The Cost of Waiting

Abraham Lincoln once said, “You cannot escape the responsibility of tomorrow by evading it today.” The same is true for addressing your health concerns. Several times each day I have patients come in who tell me they have been hurting for days, weeks, months, or even years. The story is usually that they just thought it would get better on its own but it never did. Inevitably, they express their remorse at waiting to come in.

The truth is that with any injury, the body starts the healing process immediately. The concern is whether you will heal correctly. The body will compensate in whichever way it can to stabilize. If muscles are tight or ligaments are overstretched, it will alter the proper movement of joints. Such improper movement causes the nervous system to become confused and ultimately desensitized. Consequently, the body will lay down scar tissue that will promote the new and improper movement patterns which leaves the body susceptible to reinjury or to injury of surrounding tissue.

As a chiropractor, if I can help move the joints in a proper manner before inflammation and scar tissue sets in, then the healing process is a much easier ordeal. If you wait until scar tissue repair has set in when you come in to see me, the first step will be for me to tear down most of that process so the healing can start over. As with remodeling kitchens, the demolition can be ugly. The old adage of getting worse before it gets better is often in play and can lead to a few days of discomfort.

Another caveat to waiting is establishing movement patterns that can be difficult to retrain. Old habits are harder to change than simply making new ones in a fresh environment. Chronic conditions can take years to correct for this very reason. Muscles and joints have memory locked in to the nervous system. In my experience, it typically takes around three months of consistent treatment to change that memory.

Finally, with altered movement, the the body will degenerate quicker. At a joint level that means that tissues will dry up and bone spurs will form. Once a bone spur has formed, everything changes. No amount of adjusting, taking supplements, acupuncture, or whatever is going to remove that. Tissues can be rehydrated but they are never as good as they used to be. This is mortality. However, we can help slow down the degenerative process. At the end of the day, if we just improve the function it is worth it.

All conditions will change over time. The body will strive to compensate but that compensation can lead to issues down the road. If you have an injury or if dysfunction has been brewing for too long, get in! Better yet, come consistently and do your best to maintain good health and function.

 

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Meet Eric Wagnon, DC!

Eric Wagnon Photo

If you have been in the office over the last three weeks, you may have seen a tall gentleman in passing or treating patients. We are happy to welcome Dr. Eric Wagnon!

Dr. Wagnon has relocated his practice from Rocklin to be with us. He brings with him nearly seven years of experience in helping others improve their health through chiropractic care. Dr. Wagnon and his wife, Jackie, are residents of Rocklin along with their children Tucker, Taylor, Tessa, Tyce, and twins, Trey and Talia. Dr. Wagnon was raised in the Sacramento area. His father has been practicing as a successful chiropractor for 30 years. Dr. Wagnon’s undergraduate studies in Biology were completed at Brigham Young University, and his Doctor of Chiropractic degree was attained from Life Chiropractic College West. He is also fluent in Spanish.

Dr. Wagnon plays an active role in the community involved with the Rocklin Chamber of Commerce and speaks regularly to different clubs, groups, schools, and organizations on different Wellness topics to help change the health of our community.

Growing up with chiropractic in the home, Dr. Wagnon possesses a deep passion and personal understanding for what chiropractic can truly do for individual and family health. Nothing gives him more satisfaction than to be able to give that health to the core unit of society, the family.

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Now Offering Custom Orthotics, Again

Not all insoles or orthotics are created equally. Most of the orthotics out there are really posts. What that means is that they make your foot inflexible, but in a perfect position, making it part of the post that is your leg. In this case, shock absoprtion is transferred to the knees, hips, and back. I much prefer an orthotic that helps improve the biomechanics of the foot. One that allows the force of walking to be cushioned properly by the flattening of the arch and then uses the kinetic energy generated by the stretching of the arches to propel you forward off your big toe.

Unfortunately, creating a custom orthotic that improves the function of the foot is not very common and surprisingly hard to find. The last company I used did a great job until the software crashed and the company disappeared. It took me years to find a new one but I have found a good one. Check out this video from the new company that is making the custom orthotics I am now selling.

If you want or need a pair, I am selling them for an introductory price of only $150. These type of custom orthotics retail for around $350. The special price is good until June 30th. After that they will be $225.

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Consistency and Persistency

 

First off, I know that persistency is not a real word. It is a joke to get your attention. Even if Charles Barkley, or any other athlete turned commentator, might use such a faux word to great effect, the true word is persistence. Now that we have that out of the way, let’s talk about why this is the topic of this article.

