One of the most serious—but rarely discussed—conditions resulting from extended alcoholism is alcoholic neuropathy.  One of the reasons for its relative obscurity in the public discourse, aside from difficulties inherent in any discussion of substance abuse, is that much of the empirical evidence linking neuropathy and alcoholism is somewhat vague.  Still, there is ample correlation to assume a causal link.

Alcoholic neuropathy presents in patients similarly to other forms of neuropathy, with tingling and numbness in the extremities, loss of heat and cold sensation, loss of fine motor control, impotence in men, and so on.  All this is accompanied by the chronic pain typical in cases of peripheral neuropathy.  Because of the areas of the mind and body targeted by the alcohol, it is common for alcoholic neuropathy patients to exhibit outward signs of intoxication even when sober, such as slurred speech, stumbling gait, and clumsiness.  The American Journal of Clinical Nutrition says that, in severely affected patients, the legs and hands may be nearly useless to the point of paralysis and sensation may be entirely absent in extremities.  In these cases, the skin can also be dry and atrophic.

The specific causes of alcoholic neuropathy are difficult to pin down, and thus, the case can be tricky to diagnose.  If a patient has a known history of alcohol abuse, that is, of course, a good place to start.  Generally, a pattern of heavy alcohol use for a period of ten years or more will be accompanied by neuropathy symptoms.  A leading theory contends that the cause of alcohol-related neuropathy may be the combined effect of direct nerve-poisoning by the alcohol itself, coupled with the long-term poor nutrition that often accompanies alcohol abuse.  Alcoholics typically exhibit erratic eating habits, resulting in poor overall nutrient intake, and the damage to organs reduces the absorption of nutrients from food.  Of course, difficulty in motor control resultant from neuropathy often exacerbates the malnutrition, as the patient becomes socially uneasy about mealtimes and self-conscious about feeding themselves.

Nerve damage from alcoholism is usually permanent.  The first order of business in treating patients with alcoholic neuropathy is to bring the drinking and nutrition problems under control.  If alcohol consumption is not severely limited and adequate nourishment is not supplied, additional treatments will be futile and symptoms will almost invariably compound. Beyond this, treatment seeks three main goals:

• To control symptoms
• To maximize and restore function (quality of life)
  

  Alcoholic Neuropathy requires extraordinary measures to slow or treat...

• To prevent further injury to the patient due to neuropathic vulnerabilities

Most treatments address these three tenets simultaneously.  Pharmaceutical treatments include the use of painkillers, either prescription strength or over-the-counter (such as analgesics).  When treating patients with alcoholic neuropathy, it is advisable to recommend the lightest use of pain medication possible, as the patient in question is by definition susceptible to habitual substance abuse.  Be sure to monitor use of any medications very carefully.

Because of the underlying nutritional deficit usually at the root of alcoholic neuropathy, some patients may benefit from a system of nutritional supplements.  A dietician or other qualified staff person in your office should be consulted to ensure the proper replenishment of nutrients necessary to prevent the spread of neuropathic symptoms.  Parenteral multivitamins are also useful in many cases to assist nutrition.

Several new lifestyle habits can help patients adjust to living with alcoholic neuropathy, such as carefully monitoring the temperature of bathwater to prevent burning, inspecting themselves and their clothing and footwear for points of rubbing or wear on the skin, and so forth.  In alcoholics, the establishment of these habits (which are themselves advisable for all neuropathy patients) can be instrumental in the replacement of the undesirable dependency that caused the problem.

Although nerve damage is usually permanent, the prognosis for sufferers of alcohol-related neuropathy can be very good if the alcoholic successfully refrains from indulging the dependency and works to replenish nutrition.  It is important to emphasize to patients that substantial recovery from degenerating neuropathic symptoms will not be seen for a period of several months.  Of course, subjective improvements in lifestyle and health will begin almost immediately when abstaining from an alcohol dependency as a result of general detoxification.

If you have patients you believe could be suffering from alcoholic neuropathy, we are here to help you determine for certain how best to proceed!

Contact NeuropathyDR® and we can give you even more information about how to help your patients suffering from alcohol abuse-related neuropathic symptoms.

http://www.nlm.nih.gov/medlineplus/ency/article/000714.htm

http://www.neillneill.com/alcoholic-neuropathy

http://www.bettermedicine.com/article/alcoholic-neuropathy

http://www.learn-about-alcoholism.com/alcoholic-neuropathy.html

http://www.ajcn.org/content/9/4/398.full.pdf

If you treat patients with neuropathy and pain, you’re probably very familiar with complaints about lack of sleep, trouble staying asleep, and general restlessness at night.  It’s hardly surprising, given the intensity of many neuropathic conditions, that they make it tough to rest.  Insomnia (lack of sleep) affects almost half of the overall population, but among neuropathy sufferers, that ratio jumps to over seventy percent (according to the Journal of Pain Medicine). Experts recommend between seven and nine hours of sleep for most adults, regardless of their age or gender, an intimidating goal for people whose chronic pain keeps them up at night.

