Chiropractic Treatment for Fibromyalgia

They usually come in “hurting all over.” They often are depressed, discouraged and not sleeping well. They frequently arise stiff and sore in the morning, feeling fatigued.

They have suffered bouts of irritable bowel symptoms. They appear anxious and feel chronically “burned out.” According to the American Academy of Rheumatology (ACR), 3 million to 6 million Americans suffer from some form of the disorder fibromyalgia. A majority of them are women of childbearing age. However, fibromyalgia also can affect children, the elderly and men.

Conventional Wisdom

Fibromyalgia is characterized by widespread muscle, ligament and tendon pain, chronic fatigue and multiple areas of trigger-point tenderness. The condition was recognized in previous generations, but was known by other names such as muscular rheumatism, fibrocitis and tension myalgia.

Allopathic medicine does not recognize a cause for fibromyalgia. Current thinking centers on internal imbalances that cause an increase in sensitivity to pain signals. Sleep disturbance, past injury, infection, metabolic muscle changes, hormonal imbalance and stress are other considerations in the etiology of fibromyalgia. Interestingly for chiropractors, abnormalities of sympathetic nervous system function also have been postulated as a factor in its etiology.

Diagnosing fibromyalgia can be difficult, as it can mimic many other disorders. The ACR has established the criteria of at least three months of chronic widespread pain and tenderness in at least 11 of 18 specific trigger-point sites.

Medical treatment involves recommendations for aerobic exercise such as swimming and walking, heat and massage treatments, antidepressant and analgesic/muscle relaxant medications, sleep aids, physical therapy and relaxation techniques of guided imagery. Many physicians also recommend stress-management strategies, improved diet and a healthier lifestyle.

Alternative/Holistic Perspective

Many in the alternative health care community see systemic toxicity as a fundamental consideration in fibromyalgia. They believe physiological disturbances from impaired heart, liver, lung and kidney function are at the root of the problem. As we know, the liver and kidneys are the primary detoxifiers of the body. Thus, systemic toxicity (autointoxication) can be the end result of impaired function in these organs.

As specialists in neuromusculoskeletal disorders, we can forget that life itself, as we know it, is basically an electromagnetic phenomenon. In the East, they describe this essential internal energy reserve as qi. Some even see the liver and kidneys as akin to batteries of the body, with the liver serving as the positive pole and the kidneys as the negative. When these organs are deficient in functioning, the body’s “battery” is said to be run down. Chronic fatigue, low vitality and organic depression are the result, features common in fibromyalgia patients.

Just as the internal composition of a regular battery can influence its charge, the inner atmosphere of the human body can influence its vitality and strength. Scientific evidence increasingly points to the fact that, for maximum health and wellness, we should be primarily vegetarians, with fruits and vegetables making up the great majority (70 percent to 80 percent) of consumed food. Good-quality grains, nuts and oils, dairy and lean meats should make up the other 20 percent to 30 percent. This has an anti-inflammatory effect and creates an alkalized internal atmosphere, which also produces the health benefit of discouraging reproduction of most pH-dependent human pathogens that are acid-loving.

Therapeutic Regimen

Systemic toxicity demands that primary attention be given to the basic processes of adequate hydration and increased eliminations. My personal observation is that very few patients consume sufficient water for bodily needs, which is estimated to be at least 64 ounces (eight glasses) daily. They tend to try and substitute colas, teas and coffee, all of which are diuretic, resulting in little or no net fluid gain. Almost all human biochemical processes require hydrogen. Without sufficient hydration, these processes slow, contributing to fatigue and accentuating the accumulation of metabolic wastes. Under- or frank dehydration also slows bowel motility, which contributes to reabsorption of toxic waste into the general circulation. “Water is medicine” is my advice to these patients, along with a cleansing diet of fresh fruits and vegetables. Enemas and laxatives also might be useful in internal cleansing, especially if a patient has been constipated. For the most severe cases of long-standing autointoxication, I recommend patients consider a series of colonic irrigations.

Manual therapy (spinal adjustment and massage) will prove very beneficial to most sufferers of fibromyalgia. Spinal biomechanical lesions and nerve “impingements” almost always reflexly stimulate some degree of associated regional muscular spasm, which leads to a relative ischemia and toxemia in and around the tissue. Chronic, long-standing myospasm creates adhesions, scarring and fibrosis.

In applying any form of manual therapy to those with fibromyalgia, one should take great care in the early stages. Since these patients have heightened sensitization to pain, overly aggressive, ham-fisted approaches to treatment often will backfire, creating such additional suffering pain as to lose a patient. In the early days, many osteopaths and chiropractors recommended sustained anti-inflammatory measures such as repetitive cold packs and a series of hands-on massages before even attempting spinal manipulation for those with severe pain syndromes.

In recommending dietary changes to patients, I have found it beneficial to discuss the “opportunity of illness.” While this sounds counterintuitive, I explain that the reason for the pain signal is to alert them to the underlying condition that needs to be changed for the better. I believe most frank pathology is the result of long-term imbalance in normal physiology, often caused by errors in diet and lifestyle and exacerbated by past injury or chronic inflammation.

Some form of moderate exercise such as walking or swimming is essential to recovery from fibromyalgia. Also frequently beneficial is the discipline of yoga-type stretching. Being out in the open as much as possible while exercising has been shown to be superior to time spent inside on the treadmill. Both walking and swimming mobilize needed lymphatic flow in the body. Arm swings pump this “dirty seawater” back into the veins under the clavicle, where it eventually is cleansed. Of course, the skin and lungs play an important role in metabolic waste elimination as well, so heating a well-hydrated body (hot baths, sauna) to create increased heart rate, perspiration and aerobic breathing also is beneficial.

Finally, “the mind is the builder, or the mind is the slayer” is a well-recognized axiom that acknowledges the health or disease effect of attitude and emotion. Fear-filled, angry folk who habitually engage in what motivational speaker Zig Ziglar called “stinking thinking,” eventually pay a price in their body’s lack of wellness. Taking in lots of information that creates distress and inner turmoil, while feeling completely helpless to improve the situation, is what Hans Selye (who coined the term stress) called “pathologically alarming” to us human animals. Conversely, time spent in reading and positive thought of our highest purposes and ideals can contribute substantially to the healing process.

Fibromyalgia can be healed and left behind in a person’s life experience. Recognizing its multi-faceted causes and taking a comprehensive approach to its treatment is essential to success in your efforts as true healer.

Managing Your Clinic Budget

I’m sure you’ve heard the statement, “Follow the money.” It’s been used in many situations. I thought it time we followed the money and saw where it goes. You might be surprised.

We’ll start with the money coming into your office. We’ll use $1 and see the path it follows. That dollar walks into your office and is handed to your CA. Since it’s handed to a CA, we must not forget certain expenses are involved long before that dollar walks in. Of course, those expenses are referred to as “overhead.” What constitutes overhead? Everything it takes to get that dollar into the office, the expense for that office and the salary for that CA to be there to accept that dollar. Sounds like a lot, and in many instances it is. Many times it’s too much.

What is a good overhead?

Anything below 50 percent is great. Overhead can consume a great number of the dollars that come into your office. The ultimate goal is to get some of those dollars into your own pocket. For this exercise, we’ll assume the overhead in your office is running at 50 percent. This means 50 cents are gone immediately to cover the overhead, which leaves us with just 50 cents. I have seen scenarios in which the balance is 25 cents or even 15 cents – not a good situation to be in.

Overhead can get out of control very quickly. The one situation I have seen that causes excessive overhead is having too many employees. This happens in a busy office when the CA complains to the doctor that there is just too much work for one person to handle. So, the doc hires another employee and now the workload gets split between two people. Does more work get done? Usually not. One way to cure this problem is to have job descriptions for each employee. It should cover every task they should be doing, even down to who answers the phone after how many rings, and who empties the trash cans and when. Every detail needs to be covered. If not, the employee list grows and grows, but no additional work gets done. I always say that when I go into an office and there are more CAs on their side of the desk than there are patients on the other side of the desk, there is a major overhead problem.

