Monday, August 21, 2017

OUCH-!!! I've Got An Awful Pain in My Foot!

 Severe, burning pain, often accompanied by red, swollen joint(s), and usually of sudden onset, may be a metabolic condition---gout. It most often shows up in the big toe, and is more common in men than women.
It is a type of arthritis caused when sharp crystals form in a joint because of too much uric acid in the blood. Your chances of getting it are higher if you are overweight, drink too much alcohol, or eat too many foods containing purines, such as meats, including steak, organ meats, and seafood, or drink beverages sweetened with fructose (fruit sugar).
There are other risk factors, including family history, medical conditions like diabetes or kidney disease, and certain medications such as diuretics.
Treatment may include medications, but a gout sufferer can often control the situation with diet. Avoid anything containing high fructose corn syrup (sodas, ice cream, fruit juices, sports drinks, breakfast cereals). 
Avoid high-purine foods---organ meat (liver), red meat, shellfish, anchovies, herring, mushrooms, asparagus, cauliflower, kidney beans, lentils, spinach, peas, and whole wheat http://www.ukgoutsociety.org/docs/goutsociety-allaboutgoutanddiet-0113.pdf
Keep alcohol consumption moderate or minimum, and drink lots of pure (devoid of chlorine or other chemicals) water to help your body flush out waste products and toxins.  

Monday, August 14, 2017

Vertigo

 A sensation that the room is spinning around, and a sense of dizziness, a loss of balance, is the unsettling and uncomfortable condition of vertigo. It may be of sudden onset, and can severely limit one’s ability to function in everyday activities.
Vertigo can be caused by problems in the inner ear, can be associated with head or neck injury, or can be a side effect of some medications.
After careful screening, including questions about a patient’s history, conservative treatment in my office includes assessing the cervical spine and making any precise, needed adjustments, along with examination & corrections of the cranial rhythms. 
Although there are no guarantees, I have had patients in whom vertigo completely disappeared after one or two of my gentle, precise Activator Chiropractic treatments.

Monday, August 7, 2017

Nerve Energy---What Is It?

Nerve energy is electrical energy, and it travels along our nerves by a process of chemical ion exchange. 
These electrical impulses transmit information in from the periphery to the brain, and out from the brain to all parts of the body. Information in includes the sensory system, for example the sensing of heat or cold, pressure or pain. Information out from the brain includes the motor system, commanding our muscles to move or act. 
Our nerves are like conduits along which electricity travels. Damage to a nerve interrupts the successful transmission of the electrical impulses of life. If a nerve is severed, transmission is blocked. If a nerve is impinged---not severed but interfered with in some way--- impulses are hampered, incomplete, altered, or inefficient. Examples of this are numbness, tingling, hypo- or hyper- sensitivity, or pain.
Nerve impingement might be pressure on, abrasion of, or stretching of a nerve. 
       As an Advanced Proficiency Activator Chiropractor, part of my job is to support the functioning of the nerve system by gently and precisely relieving nerve impingement. 

Monday, July 31, 2017

"It Hurts When I Take A Deep Breath"

      This is a common complaint from patients when they have a rib out of alignment. 
      The pain is usually at the junction near the spine where the involved rib articulates with a vertebra (called a costovertebral joint), although it sometimes presents in the front of the chest where a rib attaches at the sternum (costosternal joint). 
      At the painful joint, the rib may be pushing into the vertebra or sternum, causing the joint to be compressed, or it may be distracted away from the articulation, causing an extension stress on the joint. 
      A correctly placed and precisely vectored adjustment with the Activator instrument brings relief.

Monday, July 24, 2017

Dermatomes of The Upper Extremity

      Areas of our skin receive sensory innervation from particular spinal nerves. 
      These sensory areas, called “dermatomes,” are predictable from person to person, and can be “mapped” on a model of the human body. 
      This is very useful when diagnosing a problem in the arm or hand. For example, numbness or tingling in particular finger(s) may be directly related to specific spinal nerve(s), and those nerves are discernible according to the dermatomal “map.” 
      Location of the symptoms in the upper extremity leads your medical doctor or chiropractor to the involved spinal nerve. As an Advanced Proficiency Rated Activator Chiropractor, my treatment would focus on careful, precise adjusting to relieve any impingement on the involved nerve(s). 