Research suggests that sleep apnea, a common cause of insomnia, can actually cause peripheral neuropathy, as well. Beyond a mere relationship, studies have shown that apnea is a high-risk condition among the insulin-resistant, which could likely be affecting incidents of neuropathy among diabetics in very direct ways. Some doctors have reported that treating patients with obstructive sleep apnea has actually helped their cold or numb extremities recover, indicating another condition (possibly Raynaud’s phenomenon) masquerading as neuropathy.  If patients suffer from sleep apnea, CPAP treatment may be a viable avenue to explore to address their tingling or loss of sensation.

Regardless of the root cause, your patients’ pain can intensify in the evening hours, both in reality and in their own perception (fewer distractions of the day can cause a patient to focus more on their pain the closer they get to bedtime).

Insomnia from neuropathy can perpetuate its own problem, too.  Not only is your patients’ neuropathy prodigious when it comes to nighttime restlessness, but the resulting lack of sleep can make the pain even worse!  Rest is essential to recovery and treatment, and a patient’s lack of sleep can lower their pain threshold drastically.  Take into consideration that insomnia, diabetes, and other imbalances related to neuropathy can also contribute to high stress, depression, and mood disorders, and your treatment plan become that much more complicated.

If you’re treating patients whose insomnia could be caused by neuropathy (or vice-versa), NeuropathyDR® can provide the tools and information you need to help them get a good night’s sleep.  Specifics vary from patient to patient, of course, but here are some general guidelines that might be useful:

Don't Ignore Your Patients Sleep History when Pain and Fatigue are Present

• Instruct them to keep a regular sleeping schedule.  Getting to bed and getting up at the same times each day is one of the best ways for them to teach their body to sleep correctly.
• Patients should limit their intake of caffeine and any medication that incorporates a stimulant, especially in the evening hours.
• Avoiding heavy foods in the evening is important.  Metabolism continues hours after we eat, and the resultant energy boost can be bad for sleep.  Many cultures eat their biggest meal of the day in the morning and only a small snack at dinnertime for this reason.
• Turning off the TV and computer a few hours before bed is a good idea.  Mileage varies from person to person, but electronics tend to stimulate the senses.  Suggest a book or quiet conversation, instead.
• Counsel patients to adjust their environment to be ideal for sleeping.  They should layer covers to ensure they stay warm but not hot, and should minimize light and noise.

In addition to great care from you as a first line, there are a number of herbal and natural sleep aids as well, which may help insomniacs fall asleep quickly.  Sleep expert Elizabeth Shannon recommends entertaining a number of stress-relief methods, psychological conditioning, and homeopathic solutions for insomnia before resorting to pharmaceutical sleep aids, which can often form dependencies and, over time, exacerbate the problems associated with restlessness.

Of course, for severe chronic pain, prescription medications may be necessary.  Ultram, oxycodone, hydrocodone, and acetaminophen, codeine, and morphine might be used in more extreme cases. Some antidepressants or anticonvulsants could be valuable as well, depending on the specific symptoms your patient is presenting.  Benzodiazepine and nonbenzodiazepine anti-anxiety medication is also occasionally helpful, again, depending on specific symptoms.  If you have questions about pharmaceutical sleep aids, NeuropathyDR® can help provide guidance for you.

Be sure to remind patients that altering their sleep pattern won’t happen overnight (so to speak)!  It could be three to four weeks before any changes made to their routine begin to have meaningful impact on their success.  Often, since changes in routine can be unsettling in themselves, restlessness can become worse before it gets better.  Contact NeuropathyDR® and we can give you even more information about how to help your patients suffering from neuropathy to get the rest they need.

http://ajrccm.atsjournals.org/content/159/1/213.full

http://www.webmd.com/brain/understanding-peripheral-neuropathy-basics

http://www.sleeplessnomore.com/

http://www.neuropathy.org/site/News2?page=NewsArticle&id=8145&news_iv_ctrl=1221

If your patients are presenting with tingling, numbness, burning sensations, or motor function issues, they may be suffering from peripheral neuropathy.  Neuropathy can be tricky to diagnose, but becoming as informed as possible about its symptoms, treatments, and which of your patients are the most susceptible will equip you to effectively recognize this painful and often dangerous condition.

The main symptoms of peripheral neuropathy with which you and your patients should be familiar are:

• Shooting pain or burning sensations
• Weakness or loss of dexterity in the arms and legs
  

  Falls Due To Sensory Impairments are Frightening...

