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, even though 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. I had extensive training in rehab similar to physical therapy, but 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 https://myrosevillechiropractor.com/videos/

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 and ice packs (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 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 subsidiary, 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, even though 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 supposed to have a choice. Some companies are getting ridiculous with PPO benefits 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-network 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 chiropractic care available and affordable for you regardless if you have no insurance, if you 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 harassing 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 when the case settles. I highly recommend 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 bucks 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 settlement 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 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 upfront 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 upfront expenses, the low reward, and the time you will spend, it is by far the least attractive option. Plus, actually getting money from the person you are suing can be very difficult, at least in California.

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 system.

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 to increase the 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.

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.