will be grandfathered into the program. All examiner types will be on the same playing field and equal. Now is the time to begin your training and get proficient in these examinations.

As insurance companies erode your bottom line, DOT work can increase it. With a little elbow grease, equipment you already have and the desire to be investigative, your office can become a highly respected DOT clinic in your area.

Plan, in the next four months, your training path. Get going and, when the NRCME switch is flipped, be the first in your area to be an NRCME examiner, then get your drug and alcohol training to complete the “trio” of DOT services. Our profession stands to be the leader in DOT work for the future. We should all explore this opportunity.

 

Clinton M. Smith, D.C., is President of NRCME Training Systems, LLC, located near St. Louis, MO. He is a practicing chiropractic physician specializing in DOT/FMCSA physical examinations, drug screening and breath alcohol testing. He is a past member of the Role Delineation Study for the Federal Department of Transportation/Federal Motor Carrier Safety Administration. His company instructs physicians in examination protocols and certification requirements for the soon to be implemented National Registry of Certified Medical Examiners. He has instructed for Logan College and Western States and now lectures for NRCME Training Systems throughout the country.

Sacral Subluxation?

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:dropcap_open:M:dropcap_close:s. M is a 15-year-old female who has started a low-impact cardio program at her local health club. After the first week of class, she developed a pain that she describes as both a sharp pain and ache in her right buttock. She reports no pain, numbness or weakness in the lower extremities. The symptom is aggravated when going from a sitting to a standing position or going up stairs when she leads with her right leg. Other activities of daily living—like getting in and out of a car, up from a desk chair and rolling over in bed—all bring about a response of pain.

Examination included a static postural evaluation, which appeared unremarkable. Ranges of motion noted a slight worsening of her right buttock pain with flexion. A two-legged squat was performed with no pain and single-leg standing noted a positive Trendelenburg on the right. Performance of a single-leg squat on the right noted pain with a difficulty in performing the activity. She further described it as a “feeling of unsteadiness.” Further gait assessment noted a decreased weightbearing on the right and decreased right hip extension. Reflexes were normal and symmetrical. She was able to rise up on her heels and toes normally.

Palpation noted significant tenderness over the right sacroiliac joint and dorsal sacral ligaments on the right. The piriformis noted minimal tenderness.  The straight leg raise test was positive in producing right buttock pain.  There was minimal difficulty raising and maintaining a raised posture of the right leg. Braggard’s Test was then performed and was negative of eliciting radicular pain into the right leg.

Radiographs were negative of apparent fracture, but demonstrated slight right sacroiliac joint widening and increased densities. Both iliac crest and femoral heads were slightly lower on the right in comparison to the left. Axial rotation was noted in the lower lumbar vertebrae. Lateral film was unremarkable.

:dropcap_open:We have heard it too often from patients that their family medical doctor or therapist or friend told them they had nothing but arthritis and would “just have to live with it.”:quoteleft_close:

Diagnosis & Treatment
Considering the history, examination and radiographic findings, Ms. M’s neuromusculoskeletal condition sounds like a typical case we, as doctors of chiropractic, would accept. Correlating all our information, we determine Ms. M has multiple subluxation complexes of the lumbars, sacrum and pelvis. Following a report of our findings and giving our care recommendations, I have Ms. M sign an informed consent form, indicating the possible risks of chiropractic manipulative therapy. Then I begin a care program of chiropractic manipulative therapy to reduce and stabilize the existing subluxation complexes. I include the use of an exercise resistance band to strengthen the weakened right hip musculature. Exercises with the resistance band involve extension for the gluteus maximus, abduction for the gluteus minimus and medius, and internal and external rotation of the hip. Finally, I also scan Ms. M’s feet to determine the correct custom-made orthotic to add more support and stabilization.

Think Outside the Box
Let’s take into consideration some other possible diagnosis or related conditions that might be causing Ms. M’s neuromusculoskeletal condition. Based on the location of Ms. M’s pain, she is having some type of sacroiliac joint involvement, primarily resulting from mechanical alterations or joint dysfunction. Considering no history of trauma was mentioned, we must look at her activities of daily living as a potential cause. Other considerations might be within her case history or be extracted with a thorough consultation.

We have heard it too often from patients that their family medical doctor or therapist or friend told them they had nothing but arthritis and would “just have to live with it.” When assessing our patients, especially with no history of trauma, we should consider what other possible causes could attribute to the problem. We are aware that there are several progressive, inflammatory rheumatic diseases that commonly affect the axial skeleton and sacroiliac joint. This is sometimes referred to as spondyloarthritis, ankylosing spondylitis, reactive arthritis, undifferentiated spondyloarthritis, and arthritis associated with inflammatory bowel disease.

