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ISSUE #04: MARCH 13, 2007

THE MAGAZINE DEDICATED TO PRACTICE GROWTH AND PROSPERITY SINCE 1954

NUTRITION ROUNDUP 2007 27

GRAIN DANGER! 33

USE NUTRITIONAL RESEARCH TO BUILD 38 YOUR PRACTICE

THE MICROBIAL CONNECTION 44

DISPLAY YOUR PRODUCTS; INCREASE 73 YOUR PROFITS

PAGE 18

PLUS NUTRITION DIRECTORY & RESOURCE GUIDE PAGE 62

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NAMESin the ChiropracticECONOMICS NEWS Sherman faculty NEWSFLASH promoted Three Sherman College faculty United Healthcare fined in Washington members have recently been promoted. Laura Greene-Orndorff, The Office of the Insurance insurance regulations intended to DC, has been named professor of Commissioner in Washington has protect consumers. clinical sciences; Kevin Power, DC, ordered United Healthcare Insurance According to the consent order has been named assistant professor Co. (UHIC) of Minneapolis, Minn., to posted on the Washington State of clinical sciences; and Mitzi pay a $59,500 fine following an Chiropractic Association (WSCA) Web Schwartzbauer, DC, has been agency investigation into the site, UHIC used provider agreements named assistant professor of company’s use of unapproved that allegedly contained a retroactive clinical sciences. contracts to add chiropractors to its denial provision, which was Source: Sherman College of Straight provider network. UNHIC has provider prohibited by law. The insurance Chiropractic, www.sherman.edu agreements with CAN Group, Inc., the commission reviewed the allegations chiropractic provider network. and withdrew its prior approval of Logan elects new officers The agency ordered the fine after the provider agreements. Despite the Logan College of Chiropractic an investigation disclosed the ruling, UHIC through CAN added 33 has announced the election of company continued to use the new chiropractors to the network, officers. Steve Roberts, JD, LLM, is unapproved contracts after it had using the disapproved provider the chair of the board of trustees been notified that it was violating UNITED CONTINUED ON PAGE 8 ➤ and Debra L. Hoffman, DC, is the new vice chair. Foot Levelers gives $1 million to Parker College Source: Logan College of Chiropractic, www.logan.edu Foot Levelers, Inc. has made a $1 million donation to Parker College of Chiropractic. Researchers join Foot Levelers President and CEO, Kent S. Greenawalt, presented the check to Fabrizio editorial board James Brantingham, DC, PhD, Mancini, DC, president of Parker at the Las associate professor, and Cheryl Vegas Parker Seminars. Hawk, DC, PhD, vice president of Foot Levelers and Parker Seminars are research and scholarship, both celebrating their 55th anniversaries researchers from Cleveland this year. “We are honored to support the Fabrizio Mancini, DC, (left) accepts Chiropractic College, and Steve excellent work of Parker College of the Foot Levelers donation from Foster, DC, from Texas Chiropractic,” said Greenawalt. “Their Kent Greenawalt. FOOT LEVELERS CONTINUED ON PAGE 8 ➤ NAMES CONTINUED ON PAGE 8 ➤

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CHIROECO NEWSFLASH.com Many in cancer drug trials of users, with 40.3 percent opting for alternative medicine in the past year. These individuals most often sought care use herbs, supplements for general wellness (40.8 percent), although 32.5 percent The use of herbal medicine is common among patients used alternative medicine to treat an illness and 10.2 with advanced cancer who are participating in early-stage percent to supplement traditional care. clinical trials (phase I) of experimental drugs, according to The top three conditions treated by alternative a new study. medicine were irritable bowel (46.6 percent), lower back Dr. Christopher K. Daugherty of the University of (45.9 percent), and skin problems (44.7 percent). Chicago and his team, as reported in the Journal of Almost 50 percent of users have an income of more Clinical Oncology, surveyed 212 patients with advanced than $100,000 and have post-graduate education. cancer who had recently consented to participate in phase Source: Thomson Medstat Brief, www.thomson.com I trials. All of the patients were interviewed about a week before the trial began. Thirty-four percent said they used some type of D’Youville opens biologically based alternative medicine, such as an herbal chiropractic clinic in city drug, a supplement, vitamins, or minerals. About half used D’Youville College opened a 6,600 square foot herbal drugs, and about half said they used vitamins or chiropractic clinic on February 8, 2007, in Buffalo, N.Y., to minerals. serve the general public as part of its chiropractic The patients who reported alternative medicine use education program. were younger, with an average age of 55 years compared The clinic will serve as one of the college’s clinical with an average age of 62 years among those who didn’t training sites for chiropractic interns and also provide a report using these medicines. variety of clinical health services to the public, according Study participants who said they believed they would to college officials. die within the year were also more likely to report using It houses examination and treatment rooms, a alternative medicines. rehabilitation suite, conference room, patient waiting Source: Journal of Clinical Oncology, www.jco.org area, x-ray suite, and faculty and administrative offices. It has state-of-the-art diagnostic and treatment equipment New study says 22% including direct digital radiography that allows a patient’s use massage or chiropractic x-rays to be recorded on a CD for the patient to take to their primary physician or specialist if needed. A new study that mirrors results of a 2002 survey Source: D’Youville College, www.dyc.edu conducted by the Centers for Disease Control shows that 22 percent of Americans use massage or chiropractic as a preferred form of alternative therapy. The survey did not 91% of med students break out the use of chiropractic specifically. feel CAM is important The study, conducted by Thomson Medstat, surveyed A survey of 266 first-year and second-year medical 23,000 households. It found that alternative medicine is students at Georgetown University School of Medicine not a passing fad, but is used regularly to treat everything (GUSOM), Washington, DC, reveals their attitudes are from lower back pain to diabetes. favorable toward complementary and alternative medicine Among the findings: (CAM). • More than 37 percent of households use some form of When asked to rate their attitudes toward CAM and 15 alternative medicine; CAM modalities in terms of personal use, inclusion in the • Alternative medicine use is most prevalent among curriculum, and use/utility in clinical practice, nearly all those with incomes of more than $100,000 per year and students (91 percent) agreed that “CAM includes ideas and those with post-graduate college degrees; methods from which Western medicine could benefit.” • About 42 percent of respondents said insurance covers More than 85 percent agreed that “knowledge about at least part of their treatments; CAM is important to me as a student/future practicing • Nearly two-thirds discuss alternative treatments with health professional” and more than 75 percent felt that their MDs; CAM should be included in the curriculum. • The most common reason for using alternative Among all students, the most frequently indicated level treatment is to promote general wellness; of desired training was for acupuncture, chiropractic, • Herbals supplements and massage and chiropractic herbal medicine, and nutritional supplements. care are the most common types of alternative medicine. Source: Alternative Therapies in Health and Medicine, People in the 35- to 64-year-old age group led the pack www.alternative-therapies.com/at/

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CHIROECO NEWSFLASH.com New York announces symposium Logan ICAK scholarship The New York State Chiropractic Association, New York funded through 2010 Chiropractic College, and New York Chiropractic Council will Standard Process Inc. will continue its sponsorship of the present “The Art of Chiropractic: A Symposium on Chiro- George J. Goodheart Scholarship at Logan College of practic Technique,” April 21 and 22, 2007, at the Marriott Chiropractic in Chesterfield, Missouri, through 2010. New York–LaGuardia Airport in East Elmhurst, New York. The Goodheart Scholarship, a project of the The symposium’s topics will include flexion/distraction, International College of Applied Kinesiology – U.S.A. sacro occipital technique (SOT), diversified and extremity (ICAK-U.S.A.), provides a $2,500 scholarship to a adjusting, chiropractic biophysics (CBP), Graston technique, chiropractic student attending Logan College. and scoliosis. Source: Standard Process, www.standardprocess.com For more information, contact the New York Chiropractic College Postgraduate Department at 800-434-3955 ext. 132. Sherman Lyceum Source: New York Chiropractic College, www.nycc.edu makes call for abstracts Northwestern offers Sherman College of Straight Chiropractic is making a call for abtracts for its Fall Lyceum/International Research and online alumni brochure Philosophy Symposium (IRAPS), Nov. 2-4, 2007. The theme is Northwestern University of Health Sciences now offers “The Science and Philosophy of the Mental Impulse.” an online brochure outlining resources for alumni located Papers that relate to scientific inquiry, as well as topics at www.nwhealth.edu/alumni/index.html. that address methods of presenting the concept of mental The brochure gives information about the bookstore, impulse to patients and the public, are invited. the library, continuing education, and alumni associations. Abstracts should be 500 to 1,000 words. It also answers questions about the e-mail system, access For more information on possible topics, visit to the university building, and hours for the fitness center, www.sherman.edu/IRAPS. as well as other services. Source: Sherman College of Straight Chiropractic, Source: Northwestern University of Health Sciences, www.sherman.edu www.nwhealth.edu

UNITED CONTINUED FROM PAGE 5 WHAW starts April 10 agreements, until Oct. 13, 2005. The 3rd annual World Homeopathy Awareness Week The commission’s ruling said that UHIC violated the law. (WHAW) is set for April 10-16, 2007. This year’s theme, The $59,500 was to be paid within 30 days. “Women,” will focus on how homeopathy can help Sources: Washington State Chiropractic Association, women in their unique place in life, their family, and the www.chirohealth.org; State of Washington Office of Insurance world safely, gently, and effectively. Commissioner, www.insurance.wa.gov Events will be listed on the Web site as they are scheduled or contact [email protected] for more information. FOOT LEVELERS CONTINUED FROM PAGE 5 Source: World Homeopathy Awareness Organization, www.worldhomeopathy.org commitment to chiropractic education as well as to the growth of the profession is truly remarkable.” Palmer kicks off new program Founded by Monte H. Greenawalt, DC, DABCO, Foot Levelers has provided extensive financial support A group of students on Palmer College of Chiropractic’s to local, state, and national chiropractic associations, Davenport Campus is taking steps to make their dreams of as well as support to chiropractic education. practice success a reality. Their road map, Palmer Source: Foot Levelers, www.footlevelers.com Destination Success, kicks off with its first seminar — A Journey From Within — on March 31, from 7 a.m. to 7:30 p.m. in Lyceum Hall on the Davenport campus. NAMES CONTINUED FROM PAGE 5 This one-day event will give attendees an opportunity to network with chiropractic students and chiropractors Chiropractic College, have accepted an invitation to from across the country, as well as listen to motivational become members of the editorial board for the and practice management speakers. Journal of Chiropractic Medicine (JCM). More details and registration information are available Source: Cleveland Chiropractic College, www.cleveland.edu; online at www.palmerdestinationsuccess.com. Texas Chiropractic College, www.txchiro.edu Source: Palmer College of Chiropractic, www.palmer.edu

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33

38

COVER STORY

Why physician-grade supplements make the grade ...... 18 By John V. Wood

ROUNDUP

A roundup of new or improved nutritional products for your patients ...... 27 56

PATIENT RELATIONS

Grain danger! Gluten may be harming your patients — or you ...... 33 By Shari Lieberman, PhD, CNS, FACN

How to use nutritional research in your practice ...... 38 By David Barnes, PhD and Kelly Kwiatkowski, MA

The microbial connection ...... 44 By Paul A. Goldberg, MPH, DC, DACBN

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CIRCLE 291 FREE INFORMATION CHEC4p14.ps 2/19/07 8:34 PM Page 14 CONTENTS CHIROPRACTIC ECONOMICS • VOLUME 53, ISSUE 4

73 IN EVERY ISSUE NEWS ...... 5 EDITORIAL MESSAGE ...... 16 INFORMATION FOR READERS . . . . . 82 DATEBOOK ...... 88 PRODUCTS AND SERVICES ...... 93 MARKETPLACE ...... 94 CLASSIFIEDS ...... 98 NUTRITION DIRECTORY AND RESOURCE GUIDE ...... 62

ChiropracticECONOMICS

Chiropractic Economics (ISSN 1087-1985) (USPS 019-178) is published 20 times a Detox your patients; build your practice ...... 52 year, once every three weeks, by By Ronald E. Partain Chiropractic Economics, Inc., 5150 Palm Valley Road, Suite 103, Ponte Vedra Beach, FL 32082, Phone: 904- How to do ‘nutrition’ right ...... 56 285-6020, Fax: 904-285-9944, Web By Donald F. Feeney, DC, DACBN, CCN contact: www.chiroeco.com (A Florida Corporation). Team Tips: Difficult situations; positive solutions ...... 60 POSTMASTER: Please send form #3579 to Chiropractic Economics, PO By Susan Hoy Box 3521, Northbrook, IL 60065-9955. Periodicals class postage paid at Ponte Vedra, Florida and at additional mailing OFFICE DESIGN offices. GST #131868416. Subscription Rates: U.S. and possessions, $39.95 one year, Canadian Display your products to optimize sales ...... 73 subscribers add $35 per year shipping By Glen David and handling; overseas subscribers add $60 per year shipping and handling. Students, $19.95, Single copy, $4. Statement: While encouraging the free PRACTICE MANAGEMENT expression of opinion by contributors to this publication, Chiropractic Economics and members of its staff do not Use patient psychology to launch your nutrition business . . . . . 77 necessarily agree with/or endorse the By Miranda Jorgenson, DC statements made in the advertisements or contributed articles. Chiropractic Chiro Biz Quiz: Check your knowledge Economics is owned by Chiropractic Economics, Inc. a Florida Corporation, of neurodiagnostic testing ...... 80 Joseph D. Doyle, President and CEO By Marc H. Sencer, MD and Linda Segall, Editor-in-Chief. Authorization for the use of photographs and/or illustrations is the responsibility of the author(s). All LEGAL materials submitted for publication shall remain the property of this magazine until published. Ask the Attorney: Entering into a CORF? Change of Address: Six to eight weeks prior Consider all aspects ...... 86 to moving, please clip the mailing label from By Deborah A. Green, Esq. the most recent issue and send it along with your new address (including zip code) to the CHIROPRACTIC ECONOMICS CIRCULATION DEPARTMENT, PO Box 3521, STUDENTDC.COM Northbrook, IL 60065-9955. For a faster change, go to www.ChiroEco.com and click on “Customer Service.” Find your dream location ...... 92

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Editor’s Message

Prepare for the ChiropracticECONOMICS

DEDICATED TO PRACTICE GROWTH AND PROSPERITY SINCE 1954 next media assault Volume 53, Number 4 Editor-in-Chief utritional supplementation made headlines in the Linda Segall [email protected] popular press at the beginning of this year. Those N Associate Editor headlines might have scared your patients. Wendy Bautista [email protected] The first story was a controversial two-part series run by the CBS Evening Online Editor News with Katie Couric. The series was based on the book, Natural Causes: Amy Mitchell Death, Lies and Politics in American’s Vitamin and Herbal [email protected] Supplement Industry, written by investigative reporter Art Director Dan Hurley. Christine Wojton Hurley’s book purports that more than 1.6 million [email protected] people have reported adverse reactions to vitamins, Production Specialist herbs, and other dietary supplements since 1983. David Griffiths The second story was published the day after the CBS [email protected] story (possibly as “catch-up” journalism), on Webmaster MSNBC.com, Yahoo News, and other news sources. Daniel Greig Let me know what’s [email protected] on your mind: MSNBC’s article was headlined, “A vitamin a day may 904-567-1537 do more harm than good.” Circulation Manager Fax: 904-285-9944 The story cited a Consumerlab.com report on the Darryl Arquitte [email protected] [email protected] quality of 21 brands of multivitamins. Only 10 of the vitamins tested by independent laboratories met the stated claims on their Controller Virginia Y. Higgins labels or satisfied other quality standards. [email protected] If ever there has been an opportunity to talk with your patients about the National Account Executives benefit of physician-grade supplements, those two news stories provided it. I Jeff Pruitt hope you took advantage of them to educate your patients. 904-567-1542 [email protected] Prepare now to deal with the Janice Ruddiman Long 904-567-1541 media’s next assault on [email protected] chiropractic or supplementation. Frank Weiner 904-567-1540 [email protected] If you run a nutrition chiropractic practice, those stories also offered an opportunity to present yourself as an expert to the press. Although each of the Advertising Coordinator & Classifieds stories garnered opposing viewpoints from nationally recognized experts, the Sara Prewett media like to add a local flavor to these types of news stories. 904-567-1543 As much as we would like to think that assaults on nutritional supplements [email protected] and chiropractic are things of the past, we know better. Therefore, now is the President/CEO time to cultivate those relationships with the press and to have at hand Joseph D. Doyle information you can use to educate the media as well as your patients. [email protected] In this issue, we asked the manufacturers of physician-grade supplements to Executive Vice President David C. Carlton offer their advice on how to use negative news to your (and your patients’) [email protected] benefit. I hope you’ll take to heart what they have to say. We also offer our annual roundup of new and improved nutritional Business & Editorial Offices 5150 Palm Valley Rd., Ste. 103 supplements, as well as other information to help you in your nutrition Ponte Vedra Beach, FL 32082 chiropractic practice. Phone: 904-285-6020 Until next time, Fax: 904-285-9944 www.chiroeco.com Founded 1954 William L. Luckey Helen C. Luckey Linda Segall, Editor-in-Chief