• Tingling and numbness, especially in the extremities
• Loss of fine motor control (dropping things frequently becomes an issue)
• False sensory signals (reduced ability to sense temperature, sensations of being touched or wearing gloves, hats, or stockings when they are not

Other symptoms can also occur, of course, resultant from the above: sleep deprivation, restlessness, inability to sit still, irritability and nervousness, and so on.

So many groups are at-risk for neuropathy, it is practically guaranteed that learning to identify, diagnose, and even treat the condition will be a valuable asset to your practice and to the lives of your patients.  Spotting neuropathy early in a patient can mean the difference between debilitation and a comparatively normal life!

Some of the most common causes of neuropathy include (this is a partial list!):

• Diabetes
• Chemotherapy (increasingly over the past few decades, as cancer treatments become more and more effective)
• Kidney disorders
• HIV
• Nerve damage from injury or surgery
• Shingles
• Genetic diseases such as Ataxia, or even hereditary neuropathy

Discussing Neuropathy with your patients can be challenging.  Start by making certain your patient understands whatever underlying cause is behind the neuropathy (diabetes, for example, is the most common).  Explain the symptoms of neuropathy, and encourage the patient to identify any they may be suffering, even intermittently.  Don’t forget to reassure them that, while there is no miracle cure for neuropathy, it is both common and very treatable in terms of pain.  Also, be certain to emphasize the importance of monitoring their condition for signs of further degeneration or additional symptoms (as these could be signs of dangerous progression).

Medical Treatment options for neuropathy vary widely, and are rapidly changing with technology and as we learn more about the condition. Some studies recommend non-steroid painkillers such as Motrin or Aleve for mild cases of pain, whereas cases involving more pain usually require prescription  pain reducers containing morphine or similar.  Surgical treatments also utilize implants.  Of Course external therapeutic devices should always be applied by the most qualified neuropathy treatment specialists.

Where your patient’s neuropathy is resultant from chronic or persistent illness, management of that underlying illness is, of course the priority.  Proper control of diabetes, appropriate physical therapy after an injury or surgery, or treatment of other relevant conditions will, in almost all cases, help to minimize neuropathic injuries.

Patients suffering from neuropathy are already familiar with its discomfort, and inconvenience to their lives.  It is important for you both to realize that many types of neuropathy can also be very dangerous, even life-threatening.  It is not uncommon for neuropathy to be degenerative and, if left unmonitored or untreated, it can cause intestinal blockages or complications in the function of bodily organs.  Needless to say, take no chances!

While there’s no cure for neuropathy, there is plenty you can do to help your patients enjoy healthier, full lives while living with the condition.  Early intervention with a NeuropathyDR® clinician is the best route; we put at your disposal all the resources you will need to effectively treat and advise your neuropathy patients.

For more tips on your patients or growing your specific practice, contact us at http://neuropathydrprofessionals.com

http://www.medicinenet.com/neuropathic_pain/article.htm#tocd

http://pain.about.com/od/typesofchronicpain/a/neuropathic_causes.htm

http://www.neuropathy.org/site/PageServer?pagename=About_Symptoms

http://www.joslin.org/info/diabetic_neuorpathy_nerve_damage_an_update.html

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Very often when I look at a practice and its owners that are really making things happen a very simple fact emerges. Out of every conversation and analysis one simple fact emerges. When I look at productivity and results in all areas of life and practice, it is clear that those who are the happiest, most productive and profitable have engaged completely in one area and department at a time.

Quite simply, from my very first telephone contact with these offices, it becomes readily apparent analysis of every step has taken place behind the scenes.
And quite obviously, they have trained their staff to answer the phone impeccably. Happy, polite, willing to help anyway they can.

Now of course, this is something I regularly do with enjoyment. I can tell so much about a doc and his practice, based upon how the staff answers the phone. Timing, attitude, how questions are handled, are they organized? And are all their tools obviously at their fingertips?

In fact, if your not doing great at the moment, ask three friends to anonymously call your office. Two as new patients with no health insurance. You should listen in. You may however be shocked
When it comes to collections at the counter its “Here’s your options Mrs. Jones, would you like me to put the entire week (month) on the same card?”

Here’s my point. Those who build powerful practices, and indeed personal lives continuously aim to master each area! No, its never perfect, and always requires measurement and attention, but none the less the process is in place via policies, procedures and trainings.

Clinically, it’s also very important to your patients!

It is vital that your patients experience you as a "Master" clinician.

Now in my office, new patients still tell me over 30 years later, “That was the best exam I have ever had in my entire life!”

Why?

Because on each new patient I still insist on a thorough pre-exam presentation by my aides, yes even interns, and from my clinicians complete vitals, thermogram, ROMs with instrumentation, chest and carotids auscultation, VBA screenings in C-Spine cases, abdomen when indicated, on and on.

But why?