Many of these inflammatory conditions are characterized by insidious onsets, onset before age 40 to 45 years, improvement with exercise, no improvement with rest, morning pain or stiffness, and greater than three months duration of the pain. Inflammatory back pain that involves sacroiliitis has been shown to be a possible early sign of spondyloarthritis.
lee
A 1980 graduate of Palmer College of Chiropractic, Dr. Kirk Lee is a member of the Palmer College of Chiropractic Post Graduate Faculty and Parker College of Chiropractic Post Graduate Faculty. He has lectured nationwide on sports injuries and the adolescent athlete, and currently practices in Albion, Michigan.

References:
1. Braun J. “The Sacroiliac Joint in Spondyloarthropathies.” Curr Opin Rheumatol. 1996
2. Goodman, CC, Snyder, TEK. Differential Diagnosis in Physical Therapy; 3rd Ed. Philadelphia; Saunders, 2000
3. Khan MA. “Update on Spondyloarthropathies.” Ann Intern Med. 2002
4. Yochum TR, Rowe, LJ. Essentials of Skeletal Radiology, Second Edition: Vols.1 & 2. Williams & Wilkins

Forum: Ben Altadonna Shares His Side of the Story

yellowpagesforumRe: Vol 33, Issue 1

To the Editor:

The American Chiropractor only told one side of the story in its January 2011 issue, when it republished misleading information from the Danville Express in its “Chiropractic Around the World” section.

Contrary to the claims being made by the Alameda County District Attorney, I am not a practicing Chiropractor and never marketed DRX9000 or any other decompression system directly to patients.  I did not develop, manufacture or sell the DRX9000, nor did I create the product advertising claims.

Like many others in our field, I relied on statements from Axiom Worldwide in recommending the DRX9000 to doctors who purchased the product directly from the manufacturer.  I was unaware that some of the information and claims I received from the manufacturer were erroneous and misleading.  My products and services have not contained the manufacturer’s claims since 2006.

:dropcap_open:I intend to vigorously fight these charges to attempt to intimidate Doctors of Chiropractic away from the use of spinal decompression.:quoteleft_close:

My company, The Practice Building Alliance, continues to create high quality patient education material, which have been praised by doctors across the country, including Dr. Michael Roizen, the chief wellness director of the Cleveland Clinic.

I have cooperated fully with the District Attorney, and am disappointed her office has chosen to pursue this misguided, non-criminal civil lawsuit.  The public’s interest would be best served by focusing on Axiom Worldwide, the manufacturer who knowingly created the misleading claims.

In defense of doctor’s right to use this technology, I intend to vigorously fight these charges to attempt to intimidate Doctors of Chiropractic away from the use of spinal decompression.  The fact of the matter is that spinal decompression is extremely safe and continues to help countless back pain sufferers.

I would hope The American Chiropractor would seek to balance its news coverage by providing both sides of an issue in the future.

Sincerely,

 

Ben Altadonnna

 “The Practice Building AllianceTM

Acupuncture and Chiropractic…. Is there a relationship???

It is a historical fact, throughout numerous cultures in the world, spinal vertebral mobilization has been used extensively for literally centuries. Evidence exists from the ancient Mayans, Babylonians, Greeks, Egyptians, Sumerians, American Indian cultures, not to mention virtually every Asian and Middle East country, as well as the European and African nations.

Even though most people who hear the word acupuncture, relate it specifically to a Chinese healing art, the stimulation of certain key skin points on the body have been a part of the healing approach of almost every nation on earth in one form or another. From contemporary motor points, trigger points, reflex points, tender points, to the Indian “marmas,” Aboriginal “wantoo” and the Asian “jing luo mai” or acupuncture points to name just a few cultures, they are all basically the same thing.

When seen by the uninitiated, acupuncture appears to come from ancient methodologies based on myth, and pre-scientific superstition. It bases its energy flow on imaginary channels of which Western science has been unable to prove the physical existence. It has utilized a variety of stimulation devices from rubbing stone or bone over a specific skin point to the most accepted and recognized approach today, which is the insertion of a slender needle just below the surface of the skin. Modern acupuncture procedures, since the mid 20th Century, use TENS, laser and motorized mechanical stimulation to affect the skin point the same as the needle. However, all of these contemporary approaches have only been developed within the last few decades, as their discoveries and application have proven to elicit a similar response as the classic needle.

Acupuncture bases its general philosophy on the Yin and Yang, which are two dynamic polarities which affect all living and other structures of life. It is the positive and the negative. This balance of negative and positive is critical to the healthy functioning of the human body. The ancient Asians had no other way to describe this critical energetic event in the body other than by their own language, thus balancing of the Yin and Yang became paramount within the practice of acupuncture. Many will view the descriptions of acupuncture as being archaic, based on myth and folklore; however, the Asians described these applications and explanations in the only way they could, as Latin had not either been created or had not reached Asia to describe it in terms that a Western scientist today could understand.