We live in an instant gratification society. People want to see results immediately and there is very little patience if they do not.  This is true in healthcare, as well. The only problem is that it does not work. Healing is a process that takes time, effort and energy. The more consistent the effort and energy put into healing over time, the better the results.

In addition, there is significantly more value in going through the process. All too often, I am sitting across from a patient explaining the healing process and how it takes time and consistency when I see the glaze fall over their eyes. From there, they either just ignore what I explained or they honestly believe they are the exception. Very few people are the exception, that is why they are the exception!

For chiropractic the healing process centers mostly around the function of joints. We help train joints how to move correctly which then helps re-train the nervous system which then re-trains the muscle system. Proper movement promotes coordination between the three and establishes a body awareness. This awareness helps maintain balance and function and helps us avoid future injury. Proper function also slows down degeneration. Again, this is a process. On average, people get adjusted three times a week in the beginning. After about a month, they drop to twice a week and then eventually once a week. After about three months, the patient is typically as functional as they are going to be and ready for maintenance care.

Heber J. Grant said, “That which we persist in doing becomes easier. Not that the nature of the task has changed, but our ability to perform it increases.” This is true with joint movement, as well. In the beginning of care, joints are resistant to change. Not only are they harder to move but they also revert back to old movement patterns. It takes several adjustments close together to generate enough healing momentum to make a change. If you are persistent in making that change and are consistent in the application, you will reap the reward of an adjustment that lasts longer and keeps your body from falling apart. In other words, it is not that the adjustment has changed but that your body becomes accustomed to the proper movement. Proper movement, and all of the health benefits that come with it,  is the result of consistency and persistency.

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Keeping It Simple

I love being a chiropractor. I feel blessed to get to know so many great people and help them improve their health. I love discovering new things about the human body and the microcosm it is. I have seen thousands of patients come in hurting and dysfunctional and after a relatively short amount of time, they are feeling and functioning better. I love the simplicity of what I do.

In my profession, there are many ways to practice. I choose to keep my practice focused on the joints. There are hundreds of joints in the body and each one feeds the brain with information. When the joints work properly, the nervous system has a better chance at working properly, and if the nervous system works well, the body will be healthier. Simple! Right?

My success comes by improving joint movement. I do it well and I am fortunate enough to adjust around 400 patients a week. I get asked all the time how is it possible to adjust that many people? The truth is, I could do more. The fact that I am writing this article during office hours proves I could. I do my best to never rush but it does not take a lot of time to adjust someone and I am typically pretty quick at understanding where the dysfunction is. I do spend more time with new patients but a regular adjustment takes anywhere from two to three minutes.

Because I love simplicity, I choose to not employ my education in areas that are completely within my scope of practice. I do not counsel people on diet and nutrution beyond very basic advice. I am not interested in helping people lose weight, eventhough I am more than happy to liberally praise and give verbal support. Herbs and natural remedies are interesting and I use them myself but I have not dedicated the time to have a working knowlege nor have I developed the skills to give proper advice. Acupuncture and acupressure work great and I have referred many patients to good, licensed practitioners. Physical therapy can significantly help someone rehabilitating an injury, as well, and a good physical therapist can help tremendously. Eventhough I had extensive training in rehab similar to physical therapy, my office is not set up for that type of care. For complicated cases, I send patients to a physical therapist. Otherwise, I teach simple at-home exercises or refer to <a href=”https://www.youtube.com/user/thomaschiropractic” target=”_blank”>my YouTube channe</a>l.

There are many chiropractors who have a broad menu of services available to their patients in their office. They offer rehab and nutrition. They sell support products like orthotics, back braces, supplements, essential oils, exercise equipment, traction units, etc. Good for them! As a society, we need more of this type of care. We also need enough doctors and patients to understand the power of a simple adjustment. I give adjustments, point people in the right direction in terms of extra services and, although most people do not even know, I sell Biofreeze, ice packs and water based pillows (only because people want me to). All of the other things are great and beneficial and nothing is any more or less than the other. As for me, I am happy to keep it simple.

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How Do I Know If My Chiropractic Treatments Are Helping?

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One of the most fulfilling yet difficult aspects of my career is helping people navigate their journey to better health. Healing is a process that can take a lot of time. We tend to think of that process as a straight road from disease or injury to health but that is the exception rather than the rule. Often, things feel worse before they feel better and there are always plateaus and valleys. Helping patients to have faith in the process and continue care inspite of bumps in the road is a worthy challenge.