Monday, July 17, 2017

TMD---Temperomandibular Joint Dysfunction

Pain in the jaw is often due to problems with the temperomandibular (TMJ) joints---the right and / or left joint(s) may be misaligned or abnormally stressed. One example of abnormal stress is TMJ compression on one side and TMJ distraction on the opposite side. 
Treatment in my office includes careful assessment of the jaw complex and, if necessary, gentle adjustment with the Activator Instrument. This treatment is covered by insurance if the patient has chiropractic coverage. There are specific diagnostic codes which designate Temperomandibular Dysfunction, or TMD.
An interesting feature of the jaw structure is that symptoms may appear on one side, while the problem needing adjustment is actually on the opposite side. Because the mandible, or lower jaw, is one bone, a misalignment on one side may translate to pain on the opposite side.
       As an Advanced Proficiency Rated Activator Chiropractor, I am trained to evaluate and treat TMJ problems.

Monday, July 10, 2017

Once Upon a Time There Was Glycation

And it was found to be a big trouble-maker. Here’s the story: 
It is common that people with diabetes exhibit mental decline. Doctors & scientists noticed that the worse the hyperglycemia or erratic blood sugar, the greater the negative affect on mental capacity. They started wondering how sugar might be affecting the brain. 
They knew that neurodegenerative diseases like Alzheimer’s, Parkinson’s, and Lou Gehrig’s share something---deformed proteins in the brain. They also knew that deformed proteins, called prions, occur in the brain in Mad Cow Disease.
What was causing the deformation of these proteins?
Back in the early 1900’s something called the Maillard Reaction was discovered, in which sugar molecules spontaneously bond to proteins, fats, and amino acids. But it wasn’t until the 1980’s that this became revealing in trying to understand diabetic complications and aging.
The Maillard Reaction creates advanced glycation end products, or AGE’s, and these AGE’s include misshapen and deformed proteins. Glycated proteins hook up with other damaged proteins in cross-linkages, which worsens their dysfunction.
AGE’s are connected with aging in lots of ways—aging of our skin, kidney disease, damage to blood vessels, and mental decline. They stimulate inflammation throughout the body.
       It appears that if we want to keep our mental functions healthy as long as possible, one thing we can do is try to minimize the glycation of proteins. And that means reducing the availability of sugar.


Monday, July 3, 2017

Organic Farm & Garden, UCSC---50th Anniversary


       One of the country's oldest organic education and research programs, the Center for
Agroecology and Sustainable Food Systems (CASFS), with the University of CA Santa Cruz (UCSC) Organic Farm & Garden, will celebrate their 50th anniversary on July 28 - 30, 2017.
       The UCSC Farm & Garden has pioneered sustainable food production methods that are now widespread. More than 1500 graduates of the CASFS Apprenticeship Program have started their own farms, organic businesses, and food projects.        􀀰􀁉􀁏􀁎􀁅􀁅􀁒􀁅􀁄􀀀􀁏􀁒􀁇􀁁􀁎􀁉􀁃􀀀
      The weekend’s activities will be open to the public. There will be tours of the 30 acres of fields, orchards, & gardens; "food hero" speakers from the Sustainable Agriculture community; food & farming workshops; and a banquet featuring guest chef Alice Waters.
       For more information about this celebration & how you can participate, go to casfs.ucsc.edu, email casfs@ucsc.edu, or call (831) 459-3240.

Monday, June 26, 2017

Painfully Snapping "Trigger" Finger

       Fairly frequently in my office, a patient shows up with a painfully “snapping” finger, commonly referred to as a “trigger finger.” The condition also often occurs in the thumb.
       This is an inflammatory condition for which the technical term is "stenosing tenosynovitis."
       It occurs when inflammation causes a narrowing of the space around the finger’s (or thumb's) tendon and its surrounding tendon sheath. (The sheath is like a tube through which the tendon passes.) 
       My treatment includes adjusting the involved finger and teaching the patient to use an anti-inflammatory protocol at home. This includes antidotes to inflammation, such as ice, topical and / or systemic arnica, and nutritional support.  
       Protecting the involved finger to allow it to heal calls for splinting it to keep it from becoming stuck in a bent position, especially during the night. 
       Chiropractic adjustment of the involved finger with my Activator instrument is quick, precise, minimally uncomfortable, and brings immediate relief.  