On the other side of the world, the founder of the chiropractic profession, Daniel David Palmer, described health and disease in his classic 1910 book, The Science, Art and Philosophy of Chiropractic, sometimes known as The Chiropractors Adjuster. The title page specifically states this science is “Based on Tone.”

D.D. Palmer stated: “Life is the expression of tone. From tone originates all the principles which constitute the science and philosophy of chiropractic. It is a self evident fact that any change in tissue, other than that of normal tension, produces disease. Consequently, the cause of disease is any variation of tone, too much or too little.” This summation of Chiropractic literally parallels the basic concept of Acupuncture, as it describes the balance of Yin and Yang, the negative and positive. For example, on palpation, the DC may find on pressure, exquisitely tender points which are hypo tonic (Yin) or hypertonic (Yang). These tender points, which are utilized globally as “acupuncture points,” rely totally on the balance or imbalance of, as Palmer described it, “Tone.”

From the earliest days of chiropractic’s history, reflex points along the body include “zone therapy” utilizing points on the fingertips and toe tips which unequivocally relate to the famous “tsing” points used in acupuncture. Early DC’s knew of a variety of specific points on the body that, when stimulated, were predicted to elicit a response.

Perhaps the most pertinent of all of the similarities of chiropractic to acupuncture comes from the famous physician Huo Tuo. This physician, revered to this day, discovered over 2,500 years ago a series of acupuncture points which carry his name as the “HuoTuojiaji points.” These points correspond exactly to what would be discovered centuries later as the sympathetic trunk ganglionic chain, which is specific to the chiropractic “chart of spinal subluxations,” and the basis of the so-called “straight” philosophy of chiropractic. In this approach, it is known that the vertebral nerve root of C5 affects the thyroid, whereas the lungs are innervated by T3. This is carried out throughout the entire spine from Atlas to Sacrum. The ancient physicians of Asia and the Middle East were very aware of this approach to healing; D.D. Palmer made use of this ancient knowledge, which launched an entire profession. Today, with acupuncture, the contemporary practitioner makes vital use of the Huo Tuo points, which are one-half inch on either side of the midline of the spine directly over the lamina.

One major similarity of acupuncture and early chiropractic revolves around the ancient physician Mei Hua. Living at approximately the same time period as the previously mentioned Huo Tuo (2,500 years ago), Mei Hua expounded on a specific approach to healing. In this system, in all cases of any illness, before doing anything else, always treat an acupuncture point known as “Jizhong” (Middle of Spine) which today translates to GV6 between T11-T12 vertebrae. In addition, stimulate “shendao”, GV11 between T5-6. This would be followed by stimulating the points at the vertebral level of the spine, namely the famed “HuoTuojiaji” points.

Interestingly, 25 centuries later, D.D. Palmer stated in his early teachings that, in any case of any disease or dysfunction, always adjust “Kidney Place” and “Center Place” before adjusting the vertebral level of the condition. Kidney Place is the segment of T11-T12 (GV6), whereas Center Place is GV11. This approach parallels the Mei Hua approach to health identically, which is thousands of years old. Unfortunately, it is no longer taught in chiropractic but was the basis for the early profession.

There are scores of specific reflex points which have been used by the chiropractic profession in a variety of established chiropractic techniques over the last century. If one uses a needle to stimulate the reflex point then, classically and officially, it is considered “acupuncture”. However, should a practitioner use any physiotherapy modality allowed under their State Law to stimulate the same point, the procedure is referred to as TENS, Reflex Therapy, Trigger Point Therapy, etc. Today, the profession uses a variety of inexpensive electronic, laser and motorized manual approaches with stunning clinical success. It may be practiced by any practitioner, as it is non-invasive and falls within Scope of Practice Laws.

The fact of the matter is that there is a stunning relationship between acupuncture and chiropractic. Unfortunately, most people think of needles when mentioning acupuncture, however it must be borne in mind, just like chiropractic, “Acupuncture is a principle, not a technique.” It is not how you stimulate a specific reflex (acupoints), but where you stimulate.

Learning this work will insure your future clinical, financial and personal success.

Is Your Patient’s Teenager at Risk of Dying from Heart Failure? What Every Parent MUST Know to Prevent Sudden Death!

An athletic 20-year-old man is playing basketball and suddenly collapses on the court and dies.

On a hot July day, a young and vibrant college football player suddenly makes a great tackle and never gets up, only to be pronounced dead 5 minutes later.

High School track runner dies after finishing second in a race.

The sad truth is 1 out of 50,000 young adults will fall victim to Sudden Death.

Most sudden deaths have been linked to a thickened, enlarged heart called hypertrophic cardiomyopathy (HCM), or by a condition that disturbs the rhythm of the heart called an arrhythmia.

