ChiroMasterMind

Ok, now it’s time to bring some science and reality back to laser therapy. All sorts of people are out there making claims that lasers can do all these wonderful things, and that’s true. But only, and I say only, if you follow logic, science, application and proper diagnoses. I will leave it up to you to make the final decision on what makes sense after this little blog lesson is over. I am not here to judge or make recommendations. Only to show you the ‘light’. Pun intended.

Fact 1. Wavelength determines penetration. This little fact  is based on the electromagnetic spectrum of light. If you have the wrong wavelength for therapeutic application, no amount of power will make the light penetrate any deeper. The 790-820nm is the deepest penetrating wavelength. Anything lower or higher is more superficial. It’s just the law of science. Saying ‘light is light’ does not change the principle of the response. That’s like saying liquid is liquid.

Research indicates (look on PubMed for studies) that 4J-10J per cm/2 is the recommended laser dosage for deep tissue response and healing.  Dosage applies to the amount of laser energy delivered per surface area. If that’s the case, let’s look at an example of what you would need for adequate response with laser therapy on a lower back. Keep in mind that at least 50% of applied laser dosagewill be lost in the superficial tissue layers before it even reaches the target area.

Simple calculations in treating a lumbar injury dictate an area of 400cm/2. This equates to between an average of 2,500 joules of energy. How much time would that take you with a 5mw laser? Let’s see. Well, with a 5mw laser it will take you 3.3 minutes to deliver 1 joule. So it will take you 8,250 minutes to deliver 2,500 joules. That is 137 hours! How much time do you have? How about at the other end of the spectrum? How long will it take a 10watt laser? Well, you get 600 joules per minute with a 10watt. It will take 4.1 minutes to get 2500 joules. How much time do you have?

I want you to think first before you leap into using a laser and believing everything you hear. Follow the research. I mean read it yourself. Don’t take any at face value. Not even mine. Learn yourself. If you want some of the research I use to substantiate my writing, e-mail me and I will be happy to supply it. We are all here to help patients get well. They deserve to have the most effective and ethical treatment options available.

Dr. Perry Nickelston

1-866-595-7749 Ext. 102

www.k-laserusa.com

Tags: Integrative Treatment Strategies, General by Dr. Perry
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An acidic pH has considerable influence over the majority of weight problems, including Diabetes and Obesity. It seems that a habitually acid pH can directly cause immediate weight gain. Here’s what happens when a system is too acid. A condition known as Insulin Sensitivity or Syndrome X results, which forces too much insulin to be produced, and the body is flooded with insulin so that it won’t waste any calories, it diligently converts every calorie it can into fat.  

It is thought that an acid pH immediately signals the powerful genetic response to an impending famine, directly interacting with the all important and very sensitive, Insulin- Glucagon Axis. This makes the body produce more insulin than usual, and in turn, produce more fat and store it. In general, the more insulin is available to the body, the higher the probability that fat will be produced and stored, rather than used and burned as energy.

Thus, an acid pH will alert the genetic response to famine, directing more insulin to be produced and storing more fat than usual. Conversely, a healthy, slightly alkaline pH, will be more likely to yield normal fat burning metabolic activity, making no demands on the body to overly produce insulin and make fat, allowing fat-weight to be burned and naturally lost. And, with a healthy pH, there’s less likely to be any yo-yo effect, or rebounding from a diet with additional weight gain. As long as nutritional stores are maintained, a healthy, slightly alkaline pH allows fat to burn normally for energy, rather than being hoarded under the mistaken biochemical belief of an impending famine.

With increased pressure to produce insulin under the worst conditions, beta cells lose phase with one another, cellular communication is thwarted and the Immune System begins to over- respond. Stress within the cells increases, making it difficult for them to perform adequately, and further, survive. In a very real sense, they simply burn out!  Acidosis is thus thought an important yet often underestimated precursor to Diabetes Mellitus. Interestingly, before the advent of synthetic insulin, diabetes was treated historically by buffering the system with base or alkaline causing powders.

An acid pH inhibits efficient cellular and body metabolism. Acidosis causes chemical ionic disturbances, interfering with cellular communications and functions. Acidosis reduces Ca (calcium) binding of plasma proteins, reducing the effectiveness of this intracellular signal. Acidosis also leads to a disease of calcium cations (positive Ca) entry through positive Ca channels, resulting in reduction of cardiac contractibility, or the ability of the heart to pump efficiently and rhythmically. 

Also, positive Ca and positive H (Hydrogen) regulate the activity of intracellular proteins and are driven out of cells, because of the “Sodium-Potassium pump” (Na-K pump), which provides a strong incentive for sodium to be driven into cells. There are some 10 times the amount of positive Na in extra cellular fluids than in cells. The Sodium-Potassium pump regulates the amount of sodium and potassium each cell in the body stores, and uses up as much as 25% of our caloric input per day to run. Positive Ca exchanges the positive Na, being forced out of cells, but naturally, the electrochemical gradient for positive Ca favours both positive H and positive Ca entry into cells, as there is less calcium and positive H in cells than in the extra cellular fluids. 

