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Don’t Quit

What recession? Don’t fall into the negative ’stinking thinking’  of those around you. Keep your state of mind in abundance and don’t give in to negativity and lack. Never quit even when times are tough, and they will be. That is what being a successful doctor entails; focusing on your value and benefits to patients. Do that and they will come. I found this poem surfing the internet and wanted to share it with you. Enjoy

Don’t Quit

When things go wrong as they sometimes will.

When the road you’re trudging seems all up hill.

When funds are low and the debts are high.

And you want to smile, but you have to sigh.

When care is pressing you down a bit.

Rest, if you must, but don’t you quit.

Life is queer with its twists and turns.

As everyone of us sometimes learns.

And many a failure turns about

When he might have won had he stuck it out:

Don’t give up though the pace seems slow –

You may succeed with another blow.

Success is failure turned inside out –

The silver tint of the clouds of doubt.

And you never can tell how close you are.

It may be near when it seems so far:

So stick to the fight when you’re hardest hit –

It’s when things seem worst that you must not QUIT.

Author unknown

Distributed compliments of Brian Tracy, 462 Stevens Avenue, Suite 202, Solana Beach, CA 92075, (619)481-2977

DON’T QUIT” faxback #175

Just Say Thank You.

Hi everyone, sorry I have not written a post for a few days. I just got back from Las Vegas and the Parker Seminars. Always a great time to reset your focus on what’s important. I was working at the vendor show representing K-laserUSA. www.k-laserusa. We had a amazing time meeting so many different doctors from all over the world.

Here is a new view on a prior article I wrote for Student DC. I wrote it on the plane ride home. Always trying to improve. Never stop learning. Enjoy.

The Power of Hand Written Thank-You Notes/Cards to generate referrals

Think about why people refer business to you. There are several reasons.

One, people like to refer business. It makes them feel good. They are making a contribution when they refer and this makes them feel good about themselves. Given the right opportunity, people would refer you more than enough business.

Two, the Law of Reciprocity. If people feel they owe you something, they are more likely to give you something in return. One of the things they give you is referrals.

 Three, the Law of Affinity. If people feel that you like them they will go out of their way to help you. People get so little appreciation these days (Hot Tip: Using the fine art of appreciation is a powerful tool on the road to success), so when they get some they are more likely to talk about it to others. 

The level of referrals you receive is based on the level of service you provide and your ability to simply ask for them (more on that later). By using hand written than you notes you are trying to increase the level of enthusiasm, convition, delight in your patient. When I say hand written, I’m not talking about just your signature on the bottom of a pre-printed card saying thanks for the referral with a blank line to insert the persons name. No. You need to take the time to write out the entire message by hand, including the mailing and return address. 

Little things make all the difference. As I stated before, your patients expect you to get the job done. They expect results. They expect good service. They expect you to keep your word. So if you give all of these to your patients you’ll be giving them exactly what they expect. You can’t offer less than this and expect to get word-of-mouth referrals. So don’t go patting yourself on the back for a job well done thinking you have differentiated yourself from other doctors.

Think back to the time you received a hand written thank you note. Did it make you feel good? Did it make you feel the person really cared? Did it make you feel good about the person that sent the note? Was it something special, a bright spot in your day that you told others about? Why do they make such an impact?

 It’s unexpected and it makes people feel good.

It really show you care and are thinking of them

Shows that you are organized and on top of things

Increases both your trust and affinity with people

Shows you went out of your way to do something for them

Gives them something tangible and physical that reminds them of you

Is easy and inexpensive

Can be done virtually every day

Can be done no matter what your budget is (important for new doctors and new business owners.

Makes you feel good and forms a connection with your patient 

So when do you send them? Is there a successful system? Of course there is.

Send them frequently, regularly and systemtically. This isn’t something you do once and awhile. This can be your central marketing activity. I like to send out three “thank you” notes per day. Seems like a lot, but it is not. Pick a time everyday to write them (at lunch, doing insurance work, at the start of the new day), just do it.

Here are some suggestions on when to send “Thank You’ and what to say.

When you’ve set an appointment.

Set the tone of your meeting by letting them know you’re looking forward to getting together with them.  

When you are finished with an appointment.

Have your thank you card ready when you get back to the office and the meeting specifics are still fresh in your mind. Send out the note the SAME day. This is critical and very effective. You will be surprised at the response you get for how fast the note arrives. People do notice. 

When you get new business

As soon as you have a new patient, this will make them feel confident that they’ve chosen you as their doctor. Example: ‘Thank you so much for choosing me to be your doctor. Welcome to our office and family of satisfied patients.” 

When you get a referral.

