Patient Feedback--Essential to Medicare

    As a doctor serving Medicare patients, it is incumbent upon me to make sure I have careful, complete documentation for every patient visit. This includes detailing the patient’s response to the treatment plan.

Medicare wants to know whether the treatment plan is working, or not, and they want the patient to report whether they feel better, whether their pain is less or worse or unchanged, and what daily activities of their life they can do better, or still can’t do, as treatment progresses.

At every office visit, my Medicare patients fill out a brief form reporting all this.

What is Regenerative Agriculture?

“Just transitioning 10 percent of agricultural production to best practice regenerative systems will sequester enough CO₂ to reverse climate change 

and restore the global climate.” 

 Reversing Climate Change through Regenerative Agriculture - Regeneration International

Regenerative Agriculture uses farming and grazing methods that rebuild the soil’s organic matter, restore soil biodiversity (organisms and microorganisms), sequester more carbon in soil, and increase the amount of water the soil can hold.

It’s done by:

---disturbing the soil as little as possible; aka “no-till” farming. No plowing, which disturbs healthy soil fungi & microorganisms & increases erosion,

---cover crops, composting, & crop rotations to feed nutrients into soil,

---managed grazing to stimulate plant growth & increase soil fertility. 

Learn more here:   www.regenerationinternational.org/why-regenerative-agriculture/

Nerve Impingement

Something that “impinges” a nerve is something that---usually negatively---affects the nerve. Common results of nerve impingement are numbness, tingling, pain, hyperesthesia (excessive, or pronounced, sensation), or hypesthesia (diminished sensation). 

Often nerve impingement is conceptualized as pressure on a nerve, but there are also other kinds of mechanical impingement. Abrasion, stretching, twisting are some examples. Temperature changes or chemical impingement are also possible.

In my practice, the goal of relieving pain usually involves relieving mechanical nerve impingement, accomplished by careful, gentle, precise adjustments with the Activator instrument.

Managing Scoliosis

  For scoliosis (a lateral spinal curvature), one of the best self-care techniques is a special yoga designed by Elise Miller, a Palo Alto, CA yoga teacher who herself has a severe scoliotic curve in her spine  https://yogaforscoliosis.com. Elise developed this yoga as a way to manage her own discomfort, and now teaches it, as well as training other yoga instructors how to do this work. 

Santa Cruz is fortunate to have a local teacher who is certified in Yoga for Scoliosis, Karyn Bristol at Yoga Within  www.yogawithkaryn.net 

On March 30, 2019, Elise will be at Karyn’s Aptos studio www.yogawithin.com/events  and there will be an afternoon session of Yoga for Scoliosis.

In my practice, with scoliosis patients, balancing their pelvis and spine is an important first step, and then regular, intermittent full-body balancing to encourage stabilization.  As an adjunct to my chiropractic care, I then refer these patients for Yoga for Scoliosis. 

A Twisted Tibia

The knee is a hinge joint, meant mainly to move back and forth in one geometric plane. It will accommodate only minimal medial or lateral torquing (circular, or twisting, back-and-forth movement).

Torquing, or twisting, is a common cause of injury to the knee. Twisting the lower extremity on a “planted” foot, while one’s body weight is bearing on the foot, can torque the knee past its tolerance. Pain and inability to bear weight on the knee after this kind of injury often bring patients into my office.

        Usually, the tibia is most severely affected, as well as the kneecap, but the fibula, as well as the femur may also need adjusting.

I have specific, precise, and comfortable adjustments to alleviate this problem, returning the involved knee to its normal articulation and relieving the pain.

Doorway or Corner? Which is Better?

 Patients are frequently advised by other caregivers to stretch the front of their upper body / arms / shoulders / chest by standing in a doorway, placing the hands out on the door frames on each side, and leaning forward.

This will effectively give a good stretch, but I have found that people can easily overstretch due to loosing their balance, lack of control, or over-enthusiasm, and end up hurting themselves.

Instead, I advise my patients to stand facing a corner, place their hands on the walls on both sides, and lean into the corner. I have them change the height of their hands, up and down, which effects the stretch in slightly different parts of the chest, shoulders, and arms. Changing the distance from the feet to the corner can lessen or increase the stretch.

This is a safer way to do this stretch; patients are much less likely to hurt themselves.

Bone Broths

  Nutrient-rich bone broths were traditionally prepared by our mothers, grandmothers, and great-grandmothers as an inexpensive way to support the health of their families. 

Bone broth, rich in absorbable calcium, magnesium, phosphorus, & other trace minerals, is made by slowly boiling bones (preferably organic), for up to 12 hours in water slightly acidified by addition of vinegar.   

Including attached cartilage helps add to collagen content in the broth. The fats in bone broth contribute to the health of our intestinal tract, thus helping the absorption of minerals in the broth. In Traditional Chinese Medicine, bone broth nourishes the kidneys, supports the vital essence (chi) and builds blood.  http://nourishedkitchen.com/bone-broths-adrenals-bones-teeth/ 

Here is how to make Rich Bone Broth:

Bones, with cartilage, from organic chicken, turkey, or beef 

2 - 3 quarts filtered water, enough to generously cover the bones

2 Tablespoons cider vinegar

Bring to boil, then reduce heat & simmer, lid on, for at least 6, & up to 12 hours, adding water periodically as it cooks down

Prior to about the last hour of cooking, add, for flavor:

1 carrot

1 stalk of celery

1 onion, chopped

2 - 3 cloves of garlic, whole or chopped

Salt & pepper to taste

Seasoning herbs (your preference; you can make a bouquet garni of thyme, oregano, sage, etc.)