Everyone comes into the office with disfunction. Not all disfunction is symptomatic but it all has potential to become so. Sometimes people come in with symptoms that are just starting to show but during further examination, I discover that those symptoms are just the tip of a very large disfunctional iceberg. I know that when I start chipping away at the disfuntion below the surface it is going to make those symtoms much more obvious. This can be very alarming. In addition, symptoms can change or move locations. People who are more prone to worry, often need a lot of reassurance to stay the course. There are several signs and symptoms that may cause concern but are actually indicative of progress. Most of these happen in early stages of care.

Pain will often increase with increased movement. Adjustments are designed to move joints that have been stuck or moving improperly for some time. Getting them to move again can cause pain. It is not always pleasant but it is a necessary step. As a rule, the pain should be more of an ache or soreness. Furthermore, pain can centralize and therefore increase in intensity. Centralized pain, or pain that is focalizing on the disfunctional joint, is usually more painful than a broad spread out pain. In this phenomenon, the pain is going back to where it belongs which is a very positive step. The closer your symptoms are to the structure that is actually causing the symptoms, the better the body will be at promoting healing in that area.

Symptoms often change especially when nerves are involved. If a nerve is significantly injured, the worst thing is complete numbness with zero sensation. There is actually no pain. When we lessen the irritation, the sensation is one of pins and needles and achiness. This can be followed by soreness. These symptoms will wax and wane for some time before a complete recovery.

Another change that can happen that will cause a patient mental anguish is when a symptom switches sides. We often see this is disc related injuries. This is not necessarily a bad thing either. It tells me that the disc is not completely stuck in one bulging position and can change or, even better, that it has not degenerated to the point of no return. The ability to change means it can heal.

I find it much better to not focus on symptoms but to look at movement patterns, muscle tone, and inflammation. If range of motion is improving and muscles are calming down, then progress is being made, and it is only a matter of consistency and time before symptoms start to go away for long stretches of time. When people ask if they are getting better, or complain that they are not any better, when I know they are, I usually ask them how they feel after an adjustment. More often than not, they feel significantly better but it just does not last as long as they think it should. As we get better, we also tend to forget how bad the pain was. The contrast of any pain when you have experienced little to no pain promotes the idea that one is not improving. Perspective is the key.

If you feel like chiropractic is not helping you, please take a step back and consider the big picture before you cut your care short, thus nullifying all of the hard work you and your doctor have done to help you become functional again.

 

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Insurance and Chiropractic

I frequently get emails asking if I take such and such insurance. I wish my response could be as easy as yes or no but it never is. The insurance/provider arrangement is as complicated as a Kardashian relationship. I will try to explain but if you do not understand it is probably not because I am not saying it clearly enough but because it is so stupid you will be left wondering why in the world it is like this.

There are several Health Insurance companies in the US. They are typically large companies that have regional or statewide sub companies. For example. Blue Cross Blue Shield has corporate headquarters in Missouri (I think), but there is also Anthem Blue Cross Blue Shield which is headquartered in Indiana. Then there is Blue Cross of California, Blue Shield of California, Blue Cross Blue Shield of Texas, Minnesota, Illinois, North Carolina, Arizona, Federal Employees, Exchange (for Obama Care) and the list goes on. The same can be said of the all of the rest, too. They are massive entities with more subsidiaries with either identical names plus the region or completely different names altogether depending on merger agreements and who has subcontracted with whom.

Sound complicated? I have just begun. Most, but not all, of these companies do not handle chiropractic claims. Instead, they subcontract out with insurance companies that specialize in chiropractic claims or to similar sized companies who have a local division who does. Most of the time these specialty insurance companies are an HMO. Stay with me, I know what you are thinking. You have a PPO so this does not apply. Yes, it does. They manage PPO benefits, too, but under a different set of rules and typically only if you go to someone out of network. Speaking of networks, doctors never really know with whom they are contracted because companies constantly change who is managing their benefits which changes the network. By the way, different regional companies subcontract with different regional specialty managers.

Now that your brain is hurting a little, let me give you some examples in an effort to help you understand that which is incomprehensible.  Currently, I am a Blue Shield of California provider. I have been for almost 10 years now. On the occasion someone comes in and they have Blue Shield of California, I am in network. However, I am not a Blue Cross provider because they let an HMO known as ASH (American Specialties Health) manage their benefits. Only doctors willing to contract with ASH can be Blue Cross Providers. So, if someone comes in with a card that says Blue Cross/Blue Shield, we cannot tell if I am in network or out of network. We can call and hope they give us correct information but until we get the first check with an explanation of benefits, it is iffy.