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Cover Story

NUTRITIONAL SUPPLEMENTS Physician Grade vs. OTC Why your recommendations make the grade

By John V. Wood

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any Americans take over-the- to find out. The individuals questioned were Halpner; Jennifer Cherry, president of Nutraceutics; Allan Wilson, counter (OTC) vitamin national manager at Anabolic Laboratories; Matthew supplements in an attempt to Armstrong, vice president of A.C. Grace Company; Ann M Holden, vice president of quality control, and David fulfill their daily nutritional needs. Barnes, PhD, director of research, both with Standard A new study, however, shows some Process; and Richard Drucker, CEO of Drucker Labs. vitamins do not help those nutritional WHY ARE PHYSICIAN-GRADE needs, and might even be detrimental SUPPLEMENTS BETTER? to your health. The term “physician grade” refers to professional market supplements available only to and marketed ConsumerLabs, a leading provider of independent test exclusively to doctors. results and information to help educate consumers and “It is in the [supplement] manufacturer’s best interest to healthcare professionals, performed a random test of 32 ensure that their products conform to all labeling popular OTC vitamin supplements. Among those requirements, that all ingredients are present as labeled products selected, only 10 met their claims and other and that products do not contain deleterious materials,” quality standards. ConsumerLabs found: says David Barnes of Standard Process. “We expect to be • A women’s multivitamin was contaminated with 15.3 held to a higher standard.” micrograms of lead per daily serving; Several of the people questioned identify the fact that • A children’s vitamin contained 216 percent of its professional market supplements are held to high labeled amount of vitamin A; accountability statistics, and are tied directly to the results • Three multivitamins — one for women, one for men they provide. and one for seniors — did not fully break apart (disintegrate); and • One multivitamin contained none of its claimed Recent news stories reported vitamin A. serious quality problems of ConsumerLabs looked at one lot from each of the 32 supplements. When Matt Lauer of NBC’s Today Show OTC vitamins. Were you able asked if this was reliable testing ConsumerLabs’ president to answer your patients' Dr. Tod Cooperman defended the amount of supplements questions and explain why chosen. “No lot should ever be bad when it comes to vitamins,” physician-grade supplements Cooperman said. “Ideally, you’d like to look at every lot are better for them? available. We decided to look at one individual lot [of each supplement] instead, and examine it very carefully.” After the release of the study, media outlets began “When companies provide products to a doctor, they running with the story. One news agency chose the know the results will be monitored. If the product does headline, “A vitamin a day might do more harm not do what it should, the doctor stops using it,” says than good.” Allan Wilson of Anabolic Laboratories. “That feedback Andrew Halpner, vice president of product loop does not exist only in the consumer market, and also development and technical services at Douglas acts as a quality gauge. To survive in the ‘physician only’ Laboratories, a physician-grade supplement manufacturer, market, a supplement company must provide products challenges this type of sensationalistic reporting. that yield consistent results.” “This headline is exactly the type of sensational Jennifer Cherry of Nutraceutics adds the educational reporting that helps to keep a cloud of suspicion over the access doctors have with physician grade supplements dietary supplement industry,” Halpner said. “A product help as well. “Companies specializing in the physician that is reported to contain only 80 percent of a claimed market have better educational tools for the doctor. We amount of a nutrient is reason for further investigation, have trained and qualified employees to answer any but to brand the entire category of dietary supplements as question or concern that may come our way,” Cherry says. potentially harmful is simply poor reporting.” “We know about drug interactions and contraindications. Physician-grade supplements were not part of the study. We know about the conditions we are nutritionally Are these supplements better? Chiropractic Economics supporting. We know the science inside and out.” spoke with several other manufacturers of physician-grade CONTINUED ➤

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Cover Story

WHAT ABOUT QUALITY CONTROLS? formulated with a specific result in mind. They are not According to Ann Holden of Standard Process, the law intended for a person to use over the counter, as they requires the same level of quality control for both often have very high amounts of particular actives to help physician-grade and consumer OTC markets. “Products the doctor manage a case. “These products are designed to which do not contain the ingredients at the levels be part of a protocol,” Wilson says. “Consumer products indicated (within a specified margin of error) are in are designed for maximum sales and profit impact.” violation of the law,” Holden says. “Some ingredients may be produced to a certain set of standards such as the WHAT ABOUT STATED LABEL CLAIMS? United States Pharmacopoeia (USP), however such Governed by FDA, DSHEA, and FTC, all supplements standards are not available for all ingredients.” must meet stated claims and not make unsubstantiated “[Companies specializing in physician-grade health claims. According to Wilson, standardizing natural supplements] have worked very hard to gain the trust and products is a real challenge, and the only way to guarantee confidence of physicians and for our sterling reputations potency is to test the product. It is very difficult, especially in the industry,” Cherry adds. “There is no way we would when premium natural materials are used — which is jeopardize this by putting out an inferior, low-quality, typical of physician-grade products. contaminated product. It would just never happen.” Wilson has a great illustrative example of this question. “Using a multivitamin image, let’s picture a box that is 12 IS THERE A DIFFERENCE IN OTC SUPPLEMENTS? feet long, 6 feet wide, and 6 feet deep. You could probably fit “It’s not really a question of physician-grade vs. OTC; a car in it. Now you have that whole box filled with powder rather it’s about substituting fake vs. real nutrition,” says (all the multivitamin ingredients) and you’re blending it. Richard Drucker of Drucker Labs. “Many OTC “Time to add selenium — which you could fit in a soup supplements use synthetic chemical nutrients (as opposed bowl. You open the box and dump it in, but how can you to natural and organic sources) because they are much be sure that tiny bit of selenium is going to blend evenly cheaper to manufacture, and putting a vitamin into a in that huge box so that when you make tablets, you have mega-drugstore is all about profit margins.” the 200 mcg of selenium present — no less and certainly Matthew Armstrong of A.C. Grace Company says it no more — in the thousands of tablets you’re making? comes down to quality. Armstrong believes raw materials The only way to know is to test for selenium. Test the have to be checked and double-checked, and companies blend, test the tablets.” have to perform independent assays to verify potency, A quality company ensures the label meets the claim by among other things. assaying the finished product before it is released for sale Physician-grade supplements, according to Wilson, are CONTINUED ➤

Turn bad news into good

The “contaminated vitamins” story of information should prompt [MSNBC] article in the waiting room, may have raised concerns among your clinicians to ask good questions of bulletin board, or treatment room. patients about the safety and value of the companies selling them Answer questions with any variation taking nutritional supplements. Even products.” of these: ‘We offer products that are if your patients do not bring up the “DCs must first make their own only available to doctors, and these news stories, you can use the bad value judgment. Their education products are made in a regulated news as an opportunity to talk to qualifies them uniquely to educate pharmaceutical facility, so articles like your patients about the benefits of their patients and the end this do not apply, as these are taking the proper supplements — consumers on proper manufactured to a different standard. physician-grade. supplementation,” Drucker adds. “‘It is guaranteed that what is on “This type of information is a “They are qualified from both the label is in the product. You won’t strong reason to have a nutritional and long-term wellness. find these items at the grocery store, patient/clinician partnership when It is incumbent upon them to and we have seen consistent results using nutrition as a tool in health recommend the proper choices for with these products for decades.’ promotion and for clinicians to do their patients. Carrying good quality “The cornerstone of exclusive their due diligence,” Holden says. products in their offices is a service products is they are only available “High quality companies who have they should provide,” says Drucker. from the doctor, and they are part been in the marketplace for many To Wilson, the solution is quite of the patient’s ongoing years are good resources. This type simple. “DCs need to have that healthcare,” he adds.

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Cover Story

to the general public, says Cherry. HOW IS DISINTEGRATION “All ingredients stated on the label TESTED? must be assayed to ensure that the According to Wilson, tablet finished product meets label claim.” samples must be taken regularly during production and tested for HOW IS CONTAMINATION hardness, thickness, weight, and AVOIDED? friability, versus a set specification for Sealed production rooms, that product. “If the product is documented cleaning procedures, and compressed too hard, then it is a whole host of controls must be put basically a rock, and it will never pass in place to insure purity in a disintegration testing,” Wilson says. pharmaceutical plant, according to “Physician-grade per se doesn’t Wilson. mean they dissolve faster or better; “Think about a grill at the rather, companies selling in this restaurant — the cook puts down a market have a high likelihood of burger, it gets moved, and down goes conducting the appropriate diligence

some chicken, then a steak, then and reject products which don’t meet some shrimp. If a little juice from their specifications,” Barnes says. another food mixes in, no problem,” A simple laboratory disintegration Wilson says. “But if you are dealing test may not tell the whole story, says with controlled substances, then Cherry. “Factors such as the pH and contamination becomes a federal amount of gastric juices in a person’s offense.” gut come into play,” Cherry says. Cherry says raw materials need to be tested for purity and identity, HOW TO CHOOSE AMONG microbial contamination, and PHYSICIAN-GRADE PRODUCTS? environmental toxins such as lead. Holden believes the answer lies in “As a doctor, I would insist the brand the QC documentation of the supple- I recommend has this [testing] ment providers. “Clinicians may information available. I would ask for request that supplement companies this documentation on the lot number document quality control procedures I was selling. Some companies will do such as how much testing is conducted it one time on one batch or lot and by whom and who inspects their number and then claim it to be true manufacturing facility,” Holden says. for a different batch or lot number.” CONTINUED ➤

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Cover Story

“Other considerations might include how long they have been in business, whether they have their own manufacturing facility (and therefore have more control) or have product manufactured for them, and whether they produce any of their own raw ingredients.” Wilson says quality-control testing of incoming materials is important in a pharmaceutical company such as his. “If a pharmaceutical company does something wrong, penalties could include prison time for all involved employees — quite a significant increase over a ‘cease and desist’ letter and possible fine by the FTC.”

CIRCLE 213 FREE INFORMATION Cherry believes that if you are a chiropractor, your reputation is at stake whenever you are dealing with supplements and other means of patient wellness. “Everyday I see new companies entering the physician market. It is actually quite scary, because many of these companies are not offering quality education and products. How is the doctor supposed to know what’s going on?” Cherry says. “If there is a new company that you are interested in, ask questions such as, ‘Do you have PhDs on staff? Do you have pharmacologists on staff? Can I see your assays?’ Ask hard questions. If you do not get the answers you are looking for, run! This is your reputation on the line.”

John V. Wood is an Emmy- award winning journalist, as well as a nationally published freelance writer. He lives in Willow Spring, N.C., and can be reached at 919-632-1827 or by e-mail at CIRCLE 236 FREE INFORMATION [email protected].

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NUTRITION ROUNDUP New or improved supplements benefit your patients

hich nutritional products do BOWEL RELIEF Chiro-Manis Inc.’s Flax Plus Fiber your patients need? Getting is a supplement aimed at helping ease your patients to take care of the pain produced during bowel W movements in patients with radiculopathy or low back their nutritional needs may be pain because of the increased intradiscal and valsalva challenging, with their busy on-the-go pressures. It contains peppermint oil, flaxseed powder, aloe schedules and fast-food temptations. vera plus psyllium, senna leaves, oat bran, and cascara sagrada. It is also synergistic with lactobacillus acidophilus in But carrying nutritional supplementation options in implanting the colon flora. your practice and suggesting them to your patients (if Call 800-441-5571 or visit www.chiromanis.com. allowed by your state’s scope of practice) may help keep their health needs in the forefront and other health- SEAWEED EXTRACT related problems — obesity, heart disease, high blood Gly-Sea-Max by Douglas Laboratories is a blend of two pressure, and other illnesses — at bay. brown seaweed extracts and a potato extract designed to Chiropractic Economics put a call out to nutrition help moderate normal glycemic response after meals. It companies, asking for information on some of their latest helps support satiety, fullness, and healthy weight products, and maybe even some old ones that have been maintenance. The seaweed extracts are intended to affect improved. Some are highlighted here. the activity of two of the enzymes responsible for the Please keep in mind that all information has been digestion of carbohydrates, and the potato-derived extract provided by the manufacturers, and Chiropractic Economics aids to decrease a rise in blood glucose. does not test nor endorse any of the products listed. Call 888-368-4522 or visit www.douglaslabs.com.

TOCOPHEROL COMPLEX CHILDREN’S HEALTH SUPPORT A.C. Grace Company’s UNIQUE E is a high intraKID from Drucker Labs, Inc. is an all-natural, 100 concentration of the natural tocopherol complex. percent carbon-bond organic micro-complexed nutritional It contains 300 milligrams per capsule of high d-gamma supplement intended to support a number of health tocopherol content. The vitamin E complex is designed concerns for children. It utilizes Drucker Labs’ intraCELL to be in the optimal proportions to provide the V technology and has a balanced set of nutrients for the maximum health benefits. It is manufactured to promote needs of younger patients. It is available in a raspberry- healthy vascular circulation, protect lipids from tasting formula and contains over 215 nutrients including oxidation, enhance cognitive function, and promote trace minerals, vitamins, and other nutrients. cellular integrity. Call 888-881-2344 or visit www.druckerlabs.com. Call 800-833-4368 or visit www.acgraceco.com. LIQUID FORMULA UPPER RESPIRATORY AID Healthy Blend by Dynamic Health Laboratories, Inc. is Neutrophil Plus by Biotics Research Corp. is a dietary an all-natural, 100 percent pure liquid formula intended to supplement product that combines vitamin C, natural offer a synergistic blend of six natural fruit juices, important mixed carotenoids, vitamin A, vitamin E, zinc, calcium, minerals, and essential vitamins. This juice blend contains RNA, cytozyme-thy, and several standardized herbal essential fruits that work together to create a nutritionally- extracts. It is designed to be beneficial to individuals with balanced vegan juice blend that can benefit body and mind. immune problems, especially upper respiratory system, It contains wolfberry juice (also known as goji), mangosteen, such as otitis media, throat, sinus, and bronchial noni juice, açaí juice, aloe vera juice, and camu-camu juice. conditions. Call 718-472-4009 or visit www.dynamic-health.com. Call 800-231-5777 or visit www.bioticsresearch.com CONTINUED ➤

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HERBAL SUPPLEMENT to maximize benefits for cardiac health, mood, and Cold & Flu Quik Defense by Healthy Living Solution is cognition, as well as joint, skin, and immune support. Each an all-natural herbal supplement safe for the whole family. It serving of Omax3 provides 1,500 milligrams of omega-3s. can be taken when the patient is sick, as a preventative, or Call 219-390-7053 or visit www.omax3.com. at the first sign of cold or flu. It is non-drowsy, contains no additives or fillers, and is available in individual or family size. CALCIUM DRINK Call 877-505-4372 or visit www.HLS-Herbs.com. Cal-C by NutriJoy Inc. is an everyday drink formulated to deliver 50 percent more absorbable calcium than milk OMEGA 3 or supplements. It contains vitamins C and D, and calcium PureOmega-3 Fish Oil by HeartPak, Ltd. is a dietary citrate malate (CCM), which is meant to improve bone supplement intended to have numerous cardiovascular health and protect against osteoporosis. Cal-C has 60 benefits, including blood lipids, blood pressure, blood calories per serving and one-third less sugar than fruit thinning, and prevention of heart attack, stroke, and juices. Cal-C is also an alternative for lactose-intolerant sudden cardiac death. Each natural orange-flavored pill is people or those who have trouble swallowing pills. free of heavy metals and PCBs and contains 750 Call 785-323-1020 or visit www.nutrijoy.com. milligrams of omega-3 fatty acids. PureOmega-3 is available in a 200-pill bottle. HEALTHY VEINS Call 210-364-8798 or visit www.purecardio.net. Vascu-Flow by Nutura is an orange-flavored powder manufactured to improve circulation and vascular health. HEART SUPPORT It is formulated to dissolve quickly when mixed with juice Omax3, distributed through Huseman Distributing, is or water. Relaxing the artery muscles may reduce arterial manufactured to be an ultra-pure omega-3 supplement stiffening and narrowing, and may also lower blood specially developed by physicians and scientists to provide pressure, reduce serum cholesterol and plaque formation, an ultra-pure and optimally balanced omega-3 supplement. and prevent clots that can cause heart attack and stroke. Omax3 is a comprehensive omega-3 supplement formulated Call 800-824-8212 or visit www.nuturaproducts.com.