It’s because my mentors taught me, and I was smart enough to pay attention, that the most powerful practices are built upon mastery, not dabbling!

As I said in the beginning, one very simple fact emerges – Masters get everything done while dabblers struggle seemingly forever.

I see this principle frequently when something goes wrong in an office.

For example, a doc gets all pumped up over introducing a new service, or technique to the practice. The guy that sold her on it has had really great results, referrals and profitability. Case studies and referrals.

So, she brings IT back to the office, gets the staff all revved up, but in so doing actually takes them off other areas central to the practice, does not allow time for effective marketing or training, and in reality introduces this new procedure in a half hearted way.

So of course, when things don’t turn out right, there must be something wrong with IT.

I’ll give you the antidote to this practice management pandemic, but I’ll warn you in advance, side effects may include nausea and heartburn. Might even cause stronger visceral and emotional reactions.

The antidote is to vow RIGHT NOW to take each area of your practice, each of the 12 Key areas I identify, and set up the time and systems to go back and master each one!

And yes, it is a constant process (which is why frequent staff huddles and meetings are necessary). And recognition that the needs for approaching practice in this way actually expands as you grow.

This is why our 12 secret platinum coaching programs are so powerful, and our practice makeovers are so very effective.

It’s because they force you into detailed analysis and corrective action.

And as you introduce something new, you must devote time to study, implementation, marketing, pricing, and potential rough spots with implementation.

Here are just 5 things on my list that too often get overlooked:

1. Dedicated business owner study, admin and planning time. 2. Dedicated staff time for marketing and admin. 3. No clear instruction or policies for patients. 4. Lack of effective pricing and collecting at the time of service. 5. Ineffectively conveying to the patient everything about your office (from your website to your treatments) that constantly reinforces in their minds they made the right choice!

The docs that pull this off behave emotionally and physically as effective CEOs.

Mastery vs. dabbling. In this world, your choices will be readily apparent.

But so will be the results! A powerful, profitable practice and enviable lifestyle that you so deserve!

For More, Go To:  http://perfectpracticeweb.com/home

Pull Back or Leap Forward in 2012?

A timely perspective on building a phenomenal practice that delivers a lifetime of patient value and permanent income.

Looking back, about 4 years now after first writing about Commanders of Change™ as a progressive new breed of private practice owners, little did I realize how prophetic it would be. Those in private practice we see doing the best even in this brave new world are commanding their own change, and reinventing themselves, and their practices. Despite the outside world. They have indeed learned to Practice by Design ™.

Those having extraordinary difficulty in private practice are instead practicing by default.

Its no secret, things are very different in your patient’s lives now too. More than just an election year uncertainty. Entire pillars of American society are shifting very, very quickly.

So, here’s the simple choice. Learn new systems, grow, and become more patient-centric while reinventing your practice, yourself and your future.

Or, do nothing, and wish things were like they used to be. Either way, recognize it is a choice that will have profound consequences on the rest of your life.

I am not saying it’s easy. If it were, all chiropractors, physical therapists and medical physicians in private practice would easily gross six and seven figure incomes. For some of us, it’s the most difficult issue in life right now.

I do however speak from experience when I tell you that the direction you take now, because it is such a pivotal time can mean dominating your given market area, building a powerful, profitable practice knowing you are fulfilling your professional destiny, and having that extra income committed to permanent interest bearing investments that can give you a lifetime of freedom.

Or, failing to act decisively, quickly, while gathering all the tools and information you must have regardless of who or what tries to dissuade you can mean closing your doors.  It’s this simple.

Do you hang around with naysayers or dwell upon how tough things are while distressing about loss of income and your investments?

It’s your choice.

Or, have you instead asked for help where you need it, moved forward with a clear vision of the future instead of regrets about the past.

While you are reviewing or reformulating your game plan, here are some of the critical areas that need special attention.

First, are you and your entire team communicating the true value, the most meaningful benefits about what you do, and simultaneously making it easy for those who want more of what you have to offer raise their hands and buy more?

Do you talk only about pain, covered physical therapy or chiropractic visits, or ‘Longer, healthier life with the energy and physical capacity to engage your passions to their fullest’?  Do you teach them how to be continuously “Looking and feeling spectacular?” And “Having more energy than people 10-15 years younger’?

Because, this is exactly what your health care does for people.

How Are You Going To Practice in 2012?

If you are not currently fully engaged along these lines, this is where I advocate you spend lots of time investigating how the practice development programs we have developed for you can best be deployed to make all this your reality too.

Always remember, these are the patients that tell everyone about their doctors. And gladly pay for everything you do. And come back year after year with their kids and grandkids.

Next, is your team crisp, efficient, friendly and understanding? Do they go out of their way to make the office a place people love to come to, and tell everyone they know? Do they also fully support you or stress you out way too much? This also, is a choice. Your choice.

