What Do You Promise to Patients?

Did You Ever Make a Promise to a Patient?


This is an area that far too many clinicians regardless of the specialty get into trouble with. It is so important to understand that the only real promise to patients you or I can and should make to patients is that we will do our very best to help them.

That’s it, nothing more. To make promises of anything more is just fraught with peril!

Furthermore, it’s not good informed consent it’s also grossly unfair to yourself and your entire team.

As the old saying goes under promise and over deliver. It’s a far better strategy for practicing long-term.

I know there are many legal ramifications and obligations too…

Let me tell you what I’ve heard as a consultant.

“This WILL Fix You For Good Mrs Jones!”

“I know Jimmy, you have been sick for years but with this NEW treatment if you are NOT FIXED in 3 weeks you can have all your money back!”


Promise to Patients?


But lets get real. Why not be 100% honest and say something like…

“We will do all we can to help you to the best of our ability…these are the risks associated with treatment…these are the risks if you do nothing…”

I invite you to visit here frequently for more tips about creating a sustainable private practice!

I wish you the best along your journeys!

Want to learn more about how to build your private practice?

Then Join our team experts for a free strategy session HERE


Have a great day!

the PPW team 

Annies back…

If you are a long-term subscriber, you might remember

My patient Annie. You can read about her on my blog

from late October 2007.

Anyways, Annie had presented with a constellation of

symptoms which I ultimately referred her for an

ENT emergency visit.

I was her last doctor stop before her

husband wanted her admitted for a workup.

In short, she had been having

headaches, neck stiffness and pain, and when I queried,

she divulged fatigue, otalgia, and Sinusitis like Sx, attributed

 to “allergies” lassitude and on and off

respiratory Sx for many months. She also had about

three rounds of antibiotics, with no lasting changes.

She had previously seen 3 PAs, an RN, and her

PCP, (5 office visits) and when I put the otoscope in my

hand she said none of had looked in her ears

or checked her sinuses. I was dumbfounded by that.

When I examined her, in addition to her spinal findings

she had an acute otitis media, but when I looked at her

sinuses with the otoscope, she had acutely swollen turbinates

with nearly complete nasal obstruction on the side of

the OM. Certainly the nastiest I had ever seen.

After I adjusted her and got her more comfortable,

I immediately sent her to MGH, Mass Eye and Ear.

A CT confirmed nearly complete nasal sinus blockage

and acute infection.

Long story short, she had subsequent surgery for

multiple polyps with obstruction.

I saw Annie again for the first time in months yesterday.

Now fully recovered, happy, incredibly

thankful, talked about how long she suffered before getting relief,

now comes in with her six year old daughter for

evaluation of foot and leg pain.

Keep in mind, almost 20 years ago, I cared for her two then young sons, with similar issues.

Callie is a cute, funny eight year old.

 Unfortunately, she has significant valgus alignment and pronation, which is asymmetric, thus affecting her pelvis and back.

Anyways, she ended up her visit to us with

temporary orthotics and a DPM consult,

and will be back Tuesday for spinal/pelvic adjustments and

exercise instruction).

Doctors, this is the stuff of which long term careers,

and life long referrals are made. It can be this simple.

I have tons of these examples after 27 years, and you

probably do too.

Like everything in a powerful practice, these are systems.

Simply excellent care, totally focused history, clear communications, tangible benefits and staff that can direct your movements during your day, collect your fee and schedule patients.

Referrals that flow like a river.

With the right systems, it is this easy.

Without, the office can be a chaotic nightmare.

The disturbing fact…

“The disturbing fact…

…is that the vast majority of people, including educated and otherwise sophisticated people, find the idea of change so threatening that they attempt to deny its existence. Even many people who understand intellectually that change is accelerating, have not internalized that knowledge, do not take this critical social fact into account in planning their own personal lives” 

Alvin Toffler, in “Future Shock” 1970

Change. Even the word alone makes some, even doctors uncomfortable. Yet others embrace and enjoy the entire creative process needed to adapt to it.

As a consultant, I have observed numerous times over my career, right next to one another, practices, which are booming, and then at precisely the same time and local there are those doctors unhappy, stressed out, struggling to pay the bills. They suffer from future shock, an emotional and physical shutdown that occurs when confronted by cumulative or overwhelming change.