Don’t just send a note when you get new patients from a referral. Send a note right after you’ve spoken or met with the referral, even if you didn’t get them as patients. Thanking them for referring you. When and if they sign up as new patients, send a thank you note again. 

When someone helps you.

It could be anything. Someone gives you a resource, an idea, a compliment, an encouragement.  A note to an employee or manager of a store you received great service in. Do you know how many people get positive letters of praise? Not many. 

When you meet a new contact.

Through a networking event, through a business associate or any other business situation. Write a note on the back of their business card so you don’t forget them and send a note the following day. 

When you give a ‘Health Talk” or seminar.

What better way to impress the people who attend your workshop. This includes existing patients and guests. Existing patients will be happy you do not take them for granted. 

That’s a lot of notes you might say. But if you want to be successful you have to do what others DO NOT. Yes, it it, but you want to make it a habit. It takes 21 days to form a new habit, so be patient and it will feel like a natural event before you know it. The success of your marketing plan might just depend on it. 

Dr. Perry Nickelston

www.k-laserusa.com

1-866-595-7749 Ext. #2

Understanding the effects of Photobiomodulation

Photobiomodulation

Photobiomodulation, also known as laser therapy and laser biostimulation, is a medical technique in which exposure to laser light enhances tissue growth and healing. The following information will help you understand the effects of Photobiomodulation on the body.

Physiological effects:

  1. Stabilization of cellular membrane of damaged cells
  2. Enhancement of ATP production and synthesis
  3. Decreased C-Reactive protein Neopterin
  4. Acceleration of leukocytic activity
  5. Enhanced lymphocyte response
  6. Reduction of Interleukin 1 (IL-1)
  7. Increased prostaglandin synthesis
  8. Enhanced superoxide dismutase (SOD) levels
  9. Stimulation of vasodilation
  10. Increased angiogenesis (new blood vessels)
  11. Temperature modulation

Decreased Pain and Nociception:

  1. Ion channel normalization (results in pain reduction)
  2. Increase in Beta Endorphins (decreased pain response)
  3. Increased nitric oxide production (helps oxygenation and synapse normalization)
  4. Decreased Bradykinin levels
  5. Blocked depolarization of C-fiber afferent nerves
  6. Normalization of resting action potentials (back to 70 mv range)
  7. Increase release of acetylcholine (normalization of nerve function)
  8. *Axonal sprouting and nerve cell regeneration* (assists in improving nerve function and reducing pain)

Tissue healing:

  1. Increased leukocyte activity (acceleration of tissue repair and decrease of pain)
  2. Increased macrophage activity (increased phagocytosis)
  3. Increased neovascularization (new vessel growth and increase oxygenation)
  4. Increased fibroblast production (speeds tissue repair)
  5. Keratinocyte proliferation (Decreased skin healing time and early ephitheliazation)
  6. Increased tensile strength (helps prevent re-injury)

www.k-laserusa.com

Normal cells and tissues are not affected! Laser Back

 

Patient Retention Strategy #6-10

The continuation of my 21 Ways To Retain Your Patient Strategy Sytem. Just pick one and start from there. Eventually you will have all 21 and watch out, business will explode!

6. The Law of Expectation.

People will do what you expect them to do. Speak and act directly, clearly and confidently. Your beliefs about yourself and your world create your expectations. Your expectations determine your attitude. Your attitude determines your behavior and the way you relate to other people. And the way you behave toward and relate to other people determines how they relate and behave toward you. The more confident and positive you become, the more you will believe yourself destined for great success. You will generate a more powerful force of attraction around you and patients will find themselves wanting to stay.

7. Effective Leadership.

Leadership means thinking in terms of the other person. You can motivate any action if you appeal to desires, needs and wants. Keep in mind that people do not care how much you know until they know how much you care. Walk your talk.

8. Human Nature.

Become interested in other people and you will get them to like you faster than if you spend all day trying to get them interested in you. It’s called listening. You can get someone to go on endlessly about themselves if you simply ask questions, shutup and then listen. Ninety percent of a good clinician’s diagnosis comes from the patient history.
The other 10 percent is confirmed by examination. Active listening is what most doctors don’t do. Be different.

9. Pen to Paper.

One of the secrets of sales success comes courtesy of Zig Ziglar. Yes, you are in sales. You sell yourself and chiropractic every day. If you don’t, you won’t be in business very long. When explaining or outlining a treatment plan, use a pen and paper in front of the patient. Keep the pre-printed material to a minimum. People always tend to believe things in writing, whether it’s true or not. Examples include: pain scales, phases of care, goals, re-evaluations, etc.