Monday, June 19, 2017

Your Pain----Medicare Wants to Know About It


       Documentation about a patient’s condition is very important to Medicare, and caregivers, including Doctors of Chiropractic, are expected to ask the right questions. Information about your your pain, where it hurts, how badly it hurts, the type of pain you are having (is it sharp? achy, dull, burning, deep, etc.), is expected to be documented for Medicare at every office visit.
       In my office, Medicare patients fill out a brief Pain Report before every treatment. Questions include the level, or severity of pain, that day, on a scale of 1 - 10, with 10 being the worst. 
       The Pain Report also asks whether they felt relief after their last visit, and if so, for how long. They write down what they can do, or do better, since their last visit, and whether anything is still hard, or impossible, for them to do because of their pain.

Monday, June 12, 2017

Pesticides' Effects on Beneficial Insects & Other Organisms

Common pesticides, even those previously thought to be minimally harmful to human & environmental health, such as neonicotinoids, are being found to be dangerously toxic to honey bees, bumble bees, and natural parasites of crop pests. These include beneficial predatory and parasitic insects, such as “assassin” beetles & spotted lady beetles, which feed on harmful pests, providing natural pest suppression on farms.
Pesticides also affect the health of the soil. Residues of chemicals applied to crops can have harmful effects on earthworms and other soil invertebrates.
Perhaps pesticide use should be guided by the “Precautionary Principle”----stop using until we understand whether they cause undue harm to beneficial organisms.

Monday, June 5, 2017

What Our Senses Can Tell Us

          We have nerves that sense cold, heat, pressure (touch), pain, proprioception (position of our body parts), smell, taste, sound, etc. There is a theory the human body may also be able to sense magnetic fields.
Birds and bees use magnetoreception to navigate, and there is evidence that frogs, worms, lobsters, and snails have magnetic sense. Some mammals, mice, rats & cattle, apparently have it too. Scientists have located and studied magnetoreceptors in certain bacteria.
A scientist at CA Institute for Technology (Caltech) thinks he has found a “magnetic sixth sense” in humans.
Whether we actually have it, how it might work, and what the implications might be are fascinating questions still unanswered. http://www.sciencemag.org/news/2016/06/maverick-scientist-thinks-he-has-discovered-magnetic-sixth-sense-humans

Monday, May 29, 2017

Simple Solutions to Neck Pain

   
     One of the most important things you can do to relieve neck pain is to AVOID HEAD - FORWARD POSTURES. Put another way, avoid having your head out in front of the center of gravity of your body. Examples:
---bending your head forward to look down at a book or work at your desk,
---jutting your head forward, a very common, and often unconscious, posture when at your computer, 
---leaning forward from your hips when sitting.

     Think about it. In each case, your head is FORWARD of your body’s center of gravity. This causes the muscles in your neck to tighten up to support the weight of your head, which commonly weighs 10# or more!
     Practice awareness of where your head is. When you notice it’s FORWARD, gently bring it back over your center of gravity. You will notice immediate relief.


Monday, May 22, 2017

An Unsuspected Cause of Headaches

  
     Trying to identify the cause(s) of chronic, unrelenting headaches that plague some unfortunate patients is a challenge faced by Medical Doctors and Doctors of Chiropractic alike. There are many different types of headaches, and multiple causes.
     Food triggers may be involved, in which a person gets headaches when they ingest certain foods or food additives. Stress, both biomechanical and emotional / psychological, is often part of the picture.
     Now sleep apnea has emerged as a not-uncommon culprit. The mechanism is a disturbance in proportions of oxygen & carbon dioxide caused by interruptions or aberrance of breathing.
     For patients whose headaches seem insoluble, appropriate professional sleep assessment studies may yield a solution.  

Monday, May 15, 2017

An Unlevel Pelvis

     Our pelvis is the bio-mechanical foundation for our entire body. Its stability (or instability) affects everything above and everything below.
     Disturbances to the pelvis, aka the "pelvic girdle," can cause the pelvis to become unlevel.  
     An example is when your pelvis becomes distorted, or out of proper alignment. One or more of the component bones may become slightly twisted, or stressed abnormally in a superior or inferior direction. Pelvic ligaments may be affected by abnormal stresses due to joint misalignments. Any or all of these may cause pain. 
    A distorted, unlevel pelvis makes an unstable foundation for your spine. Uncomfortable, this may lead to problems above, in your neck or shoulders. An unlevel pelvis may also have consequences downward, into the lower extremities. 
     As an Activator Chiropractor, I correct and balance an unlevel pelvis as part of every gentle, comfortable full-body balancing.