CIRCLE 170 FREE INFORMATION

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PROBIOTIC CAPSULES immune system. As part of its proprietary blend, Congaplex Multi-Probiotic by Original Medicine is a capsule with a contains thymus cytosol extract, which contains the building blend of 11 different probiotic strains designed to provide blocks of the thymic hormone, which in turn supports and beneficial microorganisms that help support a healthy stimulates the immune system. Congaplex also helps support microbial balance. The bacteria in Multi-Probiotic are the healthy function of the upper respiratory tract. considered to be an integral part of normal immune system Call 800-558-8740 or visit www.standardprocess.com. support, normal absorption and assimilation of nutrients, and helps support normal cholesterol levels. The capsules ELECTROLYTE MINERAL are 100 percent vegetarian and 100 percent dairy free. Capra Mineral Whey by Mt. Capra Products is a 100 Call 800-465-1802 or visit www.original-medicine.com. percent natural electrolyte mineral supplement concentrate made from goat-milk whey powder. It is ENERGY SOURCE designed for bone density support and is a bio-sodium ATP Plus by Progressive Labs is a cellular energy source source for joint lubrication. It is processed at a low which plays a role in supporting the health of the blood temperature to retain nutritional integrity and contains vessels and increasing vasodilation for improved blood flow more than 20 naturally occurring minerals in a highly to the heart and muscles. It helps the reduction of both complex whole food. Individual serving packets are muscle pain and fatigue in fibromyalgia patients. ATP is available in a box of 30 easy-to-open packets. supported with magnesium and malic acid for additional Call 360-748-1764 or visit www.mtcapra.com. cellular energy production under low oxygen conditions. Call 800-527-9512 or visit www.progressivelabs.com. METABOLIC POWDER SlenderBerry by Sweetwater Natural Products is a berry- HEALTHY IMMUNE SYSTEM flavored powdered drink that can be mixed with water, Congaplex from Standard Process is designed to maintain yogurt, or juice. It is designed to help manage weight, a healthy immune system. It contains nutrients and tissue blood sugar, and cholesterol at healthy levels — all the extracts that contribute to the healthy response of the CONTINUED ➤

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elements of metabolic syndrome. It is Cholesterol Health, and Blood Sugar intended to improve blood lipid Health. Relief First is available in profile, serum glucose, and weight capsule form and in a cream. management. It is manufactured with Call 866-263-8425 or visit dietary fiber and probiotics to detoxify www.FirstShake.com. and maintain a healthy digestive tract, and antioxidants to help ESSENTIAL FATTY ACIDS maintain cardiovascular health. EFA (Essential Fatty Acids) by Call 888-666-1188 or visit Whole-istic Solutions provides all of www.psopc.com. the essential fats with a selected balance of fish oil concentrates, TISSUE SUPPORT evening primrose oil, and organic Repair & Rehab PRO by flaxseed oil. EFA is encapsulated in a TriElements Nutritional Supplements patented, sealed licap that further is nutritional support of treatments for eliminates oxygen exposure and the repair, rehabilitation, and main- results in a stabilized EFA product tenance of connective tissue, scar with an extended shelf life. EFA does tissue, and wound healing. It assists in not have to be refrigerated. It also the normal breakup of congested now includes peppermint oil and protein and other by-products so they spearmint oil for a mint taste. can be eliminated through the blood Call 866-814-7673 or visit stream and lymphatic system. It helps www.whole-isticsolutions.com. maintain normal tissue fluid/ electrolyte balance. Also helps to MINERAL COMPONENTS protect, strengthen, and tone blood Metabolic Mineral Modulator (M3) vessels, and clear congestion of lymph by SafeCareRX from King Bio is a and other tissues. supplement intended to be a more Call 888-876-3240 or visit complete approach to heavy metal www.trielements.com. detoxification and overall balance of mineral levels and metabolic pathways ESTROGEN HELP in your patient’s body. M3 contains Flax Lignan SDG by Vital Nutrients more than 100 mineral components, is a very concentrated form of flax parathyroid hormone, metabolic lignans, which help provide protection coenzymes, and other ingredients. from the negative effects of estrogen in Call 800-543-3245 or visit both men and women. This product is www.kingbiochiro.com. aimed at those who may show signs of estrogen dominance and it contains BONE FORMULA 78 milligrams of SDG Intemedica’s WH-OST Woman’s (secoisolariciresinol-diglucoside) per Health Formula for Bone Integrity is capsule, which is equal to the amount a natural complex blend of essential contained in one tablespoonful of vitamins and minerals for the ground flaxseed (approx. 7 grams). maintenance of bone matrix and Call 888-328-9992 or visit mineral integrity during the full www.vitalnutrients.net. spectrum of a woman’s life. This uniquely blended formula devotes COX-2 INHIBITOR special attention to support those Wellness Watchers Global, LLC’s rate-limiting vitamins and minerals in Relief First is an all-natural COX-2 the complex area of bone metabolism. inhibitor designed to provide natural This is a well absorbed, moderate relief of joint aches and pains. This dosage formula that can be taken dietary supplement for joint health with a multivitamin. contains four patented ingredients Call 800-856-7250 or visit CIRCLE 210 FREE INFORMATION including Joint Health, Lipid Health, www.intemedica.com.

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Recognize the grain danger! How to make your patients safe from gluten

By Shari Lieberman, PhD, CNS, FACN n the course of one day, you may see taste so good is poison to a significant portion of the population — possibly up to an estimated 29 percent of patients who suffer from eczema, Americans.1 When these individuals eat anything with psoriasis, colitis, Crohn’s disease, irritable gluten in it, their immune system reacts. I Medical doctors have known for more than 50 years that bowel syndrome, rheumatoid arthritis, or gluten was the cause of celiac disease (CD). Until recently, attention deficit disorder — or any they suspected that CD was a rare disorder. In 2003, number of other autoimmune diseases. researchers at the University of Maryland conducted an extensive survey of more than 13,000 people and found They come to you for chiropractic, but that 1 out of 133 people in the general population has CD.2 they suffer from these conditions. But far more are gluten-sensitive. Think of it this way: CD is the “extreme condition” of gluten sensitivity, and it Many of those unsuspecting patients may have is only one manifestation of gluten sensitivity. (See sidebar, something in common — gluten sensitivity, a little known “The gluten-sensitivity masquerade.”) Doctors only diagnose systemic autoimmune disorder that masquerades as other CD if the villi in the small intestine are flattened, which medical conditions. only occurs in extreme cases. Most people have heard the word gluten only in People can be gluten-sensitive but not have CD; all context with baking, as in “kneading dough to develop patients who have CD are gluten-sensitive. the gluten.” Gluten is the protein in wheat (and in barley Your patients (and perhaps you) may have a low level and rye) that makes the dough sticky. of gluten sensitivity without identifiable and easily Unfortunately, this chewy protein that makes bagels CONTINUED ➤

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recognizable symptoms or with The gluten-sensitivity masquerade symptoms so mild that you do not pay Gluten sensitivity, a systemic autoimmune disorder, is a chameleon-like attention to them. Feeling less than disease. It can develop in many different, unsuspected ways. The 100 percent may have become condition’s ability to hide behind a variety of symptoms makes it difficult “normal.” to diagnose correctly. Without the correct diagnosis, medical doctors often Blood tests that are used to identify prescribe harsh pharmaceuticals that often cause even more complicating CD generally do not pick up gluten problems than the original disease. sensitivity unless the patient has full- Gluten sensitivity’s masquerade includes a number of conditions that are blown CD. And even with full-blown documented: CD, it is missed at least 30 percent of • Skin diseases. These include dermatitis herpetiformis, psoriasis, the time, which is one reason so eczema, acne, and hives; many cases go undiagnosed. • Neurological disorders. These include ataxia, severe headaches, and Special saliva or stool testing can behavioral problems, including attention deficit disorder and autism; definitively identify individuals who • Other autoimmune diseases. These conditions include lupus, multiple are gluten-sensitive. Genetic testing sclerosis, diabetes, scleroderma, thyroid disease, osteoporosis, osteopenia, can identify those who have a high rheumatoid arthritis, and ankylosing spondylitis; probability of acquiring gluten • Digestive disorders. These conditions include irritable bowel syndrome sensitivity. (People can acquire this (IBS), irritable bowel disease (IBD), Crohn’s disease, ulcerative colitis, condition over time, after use of proctitis, gastroesophageal reflux, ulcers, giardiasis, and celiac disease; antibiotics, or even after an onset of • Undiagnosed diseases and conditions. Under these categories are an illness.) catch-all conditions such as chronic fatigue syndrome, fibromyalgia, Once a person becomes gluten- unexplained weight loss or gain, anemia, chronic infection, and asthma. sensitive, there is no going back. And, there is no medical solution. The only solution is a strict gluten- free diet — no wheat, barley, or rye in Supplementing a gluten-free diet any form. Some patients whose When you put your patients on a gluten-free diet, help them get well sensitivity is relatively minor may be faster by recommending a number of different supplements. These able to “cheat” and eat a small supplements should be taken in three stages. amount of gluten occasionally. STAGE 1 Others, however, will find they have These supplements provide all the multinutrients and major no tolerance to gluten at all. antioxidants the body requires: A gluten-free diet is also an • Multivitamins; excellent way to find out if a person is • Fish oil (approximately two to three grams); and gluten-sensitive. If you suspect gluten • Coenzyme Q10 (100 to 200 mg per day). sensitivity, put him or her on a gluten- free diet for at least two weeks. If the STAGE 2 condition improves, the individual is Continue stage 1 supplementation and after two or three weeks, gluten-sensitive. If the condition recommend additional supplements: remains, the patient has lost nothing. • Vitamin C (1,000 to 4,000 mg, buffered and nonacidic), and • Quercetin (500 to 2,000 mg). WHAT TO DO STAGE 3 If you suspect a patient may be At least one month into the gluten-free diet, advise your patients to gluten-sensitive: begin the third stage of supplementation, which aids in the restoration of 1. Discuss gluten sensitivity the intestine: with him. Explain what it is, how it • Acidophilus and other beneficial microorganisms (L. casei GG, one or may be manifested, what the solution two capsules daily; S. boulardii, 500 mg each day); is, and how his quality of life would • Glutamine (500 to 3,000 mg of L-glutamine); improve, should the gluten-sensitivity • Phosphatidylcholine (for collagen deposition and stricture formation, prove true. 100 to 300 mg daily); 2. Put her on a gluten-free diet. • Fiber (one or two tablespoons of fiber supplement); and This requires the patient to eliminate • Other anti-inflammatories (as needed). everything with gluten in it. She must

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go through her pantry, freezer, and The gluten fight refrigerator to check labels for gluten People who are gluten-sensitive do not have the ability to break gluten by looking for the words wheat, down into soluble proteins (amino acids). Consequently, whenever they eat barley, or rye. (Note: Malt, used for wheat, barley, or rye in any form and in any amount (not necessarily a slice flavoring in cereals, among other of bread or a piece of cake!), their body reacts to the gluten and interprets foods, is made from barley. Hence, it to be antigen. products using malt have gluten.) The gluten fails to be broken down and passes into the bloodstream, 3. Tell him to go easy on the where the body forms antibodies to combat it. These antibodies, which veggies. If your patient has reside in the intestine as long as the villi are functioning properly, may be gastrointestinal problems, he may not anti-endomysial antibodies, antigliadin IgA antibodies, or anti-tissue be able to tolerate salads or raw or al transglutaminate antibodies. dente vegetables initially, because of These antibodies try to defend the body against the invader gluten. The gastrointestinal inflammation. overreaction of antibodies to gluten may cause immune reactivity, autoimmunity, and inflammation. Introduce these vegetables slowly and judiciously. 4. Drink water. She should stay away from carbonated drinks. They may cause gas. 5. Recommend supplements. Dietary supplementation gives recovery a boost. Advise your patient to use supplements in three stages. (See side- bar, “Supplementing a gluten-free diet.”) Some patients may balk at the prospect of giving up wheat. They think it is the end of the world — that they can no longer eat the foods they enjoy. Nothing can be farther from the truth. Gluten-sensitive people have to change their lifestyles to a degree, but they can enjoy gluten-free versions of almost everything they like in the gluten variety. Wheat — the primary food in which gluten is found — is not an essential food!

Shari Lieberman, PhD, CNS, FACN, is a clinical nutritionist and a best-selling author. Her latest book, co-authored with Linda Segall, is The Gluten Connection (Rodale Press, 2007). She can be contacted at [email protected].

REFERENCES 1 Kenneth D. Fine, MD, “Early Diagnosis Of Gluten Sensitivity: Before the Villi are Gone,” www.enterolab.com. 2 A. Fasano, et. al, “Prevalence of Celiac Disease in At-Risk and Not-at-Risk Groups in the United States,” Archives of Internal CIRCLE 209 FREE INFORMATION Medicine 163 (Feb. 10, 2003): 286

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How to utilize nutritional research in your clinical practice By David Barnes, PhD, and Kelly Kwiatkowski, MA

hat is the best way to I (intervention/exposure): glucosamin/chondroitin O (outcome): improve symptoms? determine the nutritional In this case, there isn’t a (C) comparison (For example: Wsupplementation products that How well does glucosamine/chondroitin improve will benefit your patients? symptoms compared to NSAIDs?), but there could be, if that is the information you are seeking. If you practice evidence-based healthcare, you must be 2. Review the literature. Now that you have able to utilize the best and most current evidence and identified your problem you can begin a literature search. integrate your individual clinical expertise into the Locating useful information can be a daunting process practice, while considering each patient’s individual needs since evidence is abundant and is being published daily. (Table 1), because scientific Searching through evidence alone is not evidence-based, systematic Table 1: Key practices sufficient to make a clinical reviews is the most efficient decision. in evidence-based healthcare way to conduct a literature Clinicians have routinely • Find the best evidence to answer your questions search in evidence-based found value in many • Critically evaluate the evidence for its validity and practice and there are a nutritional products usefulness; variety of online resources independent of strong • Draw from your clinical expertise; that provide this scientific evidence. • Consider individual patient needs; information (Table 2). Treating patients also • Determine how to apply research review findings in 3. Consider the requires consideration of the your clinical practice; evidence. Another benefits and risks to the • Treat your patient; and important consideration is patient, the patient’s values, • Evaluate the outcome. an understanding of the the level of convenience, strength of the evidence and the costs associated with the treatment.1 that is presented in these reviews in order to critically Consider this example: You are interested in prescribing appraise them (Table 3). glucosamine/chondroitin supplements for patients The gold standard in research is the randomized control presenting with osteoarthritis. Where do you begin? trial (RCT). These experiments randomly assign human 1. Define the problem. A common problem-solving subjects to two or more treatment groups and outcomes of tool used in evidence-based healthcare is a PICO these groups are compared. Findings from RCTs provide (Patient/Problem, Intervention, Comparison, Outcomes) the strongest evidence for understanding how worksheet.2 This worksheet can guide you through the interventions affect subjects at the population level. information-seeking process. RCTs do not, however, provide strong information In our example, the PICO would look like this: about how an intervention will affect an individual, P (patient/problem): In patients presenting with which is why it is important to consider each patient osteoarthritis how well does CONTINUED ➤

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treatment plan and its underlying Table 2: Evidence-based review resources foundations with your patient. You • Cochrane database, www.cochrane.org; need to translate the research so that • Database of Abstracts of Reviews of Effects, the patient will understand it. www.york.ac.uk/inst/crd/darehp.htm; In evidence-based practice, • National Guidelines Clearinghouse, www.guideline.gov; communicating research findings to patients can be an effective way of • ACP Journal Club, www.acpjc.org; developing cooperative partnerships • Natural Standard, www.naturalstandard.com; with your patients so that together • Linus Pauling Micronutrient Information Center, you can make sound clinical http://lpi.oregonstate.edu/infocenter; decisions. Communicating this • ChiroAccess, www.chiroaccess.com; and evidence, however, is not always easy, • The Alternative Medicine Homepage, www.pitt.edu/~cbw/database.html. considering there is great variation among patients in terms of their individually at the point of care. placebo; however, for those subjects ability to understand information and Observational studies measure with mild pain, no statistically make informed healthcare decisions. health outcomes in a certain patient significant effects were observed.7 Research suggests, though, that population and provide weaker 4. Apply your findings. Now that informed and involved patients are empirical evidence than the RCT, you have the findings, how can they more likely to participate in their because unlike RCTs, observational be applied in the clinical setting? care, which leads to better health studies are not controlled, thereby As indicated earlier, it is important outcomes.8, 9, 10 making them subject to confounding to make use of your clinical expertise Using our example, one way to factors and bias. and consider individual patient needs communicate the scientific evidence Clinical observations provide the when determining whether or not you on glucosamine/chondroitin might be weakest evidence for understanding will prescribe a given intervention. the following: effects on a population, but in clinical practice, they can provide a lot of Table 3: Hierarchy of strengh value in treating individual cases. With reference to the example of evidence of clinical decisions introduced earlier, a review of the • Randomized control trials; literature reveals that the evidence • Systematic reviews of randomized trials; on glucosamine as an intervention for • Single randomized trial; osteoarthritis is mixed: High quality • Systematic review of observational studies addressing patient-important studies demonstrated that outcomes; glucosamine improves pain more than • Single observational study addressing patient-important outcomes; placebo using one type of pain scale, • Physiologic studies (studies of blood pressure, cardiac output, bone but not using a different scale.3 density, etc.); and Meta-analyses of clinical trials on • Unsystematic clinical observations. chondroitin for osteoarthritis 4 and glucosamine and chondroitin for knee For example: If the patient presents “Much research has been conducted osteoarthritis 5 found that with knee osteoarthritis, has recently separately on the use of glucosamine chondroitin improved pain and experienced moderate to severe pain, and chondroitin for osteoarthritis. The function compared to placebo.6 cannot tolerate NSAID treatment due results are unclear for glucosamine; The Glucosamine/chondroitin to gastrointestinal side-effects, is seeking however, the results show that Arthritis Intervention Trial (GAIT) an alternative to taking NSAIDS for chondroitin can be effective in provides the most current evidence pain, and you have treated a similar case treating pain and improving function on the effects of a combined with successful results, perhaps this is the for knee osteoarthritis. glucosamine/chondroitin supplement right clinical presentation for prescribing “Studies on the combined on knee osteoarthritis. Findings the glucosamine/chondroitin supplement are few; however, a large- demonstrated that 79 percent of supplement (along with other successful, scale clinical trial measured the effects subjects with moderate to severe pain evidence-based interventions such as of a combined glucosamine/ had a 20 percent or greater reduction exercise or weight control measures). chondroitin supplement on patients in pain when taking the supplement, 5. Discuss the treatment plan. with knee osteoarthritis and found that compared to those taking the Your next challenge is to discuss the CONTINUED ➤