After careful analysis, time after time, those doctors and their team members who continue to prosper, even in today’s world, have learned and fully developed the skills necessary to deal with change, to be “Commanders of Change”™.

Changes now occur so rapidly, that even our students encounter a new world upon graduation. The sheer volume of practice information, clinical, procedural and social changes can be dizzying. And it gets more complicated and faster every day! In fact, more change now occurs in a single week, than many of us older than fifty used to encounter in an entire year.

It’s in processing, sorting, scanning and ultimately applying pertinent information, not only in our personal but professional lives that is perhaps the biggest life challenge we face today.

In healthcare practices, the systems that we used to employ for this are no longer adequate. First of all, the volume of information is too much to be handled by antiquated systems. Secondly, sorting applicable ideas and data into readily usable bits (and now bytes) is critical in today’s world.

Despite this fact, much of practice growth, development and management information as well as their delivery systems remain unchanged. Traditional consulting programs are also extraordinarily time intensive, and expensive to acquire, both of which are now totally unnecessary.

The good news is, there are now specific tools and systems that makes implementing and adapting to change much easier, far less costly and much more time effective. And it’s upon this premise that a perfect, highly profitable practice can now be built, maintained and then expanded with far less cost and time investment than ever before.

Ultimately of course, it’s up to each of us to decide what’s best for us, and congruent with our major objectives. But more and more are taking a hard look at our way. Why?

I can tell you that just as Toffler noted almost 40 years ago, it’s my observation that those doctors who do the best in today’s world are “richer, better educated, and are more mobile”. Indeed they actually “live faster” than most of the population with regard to processing and then applying change to their personal and professional lives.

They are unfazed by the sheer volume of things that need to be done, and continually upgrade their systems for doing so. They rarely complain, and get an extraordinarily amount of things done. They run highly profitable practices save more money and have far more freedom. They practice on their own terms.

And they know this is precisely what we teach, with all the modern materials, tools, live teleconferencing and support and delivery systems that are unlike anything else out there. All at a fraction of what other consultants cost.

These doctors are indeed the Commanders of Change™ in their communities. The bottom line is these doctors know that these are learned skills. Systems that are teachable, procedures that are simple to use, powerfully effective, once you know how.

Failure to thrive is correctable, no matter where you practice, or how long you have been at it. Learning to make better choices and decisions goes a long way. Of course, some find it easier than others. But to really live the life you have imagined as a student and now a doctor, decide to finally acquire the information that can help you learn, prosper and grow.

If you think you have what it takes to be a Commander of Change™, why not be one of the chosen 25 to join this next class The 12 Secrets of Private Practice Mastery

But don’t wait too long, as seats are already filling up. As Jim Rohn once said, “Discipline weighs ounces, regret weighs tons”.

It’s all up to you.

High Performance Tools and Toys


High Performance Tools and Toys


Some time ago, I wrote “Core Strength and Balance”, after the first ski trip of the year. I also told you about my new high-performance tools and toys (my new skis).  These are the most powerful skis I’ve ever owned. I’ve probably skied stronger and faster than any time in my last 60+ years. So much so, I scared myself to the point of nausea.


Well, tons of stuff has happened in the last 6 weeks, jut an incredibly busy stretch. Practice is off to its best January in several, thanks to the marketing tweaks and performance tuning we did in the last quarter.


Despite my heavy schedule, I always block out me time. This week it was Fri 5PM to Sunday 6PM.  I have written extensively on the power of creative energy and where it comes from, (and its not the office-day). I have also preached the value of blocked scheduling, and how powerful a concept that one is.


So, when one of my attorney friends called Friday night and asked me to spend the day Saturday at the boat show, I didn’t even bat an eyelash.  We really had a great time. Literally, we spent hours at one exhibit with factory personnel from Grady-White.  I was like a kid in the candy store. I have owned and operated Grady-Whites for years.  They really are the Rolls Royce of 20-30’ boats. It was so awesome to talk with engineers and designers, as I so admire their commitments to continual improvement and ultra high performance.


We also spent lots of time reviewing the latest marine navigation equipment and software, and talking with the factory reps. Garmin, Furono, Navtec, you name it.


The advances of the last five years are nothing short of phenomenal. Touch Screen technology, TFT displays with higher resolution graphics, polarized lens compatible coatings on the screens, smart routing that works like your car navigation. Really cool stuff.


Boy, Sunday was one great day.