When one sweats, a significant amount of magnesium is lost. Magnesium is the most under-recognized electrolyte disorder in the U.S. Dr. Mildred Seelig, one of the country’s leading authorities on magnesium, suggests that 80%-90% of the population is deficient is magnesium

It is beyond the extent of this article why the public is being denied the truth of the seriousness of magnesium deficiency and sudden death. The amount of medical research could fill a book, but it is unfortunately being ignored.

According to Micheal A. Brodsky M.D., associate professor of medicine at the University of Medicine and the director of the Cardiac Arrhythmia Service at the University of California, mineral imbalances interfere with the heart’s normal nerve function.

While most athletes have been conditioned to drink a potassium rich drink after sweating, very few have been educated on the dangers of a magnesium deficiency. Dr. Brodsky states that arrhythmia therapy should focus on replenishing two key minerals: potassium and magnesium.

Almost all physicians have known for some time just how vital potassium is for normal heartbeat. Magnesium is an entirely different story, however.

According to Carla Sueta M.D., Ph.D., assistant professor of medicine and cardiology at the University of North Carolina at Chapel Hill School of Medicine, “apparently many doctors still don’t realize how important a role this mineral can play in some heart patients.

In fact, most never check the magnesium level. She has shown through her research that magnesium reduced the incidence of several types of ventricular arrhythmia by 53 to 76 percent.

Magnesium deficiency can be induced by the very drugs meant to help heart problems. Some types of diuretics (water pills) cause the body to excrete both magnesium and potassium, as does digitalis.

And magnesium deficiency is often at the bottom of what’s called refractory potassium deficiency. The amount of magnesium in the body determines the amount of a particular enzyme that determines the amount of potassium in the body,” he explains. So, if you are magnesium-deficient, you may, in turn, be potassium-deficient, and no amount of potassium is going to correct this unless you are also getting enough magnesium.

 

The Best Test to Determine Your Level of Magnesium

Although most physicians rarely check this important mineral, the few that do usually rely on a test called Serum Magnesium. Unfortunately, this test only measures approximately 1% of the magnesium in your body; a poor test at best.

The “Gold Standard” and the most accurate test is the RBC Minerals or more commonly called Elemental Analysis in Packed Erythrocytes. This test examines the levels of eight minerals and seven toxic heavy metals. The erythrocyte is the red blood cell that floats in our serum to carry oxygen to our cells.

The minerals this test analyzes from inside the red blood cell include magnesium, manganese, molybdenum, potassium, selenium, vanadium and zinc.

Another test which has proven to be extremely valuable in detecting magnesium deficiencies is called the Urine Magnesium Loading Test. In this test, the patient collects a 24-hour urine sample and the total magnesium is measured. The patient is then given a dose Magnesium Chloride 18% and another 24-hour urine specimen is collected. The magnesium is again measured. If the body retains more than a certain amount of magnesium, then it is concluded that the body is magnesium deficient.

 

Common Symptoms of Magnesium Deficiency

The most common symptoms include back and neck pain, muscle spasms, anxiety, panic disorders, Raynaud’s spastic vessels, arrhythmia, fatigue, eye twitches, vertigo, migraines.

 

Best Sources of Magnesium

The best way of insuring enough magnesium is to eat a variety of whole foods, including whole grains, nuts, seeds and vegetables, preferably food grown on naturally composted soil. The green color of green vegetables is due to chlorophyll, which is a molecule that contains magnesium. Avoid refined processed foods, especially white sugar and white flour products, as most magnesium is removed from them.

Here is an excellent form of magnesium I recommend: Magnesium Chloride Liquid.

 

Dr. Grisanti’s Comments:

If you are suffering with a heart problem and have not had your magnesium checked, then I want to urge you to have your physician order one or both of the tests listed above. Unless you have proof that your magnesium is within normal levels, I want you to realize that you are playing with your health!

 

Ronald Grisanti D.C., D.A.B.C.O., M.S., is medical director of Functional Medicine University. If interested in improving your diagnostic skills and increasing your community reputation and recognition, we strongly recommend subscribing to our Free Clinical Rounds Series. These challenging case studies will give you the unique opportunity to test your clinical skills and, at the same time, improve your ability to handle many of the most difficult cases. Go to the following link to get your free access: www.Clinical-Rounds.com.

 

References

Eisenberg MJ, Magnesium deficiency and sudden death (editorial), AM Heart J 1992 Aug; 124(2):544-9.