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Patient Relations

a majority of patients with moderate to for clinicians to effectively navigate David Barnes, PhD, is director severe pain saw improvements in their the scientific literature. of research at Standard Process pain when taking the supplement In addition to these factors, the Inc. He has been a research compared to patients that did not.” availability of high-quality reviews on fellow at the National Institute In addition to this information, nutritional supplements makes this a of Environmental Health Sciences and has you would discuss these findings in good time to integrate nutritional held faculty positions at the University of light of the specific needs and clinical research into your practice. Arkansas and the University of Wisconsin- presentation of the patient. Madison. His most recent research has The evidence-based practice Kelly Kwiatkowski, MA, has emphasized the multi-drug resistance framework provides a solid approach worked as a communications proteins involved in the detoxification in informing your clinical practice and professional and project mechanisms of the gut and the involving your patients in their own manager in the academic and mechanism of action of dietary phenolic healthcare decisions. Large scientific corporate healthcare research sectors for compounds on cholesterol metabolism. databases and online evidence-based the last seven years. She is currently a Kwiatkowski and Barnes can be health resources have made it easier scientific writer at Standard Process Inc. contacted through Standard Process, www.standardprocess.com, or at 800-848-5061.

REFERENCES 1 Haynes, R.B., et al., Transferring evidence from research into practice: 1. The role of clinical care research evidence in clinical decisions. ACP J Club, 1996. 125(3): p. A14-6.

2 Miller, S., PICO Worksheet and Search Strategy. National Center for Dental Hygiene Research, 2001.

3 Towheed, T., et al., Glucosamine therapy for treating osteoarthritis. Cochrane Database of Systematic Reviews, 2005(Issue 4).

4 Leeb, B.F., et al., A metaanalysis of chondroitin sulfate in the treatment of osteoarthritis. J Rheumatol, 2000. 27(1): p. 205-11.

5 Richy, F., et al., Structural and symptomatic efficacy of glucosamine and chondroitin in knee osteoarthritis: a comprehensive meta- analysis. Arch Intern Med, 2003. 163(13): p. 1514-22.

6 Singh, J., T. Wilt, and R. Mcdonald, Chondroitin for osteoarthritis. Cochrane Database of Systematic Reviews, 2006(Issue 1).

7 Clegg, D.O., et al., Glucosamine, Chondroitin Sulfate, and the Two in Combination for Painful Knee Osteoarthritis. N Engl J Med, 2006. 354(8): p. 795-808.

8 Stewart, M., et al., Evidence on patient- doctor communication. Cancer Prev Control, 1999. 3(1): p. 25-30.

9 Stewart, M.A., Effective physician-patient communication and health outcomes: a review. Cmaj, 1995. 152(9): p. 1423-33.

10 Di Blasi, Z., et al., Influence of context effects on health outcomes: a systematic CIRCLE 174 FREE INFORMATION review. Lancet, 2001. 357(9258): p. 757-62.

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The microbial connection Restore balance to your patients with intestinal flora

By Paul A. Goldberg, MPH, DC, DACBN

he gastrointestinal tract microflora • Antibacterial properties towards pathogens; • Prevention of intestinal infections; are involved with diverse disease • Improved immune-system balance; Tstates, including inflammatory • Reduced inflammatory and/or allergic reactions; bowel disease, other autoimmune • Anti-cancer properties; • Positive effects on blood lipids and heart disease; disorders, allergies, and colon cancer.1 • Antihypertensive effects; and This growing recognition has drawn attention to the • Reduction in the occurrences of urogential benefits obtainable by utilizing probiotics as a means of infections. 2, 3, 4, 5 infection control and intestinal re-innoculation. The 400 different GI flora species balance each other Twenty-first century behaviors, such as the use of and perform functions that include preventing pathogens antibiotics and processed foods, emotional stress, and from establishing a foothold. chlorinated water, put your patient’s GI flora at risk by Among the foundational (health-promoting) probiotics creating an unsuitable intestinal environment for normal are those in the Lactobacillus and Bifidobacteria genus.6 microflora to flourish in. Those in the Lactobacillus genus include L. plantarum L. Probiotic research has led to an appreciation of the role casei, L. rhamnosus, L. brevis, L. paracasei and L. salivarius. microbes play in health and disease, as well as specifics The Bifidobacteria genus includes B. bifidum, B. breve, regarding their application to improve clinical outcomes. B. lactis and B. longum. Science has provided a better understanding of the intimate Studies on L. rhamnosus, L. acidophilus and B. lactis relationship between the gastrointestinal tract and the have shown that they enhance numerous indices of immune system. This has prompted clinical interest in immunity and are considered beneficial for “optimizing utilizing specific probiotics to meet specific needs. immunocompetence in healthy, immuno-suppressed or You now have the opportunity to assist patients with a immunocompromised subjects.” 7 wide variety of conditions with specific, high-quality Lactobacillus salivarius has been demonstrated to probiotics. modulate the immune system in a balanced fashion, to Keep in mind: Probiotics are not a single item. A surge reduce intestinal inflammation and to modulate intestinal of information has opened the door to effective clinical mucosal immune response in inflammatory situations.8 probiotic applications central to improving the lives of What you can do: Help your patients take a positive step patients. toward disease prevention and to help reverse existing To select the right probiotics to help your patients, problems by utilizing a combination of probiotics such as understand the differences among probiotics that are those listed. foundational, restorative, and designer. RESTORATIVE PROBIOTICS FOUNDATIONAL PROBIOTICS The American population has a tremendous exposure Probiotics provide a number of benefits to your patients: to antibiotics. As an example, did you know that 698 of • A decrease in toxin production from pathogenic 1,000 children seen in the medical office in 1999 were bacteria; CONTINUED ➤

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Choose the right probiotics for your patients Probiotic products vary a great deal among • Shelf life (at least two years, provided on the bottle); manufacturers. Conducting basic investigation of products • Survivability or resistance to bile, gastric and can play an important role in acquiring and pancreatic secretions; recommending the best products for your patients. • Safety with regard to bacterial endo- and exotoxins Although researching the following factors is time- and lack of unusual probiotic resistance; consuming, making a one-time effort could go a long way • The knowledge of the manufacturer regarding the to ensure you obtain an effective, high-quality product. use of appropriate nomenclature — genus, species, Some areas to investigate include: and strain. (The clinical effects of a probiotic are • Colony count. This should be sufficiently high. strain-specific.); Usually it is given on the bottle; • Efficacy, validated by clinical experience; • Intestinal adhesion properties. Like colony count, • Knowledge of effects on the immune system — for this is usually found on the bottle; example, effects on T Helper Cell balance — TH1/TH2.

given antibiotics? 9 increasingly of the broad- spectrum pseudomembranous colitis. Even for those not taking variety and carry a significant potential Saccharomyces boulardii is a key prescription antibiotics, few escape of generating microbial imbalances, player in helping to prevent antibiotic exposure. Seventy percent of increasing antibiotic resistant antibiotic side effects.12 It has proven the antibiotics produced in the United pathogens, and promoting pathological helpful in reducing the incidence of States are administered to livestock. yeast and fungal organisms.11 antibiotic associated diarrhea,13 in Residues of antibiotics remain in flesh Numerous patients develop reducing the bacterial count in and milk ingested by consumers.10 antibiotic-induced diarrhea each year, patients with intestinal bacterial In addition, antibiotics are which can result in CONTINUED ➤

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overgrowth,14 is cited as an effective T helper cells Type I (Th1) and T or Th2, based on the condition symptomatic treatment for AIDS- helper cells Type II (Th2), modulate patients present with. Different related diarrhea15 and has shown allergic responses.22 Allergic probiotics influence the immune benefit in treating flare ups of conditions are thought to be due to system in varied ways and can be ulcerative colitis.16 an imbalance caused by modern utilized to support specific needs. A foundational probiotic has also lifestyles that affect Th1-type and What you can do: You now have proven helpful in preventing problems Th2-type immune responses. probiotic options to fit the patient. associated with antibiotic admin- Depending on the distribution of T Are the problems primarily allergic or istration, including L. plantarum, L. helper cells, the immune system inflammatory in nature? In each case acidophilus, L. rhamnosus, and L. carries out two inflammatory you can choose the best probiotic paracasei.17, 18, 19, 20, 21 responses (Th1 and Th2) that are suited to patient needs. What you can do: Administer the inversely proportionate. In general, Whether it is to re-balance the right probiotics to your patients during Th1 responses are antimicrobial and flora from antibiotic disruption, to and after antibiotic administration to pro-inflammatory, whereas Th2 restore homeostasis in conditions of avoid the complications that occur responses promote allergic reactivity. allergy and/or autoimmunity, or to with their usage. Start with These responses balance one take preventive measures, modern Sacchromyces boulardii during antibiotic another as Th2 mediators suppress Th1 probiotics offer options for the therapy and employ a foundational responses and Th1 mediators similarly practitioner to utilize in meeting the probiotic afterwards. inhibit Th2 responses.23 The impli- needs of 21st-century patients in cations for this extend to autoimmune promoting good health and in DESIGNER PROBIOTICS conditions, which are believed combating illness. Immune imbalances leading to mediated via excessive Th1 responses. allergies, autoimmune conditions, and Probiotic administration can Paul Goldberg, MPH, DC, infectious diseases have led to the favorably influence Th1 and Th2 DACBN, is the director of The development of specific probiotics to balance.24 You can select probiotic Goldberg Clinic meet individual patient needs. bacteria to enhance or suppress Th1 (www.goldbergclinic.com) in Atlanta. His focus is on the reversal of chronic degenerative diseases, including rheumatoid and gastrointestinal disorders. He is also the senior director of physician education and research for Original Medicine (www.original-medicine.com).

REFERENCES 1 Fooks, L.J. et. al. Probiotics as modulators of the gut flora British journal of nutrition (2002), 88, Suppl. 1, S39-S49 2 Naidu, A. S.: Bidlack, W.R.; Clemens R.A. Crit, Rev, Food Sci. Nutr., 1999, 39, 13-126 3 Saunders, M. E.; Huis in’t Veld, J. Antonie Van Leeuwenhoek, 1999, 76, 293-315 4 Sanders, M. Int. Dairy J., 1998,8,341-347 5 Sanders, M. In Probiotics, Prebiotics and new Foods: Rome, Italy, 2001, pp 27-30 6 Borriello, S.P., Hammes, W.P. et. Al. Safety of Probiotics That Contain Lactobacilli or Bificobacteria. Clinical Infectious Diseases 2003;36:775-780 7 Gill, H. S. et. al. Enhancement of natural and acquired immunity by lactobacillus rhamnosus, Lactobacillus acidophilus and Bifidobacterium lactis. British Journal of Nutrition (2000), 83 167-176 8 Dennin, V. et. al. 2003 Screening procedure for the selection of probiotic LAB with survival and immunomodulation potential: the CIRCLE 278 FREE INFORMATION CONTINUED ➤

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combination of in vitro and in vivo techniques. 2nd Probiotics and Prebiotics New Foods Conference. September, Rome Italy. 9 Pediatric Infect Dis J. 2002 Nov;21(11):1023-8. 10 V. Witte W. Medical consequences of antibiotic use in agriculture. Science 1998;279: 996 -997. 11 Ann Intern Med. 2003 Apr 1;138(7):525-33. Changing use of antibiotics in community-based outpatient practice, 1991-1999. Steinman MA, Gonzales R, Linder JA, Landefeld CS. 12 McCullough, M. J., Clemons, K. V., McCusker, J. H., and Stevens, D. A. Species identification and virulence attributes of Saccharomyces boulardii (nom. inval.) J Clin Microbiol, 36[9], 2613-7. 1998. 13 Surawicz, C. M., Elmer, G. W., Speelman, P., McFarland, L. V., Chinn, J., and van Belle, G. Prevention of antibiotic-associated diarrhea by Saccharomyces boulardii: a prospective study Gastroenterology, 96[4], 981-8. 1989. 14 Bornet, M and Bergogne-Berezin, E Bacterial growth in enteral eliminations value of the addition of Saccharomyces boulardii. Science des Aliments, 6[VI], 63-73. 1986. 15 Saint-Marc, T., Rossello-Prats, L., and Touraine, J. L. [Efficacy of Saccharomyces boulardii in the treatment of diarrhea in AIDS] Ann Med Interne (Paris), 142[1], 64-65. 1991. 16 Guslandi, M., Giollo, P., and Testoni, P. A. A CIRCLE 116 FREE INFORMATION pilot trial of Saccharomyces boulardii in ulcerative colitis European Journal of Gastroenterology & Hepatology, 15[6], 697-698. 2003. 17 Gorbach, SL, Chang T., Goldin B Successful treatment of relapsing colstridium difficile with lactobaccillus GG Lancet 1987 p 1519 18 Biller J.A., et. al. Treatment of recurrent clostridium difficile colitis with lactobacillus GG J Pedeatric Gastroenterol Nutr 1995;21:224-6 19 SiitonenS, Vapaatalo H, Salminen S, et al. Effect of lactobacillus GG yoghurt in prevention of antibiotic associated diarrhoea. Ann Med 1990; 22:57-9 20 Arvola T., et al. (1999) Prophylactic Lactrobacillus GG reduces antibiotic-associated diarrhea in children with respiratory infections: a randomized study. Pediatrics 104:L e64 21 Gotz V., et al. (1979) Prophylaxis against ampicillin-associated diarrhea with a lactobacillus preparation. Am. J. Hosp. Pharm. 36: 754-757 22 Bellou Abdelouahab; Schaub, Bianca et al. Toll Receptor Modulate Allergic Responses: Interaction With Dendritic Cells, T Cells and mast Cells. Curr Opin Alergy Clin Immunol 3(6): 487-494, 2003 23 Kline, Joel N. M.D. A New Model for Understanding and Treating Asthma. October 2003. University of Iowa Department of Internal Medicine. Virtual Hospital www.vh.org/adult/provider/internal medicine/treating asthma 9/19/2005 24 Marteau P, et. al Probiotics and health: new facts and ideas. Curr Opin Biotechnol 2002; CIRCLE 294 FREE INFORMATION 13:486-489.

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Detox your patients; enhance your practice By Ronald E. Partain

e live in a toxic soup of systems within the body. Over time, heavy metals that have accumulated in the pollution from emissions and body migrate to other parts of the body and stimulate the industrial waste released into development of degenerative disease through free-radical W formation. our environment. And people are Your patients may present with initial signs of toxicity becoming increasingly aware of the that include fatigue, an inability to think clearly, muscle pain, and poor circulation. The longer heavy metals are dangers of heavy-metals that invade and left alone in the body, the more damage they are given reside in the body. the chance to do.