10. Appeal to Emotions.

Appeal to a person’s emotions in order to persuade. No matter how rational and logical your explanations, if you don’t arouse emotions, you will have great difficulty influencing people. Ninety percent of decisions are based on emotions. We use logic to justify these decisions. Explain the facts in an emotion-based statement and give clear, specific benefits that appeal to desires. Example: “Complete your care plan and you can run that marathon this summer without pain.”

Dr. Perry Nickelston www.k-laserusa.com 1-866-595-7749 Ext. #2.

Success Quote:

“Fall down seven times, stand up eight.”

What Do You Guarantee?

What do you guarantee?

What’s that you say…you don’t have a guarantee? Wrong move. 99% of all small businesses (remember you are a small business) already have a guarantee-but they just don’t know it, nor do they publicize it. You are not going to guarantee results. Not only is that impossible, but it’s also against most state laws. But you can guarantee satisfaction, or a procedure.

These are called “soft guarantees”. What do I mean? Soft guarantees make promises based on generalities and not specifics. For instance, “We guarantee to be kind to you.” This is a soft guarantee because it’s very general and not specific.

Examples of soft guarntees:

  • Guarantee that you have the friendliest staff
  • That you have quick service (in and out in 15-minutes)
  • Gurantee patients will be treated with respect.
  • Guarnartee anything that will set you aprt from the competition, and increase your value in the patient’s mind.

Look at your competitors. Go through the yellow pages or the newspaper and search for other business’ guarantees. Look outside your specific marketplace for other ideas. What patterns do you see? Did you find many guarantees? Develop a guaranrtee that stretches you to the limits and test it. This can be one of your most powerful marketing tools. 

If you decide to offer a guarantee, then you better let the world know about it! Start small and track your results. How much did business increase over the previous totals you had before the guarantee? Be sure to test at least two combinations of your guarantee to discover which one works best. Put it in your advertisements, in your workshops, lecture topics, telemarketing, on your telephone message, USP, networking events and on your business cards.

 This strategy works in virtually every industry, yet doctors and health professionals rarely use it. That’s great news for you! More market share.

I know you might be getting a little nervous about this area of marketing, but that’s okay. Just keep an open mind. It’s natural to be afraid of making a guarantee because you might be afraid of patients taking advantage of your offer. 

I’m here to tell you, “don’t’ be afraid.” There are ways to offer guarantees that do not center on the actual treatment you provide, and only a small number of clients will take advantage. Humans are generally non-confrontational and don’t want to make a big issue of things. The pros far outweigh the cons. 

In any transaction, one individual must take all of the risk. In healthcare, the patient takes most of the risks. Some risks include:

  1. Making the wrong decision
  2. Losing money
  3. Not receiving what they paid for
  4. Not being satisfied and then not being able to recoup their investment of time and money.

As you might imagine, these keep many patients from contacting you. Even if people are desperate for help, they don’t always take action to get help. Why? HOPE.  

When people have tried everything they can imagine to get well, but nothing has worked they begin to lose hope. Notice I did not say lost hope. They still have in the back of their minds the hope for that one miracle treatment or miracle doctor to help them get well. Sometimes they won’t act to see you because they are fearful if yor treatment does not work, their last hope is gone. FEAR of the unknown keeps them from taking action. You need to use this emotional tie-in to help them take the necessary action. Look at it from the patient’s perspective, not yours.  

While all of your competitors are out there scared to death to offer a guarantee, you now know better and will stand out from the crowd.  Your patients wil naturally have more confidence in you. If you are confident enough in yourself to offer a guarantee, then you must be good. By offering a guarantee you will be lowering the patient’s natural resistance to contacting you. It’s that extra something to set you apart from the crowd.

Make the strongest promise you can comfortably live up to, and feature it prominently in all your marketing materials and don’t woryy about the myth that you’ll lose your shirt or your reputation. It just doesn’t happen.

Dr. Perry Nickelston

www.k-laserusa.com

866-595-7749

www.painlasercenter.com 

Truth…Science…Choice

Choosing A Laser (Click here to download)

Laser therapy is a new high-tech therapy changing the way physicians all over the world help their patients. Unfortunately, it is easy to become overwhelmed with misinformation marketed by laser sales reps and manufacturers interested in pushing their products. The laser you choose should be the one best suited for your clinical purposes, not the dealer’s bottom line!

 The FDA started providing marketing clearance for therapeutic lasers in 2002. Since that time, many manufacturers have blasted onto the scene. Unfortunately, clearance by the FDA does not guarantee that the laser device is effective. Much of the promotional material used by US manufacturers, and claims made by overzealous sales representatives are unscientific. I talk to doctors everyday who just don’t know what’s important. They hear so many conflicting opinions regarding lasers and don’t know who or what to believe. I have used laser therapy for two years in real world clinical practice. During this period I have opened four successful pain laser centers throughout the Northeast.  