Monday, May 8, 2017

Isn't Honey Better?

You may have heard that honey is healthier than table sugar. But is this true? 
     Perhaps it is, for these reasons: honey has ratios of glucose (30%) and fructose (40%) a bit lower than table sugar (50% glucose, 50% fructose). Table sugar breaks down quickly and causes a surge in blood sugar, whereas honey, which also contains other, different, and some more complex, sugars, breaks down slower. Dextrin, a starchy fiber in honey, also slightly slows the blood sugar surge. 
Table sugar is highly processed, and is devoid of minerals. Honey may have tiny amounts of minerals, picked up by the bees as they went from flower to flower, varying by the region(s) where the bees collected their nectar.
The “big picture” is that sugar is sugar, and is implicated in many health problems, so it’s better to minimize consumption of any sugar. But if occasionally you’re choosing, choose honey.

Monday, May 1, 2017

Co-Morbidities---Conditions for Which Medicare May Allow Extended Care


     Some things that often go along with aging are considered by Medicare to justify an extended, or longer term, of chiropractic care.
     These include degeneration of spinal discs, usually associated with spondylosis, which means bony spur formation around vertebral edges. Another term for this is DJD, or degenerative joint disease. Sciatica, or low back pain with sciatica, as well as spinal stenosis, are other conditions that may warrant extended care.
     Other co-morbidities, or health conditions which may complicate or impede healing, are diabetes, osteoporosis, and spinal curvatures such as scoliosis or kyphosis. 

Monday, April 24, 2017

Supraspinatous---An Essential Muscle of the Shoulder

     The supraspinatous is a small but powerful muscle located in our back, along the top part of our shoulderblade, or scapula. It connects the scapula with the top of the humerus, the bone in our upper arm, and is essential in our ability to raise our arm (abduction).  
     Technically, it is one of the muscles of the rotator cuff, and is commonly affected in rotator cuff injuries.
     A simple orthopedic test rules out an injury to this muscle. However, if the test is positive and involves a tear in the supraspinatous, treatment may require surgery.  

Monday, April 17, 2017

Over-The-Counter Orthotics

Patients who have fallen arches or who pronate need to support their feet with orthotics, not just for comfort, but also because these conditions in the feet reverberate up into the knees, hips, and pelvis and cause problems. Some may need prescription orthotics, but many people will find over-the-counter orthotics can do the job.
I commonly recommend a patient try one of two types that they can buy “off the rack.” One is softer, made of foam, with a mild arch support, that is easy to get used to. The other is a harder, molded orthotic appropriate for people who need more support. Either should be appropriately fitted by a staff person at the store who knows how to size them.
It’s not a bad idea to start with an over-the-counter orthotics and see if they will be sufficient. Certainly they are kinder on the patient’s wallet. If it turns out more fine-tuned or specialized support is needed, prescription orthotics are the next step.   

Monday, April 10, 2017

Polypharmacy


Literally, this means “the simultaneous use of multiple drugs by a single patient for one or more conditions.”
There are now patients coming into my office who are taking upward of eleven or twelve different medications. Often their meds are prescribed by different doctors, and there may be no one doctor who is overseeing or coordinating the mix. Potential harmful drug interactions are not being monitored, and the patient is subject to a myriad of side effects of the various drugs.
Sometimes the pharmacist who fills the patient’s prescriptions may be serving as overseer or monitor, but this is not always the case.
For patients on multiple medications, I advise them to talk with their primary care physician about making sure some caregiver is fulfilling this role.

Monday, April 3, 2017

Numbness, Tingling in Arm or Hand

Nerve impingement of the brachial plexus, the nerves exiting the spine in the neck, can be the cause of numbness or tingling in the arm and / or hand. If the alteration of sensation is diffuse throughout the upper extremity, all or most of the nerves in the brachial plexus may be affected, sometimes due to impingement between the clavicle and the first rib, or in passage between the scalene muscles at the sides of the neck. However, if only parts of the arm or hand are affected, it may be possible to pinpoint the specific spinal nerves that are being impinged. This can guide the specific Activator Chiropractic adjustment which can help alleviate the problem.