Ferrè S, Baldoli E, Leidi M, Maier JA., Magnesium deficiency promotes a pro-atherogenic phenotype in cultured human endothelial cells via activation of NFkB., Biochim Biophys Acta. 2010 Jun 30,

Magnes Res 1994 Jun;7(2):145-53

Tzivoni, Dan, M.D. and Keren, Andre, M.D., “Suppression of Ventricular Arrhythmias by Magnesium”, The American Journal of Cardiology, June 1, 1990;65:1397-1399.

Keller, Peter K. and Aronson, Ronald S., “The Role of Magnesium in Cardiac Arrhythmias,” Progress in Cardiovascular Diseases, May/June 1990;32(6):433-448.

Practical Briefings: Clinical News You Can Put Into Your Practice Now. Ventricular Arrhythmias and Magnesium,” Patient Care, October 15, 1990;16-20

Magnes Res 1993 Jun;6(2):191-2

Am J Cardiol 1992 Oct 8;70(10):44C-49C

Creating a Strong Positive First Impression with Technology

Over the past 20 years, I have had the opportunity to work with some brilliant Chiropractors. As per the nature of the profession, DC’s are warriors in what they do. They keep working hard with chiropractic education, marketing, managing a business, managing staff, finding explanations to health problems for thousands of patients, learning how to get better for themselves, for their practice and much, much more. Chiropractors do all this for one single purpose: restoring their patients’ health to their best. Unfortunately, this is not necessarily the first perception for new patients. For most of them, it could be their first time in a chiropractic office. For others, it may be a second trial, as the first chiropractor, in the patient’s perception, did not meet their expectations. For other new patients, they have tried everything else and nothing has worked, so they decide to go and give a try to chiropractic. I am using the word “try,” because they have much more doubt than faith. So the doctor has to go through a convincing period of explaining what they do, how long it will take, show the new patients testimonies from other patients and you know what? Many new patients still don’t accept care. I have witnessed many DC’s having to deal with this on a daily basis when what they really want to do is treat the patients and give them a good quality of life.

You are a great doctor and you know you can help the patients, but this will happen only if they give you a chance. On many occasions, the patient’s mind is already made up before you even say a word. As everyone knows, you never get a second chance to build a positive first impression. This is also true in chiropractic. The first time new patients comes to your office is probably when they will decide to follow your care or not. Creating a strong positive first impression is crucial in getting the new patients under care and growing a chiropractic office. Doctors have more tools than they think they have to make this great first impression. On many occasions, the patients make their decision of whether to accept care within the first few minutes when they walk in the office, not when they first meet the doctor. Their decision is based on how the office looks, how friendly the staff is, how technically advanced the office is, and other factors when they sit in the waiting room.

In many very successful practices I have been in, this first impression starts with a very well organized guided clinic tour, so the doctor takes control over this first impression. As the new patients walk through the clinic, they build their own opinion. It is much better to tell the patients what is going on, rather than to let them guess. This clinic tour has to be well-planned. The first step in creating this plan is to make an inventory of what is different, unique or better about your clinic. Ask yourself why a patient would want to start care rather than go somewhere else. Look for things like the doctors accolades, types of therapies available, technological advances in your practice, like EHR systems or digital X-Rays. Imagine yourself as a patient going to the dentist. When you walk in, what would you want to see: a grumpy assistant with piles of paper, an old sign-in sheet that has been just flipped over to a new day, an old chair with files around it? Or would you rather see a happy assistant, with no paper around, a clean desk and at the dental chair, you can see your mouth digital X-Ray and detailed documentation on a computerized station? Which of these offices would you want to start care with?

Most great clinic tours start with the CA explaining to the new patients the first day process. If your clinic is using an automated paperless system and you give each patient a bar coded Chiropractic Health Card, the success of this tour gets much easier. You start the tour by giving the Chiropractic Health Card to the patients and you explain the automated process they will follow on each treatment. The concept is to make the patients feel like they are already your patients. In other words, they are in until they are out, instead of out until they are in. The CA then walks the patients around the clinic. The first stop may be in the therapy room, where the CA will explain the therapy process. The CA will explain that the office is equipped with the latest technology to help them in achieving health. The second stop may be to the X-Ray room, to show the patients that this on-site X-Ray machine will provide the doctor with precise information on the cause of the pain. Walk the patients in one of the treatment rooms. Again, take the opportunity to explain to the patients that the EHR you are using is so advanced that the doctor will have the patient’s X-Rays on the computer screen on all visits. You may take an extra minute or two to explain to the patients all the great information available to the doctor on the EHR screen. This is a direct transfusion of trust in the patient’s mind. Patients will feel the doctor is very well organized to provide the best care possible. At the end of the tour, back at the front desk area, hand out literature or pamphlets explaining what you do. Well-planned and well done, this clinic tour will impress new patients and will build confidence. This is the goal. If you give your patients a proper office tour, they will be so impressed with your office, they will tell other people. If you are excited about your practice, it will be much easier to get your patients excited, too. When you install a new X-Ray machine, a new therapy tool or new automated EHR software, it is very easy for the doctor and the staff to be excited and pass it on to the patients. The hard part is to keep that excitement over time. And I am not talking about weeks, but years. All very successful doctors I know are more excited now about their practice, their staff and their office then when they first started.