Therefore, in acid solutions, less sodium will be present, slowing down the processing and induction of nutritional items going into cells. (Calcium may become inordinately leached from bone mass, causing osteoporosis.) An acid pH drains us of energy and disallows stored energy reserves to be used. Furthermore calcium may become inordinately leached from bone mass, causing osteoporosis.

 Evaluate your patients with urine pH+ strips and then a comprehensive program to restor the balance.

Dr. Perry Nickelston, DC

1-973-800-6570

www.k-laserusa.com

www.painlasercenter.com

Tags: Integrative Treatment Strategies, General by Dr. Perry
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Increase your Billing. Do and bill for “Neuromuscular Reeducation Code 97112.” *Don’t forget to put on a billing modifier code if you do the NMR with a CMT (adjustment) Neuromuscular Reeducation NMR is “reeducation of movement, balance, coordination, kinesthetic sense, posture, and proprioception,  each 15 minutes.”  These are the things you want to be doing anyway to ultimately reverse a patient’s condition. It’s not just about symptomatic relief, right? 

Here’s how you do it. Document 3-5 minutes of PNF stretching (Proprioceptive neuromuscular Facilitation) That’s soft tissue work. If you touch the patient you can justify the work. Just name the muscle worked. Purchase a BAP’S BOARD or WOBBLE BOARD and put one in every treatment room or make one room exclusively for this type of rehab. Have the client balance on the board for 2-3 minutes (attended). Your procedure is complete. Three things happened: You dramatically increased your rehabilitation of the patient, you can bill more for a justified procedure and you get fantastic patient retention! I know for a fact that few chiropractors do this procedure. The patients remember it, it’s fun, it’s challenging, and they will always tell you “my other chiropractor never did anything like this.”

Added incentive #1: Keep a supply of the boards in stock because the patients WILL want to purchase one for home use. Name your own price. A simple wood board can be sold for $30-50$.

 Added incentive #2: You can bill the patient for doctor supervised instructions on how to use the equipment at home. Use Code 97535 Self Care/Home Management Training. Examples of notations include, Activities of Daily Living ADL’S and Compensatory Training, Instructions In Use Of Adaptive Equipment. 

*These codes can be used if they purchase other equipment too (back cushions, lumbar belt, wrist splint, anything) Bill for your time! It’s valuable

Dr. Perry Nickelston, DC

www.k-laserusa.com

www.painlasercenter.com

1-866-595-7749 Ext. 102

Tags: General by Dr. Perry
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Self-esteem is the foundation on which everything else is built. When you have positive self-esteem, you can reach your highest potential, regardless of what kinds of opinions others have about you. Patients usually choose doctors who are self-confident and appear to have complete control of their practice. How can you improve your self-esteem? Everything starts with a plan. Yes, a plan. It’s not simply a matter of positive self talk and negative self concept control. Self confidence can’t be bought. You have to develop it inside you. It takes desire commitment and work.

 Here are some ways that you can begin to develop your own self-esteem plan starting today. Remember, just because someone rejects chiropractic care does not mean they are rejecting you!

• Accept yourself as you are. Don’t try to be somebody else. The worse thing you can do is read a “script’ from a book, consultant manual or professional resource verbatim. Make it your own. If it feels awkward to say, believe me it’s more awkward to hear. Change the script to suit you, simply use the overall theme to help you get the desired results.
• Recognize, without judgement, where you need to improve. HOT TIP: Instead of trying to improve on your weak areas (like most doctors), find your stronger areas and MASTER them. Become the absolute best at that strength and make it your uniqueness. You can’t be everything to everybody.
• Appreciate your mind. Appreciate your body. IF you don’t look and act like someone who is health conscious, why in the hell would anybody follow your advice. Walk the talk!
• Be a person of integrity. Once you cross over the line, you can’t come back.
• Keep a running list of your accomplishments. In and out of the clinic.
• Be responsible for your own decisions and actions. BE~DO~HAVE. (More on this later)
• “To become act as if.” Act confident in all situations and you will become confident.
• Look in the mirror every evening and compliment yourself on three things you that day to make a difference. For example, perhaps you smiled at a stranger, someone acknowledged your expertise, you accomplished a near impossible task. Remember something you did allowed positive things to happen.
• Your goal is to plan for, and do more, of those activities. When you do, your self-esteem and your practice will both grow.

Dr.Perry Nickelston

www.k-laserusa.com

1-866-595-7749 Ext. 102 

Tags: Practice Tips of the Day, General by Dr. Perry
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