The BC/BS arrangement is probably the most convoluted. Cigna and Aetna are East Coast companies and so they subcontract their chiropractic benefits to local HMO’s, the most common being ASH and ACN. Kaiser is the largest insurer in California and even they do not handle chiropractic claims. When I first started my practice they contracted with ASH. A few years ago they stopped offering chiropractic benefits across the board. Recently, I think there are some plans that have chiropractic benefits again through ASH. There are smaller local companies like Western Health Advantage who let their subisdiary, Landmark, handle chiropractic claims. Again, they are a managed care company or HMO. Sutter Select, for Sutter employees is managed by UMR but their chiropractic benefits are now contracted with ASH, eventhough Sutter employees have a very liberal PPO benefits package. ASH is new for Sutter. Before them, UMR was relatively easy to work with. Now, it is a bunch of red tape and rhetoric.

Then there is the question of in network vs. out of network. If you have an HMO, you have no choice but to go in network. If you have a PPO, you are suppposed to have a choice. Some companies are getting ridiculous with PPO benfits trying to force you into only going to an in network doctor. They do this by dramatically raising your out of pocket cost if you go out of network like raising your deductible and/or increasing your co-pay amount or percentage to astronomical levels. They want you to go in network because they have contracts with in networks doctors allowing them to control the amount of care and therefore the amount of money they will be responsible to pay. If you have a plan that punishes you for going to an out of network doctor, chances are the deductible will be so high that the insurance company will never pay anything. For other companies, there is no difference between in network benefits and out of network benefits.

When you ask the question, “Do you take my insurance?” it opens a Pandora’s box of scenarios. Thankfully, my assistants are great at finding the answers and asking the right questions. Besides determining if you have chiropractic benefits, at all, then figuring out if we are out of or in network, we also need to discover if you have a deductible to determine how much you will pay out of pocket before the insurance company covers anything. Then, we need to determine how much your co-payment will be after your deductible has been met.

Rest assured that we know what we are doing even if nothing I wrote above makes any sense to you. Our commitment  is and always will be helping you live a healthier life. To that end, let me be clear. We will make chiropracitic care available and affordable for you regardless if you have no insurance, if your have crummy insurance, or if you have great insurance.

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If You Are In An Auto Accident That is Not Your Fault, It Should Not Cost You Anything.

Statistically speaking, you will probably be in an auto accident at some point in your life. I believe that injuries happen in most accidents, even the small ones, and that you are doing yourself a disservice by not healing correctly after. One of the barriers that keep people from getting the care they need is the potential cost. Let me be very clear, if you are in an auto accident and it is not your fault, your care should be covered 100% either by the  responsible person’s insurance company, through your insurance company, or by the responsible person. This article explores the most common ways to have healthcare bills paid.

The simplest way to make sure your bills are covered is to hire an experienced personal injury attorney. I understand that there is a stigma with hiring a personal injury attorney and there are definitely some shady characters out there. However, there are some good guys, too, and they can make life so much easier. A good attorney will make it so you do not have to talk to the insurance company again which means no more harrassing phone calls or bullying you into believing you are not really hurt or that you are milking the system. Personal Injury attorneys work on a contingency so they get a percentage of the settlement they get for you. Usually, that is 33%. A good attorney, provided it is a decent case, will usually get a larger settlement which means more money for you in the form of pain and suffering. It can take a while for everyone to get paid using this method but most doctors will treat you on a lien backed by the attorney because they know the attorney will pay them wihen the case settle. I highly reccomend this option for most of my patients.

The next easiest, and frankly the one chiropractors like the best, is to bill your insurance company through med-pay. Med-pay is an extra on your policy and not everyone has it. It usually costs an extra few buck per month and covers up to around $5,000 in healthcare if you are in an accident regardless if it is your fault or not. Chiropractors like it because they pay as you go so they do not have to wait for a lump sum payment. You can still get an attorney if you have med pay if you would like a settlement for yourself. You can also negotiate a settlement for yourself but you need to be careful that the other insurance company knows that the total setttement includes what your insurance company already paid in med-pay.  Your insurance company can go after the other insurance company for what they paid in med-pay and if you close the case with the other insurance company by taking a settlement, your insurance company might come after you for compensation.

You can negotiate a settlement yourself with the other person’s insurance company. This is the riskiest thing to do, especially for the doctor. In this situation, after all the treatment is done, you take all of your bills and any other expenses and submit it to the claims adjuster. You can also ask for more money for pain and suffering. It has been my experience that this is not as easy as it should be. Claims adjusters will often deny a legitimate claim hoping you do not want to spend your time and energy to fight with with them. They can bully you into believing that what you are asking for it too much and way above what is normal and try and pit you against your doctors. They can even take the attitude of “what are you going to do about it?” At this point, it is usually too late to get an attorney which means you are left to figure out a way to file a complaint or sue in small claims court. Both are a pain and may cost you. Most chiropractors will not treat you unless you pay up front which can get expensive. I will treat in this situation on a lien in hopes that the insurance company will play nice and trusting the patient to pay me when it all settles.