Monday, March 27, 2017

From Ribs to No Ribs: Transition Areas of the Spine

     There are two areas of transition in our spine, one at the base of our rib cage and one at the top of it. They are called “transition” areas because they are where attachment of the ribs begin at the lower and upper borders of the rib cage. 
     These are often trouble spots because they are “transitions” from regions of comparatively less mobility to ones of comparatively more mobility. For example, in the low back, the lumbar region, where no ribs attach, is comparatively more mobile than the thoracic region, where, from T12 and up, ribs attach on each side at each vertebral level. 
     Similarly, where ribs cease to attach in the upper back, around T2 & T1, there is a transition to the cervical, comparatively more mobile, region. 
     These transition areas are more vulnerable to biomechanical stresses, and can be recurring trouble spots for some people.

Monday, March 20, 2017

Let's Hear It For Purple Foods!

     Did you know that color of most vegetables is a clue to the kind(s) & how many nutrients they contain?
     Purple vegetables often carry more nutritional “punch.” For example, purple carrots have more powerful antioxidants than the beta carotene in orange carrots. Deep purple beets are more nutritious than yellow or multicolored beets, such as Chiaogia. 
     Purple sweet potatoes, though sometimes hard to find, are richer in antioxidants than other sweet potatoes.
     Intensely purple cauliflower, which existed before the white kind we most often see today, has 2 & 1/2 more times antioxidants than the white. Purple cabbage is very nutritious, and packs 6 times more antioxidants than green cabbage! 

Monday, March 13, 2017

What Causes Scoliosis?

     Abnormal spinal curves develop for reasons that are largely unknown. Although there are several theories, about 80% of scoliosis is considered idiopathic (of unknown cause). 
     Statistically, about 4 adolescent girls in 1000 may develop it, and about 1 in 2500 boys. Roughly 2% of the adult population has some degree of it. 
     In my practice, I have found, in working with several adolescent girls, that a combination of stabilizing the pelvis & focused exercises can reverse or halt the progress of scoliotic curvatures. 

Monday, March 6, 2017

Conservation Comes Home


We can all help monarch butterflies, bees, and other endangered pollinators by planting food gardens, even tiny ones, in our yards. If you live in an apartment, put them in pots, or in community garden plots. Street medians can be planted with pollinator gardens, with support of city councils and volunteers. Support chemical-free pest control, at home and in your town. Go here for some helpful advice from The Xerces Society:  http://www.xerces.org/local-action/intro/  




Monday, February 27, 2017

Essential Function of the Pelvis

     Our pelvis, commonly called the “pelvic girdle,” is the bio-mechanical foundation for our whole body. Everything above and below depends on the stability of the pelvis.
     If your pelvis becomes distorted, due to a fall, a sudden twist or jolt, or just due to accumulated stresses, then it becomes unlevel. An unlevel foundation is an unstable foundation. This can reverberate downward and affect your lower extremities, or upward and affect your chest and neck. 
     As an Activator Chiropractor, I specialize in full-body balancing, including careful attention to the pelvis. This helps my patients’ adjustments to be more effective and more long-lasting.

Monday, February 20, 2017

Golfer's Elbow


     Pain and tenderness near the inside of the elbow may be inflammation of the tendon that attaches the wrist flexor muscles in the forearm (the muscles that bend your hand downward). 
     Called "golfer’s elbow" because it's common in golf players, it is due to overuse / repetitive motion. The muscles should be massaged, cooled with ice, and rested, and the tendon has to be protected so it can heal. 
     As an ACTIVATOR Chiropractor, I find golfer’s elbow is associated with particular misalignments of the bones in the forearm. Correcting these misalignments is an essential part of my treatment plan.

Monday, February 13, 2017

Medicare for Chiropractic Patients

     Medicare patients are welcome in my office. Although the annual deductible for Medicare has increased slightly, to $183, for 2017, it is still comparatively low.
     I enjoy serving Medicare patients in my practice. My low-force Activator Method is especially suitable for elders because it is gentle, comfortable, and safe. 