Toxic heavy metals have been scientifically linked to THE SOLUTION: CHELATION health challenges, such as cancer, candida, cardiovascular The classic solution to detoxifying the body is ailments, arthritis, sexual dysfunction, infertility, intravenous (IV) EDTA chelation EDTA — ethylene fibromyalgia, chronic fatigue, depression, multiple diamine tetra-acetic acid, a synthetic, or man-made, sclerosis, Alzheimer’s disease, and Parkinson’s disease. amino acid — is very effective in removing heavy metals, Heavy metals also accelerate the aging process, thus such as lead, mercury, and arsenic from the body. decreasing quality of life. As effective as this therapy is, it has downsides for patients — and for you: WHY METALS ARE A PROBLEM • Cost. The typical cost for each IV chelation is The human body is not designed to rid itself of heavy approximately $100, and typically 30 treatments are metals by itself; it stores them in areas, such as bones, needed, for a total cost of $3,000. ligaments, and the large intestine. • Time. Each EDTA IV chelation takes from two to Toxic heavy metals are extremely potent free-radical three hours, plus travel time. factories. In technical terms, a “free radical” is an • Possible complications. IV chelation is an invasive unbalanced molecule with an odd, unpaired electron. This therapy. Many consumers find this unappealing and risky, unbalanced molecule tries to balance itself by bombarding especially considering the number of times required for a other molecules in the body in an effort to capture the full EDTA chelation regimen. other molecule’s electron. The downside for you is that IV chelation is generally not When it “steals” the electron from the other molecule, an option, because this type of treatment is not in your that molecule then becomes a free radical and goes into scope of practice. To provide the benefits of chelation to attack mode on other molecules, causing a chain reaction. your patients, you have to refer them to clinics — and with This chain reaction — called oxidation — ultimately each referral goes lost potential income. results in the degeneration of cells, tissues, organs, and CONTINUED ➤

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EDTA OPTIONS Detoxification comparisons Providing EDTA chelation to your Oral IV Suppository patients is possible, however. And by MD needed No Yes No doing so, you can create a viable service and profit center for your Periodic blood tests No Yes No practice. Instead of IV services, though, Liver and kidney you prescribe oral or suppository function tests No Yes No chelation therapy — neither of which Typical absorption 5% 100% 95% requires a medical doctor’s supervision. Typical dosage 400 mg 2 grams 900 mg You should examine the research of Average cost each option and decide which form of per dosage per day $0.67 $125 $7.50 chelation (oral or suppository) is best for your practice and patients. Each Dosages required to has advantages and disadvantages: equal 1 IV application 150 capsules 3 suppositories • Oral chelation products. These are easy for patients to use, and patients accept them more easily than they do suppositories. Oral products have to pass through the digestive system, which reduces the amount of EDTA that enters the system. • Suppositories. Patients are not as accepting of suppositories. However, the suppository delivery system allows the agent to remain in the body for a longer period of time and provides more opportunity to pull out more metals. Many of your patients have lost faith in their medical doctors and the allopathic system of medicine. This is why they are turning to you as the alternative since chiropractors. Chelation therapy is one tool to use to help your patients attain optimal health. And consider this: In generally accepted industry standards, oral and suppository chelation are “keystone products” — which means their relative retail price is twice that of the cost to the doctor. That translates into a healthy source of income for your practice.

Ronald E Partain, Sr. is a pharmacist and a certified clinical nutritionist. As president of Kelatox, an EDTA chelation product, he takes serious interest in detoxification of heavy metals and other environmental toxins. He can be contacted by e-mail at [email protected], by phone at 866- 707-4482, or through the company’s CIRCLE 190 FREE INFORMATION Web site, www.kelatox.com.

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Patient Relations How to do ‘nutrition’ right! By Donald F. Feeney, DC, DACBN, CCN

bout two out of three practitioners offer nutrition as a modality, Aaccording to Chiropractic Economics 9th Annual Salary & Expense Survey. This statistic reflects the focus of chiropractors who embrace a total healthcare philosophy. As desirable as it is to include nutrition in your practice, to provide the most benefit to your patients (and the most income to the clinic), doing it right is more than setting up PHYSICAL EXAM a display of supplements and hoping patients will buy them. Conduct a complete nutritional physical examination Some people equate nutrition with weight that includes objective measurements you can repeat over management. A nutrition component in your practice is time. These measures provide reliable data as a foundation much more than weight management. It is a to revise the treatment protocol. They also help you to comprehensive approach to feeling better, increasing determine appropriate and practical goals with your patient: energy levels, and maintaining health and vitality. • Measure height, weight, percentage of body fat, It involves: and BMI. You can take these measures quickly in your 1. Defining a patient’s goals, office with specialized electronic scales. 2. Taking a medical history, Why take these measurements? These are baseline 3. Giving a physical exam, measurements that will help you in future exams to 4. Ordering or conducting tests, and determine if and where the patient is losing weight, 5. Recommending an appropriate dietary and drinking enough water, and exercising. supplement protocol. • Measure key body parts. These include the ankles, calves, thigh, hips, abdomen, chest, wrist, forearm, and GOALS upper arm. Every patient has different goals. Some want to lose Why take these measurements? The wrist measurement of weight; some, to gain weight; others, to improve stamina the dominant hand correlates to body-frame type. Match and energy levels. this measurement to the individual’s height and body Patients who come into your practice may have their frame on a chart, to identify the ideal weight range. own preconceived goals in mind, based on their Divide the waist measurement by the hip measurement complaints. Others may determine goals after a thorough to identify the patient’s risk of cardiovascular disease. assessment of their status. (Normal is considered 0.75 for women and 0.80 for men. Set goals so that patients know their baseline as well as Higher ratios mean higher risk.) what they are aiming to achieve. • Take the patient’s blood pressure. Do this while the patient is sitting, standing, lying down, and rising MEDICAL HISTORY quickly. Conduct a complete medical history of the patient to Why take this measurement? Blood pressure identify current and past medical problems, plus family measurements help you evaluate kidney function, adrenal, history of medical conditions. Find out about prescription risk for arteriosclerosis, and calcium absorption. The medications being taken, to avoid suggesting anything systolic pressure should drop six to 12 points from the first that may have a contraindication. CONTINUED ➤

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measurement to the last. If it does first, adrenal fatigue may be the patient has significantly fewer not, the patient may not be drinking apparent. If the first heart sound is taste buds, his brain will not produce enough water or may be serious louder than the second, calcium the chemicals in the brain that cause kidney problems. deficiency may be a problem. satiation. A decreased number of The ankle systolic divided by the • Measure the patient’s cervical taste buds may be caused by a lack of arm systolic should be above 0.9 if rotation. Use an arthrodial vitamin B1 and B2 absorption, blood flow to the extremities is protractor. Then have the patient chewing food too fast, or from adequate. If it is below 0.9, breathe in and out of a small paper whitening or fluoride toothpaste. arteriosclerosis may be suspected. bag three or four times. Remeasure • Monitor acidity/alkaline A patient should be able to accept the patient’s range of motion. balance. Send your patient home a blood-pressure cuff pumped to 220 Why take this test? If the range of with a form and a kit to monitor their at the mid calf. Inadequate calcium motion increases on rotation, the saliva and urine pH for a week to absorption may cause cramping in the patient may be eating too fast because evaluate their acid/alkaline balance. leg with the cuff at less than 220. the top of the diaphragm is locked. • Consider blood tests. Blood (Note: Do not do these leg exams if • Measure lung capacity with a tests can give additional information you see varicose veins or the patient spirometer. on nutritional deficiencies and can be has a history of recent surgeries on Why take this measurement? If the taken at a certified laboratory. that leg.) spirometer shows less than 80 percent PROTOCOLS The downside of a nutrition component Once you have collected information from the test results and As beneficial as nutritional supplementation is to your patients (and have studied the patient’s medical your practice, from the vantage of added revenues), a nutrition history and complaints, schedule a component has some downsides, which you should consider carefully: nutrition counseling session. Review • Time. Explaining nutritional needs takes time and disrupts your all your material including your adjusting schedule. suggestions for supplements. Set up a • Patient compliance. Patients remember only less than 10 percent of time in the future when you will what you tell them, and may or may not buy the supplement from your repeat the process to determine their office. If they go to a health food store with your suggestion, they may progress or possibly lack of progress. often find the supplement for less money — or possibly (unknown to Make recommendations on diet, them) for poorer quality. exercise, and supplementation, based If they try the retail supplement and it does nothing or worse makes on your objective findings. A number them feel worse, they will remember you suggested it and will tend to of supplement companies provide doubt your nutrition knowledge. complete protocols designed to address specific conditions. • Take the patient’s pulse. capacity, prescribe breathing Discuss the value of physician-grade Inquire about his activity level. exercises. Explain to the patient that supplements with your patient and why Why take this measurement? Use inadequate oxygen flow lowers the you make certain recommendations. pulse rate along with standing blood basal metabolism rate and thus makes Schedule regular follow-up visits pressure to calculate basal metabolism it harder to lose weight. with the patient, which include rate. • Measure trace minerals, appropriate reassessments, to measure When you know the patient’s vitamin C, and B6, B9 and B12 progress toward his or her goal weight and activity level, you can absorption. Use zinc assay, lingual attainment. determine the correct number of ascorbic assay tests, and homocysteine Nutrition is a valuable service to calories for them to lose weight. tests. your patients. The correct approach • Listen to the heart. Have the Why take these measurements? Assay can benefit you both. patient sit down comfortably on your tests indicate deficiencies. exam table and listen to heart sounds. • Assess the surface of the Donald F. Feeney DC, DACBN, Why listen to the heart sounds? This tongue. Count the taste buds on a CCN, runs a chiropractic and can be a great help in determining millimeter of the surface area of the nutrition practice in nutritional needs. Heart sounds that patient’s tongue. Wilmington, Del. He is also come very close together may Why take this measurement? The president of the Council on Nutrition of indicate a need for vitamin E. If the tongue should have at least 50 taste the American Chiropractic Association. He second heart sound is louder than the buds per millimeter of the surface. If can be contacted at [email protected].

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Patient Relations TEAM TIPS Difficult situations, positive solutions By Susan Hoy

e all lose patients. They change One of the best ways to acknowledge a patient’s jobs, move away, or have dissatisfaction is to write a letter. Here is an example: Dear Mrs. Miller: Wpersonal issues that affect their Recently, we were requested to send your records to Dr. desire or ability to seek chiropractic care. ______. Although we are happy to comply with your request, we want you to know that you will be missed! And, of course, some patients leave because they are My staff and I enjoyed having you as a patient. I certainly unhappy. That’s because they have unfulfilled expectations. respect your decision to try another doctor, but I want you to Even though you lose patients, keep in mind that you know that we will welcome you back to our office at any time cannot please 100 percent of patients all of the time. You in the future. If there are any particular issues you would like cannot be all things to all people. to discuss with me personally, please give me a call. Often patients who are dissatisfied do not tell you why. Please let me know if I can be of further assistance. You only find out about the dissatisfaction when they (or In addition to the letter, enclose (or follow up with another doctor) request x-rays or records. another letter) a practice survey, which can help you As distressing as it is to lose patients, your goal is to “lose” identify specific problems in the office that may affect your dissatisfied patients in a positive manner so they will patient satisfaction. Here is a sample survey form: not speak about you in a negative way. (An unhappy Dear Mrs. Miller: customer is prone to telling at least six other people about Please help us help others. Enclosed is a questionnaire about his or her experience.) our practice, along with a self-addressed envelope. This questionnaire will help us pinpoint areas needing improvement so we can continue to provide the highest quality of care. Please take a few moments to fill out the questionnaire. Your response will be confidential and your signature is not required. Thank you in advance for your help. Realistically, you cannot keep all of your patients, but if you lose them in a positive, caring way, they actually may become good-will ambassadors and refer patients. And, they may just come back!

Susan Hoy is an award-winning team trainer and consultant. She presents training seminars for teams throughout the country and is the author of two team training manuals. The newest is entitled Systemize Organize Simplify. Susan can be reached at 215-674-0130, [email protected], or through her Web site at www.beefitup.net.

Editor's Note: Go to the bonus section at www.ChiroEco.com/history and download CIRCLE 221 FREE INFORMATION a Patient Questionnaire.

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Nutrition Guide Nutrition Directory & Resource Guide Chiropractic Economics is pleased to present the profession’s most comprehensive Nutrition Directory. The information in the resource guide was obtained from questionnaires completed by the listed companies. Companies highlighted in RED have an advertisement in this issue. A.C. Grace Co. Be Well Homeopathic/Green First Deseret Biologicals Enzymes, Inc. 800-833-4368 877-438-3042 800-827-9529 800-637-7893 www.acgraceco.com www.web-outpatients.com www.desbio.com www.enzymesinc.com A2Z Health Store.Com Bio Resource, Inc. Designing Health, Inc. Essential Formulas, Inc. 818-710-7293 800-203-3775 661-257-1705 972-255-3918 www.a2zhealthstore.com www.bioresourceinc.com www.designinghealth.com www.essentialformulas.com Aboca Herbs and Health BioActive Nutritional, Inc. Diamond Herpanacine Associates Essiac Resperin Canada 206-624-7542 800-288-9525 888-467-4200 561-585-7111 www.aboca.us www.bioactivenutritional.com www.diamondformulas.com www.essiac-canada.co Advanced Naturals BioCell Technology, LLC Diamond Lotus Essentials Fitness Fit Inc./ 800-690-9988 714-631-1231 530-459-1506 Chiropractor’s Blend www.advancednaturals.com www.biocelltechnology.com www.diamondlotusoils.com 800-647-9355 www.chiropractorsblendonline.com Agel Enterprises BioGenesis DietMaster Pro by Lifestyles Tech 888-773-2499 425-487-0788 888-286-7677 FlaxUSA dolifedoagel.com www.bio-genesis.com www.lifestylestech.com 701-884-2732 www.flaxusa.com Aidan Products BioPharma Scientific Doctors' Research, Inc. 480-756-8900 877-772-4362 805-489-7185 Fresh Start 21 www.aidanproducts.com www.nanogreens.com www.doctorsresearch.com www.freshstart21.com All One/Nutritech Biotics Research Douglas Laboratories Gaia Herbs 805-963-9581 800-231-5777 800-245-4440 828-883-5953 www.all-one.com www.bioticsresearch.com www.douglaslabs.com www.gaiaherbs.com Allergy Research Group Bonvital, Inc. Dr. Clark's Store Giovane Medical Services, Inc. 800-545-9960 866-481-1002 866-372-5275 888-333-8629 www.allergyresearchgroup.com www.nutribonvital.com www.drclarkstore.com www.giovanemeds.com Alt Med Labs C'est Si Bon Drucker Labs Golden Sunshine (USA), Inc. 800-876-7722 888-700-0801 888-881-2344 800-798-3977 www.ALTMEDLABS.com www.bestchlorella.com www.druckerlabs.com www.golden-sunshine.com American Bio Medica Corp. Carlson Laboratory Dynamic Health Labs, Inc. Haelan Products, Inc. 518-758-8158 847-255-1600 800-396-2114 800-542-3526 www.carlsonlabs.com www.dynamic-health.com www.haelan951.com American Bio Sciences, Inc. 845-727-0800 Chiro Design Group Earth Power Health Logics - Arthenol www.americanbiosciences.com 512-301-0821 772-342-7808 888-402-1600 www.chirodesigngroup.com www.earthpower.com www.health-logics.com American Nutriceuticals 888-848-2548 Chiro-Manis, Inc. Earthrise Nutritionals Heartland Products, Inc. 800-441-5571 949-623-0980 701-845-1590 Anabolic Laboratories www.chiromanis.com www.heartlandnatural.com 800-445-6849 Echo Nova, Inc. www.anaboliclabs.com ChiroInnovations 877-936-6967 Heel, Inc. 800-667-1969 www.HAcompound.com 800-621-7644 Anson Aromatic Essentials www.Chiroi.com www.heelusa.com 402-489-5064 Edom Laboratories www.therapeutic-grade.com College Pharmacy 800-723-3366 HESSCO 800-888-9358 www.edomlaboratories.com 800-237-5652 Anthony Robbins - Inner Balance www.collegepharmacy.com www.hessco.com 800-397-6182 Elementals Health & Wellness www.tonyrobbins.com Control Bar 877-359-9528 Himalaya USA 800-699-0527 www.elementalshealth.com 713-863-1622 Atrium Biotechnologies, Inc. www.control-bar.com www.himalaya-proselect.com 418-652-1116 Emerson Ecologics www.atrium-bio.com CreAgri, Inc. 800-654-4432 Hollywood Health Products 510-732-6478 www.emersonecologics.com 800-330-0635 Atrium, Inc. www.creagri.com www.hhpdr.com 877-287-4862 Energique www.atriumglandulars.com Custom Health Direct 712-647-2499 Huseman Distributing 404-237-6800 www.energiqueherbal.com 219-390-7053 Ayush Herbs www.customehealthdirect.com www.omax3.com 800-925-1371 Enzyme Formulations www.ayush.com DaVinci Laboratories of Vermont 800-614-4400 Hy Tech Weight Loss 800-325-1776 www.loomisenzymes.com 866-885-5673 Banner Therapy Products, Inc. www.davincilabs.com www.hytechweightloss.com 888-277-1188 Enzyme Process Co. www.bannertherapy.com Dee Cee Laboratories, Inc. 800-521-8669 800-251-8182 www.enzymeprocess.com www.deeceelabs.com CONTINUED ➤