Finally, you can take the insurance company or the other driver to small claims court. The limit of small claims court is around $7,500 in most counties depending on the nature of the claim. It will cost you a filing fee, usually around $75 and you will also have to pay someone to serve the defendant which can be expensive. These cases are simple to win but with all of the up front expenses, the low reward, and the time you will spend, it is by far the least attractive option.

I am not a lawyer and I am not giving legal advice. If you are in an accident that is not your fault, please do yourself a favor and educate yourself on how the process works. Doing so will allow you to get the care you need which is the most important thing.

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You Can Adjust the Bones in Your Skull?

There are 22 bones in the skull connected by a type of joint called a suture. In the old days, doctors thought these bones fused together in adulthood. Now, we know that they can and do move with some regularity. The suture as a joint is only found in the skull. It doesn’t pop like the synovial joints in our backs and extremities, they just shift a little here and there. Because there is movement, though, it can be adjusted, and because of the proximity to the brain, the results can be very beneficial.

There are several reasons people need the cranial bones adjusted. Most often it is due to a build up of sinus pressure which changes the shape of the skull. The sinuses are open areas in the middle of cranial bones. They have a mucous lining and are sensitive to atmospheric changes. When full, as a result of  a cold or allergies, they tend to hurt from the pressure. When one gets cranial bones adjusted, it regulates the pressure and promotes drainage into lower sinuses and into the lymphatic systmem.

Another reason to adjust the cranial bones is for TMJ issues that won’t resolve with adjusting the jaw. The “T” in TMJ stands for Temporal, as in the temporal bone. It makes the socket part of the joint where the mandible articulates. If it is shifted, the joint is not going to work right no matter how much you try and increase movement of the mandible.

I have seen great success adjusting the cranial bones. It seems a little odd but it can make a difference. It can help with sinus issues, headaches, TMJ syndrome,  and a host of weird neurlogical conditions due to mild pressure on the brain.  Let me know if you want me to check it out.

Even If I Want to, I Cannot Help Everyone. Neither Can Chiropractic.

The great Aristotle once wrote that “The more you know, the more you know you do not know.” For me, the more experience I gain, the more I realize my limitations. People who know me well, know that I do not lack confidence. I try not to be arrogant but I do my best to assure myself that I can be a force for good in this world. That saying, I must confess that no matter how much I may want to make everyone better, there are just some people that I cannot help.

Recently, I had a patient come in that I hadn’t seen in a couple of years. She did not come in for an adjustment. She came in to explain why I couldn’t help her. You see, back then I gave her several adjustments which provided little to no relief and then she started heading south so she discontinued care. As a doctor, that is the most helpless feeling. It is made significantly worse when there is no explanation why. In her case, she was born with a birth defect called a Chiari Malformation where the lower part of the brain drops below the skull. This can lead to a syringomelia, a pocket of fluid in the spinal cord which can be very painful and dangerous. Anyway, this was never mentioned in her MRI report from years earlier. The neuro/spine specialist that she saw some time after seeing me saw it on the MRI. This little bit of information explained everything. I am grateful she came in and shared that with me.

There will always be conditions that are too far advanced for me to help. I don’t like it, but that is the way it is. We do not always know when a condition is beyond help until after we have tried. I have had many patients with serious back pain come in and ask if I can help. As a chiropractor, I know I can adjust them. In most cases, this will help in the healing process. At the very least, it is a conservative start. Most patients get better and we can manage. Others do not. I have recommended MRI’s and surgery when it is beyond my help. For the most part, those patients have seen good results and have come back to me for care after their surgeries.

Finally, there are people who either do not really want to be helped or have unrealistic expectations of how long and what it will take to heal. Healing takes time and effort. One adjustment can make a big difference in how a patient feels but it does not mean that their injury has healed. Consistent care is tentamount to healing properly. Likewise, just because there is still pain, it does not mean that injury is not healing. Pain can be tricky and is not a very good indicator of the level of damage.

In short, I sleep at night knowing that I do my best to help others live healthier lives. There are always challenges and there will be people that despite my knowledge, skills, and determination, I cannot help. For those people, I am sorry. I feel bad for you and hope there is some one out there with the answers and approach to help you in your journey.