As a vital referral driving and expanded patient care network, what is the quality of your healthcare professional relationships? Have you aligned yourself with like-minded MDs, DCs, PTs,  DMDs, DPMs, etc?  Do they refer easily back to you in complete confidence? Do you work to continue to help them as well as their patients?

Most importantly, do you have a clear vision, and a step-by-step game plan to make this all a reality?

A long ago, I wrote how to develop a step-by step implementation game plan. If you are having difficulty with any of these critical areas instead of going into overwhelm dedicate some quiet time, a day or two out of the office if need be, use the simple system I developed for you and just get it done.

And remember, this is where good coaching and modern tools and systems are priceless.

I look forward to hearing your success story this year!

PS This is a perfect day to begin with a new perspective and mentoring program.

For more information, go to http://perfectpracticeweb.com/home

Overlooked Opportunities in 2011?

Too often in practice development, as in so many areas of life, it seems what’s best and most powerful for us is right under our own noses. One of the big problems, and the reason for these missed opportunities is either not devoting time to look for them, and most often not making this “looking” time a scheduled priority.

So it goes. This discussion of the most common ones may really turn a practice around dramatically. Most cost little or any money. I suggest while reading this you compose your own opportunity list.

I just did one for our team, and came up with 8 areas that are really doing well after the last quarter, but three that seem to be the source of “irritation”, that could turn into a major wound, if not healed in time.

By the next staff meeting, they will be fixed.

Are You Planning For The Best in Private Practice in 2012?

Remember, the big idea is to continually correct and fine tune, before you need an overhaul.

The first one we’ll handle here is Staff. When was the last time you spent time reviewing purpose, duties clarity, and basic compliance issues. Fine tuning the staffing department can really be an enormous source of new patients, collections and overall energy, esprit de corps, if you will. And it costs just some quiet time, a pen and legal pad and the action (AKA guts) on your part to actually confront, and fix what and whom you have to.

Along these lines, how is your staffing payroll set up? Like GM or Toyota? Will you be looking for “BAILOUT” monies or ready to compete on any scale? Hopefully, they are fully incentivised, on multiple scales.

Also, what is your practice’s fun quotient? I don’t know about you, but when the fun goes, misery follows pretty quickly. Lots of this comes from simply having the right people, and regularly showing them your gratitude, at every turn.

Lets face it. Physical Therapy, Medicine and Chiropractic private practice can really be tough. Make sure you acknowledge the teams efforts based upon correct intent. Fix as rapidly and as gently as possible with what could be more in line with your vision. Strive to have a family like environment, and you can’t go wrong.

The next really big area is your office hours. How did you choose them? Are you overstaffed during slower times, but lack capacity of space, staff and equipment when patients in your area are really on the move, and want to be seen?

And, what is your own productivity like during demand times? Unless you are focused, clear headed and undistracted, patients are not getting what they deserve, and I guarantee you are leaving hundreds if not thousands of dollars in opportunities to chance, or overlooked forever.

Another issue, which can literally make or break a practice today is targeted and focused on and offline marketing. The things to look at are how do you capture “leads”? Then, how to you follow up with them? How do you ever learn their unique wants and needs?

(This is one area where we can really help. But you must be willing and teachable. We are even using these skills to help other business grow!)

The third area to consider here is what’s going on in your community, within just a few miles of your physical therapy or medical practice in most cases, that you could be helping, promoting or enhancing? Things like sponsored events, community awareness programs and outreach programs. Maybe its just getting more involved in your school system. Again, it’s likely just a bit of time, and no great expenditure of funds or resources.

You can take the first step by visiting city or town hall. Get a better handle on what’s going on; what the locals are concerned and talking about.

The next stop should be the local library. There is usually a wealth of information about the types of community education programs going on or coming up soon.

As a chiropractic, physical therapy or medical practice owner in town, you may be a candidate for an interview, a talk at a community center, or maybe even classes at the library itself? Who knows, you may find as I have, these turn in to radio and TV opportunities, as well as articles in print media. All of these really can do much to not only solidify your patient base, but to grow a practice its entire lifetime.

In any event, I hope you by now see the purpose of this discussion.

Too many times as multitasking, ADD prone professionals, we can suffer from “Bright Shiny Object Syndrome” (BSOS), the relentless pursuit of excitement but irrelevancy.

The result is we miss or overlook so much of what is right in front of us, often just for the asking. If you’ve got this affliction, the information contained herein is the prescription that cures.

If perchance it provides only temporary symptomatic relief but not a cure, you may need to reexamine some bigger issues. The most common is too much stress, not enough rest or down time or feelings of not being rewarded financially or otherwise by practice.

It’s high time we admit that this one’s all too common in today’s doctor, unless we very carefully, make our choices every step of the way.

Wherever this one takes you, I really wish you the best.