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Nutrition Guide

Innate Response Formulas Next Generation Therapeutics Professional Complimentary Titan Laboratories 800-634-6342 866-609-1212 Health Formulas 800-929-0945 www.innateresponse.com www.ngtlasers.com 800-952-2219 www.titanlabs.com www.professionalformulas.com Integrative Therapeutics Nordic Naturals Transformation Enzyme Corp. 800-547-4891 800-662-2544 Progena Professional 713-266-2117 www.integrativeinc.com www.nordicnaturals.com Formulations www.transformationenzymes.com 505-292-0700 InteMedica, LLC Now Foods www.progena.com TriElements 800-856-7250 800-999-8069 888-876-3240 www.intemedica.com www.nowfoods.com Progressive Labs www.trielements.com 800-527-9512 Intensive Nutrition Incorporated Nutraceutics Corporation www.progressivelabs.com UAS Laboratories 800-333-7414 877-664-6684 952-935-1707 www.intensivenutrition.com www.nutraceutics.com Rehabilitation Management www.uaslabs.com Specialists Jarrow Formulas Nutri-Spec 866-734-2202 Ulan Nutritional Systems, Inc. 800-726-0886 800-736-4320 www.123rehab.com 727-442-7101 www.jarrow.com www.nutri-spec.net www.unsinc.info Remington Health Products Kan Herb Company Nutri-West 888-333-4256 Vaxamine / Elara Nutriceuticals 800-543-5233 800-443-3333 www.drinkables.com 800-609-5214 www.kanherb.com www.nutriwest.com www.vaxamine.com Renutra-Lyflo King Bio Homeopathics Nutriceutical Solutions, Inc. 877-834-2377 VIBErant Life Nutrition 800-543-3245 866-674-2001 www.lyflo.com 866-364-8287 www.kingbiochiro.com www.inflamex.com www.creatinghealthfromhome.com Rocky Fork Formulas, Inc. Lyflo Select NutriJoy 800-630-4534 Vital Age International, Inc. 877-834-2377 785-323-1020 www.rockyfork.net 208-578-0800 www.lyflo.com www.cal-c.com www.vitalage.com Sarati International Maitake Products, Inc. Ola Loa 800-900-0701 Vital Nutrients 800-747-7418 800-880-9550 www.sarati.com 888-328-9992 www.maitake.com www.drinkyourvitamins.com www.vitalnutrients.net Scrip Chiropractic Supply Massage Warehouse Optimal Health Systems 800-747-3488 Vitamin Research Products 800-910-9955 800-890-4547 www.scrip-inc.com 800-877-2447 www.massagewarehouse.com www.optimalhealthsystems.com www.vrp.com Sedona Labs MayWay/Plum Flower OPTP 888-816-8804 Vitaminerals, Inc. 800-262-9929 800-367-7393 www.sedonalabs.com 800-432-1856 www.mayway.com www.optp.com www.vitamineralsinc.com Solanova, LLC Mediral International, Inc. Original Medicine, Inc. 415-898-1704 Wale Wellness 303-331-6161 800-465-1802 www.solanova.com 800-444-9253 www.mediral.com www.original-medicine.com www.walewellness.com Spinal Touch Formulas Membrell Pain & Stress Center 800-421-5443 Warren Labs 913-825-3740 800-669-2256 www.spinaltouchformulas.com 800-950-6149 www.membrell.com www.painstresscenter.com www.warrenlabsaloe.com Standard Enzyme Company Metagenics PrescriptionBeds.com 770-537-4445 Weight-a-Minute International 800-692-9400 Strobel Technologies www.standardenzyme.com 605-388-3755 www.metagenics.com 800-457-6442 www.weightaminute.com www.PrescriptionBeds.com Standard Process, Inc. MSP Research & Treatment 800-558-8740 Whole-istic Solutions 334-493-0420 PhysioLogics www.standardprocess.com 866-814-7673 www.mildsilverprotein.com 800-765-6775 www.whole-isticsolutions.com www.physiologics.com Stryker's N.E.T., Incorporated 800-242-0883 World Health Products 800-888-4638 Pleomorphic (SANUM U.S.A.) www.eschelator.net 877-656-4553 www.netmindbody.com 602-439-7977 www.detoxamin.com www.pleosanum.com Sun Chlorella USA Natural Wellness Centers 800-829-2828 Wysong Corp. of America Preventive Therapeutics www.sunchlorellausa.com 989-631-0009 714-635-6400 800-556-5530 www.wysong.net www.naturalwellness.com www.thymic.com Suncoast BioResearch 800-476-4112 Xango Naturally Vitamins Primary Source www.ventrescaenterprises.com 419-443-1601 800-899-4499 888-666-1188 www.jim123.com www.naturallyvitamins.com www.psopc.com Sweetwater Natural Products, LLC Yasoo Health, Inc. Nature Tech Prince of Peace / Tiger Balm 888-666-1188 888-469-2766 800-865-1475 510-723-2428 sweetwaternaturalproducts.com www.yasoo.com www.naturetech.com www.popus.com thechirobook Zonsite NewMark Priority One 800-333-3301 866-966-2778 866-963-9675 800-443-2039 www.thechirobook.com www.zonsite.com www.new-mark.com www.priorityonevitamins.com Therapy & Health Care Products 800-842-8212 www.thcpweb.com

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Nutrition Guide

Amino AcidsAnti-Aging Arthritis BodySupplement BuildingDigestive Aid Enzymes Herbs Homeopathic Men’s HealthMinerals NaturopathicNutritionalSupplementsSkin Care Sports NutritionVitamins Weight ControlWomen’s HealthManufacturerPrivate LabelWholesale A.C. Grace Co. •• •••••••• A2Z Health Store.Com •• ••••••••••• Aboca Herbs and Health ••• ••••• Advanced Naturals • • ••• Agel Enterprises ••• •• •• • Aidan Products •• All One/Nutritech • •• • •• Allergy Research Group •••••••••••••••••• Alt Med Labs •• •• • • • American Bio Medica Corp. • •• • American Bio Sciences, Inc. • •• American Nutriceuticals •••••• •• •••• Anabolic Laboratories ••• ••• •• • • •• Anson Aromatic Essentials ••••••••••••••••• Anthony Robbins - Inner Balance ••• Atrium Biotechnologies, Inc. •• • ••• ••• Atrium, Inc. •••••••••••••• Ayush Herbs •• • • ••••• • •• • Banner Therapy Products, Inc. ••••• ••••• Be Well Homeopathic/Green First •• • •• •••• Bio Resource, Inc. •• • •• • BioActive Nutritional, Inc. • •••• • • • BioCell Technology, LLC ••• • ••• ••• BioGenesis ••• •••••••• •••• BioPharma Scientific •• Biotics Research •••••••••••• ••••• • Bonvital, Inc. ••••••• • • • C'est Si Bon • •• • •• Carlson Laboratory ••••• ••••••• Chiro Design Group • • ••••••••• Chiro-Manis, Inc. ••••• •• • ChiroInnovations • •• •• College Pharmacy ••••••••••••••••• • Control Bar • ••• • CreAgri, Inc. • •• Custom Health Direct • • • ••••••• DaVinci Laboratories of Vermont ••••••• ••••••••• •• Dee Cee Laboratories, Inc. •••••••••• •••• Deseret Biologicals ••••••••••• • Designing Health, Inc. ••• ••• •••• Diamond Herpanacine Associates •••••••••••••••• Diamond Lotus Essentials ••••••• •••• DietMaster Pro by Lifestyles Tech ••• Doctors' Research, Inc. •••••••••••••• Douglas Laboratories ••• ••• ••••••• ••••• Dr. Clark's Store • •• Drucker Labs •• • •••• ••••• • Dynamic Health Labs, Inc. ••• •••• •••••• Earth Power •• •••••••••••• Earthrise Nutritionals •••• Echo Nova, Inc. • • ••• Edom Laboratories •••••••••••••••••••• Elementals Health & Wellness •••• ••••••• Emerson Ecologics ••••••••••••••••• • Energique •••••••••••••••••• Enzyme Formulations • •• Enzyme Process Co. •••••••••••••••••••• Enzymes, Inc. ••••••••••• •••• Essential Formulas, Inc. • • •• • Essiac Resperin Canada •• ••• Fitness Fit Inc./Chiropractor’s Blend •••••••••••••• FlaxUSA ••••••••••••••••••• Fresh Start 21 • Gaia Herbs ••••••• ••••• CONTINUED ➤

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Nutrition Guide

Amino AcidsAnti-Aging Arthritis BodySupplement BuildingDigestive Aid Enzymes Herbs Homeopathic Men’s HealthMinerals NaturopathicNutritionalSupplementsSkin Care Sports NutritionVitamins Weight ControlWomen’s HealthManufacturerPrivate LabelWholesale Giovane Medical Services Inc. ••• • •••••••• Golden Sunshine (USA), Inc. ••••••••••• ••• Haelan Products, Inc. ••• •••••••• Health Logics - Arthenol • ••• ••• Heartland Products, Inc. •• • Heel, Inc. ••••••••• ••• HESSCO ••••• ••• ••••• Himalaya USA • ••• • ••• Hollywood Health Products ••••••••• ••• Huseman Distributing •• Hy Tech Weight Loss ••• Innate Response Formulas ••••••••• ••• Integrative Therapeutics •••••••••• ••••• InteMedica, LLC ••••••• •••••• • Intensive Nutrition Incorporated ••••••••••••••••• Jarrow Formulas ••••••••••••••••• Kan Herb Company ••••• •••• King Bio Homeopathics •••••••••••••••••••• Lyflo Select •••• •••••• Maitake Products, Inc. • •••• ••• Massage Warehouse ••• •• •••••••• MayWay/Plum Flower •••••• ••••• Mediral International, Inc. • ••• Membrell • • • Metagenics •••••••••••••••• MSP Research & Treatment •••• N.E.T., Incorporated •• Natural Wellness Centers of America ••• ••••••••••• Naturally Vitamins • • • • • Nature Tech • • • NewMark •••• •• • •• Next Generation Therapeutics ••• • •••••••• • Nordic Naturals ••• Now Foods •••••••••••••••••• Nutraceutics Corporation •••••••••••••••••• Nutri-Spec •• Nutri-West ••••••••••••••••••• Nutriceutical Solutions, Inc. ••• • ••• NutriJoy •••• Ola Loa •• •••••••• • Optimal Health Systems ••••••• •• • •••• •• OPTP • Original Medicine, Inc. ••• • • • ••• Pain & Stress Center ••••••••••••••••• • PrescriptionBeds.com Strobel Technologies •• •• • •• ••• • PhysioLogics • •••••• •••• Pleomorphic (SANUM U.S.A.) • • Preventive Therapeutics • • •• • • Primary Source ••• Prince of Peace / Tiger Balm ••• • Priority One •••••••••••••••••• Professional Complimentary Health Formulas •••••••••• •••••• Progena Professional Formulations •••••••••••••• • Progressive Labs •••••••••••••••••••• Rehabilitation Management Specialists ••••••••••••••• Remington Health Products • • ••• ••• Renutra-Lyflo •••• •••••• Rocky Fork Formulas, Inc. •••• ••• • • Sarati International •• • ••••••••• Scrip Chiropractic Supply ••• •••• • Sedona Labs •••• • •••••• Solanova, LLC •••••••••••••••• Spinal Touch Formulas •••••••••••••••••• Standard Enzyme Company ••• •••••••• ••••• • CONTINUED ➤

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Nutrition Guide

Amino AcidsAnti-Aging Arthritis BodySupplement BuildingDigestive Aid Enzymes Herbs Homeopathic Men’s HealthMinerals NaturopathicNutritionalSupplementsSkin Care Sports NutritionVitamins Weight ControlWomen’s HealthManufacturerPrivate LabelWholesale Standard Process, Inc. ••• ••• •• • ••••• Stryker's •• • • • Sun Chlorella USA ••• Suncoast BioResearch ••••••••••••••••••• Sweetwater Natural Products, LLC •••••• thechirobook •• • • Therapy & Health Care Products, Inc. ••• •••••• •• ••• • Titan Laboratories •••••••••••••••• Transformation Enzyme Corp. • •• ••• • ••• TriElements •• ••••••• UAS Laboratories •• • Ulan Nutritional Systems, Inc. •• Vaxamine / Elara Nutriceuticals • • • VIBErant Life Nutrition ••••••••••••••••• Vital Age International, Inc. ••• • ••••• Vital Nutrients •••••••••••••••••• Vitamin Research Products •••••••••••••••••• Vitaminerals, Inc. • • • • Wale Wellness •••• ••••••••• Warren Labs • •• •• Weight-a-Minute International •••••• •••••••••• Whole-istic Solutions •••••• •••••• •• World Health Products •• Wysong Corp. •••• •• •••••• Xango •• Yasoo Health, Inc. • • ••• Zonsite ••••••••

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Office Design

Wellness center — Consider dedicating an entire wall to a wellness display area. Display your products to optimize their profitability By Glen David ou may have a number of puts products in view at the time someone may decide to purchase them. different reasons to offer Another type of client-interactive display is the “touch products, such as nutritional and feel” arrangement. Products that fall into this Y category are support pillows, mattress models, orthotic supplements, to your patients. Those displays, and any other products you want the patient to reasons may include convenience and discover and explore on their own. quality assurance. Another type of interactive display is the education kiosk that combines video, hands-on interactivity, and But aside from benefiting your patients, products can visual-display features into one space-saving center. also add to your practice’s profitability. You can build this kiosk to hold a computer station that How you display products depends upon your business plays educational videos and provides patients with a strategy and vision. Two typical sales approaches affect direct Internet link to the supplement manufacturer for location and display: in-office product ordering. Because patients can order • Client-interactive sales (a “touchy-feely” approach), what they want in the quantity they want, you do not and have to keep an inventory on hand. • Doctor-recommended purchase. • Doctor-recommended product distribution. If you Establishing which of these sale philosophies is right for provide product through your recommendation only, the you determines whether you are creating a product display area is dedicated to the storage of product and has display, providing product distribution, or combining both little “show value” or need for visual attraction. of these things: Although the display does not have to be “catchy,” it • Client-interactive displays. Also known as point-of- should look professional, be near the checkout section of service (POS) sales, this type of display is similar to those your front desk area, and be easily accessed by your CAs. you see at the checkout counter in a supermarket. You place the most attractive items directly at the DISPLAY BASICS checkout portion of the desk to spark customer interest. As you design your display area, keep in mind a few The goal of any POS display is to encourage interaction basics: with your patients. It should be located in a place that CONTINUED ➤

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Office Design

• Tell the story. Just as the • Avoid cheap cardboard racks. • Use display cases windows in Macy’s paint the picture Everything in your practice should appropriately. In the case of of vitality and fun, your product reflect your professionalism. showing off your wares, less is more. display should do so, too. Displaying a high-end product on a Do not store your inventory behind For instance: If you offer a large cardboard rack detracts from its value the glass doors. Glass cabinetry is no number of different products, do not and screams bargain basement. place to store your inventory. Only overwhelm the customer's senses. • Keep the display linked to show vignettes of the product lines. Display only a limited variety to spark your beliefs. Ensure that the • Never make a customer wait interest. Have order forms or full-line product distribution area reflects the to pay. This is rule No. 1 in retailing. brochures that describe the entire benefits of chiropractic as well as the Simplify the bookkeeping process. product line available. benefits that the product will bring to Whether you suggest a product or the Remember that only a few of your the patient. patient requests it, use order forms patients really know what they need. Since products are sold to enhance with all product purchases or orders. Most turn to you or your staff for a healthy lifestyle, be sure the display Order forms allow your CA to guidance. area looks the part. account for product sales when the front-desk CA is not busy. You can purchase two-part forms from any printer or office-supply store. The forms look professional, help in bookkeeping, and allow staff to keep patient flow moving when needed. • Watch sight lines. Locate the products appropriately within the display. Place large, bulky items, such as sleeping pillows as well as mattress models, down low. Put supplements and orthotics between knee- and eye- level heights. • Keep eye level in mind. The eye level of patients who are sitting is between 36 inches and 54 inches from the floor. Eye level for patients who are standing is between 48 inches and 78 inches above the floor. • Create a wellness area. With the trend toward the “think well, eat well, and move well” solution to health, consider dedicating an entire wall of your reception room to this concept. Just as a carefully designed office will simplify your daily activities, establishing the product-sale philosophy that is right for you will make your product sale a vital benefit to your patients and a wonderful “back end” income stream for you.

Glen David is president of Davlen Associates, Ltd., an office design firm and furniture manufacturer specializing in chiropractic offices. He can be reached at 631-924- CIRCLE 217 FREE INFORMATION 8686 or through www.davlendesign.com.

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Practice Management

Use patient psychology to launch your nutrition business By Miranda Jorgenson, DC

ike chiropractic, supplementation WRITING PRESCRIPTIONS When patients visit their medical doctors with a problem, does not always garner all of the they expect to leave with a prescription. Leaving the office L accolades it is due. Savvy with that slip of paper validates their health concerns and practitioners, however, have long confers authority and credibility to the doctor. The public perceives that “real” doctors prescribe. You understood the efficacy that can result can take advantage of this perception by treating from complementing their practices with nutraceuticals like the powerful substances they are. Have nutritional prescription pads printed and use the pads nutrition. when prescribing supplementation to patients. Developing a nutritional component of your practice is By judiciously giving your recommendations on an a logical, low-overhead solution to increasing the average official Rx pad and having your office staff provide dollar-per-visit and patient outcomes. To do this fulfillment, you achieve several things: effectively requires understanding and following simple • You gain credibility; patient psychology and marketing paradigms of: • You appear indifferent — not a pushy sales person; and • Creating credibility, • You follow the medical model your patients are • Writing prescriptions, familiar with, which happens to be the most efficient way • Starting small, and to put them at ease. • Providing what patients want. Trusting patients are ultimately complaint-free patients.