This tour is quite simple to implement and it really works. Create a great first impression and make it much easier for patients to accept your care.

EHR Certification: NOT Only For Medicare and Needed to Survive Health Care Reform

The handwriting is on the wall. Are you paying attention? The government has mandated that the Electronic Health Record (EHR) computer software that you use in your office must be certified in order to qualify for the Medicare stimulus of up to $44,000.00. It is also mandating certified EHR as part of Health Care Reform.

 

The certification is based on the Meaningful Use rules created by the government, and it is very clear that some of the Meaningful Use rules have NOTHING to do with Medicare. Included in the Meaningful Use rules are requirements for the software to record and keep track of the [1] smoking habits of each patient that is 13 and older, [2] growth charts for all patients between the ages of 2 and 20, and [3] body mass index (BMI) for each patient above the age of 2. The overwhelming majority of patients in these age groups are not covered by Medicare.

 

The Health Care Reform legislation also has hidden requirements. As Nancy Pelosi said, the bill “had to be passed for us to find out what is in it.” On April 8, 2010, the Health Care Department of Barnes & Thornburg LLP (a law firm) published an Alert in which they stated Several components of the healthcare reform legislation will explicitly or implicitly require providers to use EHR technology ….”. And since the EHR must comply with Meaningful Use, it must be certified.

 

What does this mean for you and your practice? Whether you like it or not, the expectation is that both the government and the insurance industry are going to mandate certified EHR even for those offices that never work with Medicare. When will this happen? At this point no one knows definitively, but the best guess is within the next year or 2. The bottom line is that if you are using an older computer program, you will need to upgrade to a certified system or NOT get paid by insurance.

 

How do you get a certified EHR system? The producer of your software must apply, get tested, and pass the test, or you must buy a certified EHR system. Why was it not available sooner? Because the government issued the Final Meaningful Use Rule in July but did not authorize any entity to test and certify until August 31. Applications could not be filed until September, and testing began in late October. As this is written, there are only 2 Chiropractic specific certified software systems.

 

You can start now to get certified software. Start with the company that makes the program that you already have and ask if they are going to get or already have certification. If yes, then find out [1] is there an additional charge to upgrade and how much it costs, and [2] if they do not have it yet, when do they expect to get the certification. Some companies are not charging their current clients to upgrade as part of their support. Others will charge an upgrade fee that may be as high as several thousand dollars. Some companies have been vigorously working on the certification while others may not get the certification until next year or beyond, or may not be working on the certification at all. If your current computer software vendor is not working on the certification, then the time has come to search for another computer system that will be certified in the near future.

 

Make sure your office is ready for the government and insurance requirements that come from the numerous pieces of legislation enacted into law since January 2009 that go into effect on January 1, 2011. 2011 is almost here. The bureaucrats have issued their edicts, and now we are stuck having to comply with them. Due to the ever increasing government mandates for certified EHR the costs of EHR systems are only going to increase over time. The sooner you obtain an EHR that will be/is certified, the less expensive will be your investment.

 

Push has come to shove, and the government is pushing us hard. Act now to protect your practice.

Providing Care to a Younger Generation

 Recent years have invited many evolutions in the way we communicate and in the way we hold our bodies throughout the day. These evolutions are giving rise to a rash of new complications as patients start walking through the office door with neck and shoulder pain, pinched nerves, and headaches. The cause? This infiltration of handheld devices into our every waking moment has us all looking down—to text friends, family and business contacts. Enter the new age of digital trauma and the addition of modern ailments, such as the insidious explosion of disorders associated with reading ones blackberry or android, handheld nintendo, and you begin to notice an epidemic. This latest epidemic has our younger, possibly under-considered community members, surfacing in masses and finding their way into our practices.

This new influx of young adults is an ideal place to begin planting seeds and educating the next generation about the benefits of chiropractic. With accurate treatment plans, patient education that extends beyond advising them on how to relieve imminent distress, and follow-up appointments that do more than simply send them on their way, we can start building long-term relationships that will outlast the latest gadgets they hold in their hands. And keep in mind…with every technological ailment, there is an associated piece of technology with the capability to refer your services to droves of new patients with the same habits who could benefit from the same chiropractic support and education.

We have an opportunity here to reach out to an underserviced subsection of our community. The simple fact that we may not see young adults as commonly as those in other age brackets necessitates a customized approach to patient retention and referrals.