OK, so we now have our 50 cents left. So what do you do with it? Not much, because your partner now wants to be involved. This partner is not one who works in the office to generate more dollars. This one just wants a cut of every dollar you bring in. This one actually is a relative, but not your spouse or kids. It’s “Uncle Sam,” better known as the IRS. It wants its “fair share.” The sad thing is that most people not only give the IRS its fair share; they give them additional dollars as well, and the IRS never complains when it gets too much. The complaints come when it doesn’t get its fair share! We’ll assume the fair share in this example is 25 cents to cover federal, state, city and any other local taxes. That’s enough!

Now we are left with 25 cents. A dollar walked in the door and before you could put it into your pocket, 75 cents disappeared – gone, vanished, never to be seen again. Sad but true. It’s amazing when you think about all the effort that goes into getting that dollar in the door and before you know it – poof – all that’s left is just 25 cents.

So, if all that’s left is just one quarter, what do you do with it? Well, before you start dreaming about some exotic cars or trips, let’s not forget there is another “overhead” to deal with. Rent or mortgage payments, food, clothing, insurance, car expenses, kids’ education – the list just goes on and on. Now you have all of the “personal” overhead to be covered by that quarter. It takes a lot of quarters to cover that overhead and job descriptions won’t help with this one! I’m tired just thinking about it. How much of that small quarter gets eaten up here? It can consume all of it and then some if you aren’t careful. For this example, we’ll say that 75 percent is needed to cover the personal overhead. That’s 18 cents, which leaves us with just 7 cents of that original dollar to satisfy our dreams and our plans for the future.

Want to retire when you’re age 50? Good luck! You’ve got 7 cents to get the job done. How about that education for your kids at that fancy Ivy League college? Will 7 cents do it? It’s got to. I know this sounds like a horror story, but it’s what happens in the real world. That dollar gets chopped up into a lot of pieces, and the piece you get isn’t very large.

You have to do two things. Number one is to make sure you have a lot of those dollars coming into the office and make sure the overhead, taxes and personal expenses don’t consume too much. The second task is to invest and use what’s left very carefully. Can the job be done on just 7 cents? Yes it can, as long as you take the time to explore all of the options available to you. The goals you have might be large and the amount you have to work with might be small. However, if handled properly, the rewards will be abundant.

With the economy in a tailspin, you really need to pay close attention to those pennies you have left in your pocket. I am not preaching doom and gloom, but what I’m saying is that you need to be very careful and plan ahead. It’s time to review your operations and make sure you’re getting the maximum out of those 7 cents you have left out of every dollar.

Areas You Should Look At

Insurance. Make sure your coverage is up to date and use deductibles to keep your costs down. Some of your policies are business expenses, so you get a tax deduction for the premium. Do you have a list of all the expenses that qualify? If not, get one.

Banks. Do you have a lot of money sitting in the bank? You might want to move some to a money market account to maximize its earnings. When was the last time you spoke to your banker about all the fees you’re paying? It’s time!

Cash. Got any? Put it to work. Don’t have any? Start a cash/emergency fund today.

Credit Cards. Have you called to get your rate lowered? Sixty percent of people who call get a rate reduction. What are you waiting for? They won’t call you!

Retirement. Do you have a plan? You really need to take a good, long look at the nonqualified plan that puts more away for you and gives you a tax-free retirement.

What it all boils down to is that it’s your money, and you need to know where it all goes and why.

Chiropractic Clinical Compass

The Council on Chiropractic Guidelines and Practice Parameters (CCGPP) is poised to release two additional elements of its ongoing best-practices initiative, The Chiropractic Clinical Compass.

Both documents will be available online for 60 days for stakeholder review and commentary following their release.

As of press time, “Chiropractic Management of Low Back Disorders,” a summary report, is scheduled to be posted online June 1, 2008, while “Manipulative Therapy of Lower Extremity Conditions,” an evidence synthesis included in the “Chiropractic Management of Lower Extremity Disorders” chapter (chapter five), is scheduled to be posted on June 15.

Acceptable commentary includes a discussion of the conclusions, submission of additional literature for review, and/or editorial suggestions. As with previous chapters, once comments are received and any revisions are made, the documents eventually will be published in their final forms as clinically relevant information for the chiropractic practice.

Thus far, the council has released four draft chapters for stakeholder review and comment. “Chiropractic Management of Low Back Pain and Low Back Related Leg Complaints,” the first chapter comprising the Clinical Compass, was released in May 2006. “Chiropractic Management of Prevention and Health Promotion; Nonmusculoskeletal Conditions; and Conditions of the Elderly, Children and Pregnant Women,” was released in September 2007. “Chiropractic Management of Upper Extremity Pain,” was released in October 2007. And “Chiropractic Management of Soft-Tissue Disorders” was released on March 6, 2008.

Medicare Billing Issues

Sometimes it seems as if the American Chiropractic Association (ACA) and the International Chiropractors Association (ICA) don’t agree on much, but both recently stepped forward to address chiropractic and Medicare billing issues.

Each group sees Medicare billing issues as a significant and potentially dangerous problem currently facing the chiropractic profession.

The ACA is concerned that continued high claims error rates will be used as an argument against allowing chiropractors to provide additional services under Medicare. In an April 4, 2008 letter to state chiropractic licensing boards, ACA President Glenn Manceaux, DC, noted that the Centers for Medicare and Medicaid Services (CMS) is scheduled to issue a special report to Congress in 2009, detailing the results of the Medicare Chiropractic Demonstration Project.

“It is abundantly clear that unless we can convincingly demonstrate that our profession has put into place various educational and training programs, along with policies and requirements that will collectively lead to a significant reduction in Medicare claims errors, then the U.S. Congress will likely reject any proposals allowing DCs to provide additional services within Medicare,” Dr. Manceaux said. “The ACA is fully prepared to wage an intensive battle to secure expanded and permanent chiropractic benefits under the Medicare program; however, we need the support of every chiropractic organization and every chiropractic office across the country.”

For its part, the ICA held its first National Conference on the Future of Chiropractic in Medicare April 24, 2008 in Washington, D.C. In the day-long session, 17 presenters covered a variety of topics such as the Recovery Audit Contractors Program Medicare has implemented, various documentation challenges, the Medicare Chiropractic Demonstration Project and Medicare savings accounts. The ICA also invited three members of the U.S. House of Representatives and a state senator to attend. Rep. Bob Filner (D-Calif.), Rep. Kathy McMorris Rogers (R-Wash.), and Rep. Don Manzullo (R-Ill.), and Sen. Ben Cardin (D-Md.) offered widely divergent views on how national Medicare policy can and should be adjusted to meet rising demands.

“It is clear that there is a massive amount of work that needs to be done to secure chiropractic’s rightful place in the Medicare program and in any national healthcare reform initiative,” said ICA President Dr. John K. Maltby. “The ICA recognizes that it will take an historic cooperative effort to achieve success and the ICA hopes that the conference represents a first step along that path.”

The ICA also released a white paper titled “The Future of Chiropractic in Medicare.” The white paper states, in part, “Chiropractic’s position in this massive program, while statistically small, is vitally important to the millions of Medicare beneficiaries who seek chiropractic care as their personal choice. According to the U.S. Department of Health and Human Services, Medicare reimbursement for chiropractic services has grown significantly in recent years, from $255 million for 11.2 million chiropractic adjustments in 1994 to $683 million in 2004, for 21 million chiropractic adjustments. For the current year, estimates are for expenditures upwards of $724.”

The authors go on to say, “In the coming period of national debate on Medicare, the chiropractic profession must position itself as an uncompromising champion of patient rights and competition in the Medicare system.”

Vitamin D may protect against peripheral artery disease

People with low vitamin D levels may face an increased risk for peripheral artery disease (PAD), according to researchers at the Albert Einstein College of Medicine at Yeshiva University. The scientists reported their findings at the American Heart Association’s Arteriosclerosis, Thrombosis, and Vascular Biology Annual Conference 2008.