I have tested, demoed, investigated, researched and immersed myself in the “grunt work” of learning about therapeutic lasers, so you don’t make costly mistakes. I’ve already done the investigative work you. Talk to doctors already incorporating this technology into their practice. I transformed my practice with lasers and you can do the same if you follow these tips.  

This report reveals straight forward, real world facts. Most doctors want “bargains” when they shop for laser equipment. There’s nothing wrong with that, but be aware of what you can be giving up in exchange for a “bargain laser.”  

The most costly laser is the one that does not get results!  

Click on the link above to download the Report. 

Dr. Perry Nickelstonwww.k-laserusa.com

‘Mind Mapping’ for Success

Mapping

One of the most important factors in goal attainment is setting yourself deadlines to have each goal achieved. This holds you accountable. Putting things off until tomorrow or next week will turn into another tomorrow or another week. In order to understand this I’d like to explain the different types of a word that no would-be-succesfull doctor should have in their vocabulary -PROCRASTINATION.

 When we talk about goals you could put things off by never choosing to do anything. You could also put off things by choosing to do something, but then never start it.Then you could put things off by starting something, but then you don’t continue it.

And then you could continue something, but then you don’t finish it.

 It is vital that you don’t do something tomorrow that you really could have done today. 

At every stage of your goal you must set yourself time limits and deadlines so that you don’t put things off until tomorrow. DO NOT PROCRASTINATE!

 Breakdown your goal, allot your time and formulate your deadlines. I like to call it a TIMETABLE TO SUCCESS. One thing that your goals must be are both realistic and achievable. The goal shouldn’t exceed your ability, but on the other hand they should exploit them to the fullest. Thus closing the gap between potential and performance. This is a really important point. 

Establishing realistic aims creates the habit of succeeding when each one is attained, and Success breeds Success.  To reach your objective and enjoy a balanced success, you need to-on a daily basis:

  1. Consciously spread optimism and courtesy
  2. Listen – really listen – to whomever you are with
  3. Physically, mentally, and spiritually prepare yourself everyday
  4. Greet people enthusiastically on the telephone and in person
  5. Know that you can get everything in life you want if you just help enough other people get what they want.
  6. Treat family and associates as respectfully as strangers
  7. Keep your attitude right by reading positive literature, listening to positive motivational or instructional recordings, and deliberately seeking the company of moral, positive, goal-directed people.

So just get up, get out, and make it happen. The best way to predict the future is to create it!

Dr. Perry Nickelston

www.k-laserusa.com

1-866-595-7749 Ext. 2

TMJ Syndrome

TMJ Syndrome: An Integrative Treatment Approach


By Perry Nickelston, DCTemporomandibular joint (TMJ) syndrome can be one of the most difficult and elusive conditions to treat.

Patients can suffer with symptoms, despite years of traditional medical therapy. In order to effectively alleviate the symptoms associated with TMJ, one must use an integrated treatment approach combining various therapeutic modalities.

One of the primary reasons for a poor outcome in TMJ treatment is a lack of clinical understanding of the relationship between articular, muscular and neurological causes of the condition. If any of these potential causative factors are missing in the treatment approach, poor results can occur. The doctor who diagnoses and treats all factors will notice an increase in positive results and patient satisfaction.

TMJ Anatomy

The temporomandibular joint is the articulation between the condyle of the mandible and the squamous portion of the temporal bone. An internal disk known as the meniscus is a fibrous, saddle-shaped structure that separates the condyle and the temporal bone. The meniscus and its attachments divide the joint into superior and inferior spaces.1 These disks not only act to separate the hard bones, but also to absorb and cushion vibrations and impact transmitted through the joint.

The TMJ is controlled by muscles. The muscles controlling the TMJ are predominantly the masticatory muscles including the temporalis, masseter, lateral pterygoid, medial pterygoid and buccinator. However, other muscles may have an effect on the functioning of the TMJ such as the neck, shoulder and back muscles.2 This is the key area overlooked by physicians when treating TMJ syndrome. Primary muscles include the scalene, sternocleidomastoid, trapezius, levator scapulae, supraspinatus, infraspinatus, rhomboids and latissimus dorsi. There has even been a case in which the soleus muscle affected the TMJ via kinetic-chain dysfunction.

Causes: Arthritis is one cause of TMJ symptoms. It can result from an injury or from grinding the teeth at night. Another common cause involves displacement or dislocation of the disk that is located between the jawbone and the socket. A displaced disk may produce clicking or popping sounds, limit jaw movement and cause pain when opening and closing the mouth.