So what’s the point?  And why the name-dropping?  Believe me, its not to impress. 


The fact is that there comes a point in time and life to move beyond just basic skills and tools, and yes even possessions. When you really start to crank things up, the best tools really shine, and  allow you to push your limits further than you ever imagined.


 Practice is no different. Once you have mastered all the basic skills, applied  the principal of Constant And Never ending Improvement, (CANI)  you find yourself ready and capable of producing so much more. By using only the highest performance tools, skills, and staff, your output is so much greater and your level of satisfaction  rises substantially as well. This is so true, regardless of how long you have been in practice, the type of practice you have, and the systems and people you employ.


Many years ago, while writing, “Creating your Perfect Practice”, I spoke extensively about the concept of blue printing. Blue printing involves taking an engine, typically from a racecar or other fine machine, and rebuilding to very precise tolerances, just as the engineers intended. Essentially, you start with exactly the same size engine, but end up with one that produces so much more horsepower, torque, fuel economy, performance, as well as a phenomenal sense of satisfaction when you really put it through the paces.


 Again, practice is no different.  Blue printing like we do with clients really can produce enormous gains. Absolutely everything The Perfect Practice Web team has written and designed allows you to accomplish so much more, with much greater efficiency, high performance, satisfaction, producing infinite rewards in exactly the same amount time if not less than you may ever had thought possible.


In this day and age, higher performance tools are so necessary to accomplishing more in less time. Besides, as your skills improve, just like my toys, you will enjoy these so much more.


This is also the secret to having a life outside of practice, being able to pursue your other interests and aspirations, or being stressed out, burned out, and financially dissatisfied.


 In the reality is, when you use the appropriate high performance tools and toys, input effort correspondingly decreases. So not only do you accomplish more, but also you save time, have more fun; less hassles with repairs and maintenance, and produce better results, you actually end up expanding less energy.


 So, with virtually all your office systems, see what is outdated. See what needs to be replaced, and then, only invest in the highest performing tools and systems available today.

And you too can learn these exact systems to incredible success by learning The 12 Secrets of Private Practice Mastery


Lessons Learned?

With fuel prices dropping like a stone, and a huge difference in gasoline pricing just 10 miles apart in these northeast towns, I can’t help but wonder, have we learned anything about the current trends and events that have a huge impact upon our lives?

I certainly hope so, but only time will tell.

Here’s my take.

1. Fuel prices soared, and stayed up because they could, without significant repercussions from any government authority. If you or I did that, we’d lose our licenses.

2. It’s not the last time we see this. Seems to me this strategy was tested after Katrina, and stuck this time. And I am sure its not over.

I think back to the gas lines of the 70s and lessons never learned. Instead, we get more dependent on foreign oil, and continue 35 years of incredible consumption. Next, we even gave our jobs away, make it incredibly difficult to do business in our own country, continue to line the pockets of special interests and set the stage for more corrupt politics. Now, other growing countries exhibit the same behavior.

And again in the USA, the biggest auto Companies Banks and Mortgage companies will be looking for bailouts by the feds, while posting brutal losses and shareholders stock value plummets.

Gosh, it must be nice to screw up so bad, and still come out smelling like a rose. All in the face of warning signs and trends of not so long ago.

Like Yogi Berra said, “This is like deja vu all over again.”

So, what’s the point? Again, it’s Yogi’s words of wisdom…

“You can observe a lot just by watching.”

This type of human behavior in the face of rapid change could also have everything to do with your practice right now. Here is how I think it applies.

Lesson number one. The profitable and successful business and professional practice is built upon current trends, and they often are not necessarily at all the way we are used to thinking. Way, way outside the box. This is also the harsh reality of “future shock”.

Lesson number two. Alvin Toffler was so prophetic! Future Shock is modern mans greatest psychological affliction. Simply put, given half a chance, humans will screw up big time (and screw others) by failing to acknowledge and respond to the amount and rapid pace of change, in all areas of our world.

Lesson number three. Ignorance of important trends, changes and warnings hurts. It hurts people. It changes societies very quickly.

(And, it might just destroy everything that built America, a country that no longer teaches, or touches history on any scale like it used to. Collectively, very short memories for a very young country).

In any event, most of today’s doctors are just like most people in any important endeavor. Failure to thrive and especially prosper is often rooted squarely in these three closely related crucial errors.

Here they are in a slightly different format.