In reality, fulfillment as doctors in private practice comes only by living and practicing by design.

Find More at http://johnhayersjr.com

You know the issues…

Your chiropractic, physical therapy or medical practice offers a myriad of special services…

•       For women to combat the effects of osteoporosis and/or hormonal issues

•       Sports rehabilitation services for the athlete

•       Recuperative and NeuropathyDR® Treatments for seriously ill patients

Any of these specialties should be bringing in the kind of varied patient population that would not only keep your practice exciting but do great things for your bank balance as well.

Still, day after day, you treat the strained back from the construction worker or the sore knees of the weekend warrior.  And there’s nothing wrong with that.  You just know you could be doing more.

You know the demand for your real expertise and special services is out there but for some reason you’re not reaching them.

It’s not a lost cause…

Try these tips for reaching the kind of varied patients you know you can help:

Get In Front Of Your Prospects

You know you can help all these patients but if they don’t know you exist, you can’t help them.

You have to take your message to them.  Go where you know they are.

If you want to treat sport injuries or athletes, advertise with the local marathon organizers.

If you want to specialize in senior care, get your message out to the local senior centers and retirement communities.

For chiropractors and physical therapists:  If women are your target market, start networking with ob/gyn’s referrals or speak at local professional women’s clubs on the benefits of specialty care for common female complaints.

What’s In It For The Patient?

When you get in front of your prospective market, don’t dwell on how great you are or how you’re an expert in whatever field.

Emphasize what’s in it for them.

Greater mobility, playing golf, or enjoying the grandchildren…

Less pain…

Success and healing are both so formulaic...

Literally, getting their freedom or their life back…

You have to sell the benefits of your treatment, not your expertise.  Always make sure that your top priority in marketing, initially, is answering the patients all important “What’s in it for me?”

Don’t Forget The Power Of Referrals

Referrals can be an invaluable resource for building your practice.

The art of getting referrals from other professionals takes time to develop but if you learn to foster and develop relationships between your practice and referring practices, you will reap the benefits for years to come.

If you get referrals from another practice or specialty, always make those patients a top priority.  See them when it’s convenient for them and do it as quickly as possible.  If you develop a reputation for giving top notch care to the referrals you receive, your fellow practitioners won’t hesitate to send you more patients.

And always, always thank the referring doctor for every patient they send you.  And don’t forget your referring doctors’ staff members.  They are often overlooked but many of the referrals you receive will really come from a referring practitioner’s front desk staff.  They’re the ones who hand out your card, give people your web address, or even call to setup appointments.

It has taken years for you to become a specialist.  And you expended the time and effort in your particular specialty because you knew there were people out there who needed your help.

They are your target market.

You have a priceless opportunity to help your prospective patients and grow your practice into a thriving concern all at the same time.

Go where your patients are, show up in their web space and social media, at your live events be sure to tell them what’s in it for them, build your enormous referral network and you’ll be well on your way to living and practicing by design.

And when you are ready to expand your horizons even further, go to http://perfectpracticeweb.com/home or call me 24/7 at 781-754-0599 John

Alternative Therapies for Your Chemotherapy Induced Neuropathy Patients

One of the more challenging patient populations you can treat is the chemotherapy induced peripheral neuropathy patient.  They’ve already been through the cancer diagnosis and are either in the midst of chemotherapy or they’ve finished their treatment.

Just when they think they’re done with all the side effects of chemotherapy, they’re visited with[1]

-       Shooting pain

-       Burning and numbness

-       Tingling in the hands and feet

-       Inability to sleep because of the pain

These Patients Require All Your Skills!

Can you imagine the frustration?

Chances are really good that no one told them that chemotherapy induced peripheral neuropathy (CIPN) was a potential side effect of their treatment because, let’s face it, no one can really predict which patients will develop chemotherapy induced peripheral neuropathy.  Why bring it up if you don’t know for certain that it’s going to happen?

For many, their symptoms last well beyond their chemotherapy.

For your CIPN patients, the first option is, of course, drugs to deal with the pain.  But many chemotherapy induced peripheral neuropathy patients are choosing to be more proactive and do everything they can to alleviate their current symptoms and lessen the possibility of permanent nerve damage.  They don’t just want to take a pill to make them feel better. They want to give their bodies the best treatments available.

What Else Can They Do?

More and more CIPN patients are opting for what used to be called “alternative medicine” treatments.  While many think of anything outside of conventional medicine as “alternative”, that’s really not accurate.  Alternative treatments are defined as anything not approved by the Food and Drug Administration.  The treatments we’re talking about here are more complementary or integrative therapies.  In other words, they’re therapies used in addition to and to complement traditional medicine, not taking the place of it.

Because of the growing popularity (and effectiveness) of these complementary and integrative therapies, the medical community has actually named them – Complementary and Alternative Medicine.

