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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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.

To X-ray or not to X-ray?

It is the trend these days for chiropractors not to have x-ray machines in their office . Some docs would never dream of adjusting a patient without x-rays and “proof”. For them the cost of x-rays and the radiation exposure is completely justified by their style of care. The other extreme is the doctor who feels like radiation should be avoided always. A lot of doctors just do not want to deal with the cost and hassle of x-rays. If their patient needs imaging, they refer them to an x-ray facility.

For me, it always depends on the situation. I have digital x-rays in my office. It costs me the same to take 100 x-rays as it does to take none, so cost is not a factor. That saying, there are plenty of factors that come into play when deciding to take x-rays on a patient.

First, is there a reasonable need to take x-rays? I do not believe taking x-rays on everyone before adjusting them is necessary. I respect some chiropractors methodology, but I do not adjust people based on x-rays. I take x-rays when a patient has had trauma and I want to rule out fracture or instability or if I suspect a scoliosis or some other malformation. On occasion, I take x-rays because of a gut feeling. I had this experience the other day on a fairly healthy patient who had been seeing other chiropractors for months. I was glad I did when I discovered a condition known as a spondylolisthesis which completely altered my approach to adjusting her.

Conversely, there are significant reasons not to take x-rays. I will never take an x-ray on a female who is or thinks she may be pregnant. I also have a policy in my office that I do not take x-rays of children under the age of 12 unless we need to visualize a scoliosis. Finally, if someone has had a lot of radiation, I try to avoid more exposure.

In general, x-rays do not expose someone to a lot of radiation these days. Nevertheless, they are still radioactive and should be respected. If I feel like a patient can avoid having  x-rays taken, I do my best to avoid them. If you see a chiropractor and want to avoid x-rays or feel like you need them, it is very helpful to let the doctor know why or why not. In most cases you can start care without x-rays. If the treatments are not working and the doctor suspects there may be more insight using x-rays, then do them then.

It’s a Wonderful Life From This Chiropractor’s Perspective

I love the movie, “It’s a Wonderful Life.” I am especially moved by and relate to the main character, George Bailey. George consistently puts the needs of others before his own wants. He is flawed for sure, but when it comes down to it, he does the right thing for others. In the end, we see just how much his generosity and selflessness has affected others and when George is in dire straights, they lift and support him.

I often tell people that I strive to work by the George Bailey Principle where people and community are more important than money and business. I really believe this. I am also thoroughly convinced that when we focus on relationships and helping others, money and business will come.

Why am I sharing this? It kills me that there are people out there who need help but do not seek it because they fear the expense. They suffer because of something as stupid as money. Now, I get that for some it is a priority issue. I try not to know or judge. Honestly, what I care about most is helping people live healthier lives. Because of this, I know that money and success will come. It has come, and will continue. If you need care and finances are a concern, come talk to me and let’s work it out to make it affordable.

The two quotes that impact me the most in the movie are: “Remember, George, no man is a failure who has friends.”  and “A toast to my big brother, George: the richest man in town.” In my practice, I do not need to have the most money; I just want to help the most people. This will make me the richest man in town.

Holiday Stress and Chiropractic

I probably should not admit it but, “National Lampoon’s, Christmas Vacation” is one of my favorite Christmas shows. There are few actors who pull off a complete melt-down like Chevy Chase. I think we can all relate at some level with Clark W. Griswold as it concerns the stresses and strains of the Holiday Season.

There are several reasons why stress levels rise around the holidays. Day Light Savings ends forcing us to change our internal clocks. Day light decreases unti the 21st of December. The weather changes, creating all sorts of issues with cold and pressure. We are busier with parties, school plays and concerts, and all the prep work for the holidays. Shopping. Finally, there can be an overwhelming pressure to make sure this time of year is  special. All of these things can make the Holdiays a very stressful time, indeed.

Here is my advice to help deal with the holiday stress and especially how chiropractic can help. From a mental health point of view, first, remember to keep things in perspective. The spirit of the season is, after all, one of celebration and giving. Also, things are great, but people are much more important.

From a health stand point, sleep and daylight are very important. It is getting darker earlier so, go to bed earlier! Countless studies have shown the benefits of good sleep and low stress. Your body needs time to rest. Patterning your schedule to the sun and not just the clock can make a difference. With the days being shorter, be sure to get some sun light. Light from the sun helps produce a useable form of vitamin D which affects the production of seretonin. Seretonin helps maintain a positive mood. Some of you will go to work in the dark, work in a cubicle all day and go home in the dark. Be sure to take a lunch break and go outside to soak up some sunlight for at least 10 minutes. Seretonin, by the way, also helps boost the immune system so it will help fight off all of the viruses that tend to be more prevalent this time of year.

One of the biggest issues with stress is that it creates a vicious cycle. When there is emotional stress it creates physical stress. During physical stress the postural muscles tense which causes joints not to move as freely. Blood flow is altered and the sympathetic nervous system is stimulated causing an increase in adrenaline and cortisol. This physcial stress can lead to pain which causes emotional stress and the cycle continues. Getting adjusted will help break the cycle. Chiropractic adjustments work at the joint level to restore proper balance to the sympathetic nervous system. If you are feeling stressed, it is time to come in and get adjusted.

 

Increased Days and Hours for Thomas Chiropractic!

Patients have spoken and we are listening. Effective immediately, Thomas Chiropractic will be open Monday through Friday from 8:00 am until 6:00 pm with lunch from 12:30-2:00 pm. Below is a list of the hours for each doctor:

DrThomasTwitterDr. Thomas 
Monday: 8-6 w/ lunch from 12:30-2
Tuesday: 9-12:30
Wednesday: 8-6 w/ lunch from 12:30-2
Thursday: 8-6 w/ lunch from 12:30-2
Friday: Off
Saturday: Random time based on availability
 
Dr. Nowland
DrJNowlandPicMonday: 8-6 w/ lunch from 12:30-2
Tuesday: 8-6 w/ lunch from 12:30-2
Wednesday: Off
Thursday: 8-6 w/ lunch from 12:30-2
Friday: 8-6 w/ lunch from 12:30-2

 

Dr. Thomas and Dr. Nowland are both happy to treat each other’s patients should they come in at a time when their regular doctor is unavailable.