 

Meet Them on Their Level

Understand their lifestyle and activities. What they are doing these days may be much different than what you were doing at that age. Do you understand the lifestyle of the modern young adult? Are you sensitive to their daily activities and can you diagnose their ailments and identify their triggers, based on your understanding of their environment and their habits? Take some time to learn what’s changed in the everyday life of the young adult.


Connect to the Greater Consciousness

According to a new study from the Pew Internet Project, 72% of cell phone users send and receive text messages, 38% access the internet, and 52% have apps on their phones. Typical American teens are texting 50 messages a day on average. Connections and referrals no longer only occur during an in-person meeting or a discussion over a neighbourly fence. More and more people are doing the majority of their communication remotely. Make sure you are doing all you can to integrate your practice into the web and take advantage of the booming social media society.


Cater to Their Activities

In addition to technology, there are many additional areas of a young patient’s life where we can address their routine. Imagine treating one young adult who plays sports on a team. Helping that patient with sport-specific treatment that yields results can give way to entire teams of potential new patients. You’d be surprised how much business can be generated just by showing up to a game or two and speaking with the coach about the unique needs of the team.

 

Encountering a patient in their younger years ingrains a familiarity with chiropractic that can last a lifetime. As technology evolves, the habits—and, therefore, the needs of our youth—are evolving along with it. Seizing the opportunity to address these unique habits can bring your practice into the technological loop of the younger generation and allow you the chance to bring them up-to-date on how chiropractic can address their unique challenges and fit into their today and, also, their tomorrow.

Our Profession Needs Official Chiropractic Spokespersons

    We can all agree that if the public truly understood chiropractic’s therapeutic superiority for safely correcting many of the musculoskeletal and stress related ailments which are being treated with dangerous drugs and surgery that chiropractic would multiply in public utilization and respect. Instead we are permitting a massive public ignorance and misinformation to prevent rational utilization of chiropractic while our naysayers discourage any chiropractors from going to the media and press to set the record straight. They insist that going on talk shows would confuse the public as to what chiropractic is because all chiropractors do not think alike. The naysayers insist that we should hire a public relations firm and give them a million dollars and let them define what we are and what we do. In my opinion this is a mindless and short sighted way of thinking as well as being insulting to chiropractors. Furthermore it is counterproductive. No healthcare profession will always agree on everything. It is unrealistic and naive to think we can ever get 70,000 chiropractors or individuals of any group to agree on everything. That’s common sense. It will never happen.

Our facts supporting chiropractic over medicine are so overwhelmingly in favor of chiropractic care for many musculoskeletal and stress related ailments that it’s a no-brainer. Look at the New Zealand Report, the British Medical Research Council, the Canadian Study which was headed by Dr. Pran Manga, the world renowned RAND Corporation (Acronym for Research and Development), the worker’s compensation studies from States such as California, Oregon, Utah, and many, many others. We’ll not go into detail on these studies here since they have been covered many times in our journals. All of these studies bring out the therapeutic superiority, safety and cost effectiveness of chiropractic but thanks to the naysayers we aren’t bringing these facts out to the public with carefully selected chiropractic spokespersons. I don’t know of a single State chiropractic organization that has adopted a spokesperson program. Meanwhile our naysayers are erecting barriers against chiropractic going to the media and press with these facts.

The most cost efficient and credible approach to getting the message out to the public is for each State chiropractic association to carefully select chiropractors who have the interest, desire and willingness to contact every radio and television station within their State with our facts and get on their talk shows. Give them titles as “Official Chiropractic Spokespersons” and make sure that they agree to express only the views of their organization and NOT their personal views. To scuttle a spokesperson program over fears of minute differences is very foolish and self destructive. The naysayers need to shut up and stop being so paranoid and look at the big picture which is a lack of closer inter-professional cooperation which is killing 3,000 people every week from unnecessary surgery and medication reaction.

Our naysayers at one time insisted that we shouldn’t sue the AMA because it would make them angry at us and that they would retaliate against us. Big deal! It never happened. Instead the defendants hovered into a corner like a bunch of cowards. The chief architect of the “containment and elimination of chiropractic” Doyl Taylor took an early retirement and fled to Arizona and had his son come to court and testify that his father had crippling arthritis and could not come to court. Meanwhile, we learned that papa was on the golf course golfing every day which is hardly a pastime for someone too crippled to testify. In our second trial we were able to force Taylor to take a video deposition a nd he admitted under oath that he did not know if his information was fraudulent and he didn’t care. He was a disgrace to the AMA and everything that is decent and proper in healthcare. Doyl Taylor and the AMA spent millions of dollars and eleven years trashing chiropractic with proven lies and creating a stigma against chiropractic which remains to this day. The public needs to know this and we can’t expect organized medicine to publicly admit to the people their dishonest conduct and ask us for our forgiveness. (Although they were forced to publish it in their journal) We must expose their lies.

