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Billing One-on-One, Direct Patient Contact
This is often misunderstood and leads to trepidation when documenting and subsequently billing timed services.
A Different Way of Looking at It
The way you and your chiropractic colleagues access information has changed over the past decade. According to a recent survey conducted by Dynamic Chiropractic, almost half (48 percent) of DCs read online articles on their personal computer or laptop daily.
Living Well: Lessons From Our Oldest Old
Aging is a significant public health problem, important to chiropractors in practice and important to DCs who teach students training to become chiropractors.
Holistic Skin Care and Modern Technology
Anti-aging is a concept that we hear in reference to skin rejuvenation and growing older on a daily basis. Aging begins as soon as we are born; therefore "pro-aging" is embracing all stages of life gracefully, with vitality, wisdom, joy, and gratitude as the goal.
Constructing Our Reality, Part 2
My last article discussed perception and its relationship to the primary channels. Before we get to the channels most commonly used to treat sensory disturbances, the small intestine and triple heater, we should first talk about the bladder channel.
With Low-Back Pain, Sometimes Little Things Matter
Typical treatments for low back pain involve large muscles like the quadratus lumborum, iliopsoas, and piriformis. However, there are situations when a very small muscle, the multifidus, can play a significant role in the diagnosis and treatment of low back muscular or spinal injury.
Transforming Las Vegas
On a warm spring day in Las Vegas, Sonia Kim, clinic front desk staff, is busy preparing for a full day of intern shifts at Wongu Health Center. She greets patients, makes sure documents are properly signed, and lets the interns know that their patients have arrived.
Sleepless nights, anxiety, mood swings, euphoric energy bursts, obsessive thinking, and a strange feeling in his chest. That is what Matt was experiencing when he first entered my practice. Rather than being concerned, he was loving every minute of it.
Billing Timed Services
Q: I do not always use physical medicine services but in my state I do have a scope of practice that allows me to provide many of these services. I am trying to understand what "direct one-on-one patient contact" means in relation to physical medicine services.
Distal Style Treatment of Neurogenic Pain
Treat locally or distally? This question has frequented my thoughts for the treatment of pain throughout my acupuncture career. Each style has strengths and weaknesses, thus the versatile practitioner would do well to forgo dogmatic adherence to any one style in deference to the needs of the individual patient.
Understanding Levels of Evidence
The concept of levels of evidence is a cornerstone of research literacy and a great starting point for understanding basic principles of how research works.
Building Bridges with Discipline
As practitioners of traditional Chinese herbal medicine, our role is to educate patients and medical practitioners about the various safety aspects of our medicine. Medical doctors that embrace Chinese medicine want to collaborate and include Chinese herbal medicine in more aspects of clinical care to support their patients.
Keeping Malpractice Allegations at Bay
It has been suggested that in the litigious environment in which we live, the practice of chiropractic should be defensive and practitioners should constantly be watching their backs. An element of defensive practice is a good idea.
One of the most common trends to see in clinical medical practice and public health is the cycles of health "buzzwords." These come and go depending upon the current cultural zeitgeist. One year, "parasites" are causing all the issues, and the next year it's "candida."
Finger (Pad) Pointing: Repetitive-Use Injury Waiting to Happen
"My wrist and hand hurt. I spend all day working on computers and then I come home and spend more time on a computer, usually playing video games."
A Whole-Body Approach to Chronic Tension Headaches
Nearly every day in our practices, we see patients with chronic headaches that have not responded to traditional treatment. They present in our offices with a feeble hope that "maybe" a chiropractor can help.
The Need for Standards
ISO-TC-249: You may look at these letters and numbers and wonder what they are and what they might mean. They turn into: International Standards Organization- Technical Committee – 249. There is a global organization called The International Organization for Standardization.
Discovery: Finding Insights and Each Other in Different Disciplines
Recently I've been thinking about all sorts of things which are hidden from our daily direct experience. That general category is what links nearly everything that catches my attention and then demands some kind of investigation.