Ignorance of current trends.

Continuing to use antiquated tools, and this is a real biggie for such a smart group.

Not changing key life and business components (systems) until it’s very late in the game or disaster strikes).

Please remind yourself daily that ignorance is not bliss. In fact, it’s a recipe for disaster, in most everything.

Now the good news.

You can be a better doctor and businessperson! You can learn new skills; use new tools that operate better systems. You can still create a powerful life while rendering a unique set of services to your communities. You can earn a fantastic livelihood and save many lives and countless amounts of ill heath, humanities most basic needs. You can.

But only If…

Hopefully, your answers are obvious.

Want to talk about growing YOUR Private Practice? Call me 24/7 781-659-7989 or email

Your FREE Downloadable Guide is at

Step by Step Implementation Guide

One of the biggest issues in private practice done right, is developing a step-by-step plan of implementation, what to do, and exactly when.

I am often asked by doctors, “Can you please tell me what to do next?” The reality is, this is formulaic, and with a little effort, you too can develop an implementation game plan.

Lets do this step by step.

  1. The very first thing is to outline in writing exactly what it is you want to accomplish and produce. Yes, that’s right, your goals and targets. The more precise you can be, the better the results. Doctor, do not overlook this vital step. In private practice, you are the CEO, CFO, Marketing Manger, and most often the Team Captain. If your behavior is not congruent with these roles, success will always elude you in private practice. This is a very powerful lesson that way too many ignore. You can be the best clinician ever, but private practice success and fulfillment require much more. Always remember though, your rewards are so much greater when you function at this highest level. When you have a high six to seven figures a year practice, then you can delegate some of the day-to day management, but as long as you own the practice, never abdicate its direction and financial oversight!!!Too many make this first and vital implementation step way too stressful. Make it easy, by just using a pencil and a notebook. It also may really help to just work in 90-day segments. Just mark your calendar to redo this exercise every 90 days. It also really helps if you write your primary goals every day if you want to accomplish way more than the average doctor. Anything you can do to make this more visual, like photos and diagrams can easily add a powerful emotional “hook”, and help you accomplish more in far less time.
  2. Get in the habit of operating only off a DAILY checklist!Again keep it easy, low stress. I still like white legal pads and multicolor pens for daily use. Typically you can make a list no later than Sunday Night for the week ahead. Next, color prioritize each of these items. Black is done, red is critical, green is underway, and blue is re-routed. Finally, cross off what’s been completed. Looking at your list with all items crossed off then allows you to move onto the next phase.Just make sure, that your checklists include the three core components of the practice. This would include:Production- exactly what’s happening this week to grow production? Here, you should list out Marketing Events, patient workshops, radio show, fitness screening, etc.Collections- analysis of your income and expenses, and especially the trends of these two key areas to financial independence. Pick the same day and time each week to review these.Staffing- What’s going on with your team? Are there pending vacations, missed steps in critical procedures? A compliment to be awarded or violations of policy?Next, you must note the appropriate action step on your DAILY checklist for all of these key areas.
  3. Develop and operate only off a 90 day Master Implementation Plan. Make sure your entire team knows it, and helps hold you accountable.One of the great simplifiers of implementation is to not project beyond 90 days, unless you are very proficient at all the above steps. For most of us, this is the precise interval to observe progress, trends and make corrections to what’s not working.The Master Plan is the poster of every area of practice that is multifaceted. A great example is marketing. Lets say you want to start a monthly newsletter for patients.You would first list “Monthly News” with a deadline or start date on your master plan, but your daily checklist might list, “select theme, call mailing house, fix event calendar” etc.And that’s it! You can keep it this simple. Sure, there are many other things (advanced executive skills) you could add, but I suggest holding off until you get effective at actually implementing all the key steps to practice growth and personal freedom.When you are ready to really take this to the next level, hire a coach.Personalized analysis of your situation, with someone who has done it all before can pay enormous dividends. Most coaches will gladly give you a written, personalized implementation plan as well.But recognize doctor, failure to have these basics in place first is a recipe for disaster. Don’t let this be you!

    Take these very simple steps today! Your only supplies needs are a notebook, pencil, a pack of white legal pads, a multicolor pen, a poster board and a calendar.

    The more consistent and disciplined you can operate in this way, the more successful and creative, and ultimately financially independent you must become.