During WWII Dr. Irvin Hendryson who was a member of the AMA Board of Trustees conducted a clinical study of a chiropractor within an U.S. Army Hospital. The study showed that chiropractic was therapeutically effective but the AMA buried this information for over fifty years and then disseminated its lies contradictory to its own study. It took our lawsuit and a threat of a contempt of court citation before the AMA grudgingly released the WWII chiropractic hospital study for public information. The public needs to know how dishonest the AMA has been and why such misconception of chiropractic exists.

If we took all the past scandalous behavior of the AMA and combined it with the staggering malpractice problem they have they are very vulnerable to criticism. Meanwhile our naysayers are concerned about a small speck that chiropractic had in its eye and so they are afraid to expose the huge log that political medicine has in its eye. Chiropractors can purchase an entire year of malpractice insurance for about the same price that some MD’s pay just to get one or two weeks coverage. Actuaries establish the insurance rates based on incidence of injuries based on facts and NOT bias. Chiropractic is the safest healthcare profession in the world proven by these actuarial studies while medicine is one of the most dangerous.

Go to www.chesterwilk.com and view my documentary which tells it like it is. The insight company produced this documentary and they say it will reach tens of millions of households world-wide. Celebrity host Hugh Downs will do the introduction of this documentary on TV in all fifty States on cable television. When you combine the positives and negatives you create electricity. You can’t have electricity without a positive and negative pole, and you can’t have a powerful message without using the positives of chiropractic with the negatives of medicine. But it must be done with accuracy, credibility and authority if it is to have viewer and listener impact. I can work with any State chiropractic organization willing to get started with this vital program.

The official chiropractic spokesperson program requires a doctor with a special kind of interest and temperament to want to get on talk shows and face the public. The State associations need to search out these special chiropractors and give them the job. They need to be knowledgeable, articulate and trustworthy and have the desire to do this kind of thing. It can be challenging but very rewarding and satisfying. Every State association has the potential of contacting dozens of talk shows. If official chiropractic spokespersons succeed with getting on ten to twenty percent of the talk shows contacted the impact can be great. If this is done simultaneously in all fifty States the impact would be phenomenal.

The best part is that radio stations can patch our chiropractic spokespersons into their studio by phone and their message can be heard even nationwide. The spokespersons won’t even have to leave their homes or offices, and it won’t cost an arm and a leg while the P-R is very credible.

Talk show producers often ask, “Who do you represent?” If it is a private caller their chances of getting on any talk shows are slim, but as an official State chiropractic organization spokespersons their chances are improved a hundred-fold. The producers realize that a spokesperson speaks for hundreds or thousands of chiropractors and potentially millions of patients. Ideally more than one official spokesperson per State multiplies the exposure. It is extremely important that spokespersons have official letterheads from their State associations to show that they are genuine spokespersons.

The bottom line is that the chiropractic profession needs to wake up and become PROACTIVE instead of REACTIVE! Until chiropractors wise up and adopt this proactive program of educating the public in every State, they will continue to face public ignorance and remain the underdogs excluded from hospitals while struggling with insurance companies such as Kaiser Permanente Mid Atlantic States, or defending our right diagnose such as in Texas, or forever defending chiropractic’s safety as not causing strokes. If we don’t become proactive we will forever be fighting these “forest fires.”

Our lawsuit helped level the playing field but we must assertively and proactively take advantage of what he have going for us. There are special radio and television media directories available on the market providing all of the radio and television stations in the country. These directories provide the locations, direct telephone numbers, fax numbers, e-mails and subjects they interview. The directories provide the names of all of the producers on every talk show so you can call them and ask for them by name which gives you the advantage. For example, Oprah has seventy-four producers and the directory provides all of their names. If one producer does not accept what you offer you try another. The directories provide advice on what approach a particular talk show prefers that you use whether it be fax, e-mail or direct phone calls, etc. These directories will be our vital weapon for truth and public education and can be handed to us on a silver platter if we have the common sense to use them. Christ instructed us that if we have a light we don’t put it under a basket or a bowl.

These national radio and TV directories are really great and they are protected by copyright and cannot be photocopied but our national organizations should purchase them and divide them up between the State organizations. The directories are not cheap but they are worth every penny if you use them. Spokespersons using these directories will be able to compete with the billion dollars a month P-R program of the drug houses and come out winners because we have the truth and solid facts on our side. The question is if we have the common sense to use them. I hope so for the sake of our patients and especially the 90% of the people who do not use chiropractic care.

 

Dr. Wilk is available to speak at the State conventions to provide the preparation and documentation to speak with authority, impact, accuracy and credibility. Dr. Chester Wilk, 1700 Des Plaines Ave, Park Ridge, IL 60068. Tel. 847 825 0500.