How to Reach Your World With the Chiropractic Message
My latest effort to share chiropractic occurred in mid-May while I was sitting at an introductory parent information night for high schoolers. The IT instructor informed us that each student would be receiving a computer for all their studies.
Prostate Cancer Risk
A large study published in January 2016 in the American Journal of Clinical Nutrition showed that men who are vegans had a 35% lower risk of developing prostate cancer compared to non-vegan men. The study followed more than 26,346 men who are part of the Adventists Health Study-2.
Parker University Embraces New Era
Change is in the air at Parker University, which recently announced the selection of both a new president and a new consultant for its seminar program.
In This Current Age of Anxiety
Anxiety, also referred to angst or hysteria, goes by many names. One, popularized by the sagacious Zhang Zhong Jing, who many practitioners of Chinese Medicine may be familiar with, is known as Restless Zang/Fu disorder.
Hip Flexor Contractures & LBP in Above-the-Knee Amputations
Patients with above-the-knee amputations (AK or AKA) are particularly prone to developing hip flexor contractures. Not to be confused with muscle tightness, contractures are a permanent shortening of tissues which cause deformity or distortion.
Streamline Your Front Desk
Your front office can be your greatest source of efficiency or it can be a constant bottleneck. Increasing the productivity of this area, while not sacrificing the quality of patient interaction, can be a little tricky. However, with some focused effort and intention, your front desk can keep your practice running smoothly.
News in Brief
NYCC Aggregates Degree Programs in New School; Palmer Chancellor Receives Education Award From ICA; Oklahaven Announces "Have a Heart" Winners.
May, 2009, Vol. 09, Issue 05
The Progression of Airway Obstruction
By Dale G. Alexander, LMT, MA, PhD and Thomas M. Walsh II, DDS
Subtle progressions that reduce the quality of our clients' lives and contribute to many of our clients' chronic somatic problems continues as a theme for this column. Thomas Walsh, DDS offers his 33 years of clinical experience as a general dentist and extensive orthodontics training to bring to light the progression of airway obstruction.
Air is one of our greatest needs for survival as human beings. The "airway is the tube" through which we breathe. It begins at the opening of the nostrils and continues all the way to the lungs. Visualize this tube as the snorkel through which we breathe. The diameter, shape and volume of this tube regulates the rate of exchange between oxygen entering the lungs and the exiting of carbon dioxide out of the lungs. A large diameter airway encourages an easy passage of air whereas a small diameter airway generates a greater resistance to airflow in both directions.
This essential airway tube is formed in utero and continues to develop from infancy until the teenage years. The airway is comprised of multiple spaces including the: nasal chamber; sinuses; and the upper, middle and lower pharynx. In normal growth, these chambers need to form in proportion to the size of the individual. That is to say that one needs a tube to breathe through that is large enough in diameter to support respiration during sleep and daily activity. The genetic design (preprogrammed in our DNA) mediates the enlargement of the bones, muscles, connective tissue etc., of our face and throat, to provide room for these spaces of the airway.1
Unfortunately, many times this airway tube does not form properly. A malformed airway can wreak havoc with muscle tone and head position. Research has clearly correlated head posture with mandibular position and temporomandibular joint disorders.2-7 Many of your clients will likely have these problems. They may complain of pain in the following muscles: masseters, sternocleidomastoid muscles (SCMs), trapezius, scalenes, splenius capitis and cervicis, medial and lateral pterygoids, temporalis and even the muscles of the low back. Simply put, if an airway is obstructed, a person will instinctively modify their muscle function to optimize or open the airway. This postulation reflects the essence of the Inside-Out Paradigm.