PAD is a common disease that occurs when arteries in the legs become narrowed by fatty deposits, causing pain and numbness and impairing the ability to walk. PAD affects about eight million Americans and is associated with significant disease and death, according to the American Heart Association.

People obtain vitamin D by making it themselves (through skin exposure to sunlight), by ingesting foods such as fish and fortified dairy products that contain vitamin D, or by taking dietary supplements. Adequate vitamin D levels are necessary for bone health, but scientists are only beginning to explore vitamin D’s connection to cardiovascular disease.

To see whether vitamin D might influence PAD, researchers analyzed data from a national survey measuring vitamin D levels in the blood of 4,839 U.S. adults. The survey tested these people using the ankle-brachial index, a screening tool for PAD that measures blood flow to the legs.

The researchers found that higher levels of vitamin D were associated with a lower prevalence of PAD. When researchers adjusted for age, sex, race, and co-existing health problems, they found that PAD was 64 percent more common in the group with the lowest vitamin D levels compared with the group with the highest levels. While these findings suggest a role for vitamin D in preventing PAD, they don’t necessarily show that vitamin D truly deserves the credit. It’s possible that vitamin D levels are a marker for other health practices such as eating a healthy diet.

The research was funded by the National Institute of Diabetes, Digestive and Kidney Disease of the National Institutes of Health.

Ask a number of consultants to define a wellness practice and you’ll get a variety of answers.

Ask them how to market a wellness practice and you’ll learn about a number of approaches.

Ask them what not to do, and you’ll want to listen closely

Chiropractic Economics asked a number of practice-management consultants what a wellness practice means to them and for advice on what should and should not happen when marketing a wellness practice.

DEFINING A WELLNESS PRACTICE

Consultants define “wellness practice” in a variety of ways. However, one element common to all definitions is education.

Whether wellness hinges on lifestyle changes, making healthier choices, or changing patients’ perspectives of chiropractic from pain relief to a higher quality of life, education assumes a predominant role.

Michelle Geller-Vino, owner and president of MGV Marketing, said a wellness practice “continually educates its patients on becoming aware of and practicing healthy choices to create a successful balance in their lives.”

She added, “Wellness is a choice and a process of seeking more information on how to improve a person’s physical, emotional, spiritual, social, and environmental well-being.”

C. J. Mertz, DC, president and CEO of Team WLP — The Waiting List Practice , agreed, but added that a wellness-based practice should focus on family and provide solutions for thinking well, eating well, and moving well for life.

“A wellness chiropractor will educate patients with tools for lifelong changes,” said John Heggie, DC, founder and president of Lakeside Chiropractic Seminars, Inc.. “This education should include stretching exercises, strengthening exercises, home and office ergonomics, nutrition, healthy eating habits, organic food advice, and stress management.”

Wellness is not just a state of being; it is the doctor’s wellness philosophy reflected in the services offered and embraces the principles of a healthy life, stated Mark Sanna, DC, CEO of Breakthrough Coaching, and Len Schwartz, DC, president and CEO of ChiroPractice Marketing Solutions
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Timothy J. Gay, DC, director of Ultimate Practice, said “A wellness practice is talking to patients about the things they can do beyond chiropractic care and how to implement them into their lives.”

MARKETING A WELLNESS PRACTICE

The consultants offer a variety of suggestions on how to market a wellness practice. Among them: Attend or host external events, offer a wide variety of wellness services, hold internal events, hire a public-relations firm, and properly advertise.

Provide external events.

President of Integrity Management, Keith Maule, along with John Madeira, DC, of Madeira Success Strategies, believe community outreach programs are some of the best ways to market your practice.

Speaking engagements at health fairs, local chambers of commerce, expos, libraries, local businesses, and corporations, as well as giving wellness talks, health screenings, and attending conferences, all maximize your exposure and build brand awareness.

“Doing lectures on any topic, such as arthritis, digestive problems, sleep disorders, and fatigue, promoted as a wellness solution to these problems is the way to present not only oneself, but to reshape the way people perceive you,” said David Singer, DC, founder of David Singer Enterprises. “Knowing how to present a wellness program not only allows you to double and triple your new patients, but also allows you to become involved with corporate America on a level which only wellness programs could provide.”

External events, or events that take place outside of your practice, also provide opportunities to network with healthcare professionals that provide noncompetitive services and/or services for which you provide synergy.

Jason A. Deitch, DC, chief wellness officer for The Masters Circle and co-author of Discover Wellness, said, “The most cost-effective and time-efficient way to educate people is through professional, informative, and inspiring wellness presentations … in the office, at local employers, churches, community centers, and other providers’ offices.”

Offer other services.

In addition to chiropractic, the consultants suggest offering nutritional evaluations, supplements, massage, acupuncture, physical therapy, biofeedback, Pilates, and yoga. They also suggest providing ongoing educational programs related to nutrition, stretching and strengthening exercises, ergonomics, stress management and reduction, and weight loss.

Host internal events.

Events held in your office can include hosting dinners for patients and their friends or co-workers, so they can learn more about the benefits of chiropractic care. Other internal events include sending e-newsletters, posting articles in your office or on your Web site, mailing out a wellness-oriented newsletter, and conducting special “health” days or events in your practice every month.

Deitch added that DCs who offer educational material provide continuing education, and then stay in touch with people through periodic e-mail newsletters. They position themselves to become perceived as “the” wellness resource in the community.

Hire a PR team.

According to Laura Carabello, principal of CPR Strategic Marketing Communications, “Hiring an effective public relations team is key to building your practice and reaching your market segments.” She said a PR team can help you create specific media announcements, events, press releases, and media advisories which would target consumers, local town media, and even mainstream national media to spread the word about your wellness practice.

Advertise properly.

“When a member of the general public sees a sign on a chiropractic office (or anywhere else) that says ‘Wellness Center,’” said Ty Talcott, DC, president of Power Strategies Inc., “they have no idea what to expect if they were to walk in the door — therefore, all too often, their reaction is, ‘Why walk in the door?’”

Talcott and Gay believe that to be successful, you need to properly advertise properly the specific benefits an individual will gain by visiting your facility.

Carabello said not to be vague about the services you offer: Specify on your Web site or within your office the variety and types of services you offer to clients, so they understand the full array of what you provide.

ACTIVITIES TO AVOID

In a perfect world, there would be no mistakes. Since we do not live in a perfect world, the consultants offer advice on things to avoid when marketing your wellness practice.

• Avoid focusing on symptoms.

According to Shawn Powers, DC, of Powersource Coaching, you want to avoid focusing on treating conditions or symptoms. “I do not use a symptom-oriented case history,” she said. “If a new practice member has a symptom or condition, I ask for permission to explain how the body works before discussing anything, so they have a better knowledge base to make their family’s healthcare decisions.”

Madeira and Mertz also said to stay away from symptom-based advertising.
“Make sure not to market or teach on symptomatic-relief care or you will destroy any chance of becoming a highly successful wellness center,” said Mertz.

Heggie agreed by saying “headaches and low-back pain are both common roads chiropractors use to attract new patients into their office. But, the fact is, this type of advertising promotes short-term patients. When the patient’s pain is gone and the patient feels they received what they were looking for, they will terminate care.”

• Avoid improper names.

“An effective branding strategy begins with an evaluation of the practice name, logo, and image the office projects,” advised Deitch. “Marketing experts agree that if a DC is seeking to position a practice as a ‘wellness practice,’ then the word wellness should be in the name of the practice.”
Gay agreed, “If you want to make your practice a wellness-based practice, then put wellness in your clinic name and also involve other natural healthcare practitioners.”

Lawton W. Howell, CEO of WellnessOne Corporation, said the first key step is the right brand name. “When your brand name is focused on ‘chiropractic,’ such as Jones Chiropractic, the unstated message is that you only provide chiropractic care, not holistic or wellness care.”
Singer said practitioners need to change not only the name of their practices, but also their signs, stationery, cards, and programs. Doing so sends a consistent message.

• Don’t limit yourself.

If you are going to market yourself a wellness practice, then don’t limit yourself to one or two services, said Talcott. “In other words, say what you do and do what you say. If you are going to be all-encompassing, then potentially label yourself as a wellness practice.”

