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 in Chiropractic

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

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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, 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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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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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.

 
 

 

Low Back Pain and Tight Hamstrings

If you are around my age, you might remember having to pass the Presidential Fitness Test in P.E. Part of that test was flexibility demonstrated by sitting on the ground with the legs extended and the knees straight. Then, you would reach forward as far as you could. Not to brag, but I could reach well beyond my feet. I was, in fact, the most flexible boy in my whole middle school. I remained pretty flexible until I was in college when I hurt my low back. Since then, I can barely touch my toes on a good day.

With any injury, the body has protective measures. When you hurt your low back, the hamstrings will shorten to protect against bending forward and causing further damage. Like most of these reactions though, the body doesn’t always know when to stop guarding which can prolong the healing process or lead to more problems down the line. My recommendation is to first start improving the function of the low back through chiropractic adjustments, and then to start regularly stretching the hamstrings.

I created the following video to help you do this stretch properly. Remember that in order to actually lengthen a muscle, you must sustain the stretch for at least 30 seconds. It can take time before you see results. If after several weeks of stretching you are not improving, it most likely means that there is still a significant amount of  dysfunction in your low back that you need to address.

Hamstring Stretch

Do Your Hands Fall Asleep?

Most of us have experienced it. There you are sitting in what seems like a comfortable position, watching tv. All of sudden you notice that you have no feeling in your hand! It has fallen asleep. You move from the all-of-a-sudden awkward position trying to pause the show you are watching but you can’t because you have no feeling. You do the obligatory shaking of the hand trying to get it to wake up. It starts to get some feeling back but really it just feels like someone is jabbing you with thousands of pins and needles. Then you start to flex and extend your fingers. It finally starts to wake up and you are able to reverse back and watch what you missed. Slowly, the hand goes back to normal. You have just experienced paraesthesia.

The scenario described is the least serious form of paraesthesia. It is usually temporarily caused from either a direct pressure on a nerve or by cutting off blood supply to the nerve. Once you release the pressure or get the blood moving, feeling starts to return. One still needs to be careful in such a situation. I have a  patient who tried to walk when, unbeknownst to her, she had a foot that had fallen asleep. When she got up to walk, she fell and shattered that numb foot requiring surgery and a litany of issues. So, be careful!

The bigger issue, however, happens when paraesthesia comes on insidiously. In these types of situations, there is something deeper that is irritating the nerve. For the hand, this can happen at the carpal tunnel, at the elbow, at the shoulder, under the pectoralis minor muscle, under the scalene muscles, and at the nerve roots in the neck. Irritation can be caused by swelling of soft tissue (ligaments, muscles or tendons), by bulging discs, by stretched nerves due to poor posture, by a deficiency in blood supply due to a host of conditions, and the list goes on. If your hand consistently falls asleep, you need to figure out the cause. It could be a simple remedy or it could be a sign of something serious. The longer a nerve is injured, the longer it takes for it to heal. In addition, you run the risk of injury to the area the nerve supplies. So, if you are getting numb hands, get in and let us help you.

Photo by Matilda Vistbacka on Unsplash