The disk also can develop a hole or perforation, which can produce a grating sound with joint movement.3 Bruxism (teeth grinding) causes micro-trauma to the joint capsule, ligaments and soft tissue, leading to symptoms from active trigger points and adhesions.

Common symptoms: Clicking or popping, bruxism, headaches, earaches, dizziness, eye pain and neck/shoulder pain.

Integrative Treatment

One must take into consideration all of the physiological and anatomical structures listed above. Starting with a three-day-a-week program, the following therapy approach has proven to be successful in alleviating symptoms associated with TMJ dysfunction.

Laser Therapy

The bio-stimulation, anti-inflammation, and pain-alleviating effects of laser light are what makes this therapy so special and of prime importance. Laser dosages of between 600 and 700 joules per side are recommended. Be sure to aim the laser inside the joint capsule with the jaw open and cover all the trigger points found on palpation. You may also laser the pterygoid muscles from inside the mouth.

If TMJ symptoms are due to arthritis, laser therapy may be the only therapeutic modality to offer lasting pain relief. Due to treatment time constraints and penetration capabilities of low-level cold lasers, higher-power class-4 therapy lasers may be the preferred instrument of choice.

Trigger Points

Check all of the muscles previously listed. You may use ART, MRT, TPT or MFR depending on your skill level. Primary trigger points include the pterygoids, sternocleidomastoid, scalene and temporalis. These points can be excruciatingly painful when treated, so make sure to prepare the patient. Active trigger points may take six to 10 therapy sessions for resolution. If you feel comfortable, do trigger-point therapy with a gloved finger to the pterygoids inside the mouth.

Check the infraspinatus carefully. These points are typically latent and only present pain on palpation. A knotted infraspinatus causes internal rotation of the glenohumeral joint and external rotation of the scapulae, leading to over-recruitment of the rhomboids and trapezius, resulting in forward-head carriage. This abnormal posture over-stimulates the scalene and sternocleidomastoid muscles, causing faulty TMJ mechanics and an elevated first rib.

Check the latissimus dorsi attachment at the thoracolumbar junction. Myofascial adhesions here can restrict normal scapular motion during glenohumeral abduction, resulting in cervical kyphosis and altered righting mechanisms via kinetic-chain dysfunction. MFR and ART can be very successful in this region. A high dose of laser therapy along the entire thoracolumbar region with a dosage of 1,000 joules can break up chronic adhesions that have been lying dormant for years. This can be the “magic bullet” area for unresolved shoulder and neck disorders, too. Don’t overlook it!

Articular

Check for a hypomobile occiput and atlas articulation. I have found occiput is the primary culprit, usually subluxated posterior. An elevated first rib may cause a kinetic-chain alteration with the sternoclavicular joint, resulting in overactive neck flexors. Normalizing a subluxated first rib can have an immediate pain-relieving effect on TMJ pain and chronic trapezius muscle spasm. Speed is of utmost importance when adjusting a first rib.

I only recommend manually adjusting a TMJ if you have specialized training in TMJ disorders or if you work directly with a TMJ specialist. Adjusting the wrong side, an incorrect line of drive or a hypermobile joint can have severe pain-inducing consequences.

Cranial

Using a gloved finger/thumb, put superior pressure for five seconds on the center of the hard palate and then bilaterally on the horizontal plate by the back molars. Repeat three times while the patient inhales slowly, releasing pressure as the patient exhales. This technique normalizes function of the sphenoid bone, which can improve TMJ mechanics.

As you can see, success in TMJ treatment involves looking way outside of the proverbial box. The word integrate means “to make something part of a larger whole, or be joined or made part of a larger whole.” Remember to look at the whole patient and don’t get caught up in the vicious cycle of targeted symptomatic care. This integrated treatment protocol can give profound improvement to your patients’ quality of life. Take the time to implement them; your patients will be glad you did, and so will you.

References

  1. Basmajian J. Muscles Alive. Baltimore: Williams and Wilkins, 1974.
  2. III Gillespie T. TMJ Anatomy. Accessed Oct. 12, 2007 from University of Washington: www.rad.washington.edu/anatomy/modules/ TMJ/TMJAnatomy.html.
  3. NYU Medical Center. Accessed Oct. 11, 2007, from www.med.nyu.edu/surgery/oral/patients/ article.html.

Dr. Perry Nickelston is a 1997 graduate from Palmer College of Chiropractic. He practices in Ramsey, N.J., and is vice president of practice development for K-Laser, USA. He can be reached for clinical questions or discussion at www.k-laserusa.com.