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It could be the late cold season or a rampant allergy season, but I have had several patients come  in with vertigo this month. If you do not know what vertigo is, lucky you! If you have experienced the nauseating feeling of being on solid ground while your brain is telling you that the tilt-a-whirl is in full force, then you know that vertigo can seriously affect your life. Vertigo is described as a feeling of being stable while objects around you are spinning. The three systems that can cause vertigo, in order of most common to least, are the inner ear, the neck, and the brain stem.

1. The Inner Ear has a complex system of tiny hairlike sensors, called cilia, that send information to the brain based on the movement of fluid through a maze of canals. When there is in an increase of fluid in the inner ear or the fluid gets too thick and mucousy, it affects the movement of the cilia, and can cause vertigo. This is common with inner ear infections, colds, flus, hay fever, and sinus infections. Drainage is critical to success in treating vertigo caused by inner ear congestion. Chiropractic adjustments help loosen the muscles in the neck which allows for freer lymph flow and better drainage. In addition, cranial adjustments can help pump the congested sinus and promote drainage. Drinking plenty of water will also help to thin the mucous which will help is drain.
2. The Neck, especially the top two vertebrae called the atlas and the axis, respectively, have sensors in the joints called proprioceptors. Proprioceptors relay position to the brain.  They are found in all joints but the nerves in the neck are particularly sensitive to head movement. When these vertebrae do not move as they should, they send a mixed signal which can make the brain feel like the body is moving when it is not. Again, chiropractic adjustments will help reset proprioceptors which will restore the proper flow of position sense, thereby halting the vertigo.
3. Brain Stem Dysfunction is by far the least treatable of the three. In general, brain injuries are extremely slow to heal. Depending on the nature of the injury, there is little hope of treatment save time and prayer. I have no empirical evidence, but I would imagine that hyperbaric therapy could be helpful. Chiropractic adjustments will not directly help but keeping the body and nervous system functioning well is always beneficial.

If you are suffering with vertigo, there are some easy, non-invasive tests to figure out which system is causing the symptoms. Treatment is effective and we usually see results pretty quickly in most cases.

I see it every day. For some patients, it is a major concern. They tell me their previous chiropractor diagnosed them with it. I tighten my lips and lower my eyebrows with an empathetic look. On the inside, my eyes are rolling. I can tell the patient needs me to understand that this is a serious chronic issue. This is obviously learned behavior from their previous doctors. I wonder if I am the only one that thinks this is no big deal. I try not to be condescending and to acknowledge their concern. The truth is that it is another temporary sign. I am talking, of course, about having a “short leg.”

Symmetry in nature is rare. I am sure everyone has one leg a little shorter than the other if you start measuring in millimeters. This begs the question as to why one leg can look so much longer than the other? The answer is found in the mechanics of the body.

Most movements in the body have a coupled movement to help maintain balance and flexibility. Side to side bending and rotation go together. In the low back, when a disc bulges and causes the vertebrae to bend to one side, it is accompanied by rotation. Rotation, in turn, contracts the muscles on the same side pulling the leg toward the trunk of the body. When lying face down, this leg will appear short because it contracts up.

I will not get into the mechanics and how it looks when standing up but think of standing with one shoe on. In addition, if the pelvis is rotated it can cause a different scenario. Suffice it to say that no matter what, a “short leg” is usually temporary and correctable, if not very manageable. No reason to get alarmed and go out to find the perfect sized lift or to change all of your shoes. After one chiropractic adjustment, balance can be restored. Now, how long that balance will last is anyone’s guess. It may take a series of adjustments before the legs become or stay relatively the same length. However long it takes, just remember, a “short leg” is not the end of the world.

In Jack London’s Call of the Wild, the main character, a dog named Buck, finds himself face to face with a man who has a club in his hand. Buck attacks that man in an attempt to escape his abduction, only to be hit painfully on the head nearly unconscious. He attacks again with the same result. Buck is a large and powerful dog and honestly feels he can beat this man. However, after several more attempts, he finally submits believing that if he continues, he will end up dead. He reasons that the man with the club in his hand is too persistent and strong and therefore must be obeyed.

Switching perspectives to the man with the club, there has to be some trepidation when confronted by a large animal with sharp teeth. Safety only comes from using the club effectively. Not using the club at the right time or the right way can be disastrous. It is likely there is a fear that the dog may be to big or too fast. Finally, not being prepared or ready to use the club again, at all times around the dog could also be fatal. Each animal has a different temperament. Some are more predictable than others but none are truly controlled.

This scenario is like an injury. Sometimes, after one or two adjustments the injury heals and is never a problem again. Other times it is good for a while but comes back again. Some injuries take several adjustments before healing and some never heal completely and need continuous work. There are injuries that will never get better. The best we can hope for, sometimes, is that we slow down the progression of an injury. The worst are injuries for which we cannot help.

Often times, in the healing process, we believe we have healed and disontinue care too early. When this happens, healing momentum is lost and can prolong the overall healing time. The question I get more often than not is how many adjustments it will take. As much as I would love to give an answer, I do not know. I can give general outlines and recommendations. Average injuries generally take about three months to heal with consistent treatment. There are so many factors that can decrease or increase the healing time. Factors such as age, degenerative change, weight, etc. can significantly change a prognosis.

The healing plan for chiropractic is the same as the law of the club. We keep hitting or adjusting the incoopertive joint until it decides to submit to the proper movement and heal appropriately. Some joints and injuries are going to respond quicker and easier than others and some are not going to respond at all. We do not always know how the healing process is going to respond without consistent care over a significant period of time.

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.

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. At 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 in close succession 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.

***Photo by Emily Campbell on Unsplash

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.

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.

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.