Clients rarely sense that they have a problem with their airway. (Dr. Walsh: "After 33 years of practicing dentistry, not one growing child or adult client has ever reported to me that they have a small airway.") The development of the airway is controlled by the autonomic nervous system of the growing child. Nature (your biologic engineer) detects this progressively developing constriction in the airway and makes alternate plans involving compensatory patterns of the musculoskeletal system.
For example, if the constriction is in the nasal cavity, the growing child will start to breathe through the mouth instead of the nose. The muscles of the face will pull open on the lower jaw, the mandible, and redirect the growth of this mandible to a more vertical or open position.8 If the airway obstruction occurs in the middle to lower oral pharynx (throat) the individual will likely extend their head forward to help open this airway tube.9-11 Again, this occurs without any conscious awareness within the individual. The head has now extended forward beyond the normal plane of vertical posture.
Forward head posture is very common and easily misunderstood. It is the opinion of these authors that many cases of forward head posture relate back to early childhood airway disorders, and improper muscle function of the oral cavity and have been clinically correlated to a congenitally short or an emotionally reactive esophagus.12
That being said, it is very difficult to separate the primary cause or etiology. We have the case of the proverbial chicken and the egg scenario, i.e., which came first? For some individuals the muscle function was altered first and in other children the airway obstruction occurred first.
There are many contributors to airway obstruction. Common influences include the following: improper swallowing habits developed from bottle nursing, air pollutants, food allergies, junk foods, broken nose, deviated septum, improper growth of the jaws (the maxilla and mandible), improper tooth position, imbalanced facial muscles, oral habits such as thumb sucking and many more. The thread that links all of these issues to you and your practice tends to be the compensatory forward head posture and associated muscle pain.
Feel this. Your head weighs about 12 pounds much like a bowling ball. Imagine if we placed a stick inside the hole of the bowling ball. Supporting this ball would not be difficult assuming the stick were directly under the bowling ball. Now, let's extend the bowling ball (your head) out beyond the stick (your spine) at a 45-degree angle. Suddenly the force on your spine from your head is dramatically increased. Forward head posture associated with airway obstructions places your neck and shoulders at a leverage disadvantage. It is reasonable to expect cervical bone remodeling and muscle pain to occur over time.
Airway obstructions and improper oral muscle balance commencing near infancy or in a growing individual have been linked to many systemic disorders later in life. These include the following: dental malocclusions, TMJ joint disorders, distorted faces, obstructive sleep apnea in children and adults, bed wetting, migraine like headaches, neck and back pain, lower IQ, stunted growth, criminal behavior tendencies, heart damage and increased risk of heart attack, arteriosclerosis and atherosclerosis, stroke, acid reflux and digestive disorders, anxiety and depression associated with lack of proper REM sleep, increased risk of occupational accidents and the list goes on.13-18
The following images graphically display the difference between normal and obstructed airways. These images have been acquired through cone beam imaging technology similar to CT scanning but with dramatically reduced radiation exposure as part of a comprehensive dental examination to evaluate patients for temporomandibular joint, orthodontic and sleep disorders. Figure 1 depicts the size and shape of a normal airway from a side view (coronal) and figure 2 from a cross-sectioned view looking downward (transverse). Notice the area identified by the pointer. Figures 3 and 4 demonstrate the reduced airway from both a coronal and transverse view. Note the constriction of the airway.
The diameter of the constricted airway is equivalent to the diameter of drinking through a straw. "Imagine the experience of breathing through a straw" all day. This client was completely unaware of any obstruction in the airway yet suffered from many clinical symptoms including lack of sleep, grinding of their teeth, pain and spasms in the neck and shoulders.
In summary, many of our clients suffer from airway obstructions that progress and worsen through life. As massage therapists we see many individuals with underlying problems as have been described here. Clients with head and neck pain including forward head posture are likely to have airway obstructions and are at risk for obstructive sleep apnea, a known contributor to decreased quality of life and reduced longevity. Your sharp observations can actually save lives.
Click here for more information about Dale G. Alexander, LMT, MA, PhD.
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