CREATING CREDIBILITY STARTING SMALL If your want your patients to take your It is difficult for nutrition-minded practitioners to wear recommendations seriously, you must take nutrition both their clinician’s hat and a marketing hat because the seriously. Be prepared to: hats often do not fit well together. What you believe • Talk about your own personal nutrition plan at a would benefit a patient and what is mentally and fiscally moment’s notice. If you “talk the talk,” you must “walk prudent for a patient may be two different things. the walk;” For example: You may want to send a new patient home • Tailor nutritional plans to individual patients. Needs with a multitude of supplements, or a large complex vary; assess each person’s and address them specifically; protocol. You know this would greatly benefit the patient, and but doing this would violate two patient psychology factors: • Carry premium-grade supplements. Provide • Trust. First, you have not earned the patient’s trust physician-grade supplements that are available exclusively yet, so he will be more apt to question your advice. through healthcare providers. You lose credibility if your • Prevalent mentality. Second, the prevalent one-per- patients can Google your recommendations and purchase day mentality of patients ensures that most are not used to the same brand at less cost on the Internet or in retail taking large quantities or even therapeutic doses of nutrients. stores. CONTINUED ➤

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Practice Management

patients visisted an allopath instead of a chiropractor, the A slow but good start MD would likely prescribe a painkiller or a muscle Many patients present with muscle pain or spasms relaxant as a remedy to the pain. on their first visit. Prescribing a quality magnesium You can prescribe your own natural equivalent with a supplement is a good way to help relieve the pain and nutritional supplement. Introducing nutrition in a baby- get the patient started on a nutrition regimen. step manner with a simple formula is affordable for the Magnesium has the distinction of being a natural patient and increases your dollar-per-visit. (See sidebar, "A anesthetic, analgesic, and muscle relaxant.1 It also has slow but good start.") This is especially important on the natural joint lubricant properties and acts as a gentle first visit when you may not give an adjustment and either sleep aid. With comparatively few contraindications, discount or write off the patient visit. magnesium is a natural complement to chiropractic treatment, with a typical prescribed dosage of 200 mg PROVIDING WHAT PATIENTS WANT – 300 mg taken in the morning, and an additional 300 Americans want (and buy) multivitamins and essential mg – 400 mg taken before bed. fatty acids. Evidence of this is clear: 1Guptha K, Vohra V, Sood J. The role of magnesium as an adjuvant • In a 2006 poll commissioned by the Council for during general anesthesia. Anesthesia. 2006 Nov; 61(11)1058-63. Responsible Nutrition (CRN), 54 percent of respondents over 50 years of age, and 39 percent of respondents younger If they are reticent about taking their supplements, the than 50 years of age, reported using a daily multivitamin. supplements will sit untouched on their kitchen counter. • In the June 19, 2002, issue of the Journal of the Ultimately, patients tend to blame a lack of progress on American Medical Association, two Harvard researchers their practitioner, not their inability to follow your advice. stated the need for vitamin supplementation, indicating, It is much more pragmatic to guide your patients into “Most people do not consume an optimal amount of all nutrition with baby steps. vitamins by diet alone … it appears prudent for all adults For example: Patients generally come in to see you to take vitamin supplements.”1 because of neuromusculoskeletal complaints. If these • The Nutritional Business Journal reported that in 2005

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supplement sales exceeded $21 billion. The FDA average American fills more than 10 prescriptions per year, estimated that 48 percent of those sales were from Americans are as unhealthy as ever and are now demanding multivitamin formulas. safer alternatives to pharmacological medications. Clearly, patients are taking multivitamins. If they are No segment of the healthcare industry has taken not getting them from you, they should be. You have the ownership of supplementation. This void leaves a huge opportunity to generate a potentially huge stream of opportunity for the chiropractic profession. At a time revenue by simply prescribing a superior quality, broad when scope of practice and clinical identity are being spectrum, bioavailable multivitamin, or a comprehensive challenged, you have a major opportunity not only to bone supportive. implement nutrition, but also to be recognized as The public is also rallying behind the need for essential preeminent nutritional specialists. fatty acid supplementation which is being recognized as an The facts are simple: Your patients are taking essential component in the treatment of inflammation.2,3 supplements. Shouldn’t they be buying quality and Marine lipid concentrates are excellent sources of omega- reliable ones from you? 3 fatty acids, while products that combine marine lipids, flaxseed oil, and borage oil to provide optimal ratios of Miranda Jorgenson, DC, a graduate of Texas oleic acid, ALA, EPA, DHA, and GLA are also excellent. Chiropractic College, is a physician advisor to Biotics If you educated your patients on the need and Research Corp. (www.bioticsresearch.com). She can be superiority of physician-grade supplements, and only 30 reached at [email protected]. percent chose to purchase their multivitamins from you, you could add from $13,000 to $20,000 per year in REFERENCES revenues to your practice, with minimal effort. 1 Journal of the American Medical Association, 2002 June 19; 287 Nutrition and the supplement industry are developing in (23):3127-3129. direct proportion to the ever-growing pharmaceutical 2 Simopoulos, AP. Biomed Pharmacother. 2006 Nov; 60(9):502-507. industry. The public is inundated with advertisements and Epub 2006 Aug 28. media reports on healthcare, and despite the fact that the 3 Calder, PC. Am J Clin Nutr. 2006 Jun;83(6 Suppl):1505S-1519S

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Practice Management CHIRO BIZ QUIZ Check your knowledge of neurodiagnostic testing By Marc H. Sencer, MD

re you thinking about doing NCV will subject your claim to extra scrutiny and review. Some testing companies propose to pay you a rental fee (nerve conduction velocity) and for the use of your space, and they collect the reimburse- EMG (electromyography) tests in ment for the test. For this arrangement to be legal, the rent A must be so small it would not be worth the trouble. Even your office? though hiring a medical specialist introduces more Test your knowledge of neurodiagnostic-testing basics overhead, it is more profitable to do your testing this way. with this quiz. (c) False. For purposes of documenting medical necessity, the patient’s subjective complaints are much less Which of the following statements about important than objective findings. This applies to most neurodiagnostic testing are true? medical and chiropractic procedures, and neurodiagnostic Q (a) As a chiropractor you may perform and tests are no exception. interpret NCV tests in some states. Objective criteria, such as positive findings on the (b) It makes good business sense to use a testing neurological exam, MRI showing nerve-root compression, company that will split the technical and professional or past history of positive electrodiagnostic findings, are component of the test with you, instead of adding an the kinds of things insurance companies look for when expensive medical specialist to do your testing. they ask you for medical necessity. (c) When you document the medical necessity for Remember, also, that if you established medical NCV/EMG testing, the patient’s subjective complaints of necessity when you ordered the test, a negative result from tingling and numbness are most important to emphasize. the test is not in itself a justification for an automatic (d) It is better to have these tests performed by a denial by the insurance company. You should challenge neurologist than a physiatrist, because neurologists have these denials if they occur. more specialty training in this area. (d) False. Neurologists and physiatrists both have (e) The NCV test is best for diagnosing lesions of the subspecialty fellowships in electrodiagnostic testing, and it is peripheral nerves, while the EMG is more useful for the within the scope of each of these specialties to do these tests. diagnosis of spinal nerve root lesions. (e) True.Typically these tests are done together, because usually the diagnostic challenge is to determine whether The correct answers are (a) and (e). symptoms are caused by a problem in the peripheral A (a) True. In some states chiropractors may nerves (such as carpal tunnel syndrome), a problem in the become board-certified in electrodiagnostic nerve roots (such as radiculitis), or a combination of the testing by taking a rigorous program of special training. two, often referred to as “double crush.” Typically these courses are given on weekends and may The information these tests provide is invaluable in take a year or longer to complete. making diagnostic decisions and often leads to important After becoming certified, a chiropractic physician may changes in the treatment plan. For example: If damage to perform and interpret NCV tests in states that recognize the median nerve is occurring, you could refer the patient this type of certification. for surgical treatment that would preserve the function of Keep in mind, however, that some payers do not the nerve, whereas a less serious case of carpal tunnel reimburse for these tests. And if you become certified, you syndrome can be managed with wrist splints and therapy. will be creating yet another job for yourself, and will be moving one step away from having a practice that can run Marc H. Sencer, MD, is the president and founder of effectively without you. MDs for DCs, which provides intensive one-on-one (b) False. Reimbursement is generally very poor when you training, medical staffing, and ongoing practice- split the technical and professional components of these management support to integrated chiropractic practices. tests. In addition, doing so raises a flag with most payers, and He can be reached at 800-916-1462 or www.mdsfordcs.com.

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Legal ASK THE ATTORNEY Consider all aspects of a CORF business By Deborah A. Green, Esq.

I have been approached by some business people means that you may not refer patients from your practice Q about forming a CORF. What is it, what does it to the CORF and patients from the CORF cannot be do, and how would it benefit me? referred to your practice. (Note: Do not try to skirt the rules by having a family member own the CORF. The A CORF (comprehensive outpatient amount of money you will spend in fines and legal fees A rehabilitation facility) is a non-residential will far exceed any profit you make.) healthcare provider that furnishes diagnostic, The referring doctor (who, again, must have no therapeutic, and restorative services under a physician’s financial interest in the CORF) must provide the CORF supervision, to injured, disabled, or sick people in need of with the following information concerning the patient at rehabilitation, on an outpatient basis. or before the CORF services are to begin: A CORF must supply, at the very least, physician • The patient’s significant medical history; services, physical therapy, and social or psychological • Current medical findings; services. It is permitted to supply other services, such as • Diagnosis(es) and contraindications to any treatment oncology, transplants, AIDs therapy, and renal dialysis. modality; and In order to establish a CORF, the facility must have • Rehabilitation goals, if determined. adequate space and the necessary equipment to furnish A CORF physician must review the written plan at the services it elects to provide. A CORF must be able least every 60 days and consult with the professional to provide all the services required by the patient, as personnel who furnished the services. The reviewing established in the patient’s treatment plan. On those physician must certify or recertify that the written plan is days that the CORF is being operated in your office being followed, that progress is being made, and that the space, you are not permitted to conduct your treatment is not causing any harmful effects to the chiropractic practice. patient. Private insurance companies reimburse for CORF Running a CORF may be a profitable venture for you, services on a reasonable-cost basis. Medicare pays for but make certain that you get the advice of competent CORF services under the physician-fee schedule. CORFs legal counsel. CORFs are highly regulated entities and you are subject to Medicare Part B co-insurance and must be sure that you are operating legally. deductible requirements. Assignment is mandatory. Finally (and I cannot stress strongly enough), make sure Some states have their own licensure requirements for you know your new business partners. Remember that you CORFs, which must be complied with in addition to the are the one with the professional license and that you Medicare requirements. could possibly lose it if the rules are broken. All CORF services must be furnished to a patient who Your non-professional partners would simply find a new is under a physician’s care. The services must be rendered business. The penalty to you could be a lot more drastic. on the facility’s premises, except for a single, home- evaluation visit. In order for CORF services to be Deborah A. Green is a practicing health attorney, rendered, the patient must be referred by a physician who licensed in New York and Florida. If you have any certifies that the patient requires skilled rehabilitation questions regarding the issues addressed above or any services. other legal heathcare issues, please e-mail her at Several years ago, a number of chiropractors formed [email protected]. CORFs and got into serious trouble for violating Stark anti-referral rules. They referred patients from their DISCLAIMER: This column is provided for educational purposes chiropractic practices to CORF facilities that they owned only. The information presented is not intended as legal advice or in which they had a financial interest. with respect to any matter and no attorney-client relationship is CORFs must comply with all Stark requirements. This established.

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Datebook

American Board of Blanchard Golf Injury April 28–29, Detroit Erchonia Integrity Independent Medical Seminars May 5–6, St. Louis 888-242-0571 Management Examiners 805-772-8298 March 24–25, 800-843-9162, ext. 304-523-1415 April 13–15, Orlando, Fla. Certified Chiropractic Indianapolis 128 ext. 3 April 13, San Juan, Puerto Rico June 22–24, Long Island, N.Y. Sports Physician March 30–April 1, March 24–25, Atlanta April 14–15, San Juan, Puerto Rico CCSP-DACBSP of PA Baltimore March 31–April 1, June 8, Chicago BodyZone.com 610-929-9882 March 31, Madison, Wis. Chicago June 9–10, Chicago 866-443-8966 March 30–31, Springfield, Ma. March 31–April 1, April 14–15, Philadelphia June, Amsterdam, Netherlands March 31–April 1, Phoenix May 11–12, Fort Washington, Pa. Cincinnati April 21–22, Kansas City, April 14–15, Chicago June 22–23, Monroeville, Pa. April 14, Charleston, S.C.; Kan. Apex Energetics April 21–22, Nashville, Tenn. Omaha, Neb. April 28–29, Minneapolis 800-736-4381 ext. 2041 May 5–6, Seattle Chiro Advance Services April 14–15, Seattle May 5–6, Columbus, Ohio April 14–15, Knoxville, Tenn. 715-635-5211 April 20–22, San Jose, June 1–3, Chicago April 21–22, Philadelphia Breakthrough Coaching April 20–21, Bloomington, Minn. Calif. May 19–20, Dallas 800-723-8423 April 21–22, Los Angeles; International June 14–15, San Francisco May 17–19, Las Vegas Cox Seminars Dallas College of Applied June 23–24, New York 800-441-5571 April 28, Chicago Kinesiology CATS International April 20–22, Boston May 5–6 Las Vegas (ICAK-USA) BioResource Inc. 705-792-1315 May 4–6, Lombard, Ill. May 12, Orlando, Fla. 913-384-5336 800-203-3775 March 24–25, Calgary, Canada June 2–3, Fort Wayne, Ind. May 18–20, Boston June 7–10, Detroit June 2–3, LaGuardia, N.Y. April 14–15, Newark, N.J. May 19, Chicago May 19–20, Philadelphia King Bio 800-543-3245 The Family Practice March, Asheville, N.C. Seminars 866-532-3327 Lakeside ext. 111 Chiropractic April 20–21, Chicago Seminars May 18–19, Seattle 877-553-4455 June 8–9, Boston April 21, Charlotte, N.C. April 22, Charlotte, N.C. Foot Levelers 800-553-4860 Life Systems March 24–25, Software Philadelphia; 800-543-3001 Wilmington, Del. April 15, Los Angeles March 31–April 1, June 19, Seattle Davenport, Iowa; Sacramento, Calif.; Life University Trenton, N.J. 800-543-3406 or April 14–15, Denver; 770-426-2753 Milwaukee April 7–8, Marietta, Ga. April 21–22, Cleveland; April 21–22, Marietta, Ga. Columbus, Ohio; Los May 5–6, Marietta, Ga. Angeles; Oakland, May 12–13, Marietta, Ga. Calif.; Portsmouth, May 19–20, Marietta, Ga. N.H.; Sioux Falls, S.D. June 2–3, Marietta, Ga. April 28–29, Worcester, June 9–10, Marietta, Ga. Mass. June 16–17, Marietta, Ga. May 5–6, Chicago; Des Moines, Iowa; Lordex Corp. Greenville, S.C. 281-395-9512 May 19–20, Albany, N.Y.; March 24, Houston Harrisburg, Pa. June 2–3, Colorado The Masters Circle Springs, Colo.; 800-451-4514 Greensboro, N.C. June 8–9, Rosemont, Ill.