Monday, February 6, 2017

Choosing Seafood That Supports Healthy Oceans

“Many of the fish we enjoy are in trouble due to destructive fishing & farming practices,” says the Monterey Bay Aquarium’s SEAFOOD WATCH.  They recommend asking your favorite restaurants & businesses, “Do you serve (sell) sustainable seafood?” to let them know you want ocean-friendly seafood.
On the website  https://www.seafoodwatch.org  you can:

 Download Consumer Guides by region where you live 

             Get the Seafood Watch App for iPhone or Android


Monday, January 30, 2017

Ribs---Like a Bucket Handle

Think of each of your ribs as being like a bucket handle:  on our right side, each rib is attached in our back at a thoracic vertebra, and curves around under our arm and across our chest, where it attaches in the front to our sternum. Ditto each rib on our left side at the matching spinal levels.

With inhalations, our chest expands. With deeper breaths, the ribs move up / out from their front & back attachments, in the same way that a bucket handle moves from its attachments on either side of a bucket.

An impact on a rib in the back can affect its attachment in the front of the body, and vice versa. Impacts on side(s) of rib(s) can disturb their attachment(s) in front and / or back. Careful assessment of the rib cage is part of my full-body balancing with Activator Chiropractic.

Monday, January 23, 2017

Using FOOD to Reduce Inflammation


Many things in the standard American diet (SAD) stimulate inflammation in the body. Avoiding these foods or food components can be an effective way to reduce inflammation in our joints and throughout our bodies. Here are some of the main “culprits:”
SUGAR in any form, including honey.
DAMAGED (oxidized or chemically altered) FATS & OILS including hydrogenated oils, which have trans fats (found in margarine, shortening, & many packaged or processed foods such as pastries, cookies, and chips). Damaged oils include vegetable (soy, corn, sesame, etc.) or nut oils, (except coconut) which oxidize at room temperature. Exposure to heat (even cooking at low temperatures) causes accelerated oxidation. Oxidized oils are highly inflammatory.
GRILLED FOODS and foods cooked at high temperatures or “blackened.”
WHEAT products, including white, whole wheat,&  sourdough breads, pasta, cereal, pretzels, crackers, or any product made with wheat flour, which includes most desserts and packaged snacks. Exception is any food made with heirloom wheat, which has not been hybridized.
Diet high in MEATS, which contain inflammation-promoting prostaglandins. Use healthy meats in moderation.

Monday, January 16, 2017

Scoliosis--An Unwelcome Spinal Curve


Our spines have normal front-to-back curves:  forward-facing curves in the neck & low back, and a backward-facing upper back curve.

But “sideways” curves in the spine, called scoliotic curves, aka "scoliosis," those that you would see if the person has their back to you, are abnormal and can cause trouble. They have the effect of weakening the stability of the spine, which affects the attached and related soft tissue, including muscles and organs. 

Severe or advanced scoliosis can impair the lungs & breathing, as well as the functioning of other essential internal organs, and may require surgical stabilization. 

In my practice, I have worked with scoliosis patients who have successfully chosen to avoid surgery, and instead relied on consistent, regular, specific exercises and regular chiropractic care to manage the effects of their abnormal spinal curve(s). 

Monday, January 9, 2017

What's That Pain at the End of My Collarbone?


Among the several joints of the shoulder complex is an articulation at the outer end of the collarbone, the end furthest away from the center of your chest, called the AC, or acromioclavicular, joint. 

It is a common site of injury, partly because it consists of two bones that essentially just “butt together” and their ends, and are fastened together by surrounding ligaments. It is a less efficient joint than many others in the body, and is vulnerable to injury. 

In my practice, an aberrant AC joint is a common cause of patients’ shoulder pain; I have very precise adjustments which I make with my Activator instrument that help.   

Monday, January 2, 2017

Can Chiropractors Opt Out of Medicare?


No. Medical doctors can choose to opt out, but Chiropractors cannot.

If a licensed Doctor of Chiropractic sees a patient who has Medicare, the Chiropractor must, by law, report it to Medicare. Medicare covers Chiropractic treatment to the spine, and patients with Medicare insurance have the right to have their Medicare pay for their spinal treatment. 

If your Chiropractor sees Medicare patients but does not accept assignment (accept payment from Medicare), you must pay at the time of service, your Chiropractor then sends the report of her / his services and charges to Medicare, and you will be reimbursed directly from Medicare. 

Medicare will process the statement of services and charges received from your Chiropractor, and then send the statement on to your secondary or supplemental carrier. Whatever amount your supplemental insurance will pay, they will also send the reimbursement directly to you.