Singer said that when doctors of chiropractic market themselves as chiropractors they have to accept the image or branding that the vast majority of people have of who and what a chiropractor is. “They perceive chiropractic as a limited specialty within the area of back treatment. You need to become a chiropractic wellness center or a wellness clinic.”

Howell added that you should not limit your practice to only chiropractic or avoid interaction and alliances with other healthcare professionals.

LAST WORDS OF ADVICE

“To achieve the desired results of a wellness clinic, the doctor must have a good report of findings and do proper re-exams to help support the treatment as the patient progresses through care,” said Ed Sharp, president of Sharp Management Consulting. “If patients do not get through their corrective levels of care, they will not be there to get on to wellness care.”

Mertz suggested visiting a practice that is fully functioning in wellness and begin modeling it. He also suggested hiring a coach to determine the correct actions and strategies that transition a nonwellness practice into a highly functioning wellness-based practice.

“Building a wellness brand is more than just providing the same chiropractic experience you have always provided and just adding the word wellness to your conversations,” said Deitch. “It requires a mental and structural makeover of your communications, procedures, and fee structure.”

Talcott recommended pricing and packaging services to be attractive and self explanatory, highlighting the benefits to the patient that can be easily explained to others.

He also said it is not always profitable to place advertisements in the same sections of the newspaper that other healthcare professionals use. “You may find more success placing ads where you see spas, health clubs, yoga, or alternative providers.”

Schwartz summed up marketing by saying, “DCs who want to have a wellness practice should be doing everything mentioned earlier — and they should avoid anything that is inconsistent with those activities.”

Angies List Rating Chiropractors

Some people are making a list and checking it twice — Angie’s List, that is. And they are checking it for reports on chiropractors, medical doctors, dentists, hospitals, and urgent-care centers.

Angie’s List is a word-of-mouth network of consumers who submit reports and rate local businesses. Until recently, reports covered many different categories, ranging from accountants to wrought-iron fabricators. Businesses do not pay to be on the list.

Cheryl Reed with Angie’s List told Chiropractic Economics that the company only added “medical providers” as a category a few weeks ago. She said, “We’ve been collecting reports on healthcare providers for a just few weeks now and have had overwhelming response nationwide across all healthcare categories ... Part of our service — which is unique to most other ratings services — is that we have human review of each report before it’s posted. So the reports don’t appear instantly; we first ensure they meet our guidelines.”

Reed cited Portland, Ore., and Columbus, Ohio, as having the most medical reports. Each listed reviews of seven DCs listed. All the DCs received an “A” grade.

Five Day Wait for Strep Results at Minute Clinic while on Vacation

My wife and I were looking forward to a long awaited vacation to California, and Hawaii. When we got off the plane in California we both had a bit of a scratchy throat which can happen after a long plane flight with all the bad air, and contact with so many different people in airports.

After two days our symptoms had worsened, and both of us still had a sore throat that was visible swollen, increasing congestion, and a lack of energy. We decided at that time to seek medical attention on the road. I suspected that we both had been infected with Strep throat.

The closest medical facility to where we were staying was what was called MinuteClinic was staffed by a Nurse Practicioner at a local pharmacy, in Santa Ana, California.

NP's can treat a very limited list of ailments, but since it was upper respiratory I decided they could probably handle it, and get us the antibiotics to begin feeling better before we left for Hawaii.

I could have called the medical clinic that I work at back in Chicago also, but when it comes down to using an antibiotic these days you want to make sure that you have a bacterial, not viral infection, so I felt a test for strep was necessary.

The nurse at the clinic checked us both out in a small examination room next to the pharmacy. I told her I suspected we both had Strep. She examined my wife, and didn't take a throat culture, she felt my wife has a sinus infection. She inspected me and did take a throat culture. The ready test showed nothing, so she did not prescribe me anything. She did prescribe my wife some antibiotics even though she never took a throat culture from her.

We visited the MinuteClinic on a Saturday, on Wednesday afternoon I got a call on my cell phone that indeed my culture for Strep had come in positive. The person on the phone relaying the news could barely speak English, and she said to come into the pharmacy to pick up a prescription. I told her that I was in Hawaii now and that she would have to call it in to a local pharmacy in Lahaina which she did. As for my wife she couldn't tell me if they had originally prescribed the right medication if she indeed have strep throat rather than the suspected sinus infection.

I find it hard to believe that we were sick on Saturday, but were not able to get antibiotic treatment until the following Wednesday evening which meant we had to spend five days being sick before we got the antibiotic treatment we needed to start feeling better.

The bottom line, and I should have followed this one simple rule... it is best to go to a real urgent, or immediate care center to see a real doctor, and get a real lab test so treatment could begin right away.

Ready tests for Strep can be tricky if the NP administering it does not do it correctly which is evidentially the case in our situation. If we had gone to an Immediate Care facility like Healthy Trust we would have gotten the treatment we needed, at the same price, without waiting five days for a test to come back from the lab.

In our scenario it is real risky business to see a since my wife is a diabetic. A strep infection for a diabetic can turn into pneumonia overnight. It would have been a smarter choice to take a longer drive from where we were staying to visit an urgent care center, or an ER.

Healthy Trust Immediate Medical Care in Wheeling is your choice for urgent medical care when you cannot get into see your own physician, do not have a regular physician, have health insurance, or do not have health insurance and need medical help right away.

Don't risk your health at a pharmacy, come see a real doctor at Healthy Trust and start feeling better immediately.

We serve the Chicago North Shore Communities of Lake County, Wheeling, Prospect Heights, Lincolnshire, Deerfield, Buffalo Grove, Northbrook, Highland Park, Long Grove, Riverwoods, Des Plaines, Palatine, Glenview, Highwood, Northfield, Libertyville, Winnetka, Arlington Heights, Mount Prospect, Lake Bluff, Lake Forest, Mundelein, and Bannockburn.

Why Choose Healthy Trust Immediate Medical Care?

• Fast, Convenient, Immediate Attention
• No Appointments Neccesary
• Extended Hours
• Convenient Location
• Quality Healthcare
• Affordable Pricing With or Without Insurance
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62 Receive DC degrees from Northwestern

Northwestern Health Sciences University College of Chiropractic conferred the Doctor of Chiropractic degree on 62 students April 5. The university also awarded 13 Bachelor of Science degrees during the ceremonies. Students hailed from nine states and one Canadian province.

The commencement address was delivered by Louis Sportelli, DC, president of the NCMIC Group. Ryan Hewitt, a member of the graduating class, gave the student greeting.
Alison Angeline Phillips was named valedictorian.

Oklahaven Releases Chirorpractic Film

Oklahaven Children’s Chiropractic Center recently celebrated its 45th anniversary by completing an 11-minute film entitled “A Mother’s Story of her Child’s Journey to Health.” The movie documents a child’s path to recovery through chiropractic.

The documentary shows the child’s transformation from debilitating juvenile rheumatoid arthritis at age two to his healthy high school days.

The film is designed to empower as it answers the questions and concerns parents have about choosing a chiropractic lifestyle for their children. Oklahaven, a nonprofit organization dedicated to restoring health to children, is offering the DVD for sale.

Majority of American's Struggling with their Health

Most Americans are struggling to achieve satisfactory health and well-being according to initial results of the Gallup-Healthways Well-Being Index. When asked to evaluate their lives based on a ladder scale, 47 percent of the 100,000 respondents polled in the 1,000 daily surveys conducted since January say they are struggling and an additional four percent say they are suffering.

Factors contributing to these findings include negative workplace environments and difficulty making positive health decisions about modifiable health behaviors like diet, exercise, and stress.

The Well-Being Index data has implications for the American workplace and reveals that workers believe their work environment plays an important part in their overall well-being.