Cool, then strain into portions for the freezer & / or refrigerator

Trigger Finger

         A common condition when a finger, or thumb, gets stuck in a bent position, and straightening it causes a painful “snap.”

This happens when inflammation develops around the tendon inside the tendon sheath (a tissue “tube” surrounding the tendon), and is called tenosynovitis. The inflammation narrows the space between the tendon and its sheath, and the thumb or finger gets “stuck” in the bent position.

This painful condition often results from repetitive gripping motions with the hand(s).

My treatment plan includes gently adjusting the involved finger, anti-inflammatory management, and splinting of the finger in a straightened position while the inflammation resolves.  

Ventana Wilderness Alliance

    

     As an avid hiker and backpacker for many years in the Central Coast and the Sierra, my support of wilderness preservation is very personal. Early on, John Muir’s words touched my soul: “Climb the mountains and get their good tidings. Nature’s peace will flow into you as sunshine flows into trees.” 

     Climbing trails into the rugged Santa Lucias with breathtaking views of the Pacific at my back, sleeping on the ground in coast live oak woodlands, waking to the raucous chatter of acorn woodpeckers—these are vivid and cherished memories. My grandchildren have been my camping and hiking companions throughout their childhoods, and I have taught them to be safe hikers and careful stewards of wilderness in our many adventures together.

     I care deeply that public lands be protected, be preserved, and remain available for all to enjoy, and I applaud and support the work of the Ventana Wilderness Alliance. 

Donations made to VWA via Monterey County Gives!--now through Dec. 31, 2018--will be matched up to $30,000 by a Challenge Gift  https://www.montereycountygives.com/nonprofit/ventana-wilderness-alliance/            

Founded in 1998, the Ventana Wilderness Alliance (VWA) is a CA nonprofit corporation with 501(c)(3) tax-exempt status, dedicated to protecting the wildlands of California's northern Santa Lucia mountain range www.ventanawild.org

Retrolisthesis

      Retrolisthesis is a slippage backwards of one vertebra along its neighboring disc above or below. It is most common in the lumbar (low back) or neck regions.

     Often this is part of a general degenerative process in the spine, sometimes associated with aging, or it may be a sequela of injury.

     The condition often causes pain at the site, and may also cause radicular symptoms down the leg(s), such as pain or paresthesias (e.g. numbness, tingling).

     Chiropractic management in my office includes careful, gentle adjusting with the Activator instrument, exercises to strengthen the low back and abdominal muscles, and nutritional counseling for supporting a healthy body.

          

Toxic Oils

     "Designer oils" such as rice bran oil and grapeseed oil, often promoted as "healthy," are, in fact, highly toxic. Here's why: these oils are highly PROCESSED.

     Also beware canola oil, which is popularly touted as a healthy oil. It is also in the HIGHLY PROCESSED category. 

     Processing is necessary to extract the oil from rapeseed (canola), rice bran, and grape seeds, and may include extraction with heat and solvents, as well as chemical bleaching, degumming, and deodorizing. 

     Because the raw oils have monounsaturated and polyunsatured components, when exposed to heat, they readily oxidize. Oxidized oils are toxic and highly inflammatory.

     Avoid these oils, and use extra virgin olive oil (the highest grade olive oil, extracted with cold pressing without the use of solvents) instead.   

Sinus Congestion

Congestion in the sinuses can often be alleviated by balancing the cranial rhythms. This gentle balancing is something I include with every treatment in my office.

     The rhythms of the bones in the head are very subtle, and are related to the circulation of the cerebrospinal fluid. Correcting aberrances in these rhythms can relieve headaches, sinus congestion, or vertigo. 

     I also have an effective direct adjustment for the sinuses with my Activator instrument. The adjustment is gentle, and is often followed by immediate sinus drainage. 

Side Sleeping

        Patients often ask if they must sleep on their backs, for the sake of their necks, even though they are more comfortable on their sides. The answer is a qualified “No.”

It depends on the pillow you use under your head and neck.  A pillow that adequately supports your cervical curve and maintains your spine in proper alignment is essential for healthy side sleeping.

I recommend an orthopedically designed pillow. I am a side sleeper, and this is what I use. I have orthopedic pillows in my office for my patients, and although the particular configuration may not be comfortable for a small percentage of patients, it works beautifully for most.

Side sleeping is OK if you have the right pillow.

Bunions

      Bunions commonly form at the base of the big toe, as a result of abnormal biomechanical stresses in the foot. The body's autonomic response to these stresses is to build extra bone in the enlarging joint.

     A fallen arch, especially if combined with pronation of the foot (bending inward of the inside of the foot), can cause development of a bunion. The process is slow, and may not be noticed until the toe starts to hurt, or shoes don't fit well.

    Problematic changes in our body's biomechanics can develop at any age, and are almost always a complex interplay of forces and effects.

    Bunions can be treated effectively without surgery. Here is my treatment plan:

    As an Advanced Proficiency Rated ACTIVATOR chiropractor, I check the status of the arch, assess for pronation, and check & adjust all the joints of the feet. I advise the patient if orthotics are necessary to support the feet, and I prescribe exercises to strengthen the arch.

    Prescription orthotics may be needed, but patients can usually start with a good over-the-counter orthotic, properly fitted.

    Every aspect of my treatment plan is designed to relieve or counteract the stresses that caused the bunion. I have found this approach successful many times in my practice.