Some complementary and alternative therapies providing good results for chemotherapy induced chemotherapy patients are:

-       Cancer treatment specific diets

-       Herbal supplements

-       Non-herbal supplements (like Vitamins B6 and B12, alpha lipoic acid)

-       Acupuncture

-       Massage therapy and Reflexology

-       Exercise

-       Homeopathic and ayurvedic medicine

Any of these therapies, in the hands of skilled practitioner, is a great complement to your chemotherapy and other cancer treatment and can provide substantial relief from chemotherapy induced peripheral neuropathy pain.  Offering these services to your chemotherapy induced peripheral neuropathy patients is an excellent way to treat the whole patient and not just the symptoms.

Involve Their Oncologist

Before you start any Complementary and Alternative Medicine treatments with your chemotherapy induced peripheral neuropathy patients, talk to their oncologists.[2] Make sure that what you’re planning to do will not have an adverse effect on their chemotherapy regimen (some antioxidants do).  Always keep the oncologist in the loop on what you’re doing to complement or following a chemotherapy regimen.

Why These Complementary and Alternative Medicine Treatments Work

Many of the Complementary and Alternative Medicine regimens we mentioned above will help deal with and even alleviate some chemotherapy induced peripheral neuropathy symptoms.

The body is a finely tuned instrument and all the systems work together.  Massage therapy, acupuncture and Reflexology can help with muscle pain and stimulate the systems within the body to fight the cancer.

Certain supplements can help give the body the nutrients and vitamins it needs to repair itself and eliminate the possibility of permanent nerve damage caused by chemotherapy induced peripheral neuropathy.

Treating the Whole Patient By Working With The Whole Team

None of the medical specialties treating chemotherapy induced peripheral neuropathy patients operates in a vacuum.  You all need to know what the others are doing.

Luckily, most oncologists these days are familiar with the Complementary and Alternative Therapies chemotherapy patients are turning to for relief from the chemotherapy induced peripheral neuropathy symptoms.  Make sure that you involve your patients’ other treaters in your care by communicating with them.  By integrating your Complementary and Alternative Medicine treatments into the overall treatment program, you have a much better chance of giving your patients the optimum results they deserve.

When you are ready, let them know you’re there to help them.

For more tips on growing a successful chiropractic, physical therapy or pain management practice, log on to http://perfectpractice web.com to download a FREE E-Book Copy of my 5 star Amazon  “Living and Practicing by Design” at http://perfectpracticeweb.com.

Patient education and patient compliance are key to success.

For better or worse, a rapidly growing patient population is the chemotherapy and post chemotherapy patient.

While dealing with the emotional issues involved in a cancer diagnosis, they can also be dealing with side effects of chemotherapy like

• Loss of appetite
• Nausea and other digestive issues
• Post chemotherapy peripheral neuropathy
• Dry mouth

In addition to counseling them on taking their medications properly and physical therapy or massage therapy for muscle, joint and nerve pain, offering nutrition counseling and diet planning is a great way to ensure that your post chemotherapy neuropathy patients are doing everything they possibly can to heal.

Study after study is confirming that proper nutrition is a vital piece in the treatment puzzle for a successful recovery from chemotherapy and other cancer treatments, as well as recovering from the cancer itself.

Just like any other treatment program, patient education and patient compliance are key to success.  Here are some things to think about when designing a chemotherapy or post chemotherapy recovery nutrition program:

Cancer Nutrition Tips[1]

The chemotherapy or post chemotherapy patient’s body needs extra support for the immune system.  Chemotherapy wrecks their immune system and that makes them more likely to catch virtually any bug they come into contact with.  And that makes it even harder for them to heal.

Their best option for immune support is a diet full of whole foods that are easy on their sensitive digestive system.  They need foods that are high in anti-oxidants and protein.  Make sure your diet plan for them includes foods rich in vitamins C, D and E and nutrients like soy isoflavones, amino acids, folic acid, l-glutamine, calcium and carotenoids.

When designing their daily nutrition intake, build in a requirement for drinking plenty of water.  Actually give them a schedule if you have to.  Remaining hydrated is vital for tissue repair.

Rebuilding The Body During and After Chemotherapy

When designing a nutrition plan, take each individual patient’s requirements and tastes into consideration.  Make sure you include foods rich in the following vitamins and minerals but try, wherever possible, to include foods the individual actually likes in their meal plan.