Among the nearly 46,000 full-time workers surveyed to date:

• Nearly two-thirds are obese or overweight (25 percent obese, 40 percent overweight);
• Two-thirds report one or more chronic diseases or recurring conditions;

More than 20 percent report they are not able to perform their usual activities on one or more days last month due to illness. These workers reported being out sick an average of six days in the last 30

• Workers with one to three diseases and/or conditions report they cannot carry out their usual activities on 13.5 days each year. The impact of a negative work environment is an additional 6.6 days (48 percent higher) annually. Workers with four or more disease conditions report they cannot carry out their usual activities on 52.7 days each year. For these workers, the presence of a negative work environment increases that total to 68.9 days (a 31 percent increase).

Healthy Trust Chiropractic serves the Chicago North Shore Communities of Lake County, Wheeling, Prospect Heights, Lincolnshire, Deerfield, Buffalo Grove, Northbrook, Highland Park, Long Grove, Riverwoods, Des Plaines, Palatine, Glenview, Highwood, Northfield, Libertyville, Winnetka, Arlington Heights, Mount Prospect, Lake Bluff, Lake Forest, Mundelein, and Bannockburn.

U.S. Facing MD Shortage

The United States will suffer a shortage of primary-care physicians as the workload will increase by 29 percent by 2025, according to a study published online April 29 in Health Affairs, a public-policy journal.

The authors of the study, Jack M. Colwill, James M. Cultice, and Robin L. Kruse, predict a 14 percent increased workload for care of children by pediatricians and family physicians, but the supply of generalists for adult care will increase 7 percent.

The study addresses medical healthcare availability, not chiropractic, but the authors say they expect deficits of 35,000 to 44,000 adult-care generalists, which threaten the nation’s foundation of primary-care for adults.

More than 6.1 Million Enrolled in HSA's

More than 6.1 million Americans are covered by Health Savings Account (HSA)-eligible insurance plans, a 35 percent increase since last year, a new census released today by America's Health Insurance Plans (AHIP) has found.

HSAs were authorized starting in January 2004. Since then, AHIP has conducted a periodic census of its members participating in the HSA plan market.

Anti Oxidants Have Little Effect on Mortality

A report published in the Cochrane Database of Systematic Reviews (April 16, 2008), concludes that antioxidant supplements have little effect on mortality.

Researchers looked at 67 randomized trials with 232,550 participants. The aim of the research was to assess the effect of antioxidants on mortality in primary or secondary prevention, randomized trials.

They included all primary and secondary prevention randomized clinical trials on antioxidant supplements (beta-carotene, vitamin A, vitamin C, vitamin E, and selenium) versus placebo or no intervention. Included participants were either healthy (primary prevention trials) or had any disease (secondary prevention trials). Researchers concluded that the antioxidant supplements had no significant effect on mortality in a random-effects meta-analysis, but significantly increased mortality in a fixed-effect model.

In the trials with a low-risk of bias, the antioxidant supplements significantly increased mortality. When the different antioxidants were assessed separately, analyses including trials with a low risk of bias and excluding selenium trials found significantly increased mortality by vitamin A, beta-carotene, and vitamin E, but no significant detrimental effect of vitamin C. Low-bias risk trials on selenium found no significant effect on mortality. The researchers concluded there was no evidence to support antioxidant supplements for primary or secondary prevention and said aitamin A, beta-carotene, and vitamin E may increase mortality.

They said the current evidence does not support the use of antioxidant supplements in the general population or in patients with certain diseases. The combined evidence suggests that additional research on antioxidant supplements is needed.

The review did not assess antioxidant supplements for treatment of specific diseases (tertiary prevention), antioxidant supplements for patients with demonstrated specific needs of antioxidants, or the effects of antioxidants contained in fruits or vegetables.

Less than 1% of DC's Blog

Less than 1 percent of American chiropractors blog and, of those who do, more than one-third of chiropractor blogs are inactive, according to a new study by The Kahuna Content Company, a social media research company, into how chiropractors use blogs to market their businesses.

“Unfortunately, blogging as a marketing tool is not regarded seriously by America’s chiropractors,” says Richard Telofski, principal consultant at The Kahuna Content Company. “In fact, their absence from blogging is just downright astounding.” Telofski says there is a high correlation between the average blog reader and the average chiropractic patient. According to industry statistics, males between the ages of 31 and 50 comprise a high percentage of chiropractic patients and an even higher percentage of blog readers.

“If this isn’t a perfect demographic alignment between a marketing medium and its target audience, then I don’t know what is. It could be a perfect tool.”

The Kahuna Content study also found that only 13 percent of chiropractor blogs post more frequently than once per week. “With that kind of irregularity and infrequency,” says Telofski, “it’s hard to develop and keep an audience.”

Blogs, like other media vehicles, are dependent on fresh and regular content. Telofski said that from the research he got the impression that the chiropractors jumped into blogging without much planning.

Generally, the chiropractors use only a few of the many available blog tools. But there was one silver lining, said Telofski. “Of the blogging chiropractors we did find, they mostly write short posts. We found that about 87 percent of chiropractors keep their posts to 300 words or less. Generally, blog readers don’t want to read long posts.”

Consumers Driving Health Care Change

Customer service is becoming a key differentiator in where consumers choose to receive their healthcare, said speakers at The Beryl Institute’s “Power of Impressions” conference in Dallas.

“As consumers are asked to spend more of their own money to receive care, they will consider the entire spectrum of value, from access and expertise to service, convenience, and price,” said Chris Bevolo, partner in GeigerBevolo.

To win in this consumer-driven environment, speakers challenged healthcare providers to:

Always deliver on their brand promises;

• Create a corporate culture that nurtures engaged employees;

• Challenge traditional ways of approaching the market;

• Understand the customer service opportunities before, during and after a clinical visit;

• Empower consumers by making it easy to navigate the healthcare system; and

• Turn moments of truth into moments of trust.

“Every healthcare organization should strive to be a first-choice provider, which is a trusted healthcare partner that the consumer believes will provide them with the highest degree of satisfaction,” said Paul Spiegelman, executive director of The Beryl Institute.

The Beryl Institute was founded in 2006 with the mission of improving customer service in healthcare by defining best practices around all touch points in the continuum of a consumers’ healthcare experience

Steroid Injections Offer Little Relief for Lower Back Pain

A randomized, controlled trial has shown an epidural or translaminar steroid injection is ineffective for the relief of lower back pain.

"I'm not saying that steroids don't work. I'm just saying there's definite reason to question whether they work or not," Dr. Daniel Steinitz, an orthopedic surgeon at Belleville General Hospital in Ontario, said in an interview after his presentation at the American Academy of Orthopedic Surgeons meeting here.

Dr. Steinitz, who worked on the study during his residency at McGill University in Montreal, said steroid injections for lumbar pain are popular but research on their use over the past 40 years has produced conflicting results. Nor is the procedure benign, with dural puncture leading to headache being one of the more common complications.

The study involved 50 consecutive patients who were referred to an interventional radiologist for a translaminar block or selective nerve root block. The patients' pathology had been confirmed by CT or MRI and none had undergone spine surgery or had previous injections.

All patients received an epidural injection of lidocaine and bupivacaine and a radio-opaque dye to confirm the accuracy of the injection under fluoroscopy. In addition, patients randomly assigned to the steroid arm received 12 mg betamethasone.

A research assistant evaluated the patients two weeks before their injection and three and 16 weeks afterward.

Both the radiologist and the evaluator were blinded to the treatment type.Although the procedure helped relieve back pain in both groups, there were no differences between the two groups at any visit on any of the outcome measures, which included the Musculoskeletal Functional Assessment, Bother Index, Functional Index, Oswestry Score and Visual Pain Analogue Score.

Dr. Steinitz said the study was felt to be large enough to show a significant advantage of steroid injections, if there was one, but he added there are other variables that need to be followed up in other studies, such as the number of injections and dose of steroid.

Brief Definitions of Chiropractic

Chiropractic is defined in the dictionary as "a therapeutic system based upon the premise that disease is caused by the interference with nerve function, the method being to restore normal condition by adjusting the segments of the spinal column."