Graston Technique Meditech 866-926-2828 International Inc. March 24–25, 888-557-4004 Davenport, Iowa March 31, Toronto, April 14–15, Boston Ontario, Canada April 14–15, June 5–7, Toronto, Bournemouth, England Ontario, Canada April 28–29, Minneapolis April 28–29, Neuro Emotional San Jose, Calif. Technique (NET) May 5–6, Newark, N.J. Seminars May 19–20, Indianapolis 800-888-4638 June 2–3, Boston March 24–25, Boston June 9–10, Toronto, April 25–28, Sedona, Ariz. Ontario May 3–4, Chicago

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May 5–6, Chicago March 31, SCU Whittier May 12–13, Campus, Calif. United Kingdom April 14, SCU Whittier June 21–22, San Diego Campus, Calif. June 23–24, San Diego April 21–22, SCU Whittier Campus, Calif. NeuroMechanical April 28–29, San Diego Innovations April 28–29, SCU Whittier 888-294-4750 Campus, Calif. April 14–15, Seattle May 12, SCU Whittier April 28–29, Chicago Campus, Calif. May 5–6, Boston May 19, SCU Whittier May 12–13, Philadelphia Campus, Calif. May 19–20, NCMIC Group, Inc. Santa Barbara, Calif. March 30–April 1, June 2–3, SCU Whittier Oklahoma City, 918- Campus, Calif. 641-0444 June 9–10, SCU Whittier April 21–22, Providence, Campus, Calif. R.I., 401-245-7010 June 16, SCU Whittier April 21–22, Bay St. Louis, Campus, Calif. Miss., 601-276-3336 June 23, SCU Whittier June 2, Scottsdale, Ariz., Campus, Calif. 602-246-0664 Standard Process Parker Seminars 800-835-9637 888-727-5338 March 24–25, Irving, March 29–31, Dallas Texas, 817-845-9325 March 31–April 1, Austin, Powersource Texas, 800-998-6687 Coaching and April 28–29, Houston, Chiropractic Society 800-998-6687 of Texas April 28–29, St. Louis, 512-306-1844 800-532-2128 May 5–6, Lake Geneva, April 27–28, Austin, Texas CIRCLE 235 FREE INFORMATION Wisc., 800-558-8740 The ProAdjuster ext. 1204 Group 877-942-4284 Synergy May 11–18, Pittsburgh, Pa. Therapeutic May 18, San Francisco Systems May 30, San Francisco 800-639-3539 June 1–8, Pittsburgh, Pa. June 30–July 1, June 21, Pittsburgh, Pa. Los Angeles

Sherman College The Waiting List of Straight Practice Chiropractic 877-TEAM-WLP 800-849-8771 April 13–14, Lisbon, April 14–15, Portugal Spartanburg, S.C. June 29–30, Phoenix May 5–6, Spartanburg, S.C. Ulan Nutritional May 24–27, Systems, Inc. Spartanburg, S.C. 727-442-7101 June 23–24, Atlanta March 23–25, Clearwater, Fla. Southern California March 30–April 1, University of Health Clearwater, Fla. Sciences/ Los Angeles World Federation of Chiropractic College Chiropractic (SCUHS/LACC) (WFC/ECU/APQ/FCER) 562-902-3379 416-484-9978 March 24–25, May 17-19, Tivoli Sacramento, Calif. Marinotel, Vilamoura, March 24–25, SCU The Algarve, Portugal Whittier Campus, Calif.

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studentDC com Find your dream location

here do you want to live? 3. Request information about the city. Go to the Web site of the chamber of commerce or to the local If you haven’t decided, now is economic development organization. Review information the time. about the economic situation, schools, and employers. W 4. Read online editions of local newspapers. Get to Your “dream location” is the perfect chiropractic office know the community and find out about housing costs. in the perfect city for you. 5. Inquire about your favorite activities. If you are To find your perfect location, start with the country in interested in a specific sport or activity, find out if you can which you want to practice, then zoom down to the region, enjoy that activity in the area you will be visiting. then to a specific state or province, and then to the city. When you get to the area, drive around to get the “feel” Be clear about your purpose — you are searching first of the place. Eat at local dining establishments, not chain for a place where you will enjoy living and second for a restaurants. Find the local parks and shop in the stores. good place to practice chiropractic. You will quickly begin to sense which cities or towns feel You can practice anywhere, but if you go somewhere for a right and which don’t. Don’t be afraid to talk with people to practice and you don’t hear what they say enjoy living there, you For more career-planning help, about the town — or won’t be content, and go to www.studentDC.com. about chiropractic. you’ll soon be selling When you find a your practice and moving to the location you should have city that looks promising according to your list of criteria, chosen in the first place. check out the local chiropractors. Talk with them about When you have narrowed your search to a state or the town; you’ll be able to tell whether they consider you province, it’s time to start wandering around. This sounds an asset to the community or a potential threat. obvious, but some graduates have actually waited until Plan at least one trip to the while you are in school and graduation to visit where they think they want to practice! then another trip close to graduation. The focus of the second trip will be different. You will TRIP PREPARATION want to meet chiropractors with whom you’ve talked Here are some tips to make your visit more worthwhile: about potential employment or practice purchase; you will 1. Research the chiropractors in that area. Go to be looking for a place to live; or you’ll be searching for an Google Local (local.google.com) and type in the city and office location. the word “chiropractor” to identify who practices there. Going through this process of selecting a location may 2. Check out career opportunities. Check with a seem intimidating because you’ve never done it before. job-search or practice-search service to see if anyone in You are making a major life decision, so take the time to the area is looking for an associate or to sell a practice. be sure. Most of all relax and enjoy the experience.

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Products and Services

Home chelation Reference booklet Kelatox by Chelation Specialists, Learn How to Get Paid for Orthotics, Get Paid Properly and LLC is a rectal, time-released Quickly by Foot Levelers is a quick reference insurance booklet suppository with added antioxidants that contains diagnostic codes to maximize intended to bind and remove heavy your reimbursements. Experts in the field metals from the body while supplying combine their knowledge of the insurance added nutrients while your patient world to provide you with suggestions on sleeps. Each EDTA, a synthetic amino verification and proper coding, ways to bill acid, suppository will dissolve through body heat and gradually for orthotics and all the services that go spread over the lining of the colon and be absorbed directly along with them, and how to get paid by into the blood stream then excreted by the kidneys or bowels insurance companies. within 24 hours. Call 800-553-4860 or visit Call 866-707-4482 or visit www.kelatox.com. www.footlevelers.com. Circle 263 on free product info card Circle 266 on free product info card

Mood support Online program DHEA MAX from Nutraceutics is Elementals Health offers formulated to help support adrenal ways to enhance your profits function, promote positive mood, tackle and services to your patients stress, and fight the blues. Each tablet with nutraceuticals, weight contains 25 milligrams of stabilized rice management programs with bran and 25 milligrams of DHEA, a metabolic testing, and online hormone produced in the human body, meal planning. It delivers premium grade nutraceuticals which may contribute to support for a healthy positive formulated in GMP-certified facilities; weight management outlook. Each bottle contains 60 tablets. program which includes metabolic testing and online meal Call 877-664-6684 or visit www.nutraceutics.com. planning programs, and a complimentary online wellness Circle 264 on free product info card resource center filled with home fitness guides, workout tips, wellness education articles, and life balance coaching tips. Call 877-291-8720 or visit www.elementalshealth.com. Circle 267 on free product info card Chiropractic software ChiroPulse Advanced version 4 SQL from Pulse Software LLC is marketed as Support system the ultimate virtual paperless The Spinal Reflex Analysis (SRA) office. It runs on the Complete Self-Paced Training Package by Microsoft SQL server desktop the Spinal Reflex Institute is a digital engine database (all software system that allows you to complete is included) which enables your SRA certification, including universal accessibility from a chiropractic, soft tissue training desktop, tablet PC, or notebook to offer you easy accessibility patient management, education, across the network. It also offers all of the necessary CMS and and exercise. This system includes HCFA 1500 changes updates as well as the NPI field. software, PDA, LCD-VGA monitor with DVD and TV, Bluetooth Call 908-289-9613 or visit www.chiropulse.com keyboard and mouse, SRA Thermoscan unit, educational Circle 265 on free product info card modules 1-4, evaluation, testing, support, and all materials and training for SRA certification. Call 877-259-5520 or visit www.SpinalReflex.com. Circle 268 on free product info card Portable chiropractic table The Chiron professional portable chiropractic table from Custom Craftworks was created to address the needs of the mobile chiropractic office. The table is light enough to carry easily and yet durable and strong enough to withstand the rigors of the most demanding adjustments. Custom Craftworks offers special discounts to DCs. Call 800-627-2387 or visit www.CustomCraftworks.com. Circle 269 on free product info card

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ChiropracticECONOMICS Advertising Marketplace

FlucomuneTM Ayush Herbs Inc’s Flucomune™ is a formulation containing seven different herbs that are combined in a proprietary blend to form a product that is an immune-balancer, a mucolytic (mucus thinning), antiviral, antibiotic, expectorant and a great detoxifier. This formula is an excellent choice for preventative and supportive action against viruses, bacteria and towards treatment of common colds, the flu, allergies, sinuses, ear infections and a weak immune system.

First 50 Callers Will Receive a FREE SAMPLE. For more information and samples, contact: FREE INFORMATION FREE INFORMATION Ayush Herbs Inc. www.ayush.com 188 251 1-800-925-1371 *Statements herein have not been evaluated by the U.S. Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease or condition. CIRCLE CIRCLE FREE INFORMATION FREE INFORMATION 198 231 CIRCLE CIRCLE

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ChiropracticECONOMICS Advertising Marketplace

Practical Trigger Point Self Care The Original Backnobber II includes a 35 page Patient Guide

• Reduce pain • Improve range of motion • Restore function

“Your Backnobber® II is great for those patients who need to have regular specific trigger point therapy in chronic areas, as well as for all of us who need to de-stress after a hard day’s work. Add me to your list of loyal fans.” — Betty Knox Singleton, D.C. Gig Harbor, WA

At The Pressure Positive Company we provide practical and quality self care massage tools that work for you in the clinic and for your patients at home.

FREE INFORMATION FREE INFORMATION 128 Oberholtzer Rd., Gilbertsville, PA 19525 www.pressurepositive.com 183 120

Health Professional and Distributor inquiries welcome. Call 800-603-5107 to place your order today. CIRCLE CIRCLE

Advice students can’t live without!

Our free, bimonthly newsletter provides students with information on: • Starting their own business • Managing their finances • Preparing for their career • Attracting patients • And more.

To sign up, log on to www.studentDC.com.

Sponsored by: Biofreeze • Erchonia • Footlevers • ProAdjuster • Scrip • The Masters Circle

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Chiropractic Classified Marketplace ECONOMICS To place an ad call 904-567-1543 or visit www.chiroeco.com

ANTI-AGING CAREER OPPORTUNITIES PRACTICES FOR SALE I TEACH, YOU LEARN, WE BENEFIT. PRACTICES FOR SALE AR, AL, GA(9), Master all areas of practice development. IN,KY,NC,NM,OK,OH,PA,SC,TN,TX,WI. New patient acquisition, acceptance of care $200.00 for your Practice Evaluation. and paperwork processing. Great career I have new doctors who want to buy your opportunity. Please email [email protected] practice. Call Dr. Tom Morgan, 770-748- or fax 412-399-4093. 6084. [email protected], www.VolumePractice.com FINANCIAL SERVICES STERLING NATIONAL BANK- Working SELL YOUR PRACTICE IN 180 DAYS capital loans up to $15,000 and financing OR LESS – GUARANTEED!!* “Hassle for all types of chiropractic equipment from Free listing”™, cancel anytime, 100% cash $10,000 and up. Very competitive rates, fast at closing. Call for details. Professional approvals and no application fee. For more Practice Advisors, Inc. 800-863-9373. information, call Paul Lee 856-988-0070 or www.practiceadvisors.com ASSOCIATE WANTED cell 856-287-5213. http://www.sterlingbancorp.com/products/le PRACTICE FOR SALE: Locations in CA, SEEKING FULL AND PART-TIME DC'S asing.cfm CO, MT, SC, NC, TX. Call for other states. POSITIONS AVAILABLE IN WI, FL, NJ, E-mail: [email protected] or call 727- NY, MA RELOCATION ASSISITANCE, HOMEOPATHY 492-0236. Talk to a DC. SIGN ON BONUS, SALARY, AND BENEFITS PLEASE CALL 888-369-2224 HIGHLY PROFITABLE PRACTICE OR E-MAIL (600K+) PER YEAR FOR SALE in [email protected] Vermont with excellent growth potential. Attractive, well-equipped facility. Efficient, ASSOCIATE WANTED FOR BUSY 40 well-trained staff. Thriving community YEAR OLD PRACTICE. Neither mixer with low crime, excellent schools, and a nor straight but somewhere in the middle. wide variety of recreational activities. Must be conscientious, a good Physician retiring due to health issues, but communicator, a hard worker, and have a can introduce. Asking only $225K with North Carolina license. Please submit a owner financing available. Contact handwritten introduction of yourself [email protected] including why you decided on chiropractic for a career and a general explanation of 40 YEAR OLD PRACTICE FOR SALE IN your philosophy of life. Mail to: Associate, WESTERN NORTH CAROLINA. P.O. Box 1032, Asheville, NC 28802 Prosperous and stable will keep two doctors MARKETING busy. Enjoys a reputation for ethical and compassionate relationships with patients, community, and other professionals. Doctor TRITON DTS is retiring and in excellent health so will be available for a smooth transition. We will Spinal Decompression sell only to the “right” person(s) so if you Brochures, Websites, are interested please submit a handwritten introduction of yourself(ves) including why MD Letters, Newspaper Ads you decided on chiropractic for a career and & Inserts, Clinical Studies, a general explanation of your philosophy of Patient Agreements, Office life. Mail to: Practice, P.O. Box 1032, Procedures & Coding Advice Asheville, NC 28802 WANTED MISCELLANEOUS MDs for DCs MarketDTS.com PERSONAL DEVELOPMENT MDs AVAILABLE in every specialty who COMPANY LOOKING For want to work with you. Complete ENTREPRENEURS. Have Time and MD/DC practice startup, MD training, Financial Freedom. Join other Chiropractors and ongoing support. Call today to speak to Marc H. Sencer, MD, President in This Exciting Opportunity. 1-800-692- and Founder. 8771. www.leadhomemarketing.com

1-800-916-1462 NET 250K-500K PER YEAR. Hottest or visit www.MDsforDCs.com Personal Development Business. 10-15 CAREER OPPORTUNITIES hours per week. Not an MLM and no personal selling. Call: 1-800-342-1738 or DISTRIBUTOR WANTED: For New Top visit www.nolimits4you.com of the Line Decompression Tables and other Medical Products. Great Opportunity! Interested parties, contact Ronald Sheppard, CEO of American Back Solutions, Inc. 800-515-8227 or [email protected]

98 CHIROPRACTIC E CONOMICS WWW. CHIROECO. COM V OL 53: ISSUE 4 • MARCH 13, 2007 CLASSIFIEDMARKETPLACE<<

PRACTICE OWNERSHIP PRACTICE MANAGEMENT SUPPLIES WE TEACH DOCTORS HOW TO HAVE THEIR OWN PRACTICE ANYWHERE Correct the Curve! IN THE U.S... You pick your own location and we will provide you with a low start-up, low overhead, high quality and high profit practice. Beware of the other groups who take a percentage of your income, we do not. Start doing something about creating a lifestyle that gives you both personal and professional success, earning high income and living debt free. Call Dr. Brad Chapman at 630-375-1330 or 800-300- 2205. Email: [email protected] Suggested retail $39 NEW, RECENT CHIRO GRAD AND 4 - $99 • 6 - $129 • 12 - $199 • 24 - $372 DREAM OF OWNING YOUR OWN How do I write a Online Demo’s • 30 Day Guarantee • No Free Samples PRACTICE? But don’t have the real-world experience, business acumen, or financing business plan? www.neckorthotic.com to get started? Our Rapid Practice Ownership (RPO) program may be your How do I get 586-727-7557 answer! After 47 practices opened, we can started in practice? mentor, coach, and finance you toward owning your successful, profitable practice Let Planning for Practice Success in as little as 12-18 months. Visit rapidpracticeownership.com or call 866- help you do it YOUR WAY. 925-8666. Book and CD with information, financial planning spreadsheets, business plan LIVE IN CHARLESTON!!! Wonderful template opportunity to live and practice in one of For startup, practice purchase, the most beautiful cities in America. We provide a state of the art facility including independent contracting all equipment, excellent staff, billing and For more information: scheduling. You own your own practice. www.DCPracticeSuccess.com Call Dr. Farrel Grossman at 843-552-8000 1-866-940-7526 (toll free) or 843-670-7254.

EQUIPMENT FOR SALE Why advertise here? COMPLETE NEW X-RAY SYSTEMS AS Because it works! LOW AS $11,087. Includes freight, And every ad that runs here, installation and full-factory warranty. Over also runs on our Web site: 500 installed. For details visit our website at www.ChiroEco.com www.americompus.com or call 800-458-1782. CHIROPRACTORS - PLACE YOUR $60 CLASSIFIED AD TODAY $60 flat rate for 25 words, $1 for each additional word. Doctors only for help wanted, practice or equipment for sale ads. Go to www.chiroeco.com/myad and fill out our secure form or fill out the form below and fax it to 904-285-9944.

Check off the issues you want your ad to run in. Ad heading: ❑ Associate Wanted ❑ Practice for Sale ISSUES AD DEADLINE MAIL DATE ❑ Equipment for Sale ❑ Financial Services ❑ 7 March 26 April 20 ❑ 8 April 13 May 8 Ad copy ❑ 9 April 27 May 25 ❑ 10 May 18 June 12

Name on credit card

Phone #

CC # (Visa/MC)

Exp. Date Fax this form to 904-285-9944, or e-mail your ad to [email protected]

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