The following list is a really good guide for meal planning:[2]

Vitamin C

• Red cabbage
• Kiwi fruit
• Oranges
• Red and Green Bell Peppers
• Potatoes
• Strawberries and tangerines

Vitamin D

• Salmon and tuna

Vitamin E

• Nuts, including almonds and peanuts
• Avocados
• Broccoli
• Mangoes
• Sunflower seeds

Carotenoids

• Apricots
• Carrots
• Greens, especially collard greens and spinach
• Sweet potatoes
• Acorn squash

Soy Isoflavones

• Soybeans
• Tofu
• Soy milk – might be easier to digest than regular milk because it’s lactose-free

Folic Acid

• Asparagus
• Dried beans
• Beets
• Brussels sprouts
• Garbanzo beans
• Lentils
• Turkey

Turning The Food They Need Into The Food They Want

It’s easy to tell your chemotherapy and post-chemotherapy patients what they need to eat.  The tough part, especially if they’re nauseated or just have no appetite, is getting them to eat it.  Make your meal plans more appetizing by liberally using herbs and spices to enhance the flavor of the foods they need. Try recipes that use:

• Cinnamon
• Cardamom
• Basil
• Coriander
• Cumin
• Ginger (natural anti-inflammatory properties)
• Garlic (natural anti-biotic properties)
• Mint (great for fighting nausea as well)
• Fennel
• Turmeric
• Parsley

If your’ clinic doesn’t offer diet planning and nutrition counseling to your chemotherapy and post chemotherapy patients, you and your patients are missing out on a vital part of the recovery puzzle.

Use this article as a guide for diet planning.  The combination of your professional expertise and proper nutrition support and counseling is a winning combination for doctor and patient.

When you are ready, let them know you’re there to help them.

For more tips on growing a successful chiropractic, physical therapy or pain management practice, log on to http://perfectpracticeweb.com to download a FREE E-Book Copy of my 5 star Amazon rated book ”Living and Practicing by Design”.

Diabetes is one of the fastest growing diseases in the country.

Nothing builds a powerful specialty practice like incredible results!

With the increase in the number of patients developing diabetes comes an increase in the number of patients developing complications.

One of those complications is diabetic neuropathy.

The good news is that with proper treatment and a compliant patient, diabetic neuropathy can be managed and quality of life vastly improved.

Meet “Evelyn”

Evelyn is a 62 year old woman who presented to our office with progressive and severe diabetic neuropathy.  She suffered from peripheral neuropathy symptoms in her hands and feet, intense cramping in her legs and tingling in both feet.  The range of motion in her back was severely limited from the middle of her back to her hips. She was no longer able to sleep and could not exercise due to the painful neuropathy symptoms in her legs and feet.  Even the easiest exercise, such as walking, was no longer a possibility.  At the time she came to us, she had been suffering with these symptoms for 10 years.  Even after 10 years of medical and podiatric care, she was getting worse instead of better.

Treatment

After a thorough history & physical and evaluation, we took her into the NeuropathyDR® treatment program.  Her customized treatment program consisted in part of our three pronged approach – manual therapies, in clinic Rebuilder® therapy using both the basin with the feet and the gloves with the hands, daily blood sugar monitoring and charting (four times per day) and metabolic and dietary counseling and treatment. 

With the combined NeuropathyDR® metabolic therapies, Rebuilder® treatment and effective nutritional planning, we were able to drop her blood sugars by 120 points, without changing or increasing her medication.

The drop in her blood sugars led to a decrease in her medication needs. 

In addition to diet planning and counseling, we put her on a combination of nutrients.

Results

As a result of the metabolic and nutritional work we did with Evelyn, her blood sugar was down by 120 points, without any medication changes or additions.  Ultimately, her primary care physician was able to reduce her prescription meds. After 5 weeks of treatment, her numbness and tingling levels on a 0 to 10 scale, with 10 being the highest, went from 10 before treatment down to 5 after treatment. She reported overall improvement of 25 – 30%. The tingling in her feet and hands was significantly reduced.  Her leg cramps were markedly better as was her back pain.

 With the improvement in her leg and foot pain, she was able to start significant walking again.

Every day that she can exercise puts her one more day closer to a normal life.

The success of her treatment is a testament to the patient as well as the treatment protocol. She followed our orders diligently and was extremely compliant with our treatment program.

She purchased from our clinic a special ND/Rebuilder® home care kit, treating herself at home concurrently with the office care, took her prescribed ND supplements, did the prescribed blood sugar monitoring as well as her exercise and metabolic rehab.

While there are no miracle diabetic neuropathy cures, this case illustrates the results that can be achieved with a solid treatment strategy and patient compliance.

 Without a strong partnership between patient and clinician, these results would not have been possible.

As effective specialty practice clinicians, patient success depends upon your ability to convey the message that from the outset of treatment that without your patients full compliance with your treatment regimen, they will not see the results they’re looking for.

And nothing builds a powerful specialty practice like incredible results!

For more tips on growing a successful chiropractic, physical therapy or pain management practice, log on to http://perfectpracticeweb.com to download a FREE E-Book Copy of my 5 star Amazon rated book ”Living and Practicing by Design”.