The International Chiropractors Association defines chiropractic as follows:

The philosophy of chiropractic is based upon the premise that disease or abnormal function is caused by interference with nerve transmission and expression, due to pressure, strain or tension upon the spinal cord or spinal nerves, as a result of body segments of the vertebral column deviating from their normal juxtaposition. The practice of chiropractic consists of analysis of an interference with normal nerve transmission and expression, and the correction thereof by an adjustment with the hands of the abnormal deviations of the bony articulations of the vertebral column for the restoration and maintenance of health, without the use of drugs or surgery. The term "analysis" is construed to include the use of X-ray and other analytical instruments generally used in the practice of chiropractic.

The definition given by the American Chiropractic Association is:

Chiropractic practice is the specific adjustment and manipulation of the articulations and adjacent tissues of the body, particularly of the spinal column, for the correction of nerve interference and includes the use of recognized diagnostic methods, as indicated. Patient care is conducted with due regard for environmental, nutritional, and psychotherapeutic factors, as well as first aid, hygiene, sanitation, rehabilitation and related procedures designed to restore or maintain normal nerve function.

According to chiropractic, the deviation of the body segments of the vertebral column from their normal juxtaposition that interferes with nerve transmission and expression is called subluxation.

Two chiropractic descriptions of subluxation are:

"The vertebrae are . . . within their normal range of motion, although not functioning at their optimum."

"A vertebral subluxation may be interpreted as 'off-centering of a vertebral segment.' A subluxation is a fixation of the joint within its normal range of movement, usually at the extremity of this range."

In other words, subluxed vertebrae (spinal bones) are characterized by fixation and misalignment within the normal range of motion.

Daniel David Palmer, a tradesman who posed as a magnetic healer, "discovered" chiropractic in 1895. Magnetic healing was a popular form of quackery in the nineteenth century in which the healers believed that their personal magnetism was so great that it gave them the power to cure disease .

Palmer said: I am the originator, the Fountain Head of the essential principle that disease is the result of too much or not enough functionating. I created the art of adjusting vertebrae, using the spinous and transverse processes as levers, and named the mental act of accumulating knowledge, the cumulative function, corresponding to the physical vegetative function -- growth of intellectual and physical-together, with the science, art and philosophy -- Chiropractic. . . . It was I who combined the science and art and developed the principles thereof. I have answered the question -- what is life?

The chiropractic philosophy originated by Palmer is the frame of reference of modern-day chiropractic thinking as exemplified in the most widely used chiropractic textbook at the present time. Palmer put forth the concepts of Universal Intelligence, Innate Intelligence, and Educated Intelligence. Universal Intelligence is God. Innate Intelligence is the "Soul, Spirit or Spark of Life" or "Nature, intuition, instinct, spiritual and subconscious mind." It is the "something" within the body which controls the healing process, growth, and repair and "is beyond the finite knowledge." While Innate Intelligence utilizes the autonomic nervous system, the Educated Intelligence, or "conscious," utilizes "the cerebrospinal division for the volitional expression of its function."

Nature, or Innate Intelligence, has a great capacity to maintain or restore health if it is allowed normal expression within the body. However, mental, chemical, or mechanical stress can produce a greater or lesser displacement of the vertebrae, or vertebral disrelationship, and this displacement interferes with the planned expression of Innate Intelligence through the nerves. This interference then produces pathology.

The chiropractor, by correcting the displacement, allows the Innate Intelligence to effect the cure. The pathology that chiropractors treat by manual manipulation of the spine totals over ninety diseases, including gastrointestinal, genitourinary, respiratory, vascular, and emotional disorders; diabetes; deafness; eye disorders; cancer; arthritis; and infectious diseases such as polio, mumps, hepatitis, diphtheria, and the common cold.

Palmer College Becomes Social Media 'Friendly'

Palmer College has entered the podosphere. The first ever Palmer Podcast has been posted on the Palmer website. For those not familiar with podcasting, a podcast is basically an online, downloadable radio show.

The current episode of the Palmer Podcast features an interview with Rob DeStefano, D.C., a 1986 Davenport Campus graduate who is team chiropractor for the recent Super Bowl champions the New York Giants. There's also information about the upcoming Destination Success 2008 event on the Davenport Campus.

“The Palmer Podcast allows us to take Palmer's message to a different level,” says podcast host Minda Powers-Douglas, Davenport Campus Marketing and Public Relations. “The podcast encourages interaction with listeners and will feature a variety of participants, including students, faculty and alumni.”

The Palmer Podcast is for current and pre-chiropractic students, Palmer alumni, faculty and staff, patients, chiropractors, and anyone else interested in chiropractic.

Since the Internet became worldwide, changes online have been fast and furious. What was new last week may be old technology today. As a college reaching out to people-especially young people-Palmer has to keep up with the ever-evolving online world. And one key area of that world is social media.

According to Wikipedia.org, social media “integrates technology, social interaction and the construction of words and pictures.” Social media includes online forums, message boards, blogs (used as online diaries or for sharing news and opinions), wikis (“software that allows users to easily create, edit and link pages together,” according to Wikipedia.org), podcasts, photos and videos.

When the World Wide Web hit the mainstream, it started as a “place” where a select number of people would create and post websites for the rest of the online population to view. Since then, it's progressed into a collaborative and highly interactive world. Programmers are no longer the only ones creating major content on the Web; anyone with Internet access can now easily build his or her own site, start a blog, create a podcast and potentially become someone of merit online. According to Advertising Age, traditional media is losing credibility while the credibility of social media is rising fast (“90 percent of Internet users 'moderately' or 'highly' trust information from online acquaintances”).

According to Paul Gillin's book “The New Influencers,” there were one million blogs on the Internet in January 2004. As of June 2006, there were more than 50 million. Blogs are only one part of the social media picture, but they play an important part. For example, perhaps a student at the College who is really excited about Palmer and chiropractic, and he starts a blog about his experiences. Years ago, his influence would have only been word-of-mouth; today, he can potentially reach anyone in the world with Internet access. Plus, most social media websites offer their services for free, so anyone with access can make a presence online.

While blogging can be done on blog-focused sites like Blogger.com, it can also be done on social networking sites like MySpace.com. MySpace is an online community that offers members a customizable profile page, a blog, online photo albums, internal e-mail, chat rooms, forums, groups, classifieds and more. A main feature is the ability to connect with other members with the “Friend Space” feature. Members may add “friends” (who can be people they already know or people they want to get to know) and then share information or communicate with them.

Facebook.com is another popular social networking site. Through Facebook, members can also upload photos and videos, join groups, invite people to events and otherwise connect with each other. It's an easy and free way to link with people who attend the same school, work for the same employer or share interests.

Clinical Utilization and Cost Outcomes

OBJECTIVE:

Our initial report analyzed clinical and cost utilization data from the years 1999 to 2002 for an integrative medicine independent physician association (IPA) whose primary care physicians (PCPs) were exclusively doctors of chiropractic. This report updates the subsequent utilization data from the IPA for the years 2003 to 2005 and includes first-time comparisons in data points among PCPs of different licensures who were oriented toward complementary and alternative medicine (CAM).

METHODS:

Independent physician association-incurred claims and stratified random patient surveys were descriptively analyzed for clinical utilization, cost offsets, and member satisfaction compared with conventional medical IPA normative values. Comparisons to our original publication's comparative blinded data, using nonrandom matched comparison groups, were descriptively analyzed for differences in age/sex demographics and disease profiles to examine sample bias.

RESULTS:

Clinical and cost utilization based on 70,274 member-months over a 7-year period demonstrated decreases of 60.2% in-hospital admissions, 59.0% less hospital days, 62.0% less outpatient surgeries and procedures, and 85% less pharmaceutical costs when compared with conventional medicine IPA performance for the same health maintenance organization product in the same geography and time frame.

CONCLUSIONS:

During the past 7 years, and with a larger population than originally reported, the CAM-oriented PCPs using a nonsurgical/nonpharmaceutical approach demonstrated reductions in both clinical and cost utilization when compared with PCPs using conventional medicine alone. Decreased utilization was uniformly achieved by all CAM-oriented PCPs, regardless of their licensure. The validity and generalizability of this observation are guarded given the lack of randomization, lack of statistical analysis possible, and potentially biased data in this population.

Discussion:

Although it is not valid to make the assumption that the predictive vs actual utilization of medical expenditures is an accurate generalized measure of treatment efficacy, it is interesting to note that the utilization data are substantially lower during both eras of 1999 to 2002 and 2003 to 2005. This gives credence to the argument that the power to achieve reduced utilization is due to the underlying philosophy of medical management and not due to differences in PCP education or licensure. It would be interesting to know the normative ratio of predicted vs actual utilization of these relative cost value units for the HMO network as a whole, but this information is unavailable.

The escalation of medical expenditures remains an urgent problem. Conventional medical strategies for clinical improvement and cost containment are failing to achieve their target goals. Many patients, looking for improved outcomes, commonly use CAM therapies mixed with conventional medical care without the oversight of a physician specializing in integrative medicine. The safety, efficacy, and cost effectiveness of this unsupervised concomitant use are unknown at this time. However, this study makes the observation that over a 7-year period, the cost outcomes of the integrative medicine IPA are below those of the conventional medical IPAs contracted with the HMO and that, concomitantly, the member satisfaction scores are higher than the conventional medical IPA's.

Along with the single targeted question on patient satisfaction, the HMO's independent quality control division analyzed approximately 50 other questions on the annual member survey to determine if a given IPA achieves “blue ribbon status.” The AMI's IPA has achieved blue ribbon status every year since its inception. In the AMI model, the annual onsite audit scores measuring IPA compliance with the HMO utilization management policies and procedures continue to be above the HMO network normative values.

The AMI's annual audit scores in the years 2002-2005 for medical administration and medical management were between 97% and 100% in each category. The HMO minimum required score for IPA performance is 90%. This observation may demonstrate that it is possible to deliver CAM-oriented primary care in a highly regulated environment without compromising either quality or safety.

There are several limitations within this study. First, it is a limitation of the methodology that the data available to us did not allow for a regression analysis. Our analysis of utilization data was unfortunately limited to descriptive comparisons between the identified populations as subsets of the entire HMO population. As the necessary data for traditional statistical methods were unavailable to us, we attempted to assess possible population bias via other strategies. We acknowledge that the lack of statistical analysis may have led to a serious bias. However, even without the ability to complete a statistical analysis and with the potential for bias, these preliminary data are important to present within the medical community.

Likewise, attempted statistical analysis might have implied results beyond the methodological capacity of this study. Second, this article is an observational report and does not claim to report causal outcomes but rather the continued long-term observational correlation in decreased utilization seen by enrolled members of an integrative medical model. It is one of the few medical models where concomitant use of both conventional and CAM-oriented treatments is supervised by a licensed health care professional with expertise in both arenas. Third, based on the methods of this study, there is some question about scientific reproducibility. A randomized clinical trial would be necessary to determine if the alternative medicine IPA had a different utilization rate and cost outcome than the conventional IPA.

Finally, we were not able to control for differences in baseline characteristics between the integrative medicine group and the conventional IPA. If the baseline demographic or clinical factors differed between the groups, the data may be seriously biased in either direction.In its effort to improve outcomes, the lay public continues to increase its CAM-oriented utilization; and CAM providers of all licensures continue to slowly gain acceptance within the conventional medical arena. It is clear, however, that not all CAM therapies are efficacious for all disease states.

Although a blinded, randomized controlled trial isolating individual CAM therapies targeting individual disease states is beyond the scope of this endeavor, it is of great interest that the correlation of decreased utilization of standard managed care benchmarks is seen across the board for the variety of medical conditions reported in the IPA's enrolled population.Early results from AMI's Integrated Therapies Demonstration Project, a utilization and cost analysis study for the treatment of chronic pain produced for the Florida Agency of Health Care Administration, suggest that the integrative medical strategies, which are the core component of AMI's medical management, seem to be generalizable to other populations, such as Medicaid/Medipass and targeted disease states in a more classic disease management model.

Conclusion:

Although the generalizability of such observations is always in question, the IPA model presented here is correlated with a decrease in clinical utilization and cost outcomes, compared with conventional medical strategies, over an extended period and in a safe and highly regulated environment. The consistent decrease in cost and care utilization achieved by AMI's integrative medical management strategy over a 7-year time frame warrants larger independent third-party funding for multicenter, randomized controlled trials.

Chiropractic Blogging

Dozens of chiropractors woke up Monday morning, the fifth of May, 2008 (Cinco de Mayo) to the discovery that a new opportunity existed to tell the world about their chiropractic practice. Within hours, word was spreading via RSS feeds and forwarded e-mails that a popular chiropractic website was going to begin writing featured articles about chiropractors and the towns they practice in. The activity wouldn't even make a tiny blip in the world of traditional social media, but inside a niche group like the chiropractic profession, a simple post made to a chiropractic blog can move among inside circles rapidly, especially when users are engaged in contributing and spreading information.

As the Internet grows as a social platform, business owners such as chiropractors are engaging in numerous online activities that connect themselves with the communities they serve. Call it getting social, call it Web 2.0, or simply call it communication, doctors of chiropractic are only one example of niche or vertical industries utilizing the power of online community building to spread their message of health and natural living.

The post was simple, Dr. Michael Dorausch (founder of Planet Chiropractic) openly shared the difficulties he has been having in gathering up-to-date address information for chiropractors, and connecting those chiropractors with the general public.

The post, titled: Chiropractors offered a unique incentive for visiting chiropractors to share their website and office information. Dr. Dorausch basically decided that beginning in June, Planet Chiropractic would begin presenting articles written about local chiropractors practicing throughout the world. The chiropractors being featured in the articles would come directly from office and contact information provided by doctors of chiropractic in the comments section of the blog post.

Last time I checked, Dr. Michaels chiropractor blog post had 18 comments, including those from chiropractors practicing as far away as Lima Peru. The current list features chiropractors from Lancaster California, Bolingbrook Illinois, Weatherford Texas, Huntington Beach California, Tustin California, Vaughan Ontario, Seattle Washington, Salinas California, Lantana Florida, and other chiropractic office locations throughout the United States and Canada.

With typical blog posts receiving only two or three comments, I must admit I was surprised to see nearly 20 appearing within just a few hours of the post going live. Looks like the Planet Chiropractic office is going to have to organize a twice weekly effort just to get news out featuring the chiropractors that have participated so far. I am excited to see how many others will be posting comments.

Research on Chiropractics Effect on Diabetes

Diabetes is the fifth deadliest disease in the United States and a growing epidemic worldwide. Now, researchers are finding evidence that chiropractic adjustments might be able to make a valuable contribution to an overall program of wellness care to help diabetes sufferers.

A study published in the Journal of Vertebral Subluxation Research, focused on the positive response to chiropractic when used as part of an integrative treatment in the care of a patient with adult onset diabetes. The disease was diagnosed by a medical doctor.

Along with chiropractic care, the patient also received nutritional and exercise guidance.
The chiropractic care was directed toward correcting misalignments in the spine, called vertebral subluxations, which affect the relationship between the nervous system and organs.

After one month of being on the program, the patient's glucose blood and urine levels had normalized and remained stable. His medical doctor, who monitored his progress, said the patient would not need insulin if the condition remained stable.

According to the author of the research paper, Charles Blum, DC, president of the Sacro Occipital Technique Organization-USA, "It is unclear how much impact chiropractic care might have on the primary or secondary care of patients with diabetes. Further study is necessary to determine if there is a subset of patients with diabetes that might respond to chiropractic care incorporated in a system of other integrated methods of care."

The study was one of several recent research projects exploring the impact of vertebral subluxations on human health and well-being and the potential benefits of chiropractic. In the past, chiropractic was thought to be of help mainly to adults suffering back pain or headaches but current research is showing it has far broader applications.

"This type of study is popping up everywhere," stated JVSR Editor Matthew McCoy, DC. "For more than 100 years, chiropractors have maintained that what they do affects organ system function and general health. Case studies like this demonstrate the urgency for more research funding from the public and private sector on chiropractic and its effects beyond neck and back pain."

The potential for chiropractic to help people with diabetes is a particularly important line of inquiry. Between 1990 and 1999, incidence of disease increased by more than 40 percent. By the year 2000, nearly seven percent of the population was affected. Unless something changes, the future looks bleak. Roughly one out of every three men and two out of every five women born in the year 2000 will suffer from diabetes in their lifetime.

The life expectancy of men diagnosed with diabetes at age 40, is shorted, on average, by 11-13 years. For women, the figures are even more disturbing: their life expectancy is cut by 12 to 17 years of life. The disease also takes a huge financial toll, accounting for about $132 billion of the $865 billion spent in health care in 2002.

"Given the devastating effects of diabetes on people's health and the economic implications it is well worth investigating other treatments like chiropractic for diabetes," Dr. Blum pointed out.

"We need to examine if chiropractic can help with improving a patient's sugar handling difficulties or even just help a patient under medication improve their quality of life and only further research and investigations will uncover these answers." JVSR, a peer reviewed scientific journal devoted to subluxation-based chiropractic research, is affiliated with the World Chiropractic Alliance (WCA), an international organization representing doctors of chiropractic.

Healthy Trust Chiropractic Clinic

Chiropractic care maintains the integrity of the spine and nervous system to help prevent health problems. Chiropractic can be a successful treatment alternative to risky, invasive procedures. Healthy Trust Immediate Medical Care has a modern and comprehensive Chiropractic program that serves residents of Chicago's North Shore.

What sets Healthy Trust apart is that we are a complete Medical Clinic with a Chiropractic division which means, X-Ray, Lab, access to MD's, and all diagnostic services are all under one roof. That means you can get everything done in one place which saves you considerable time, and money.

Dr. Kaspars Vilems leads the HTMIC Chiropractic team. He is a Board-Certified Chiropractic Physician.

Dr.Vilems trained as an M.D. in Europe. Dr. Vilems graduated from the Life Chiropractic College West in Hayward, California with Cum Laude. Prior to joining Healthy Trust Immediate Medical Care Dr. Vilems worked at the Spine Institute in New York. He provides big picture solutions for Back/ Leg/ Sciatic Pain Neck Pain/ Whiplash/ Headaches Shoulder/ Arm/ Knee/ Leg Pain Carpal Tunnel/Herniated Discs Auto/ Sports/ Work Related Injuries. Dr. Vilems is committed to relieving your pain using the principles of spinal manipulation, exercise, physical therapy and nutritional recommendations.

Our Chiropractors may help you with:

Back pain

(Common back pain causes include nerve problems, disc problems, osteoarthritis, and muscular problems.)

Headaches/neck pain

(Headaches that stem from neck pain are found mostly in individuals who have tightness in the posterior neck muscles, which are at the back of the neck.)

Carpal Tunnel

(The first symptoms may appear when sleeping and typically include numbness or a burning and tingling sensation in the fingers, especially the thumb, index, and middle fingers)

Pinched Nerves

(A nerve can be pinched as it leaves the spine by a herniated disc or bone spurs that form from spinal arthritis.)

Arthritic conditions

(Arthritis is a joint disorder featuring inflammation. A joint is an area of the body where two different bones meet. A joint functions to move the body parts connected by its bones. Arthritis literally means inflammation of one or more joints.)

Scoliosis

(It is a medical condition in which a person's spine is curved from side to side, and may also be rotated. On an x-ray, the spine of an individual with a typical scoliosis may look more like an "S" or a "C" than a straight line.)

Sciatica

(The pain is felt in the lower back, buttock, and/or various parts of the leg and foot. In addition to pain, which is sometimes severe, there may be numbness, muscular weakness, and difficulty in moving or controlling the leg. Typically, the symptoms are only felt on one side of the body.)

Slipped disks

(The disks are protective shock-absorbing pads between the bones of the spine. Although they do not actually "slip," a disk may split or rupture. This can cause the disk to fail, allowing the gel to escape into the surrounding tissue. The leaking jellylike substance can place pressure on the spinal cord or on a single nerve fiber and cause pain either around the damaged disk or anywhere along the area controlled by that nerve.)

Shoulder/Rotator Cuff Syndrome

(The rotator cuff is a group of four muscles that helps to lift your arm up over your head and also rotate it toward and away from your body. Rotator cuff tendonitis, also knows as "bursitis" or "impingement syndrome" occurs when the rotator cuff gets irritated on the undersurface of the acromion. A rotator cuff tear occurs when the tendonitis in the rotator cuff gets so bad that it wears a hole through the rotator cuff tendon.)

Hip/knee/ankle pain

(Hip pain can be caused by muscle strain around the hip, direct trauma (injury) to the hip joint or may be referred pain from joints or muscles of the spine. Knee pain may be caused by leg muscle strain or injury to the hip, knee or ankle joints. Foot and ankle pain may result from a direct foot trauma to the joints, ligaments or muscles. Foot pain is often caused by fallen arches (flat feet), which place the feet under abnormal strain. However foot and ankle pain can also be caused by injury to the sciatic nerve.)

Joint stiffness and muscle spasms

(If a joint has been hurting you, then becomes stiff and "rickety"-feeling, your body may actually be making its own splint to protect the joint from further injury. Muscles surrounding the joint go into spasm to prevent the joint from moving, and those spasms contribute to stiffness.)

On Site Diagnostic Studies we provide:

X-Ray

(We have X-Ray facilites on site at Healthy Trust so we can immediately diagnose your problem without waiting so we can begin treating it immediately.)

NCS

(Nerve conduction studies are used mainly for evaluation of paresthesias (numbness, tingling, burning) and/or weakness of the arms and legs. We provide this testing on site at Healthy Trust to help immediately diagnose your problem.)

Diagnostic Ultrasound

(This medical imaging technique is used to visualize muscles, tendons, with real time tomographic images. Once again it allows us to help diagnose your problem immediately and then begin treatment.)

Fluoroscopic exam

(These exams are special applications of X-ray imaging, in which a fluorescent screen or image intensifier tube is connected to a closed-circuit television system, which allows real-time imaging of structures in motion.)

Physical Therapy Treatment Modalities:

Chiropractic manipulations (The term "adjustment" refers to the specific manipulation chiropractors apply to vertebrae that have abnormal movement patterns or fail to function normally. The objective of the chiropractic treatment is to reduce the subluxation, which results in an increased range of motion, reduced nerve irritability and improved function.)

Deep tissue therapeutic massage:

(Deep tissue massage is a type of massage aimed at the deeper tissue structures of the muscle and fascia, also called connective tissue. It is a more focused type of massage, as the therapist works to release chronic muscle tension or knots (also known as "adhesions.")

Core body strengthening and individualized exercise treatment programs:

(Core strengthening requires the regular and proper exercise of your body's 29 core muscles. At Healthy Trust we design individualized exercise treatment programs which rehabilitate injuries and help prevent new ones frm happening.)

Therapeutic Ultrasound:

(Ultrasound can produce many effects other than just the potential heating effect. It has been shown to cause increases in tissue relaxation, local blood flow, and scar tissue breakdown. The effect of the increase in local blood flow can be used to help reduce local swelling and chronic .inflammation, and, according to some studies, promote bone fracture healing.)

E-Stim:

(Through E-Stim, or electrotherapy, you can achieve three general outcomes: pain reduction, tissue therapy and muscle rehabilitation or strengthening.

Exercise and Fitness:

(Carefully planned exercise regimens and physical therapy help rehabilitate existing injuries, and prevent new ones.)

The Chiropractic Care division at Healthy Trust Immediate Medical Care Clinic is trained to deal with all kinds of injuries, and we are the best place on the North Shore to go when you need Chiropractic care.

We serve the Chicago North Shore Communites of Wheeling, Arlington Heights, Mount Prospect, Prospect Heights, Lake Bluff, Lake Forest, Lake County, Lincolnshire, Deerfield, Buffalo Grove, Mundelein, Northbrook, Highland Park, Long Grove, Riverwoods, Des Plaines, Palatine, Libertyville, Glenview, Highwood, Northfield, Libertyville, Winnetka, and Bannockburn.