  4. Lastly, Download your FREE Guide Template at then call 781-659-7989 or email me

Why Not You?

Recently, especially as the private healthcare environment harshens, I have been asking myself much more often about the real differences between those who are wildly successful, and those who struggle, year after year in practice. This really hit me hard after I relistened to my own most recent webinar on developing perfect practice for prospective members. Frankly, I sometimes wonder what makes those who study, implement and follow advice and become wildly successful different than those who don’t. (If you missed this recent event, you can get it at

Frankly, It hit me again just this morning after a fabulous outing at a local yacht club, why anyone would even expect to be successful, or better yet become truly independent, without careful attention to every aspect and area of business, success and personal achievement.

First, I thought about this at some length on my way home early this morning, put it aside until a little later on, then the differences became readily apparent. The answers came to me with blinding simplicity. So, I made a list of the top three reasons for failure to thrive in practice. And you know what? Its just three things!

Those who become very successful in life and practice do three unique things that those who struggle don’t.

  1. Successful people totally and unconditionally accept full responsibility for their lives and practices. They never blame the economy, insurance companies or patients who just don’t understand.
  2. The most successful are continuously gathering new information. These are the readers and seminar takers. Theses doctors take every call we sponsor, request more help, frequently with letters and emails. They travel to every live event we give or advise them to take. They regularly gather all the knowledge they can. These doctors completely understand that knowledge is power, and the ultimate in personal freedom. They have a book or CD or mp3 on success handy, at all times. It makes no difference if they are in year 3 or 30 in practice.
  3. Lastly, these doctors know what they want. They can spout off their goals and aspirations with great clarity. And when their mental pictures become cloudy, they pause, reflect and redirect. Ultimately, these doctors make their own decisions, after gathering all the data, and truly decide what’s in their own best interest, as they tweak and fine-tune their game plans. To the core, they are internally focused, but ever vigilant to support in everyway possible those who mean the most to them.

Doctors, the good news is changing from mediocrity to complete fulfillment and happiness is as simple as hitting just these three things.

But, what if you are overwhelmed with challenges? What are we to do first? What do those who are ultimately hugely successful in life do?

Ask successful people for guidance. They never fail to share and help.

Always ask for help and guidance from those who have been there. This is exactly why I have three coaches and belong to mastermind groups.

Successful people engage in all the critical aspects of living a self-actualized life. And they tell you just how they get it all done. This is the reason that continued immersion in success skills and philosophy; personal growth, physical fitness and spirituality all are essential components of a powerful life .

Remember as great as spouses and families kind support can be while you are stressed, nobody really knows what you face in practice except peers. So, when it’s really critical information you need, do you take advice from the most successful, or not? The answer should be obvious.

Next, practice total and unconditional acceptance of personal responsibility.

If you have not done this, you may need to work on this. Daily. This where reading the masters, and spiritual works such as the Bible, the Gita, Koran or simply going to that quiet place within your own soul really helps.

Lastly, if things aren’t working for you in any area of life, make a new plan!


Remember, the definition of insanity is doing the same old thing in the same old way expecting different results. And as the world changes, our plans often need to adapt or change as well. Realize, this is exactly why I repeat our Core Modules for members live, every six months. Because the pace of change is now so rapid.

And, remember Future Shock? Remember how easy it is to be mesmerized in the face of rapid changes, and the tendency to shut down and do nothing, rather than taking on a new game plan.

Now, here’s the really good news. These are behaviors, and learned choices!

If you are capable of reading this, you can fix any of the issues I discussed here today.

So, here’s a simple plan you can act upon right now to be happier, more successful and fulfilled,

  1. Be a better and bigger asker! Jim Rohn says the problem with most of us is that too many metaphorically go to the ocean to gather water with a thimble, instead of a bucket. Be a better and bigger asker and life rewards in kind!!!
  2. Continually engage and learn! Not just practice, but all of life’s most important skills. Be willing to pay the price of success and then reap all its joy.
  3. Make sure you know what you want, and continually move towards it!

Lastly, burn all your bridges to past failures. You will be glad you did. Why not do all you can this year by joining us HERE:

Educating and Treating Herniated Disc and Compressive Neuropathy Patients

As a Private Practice professional specializing in neuropathy, you can offer these patients the best chance possible for avoiding permanent nerve damage.

Let’s say you have a patient who presents with[1]

∙           Severe, sharp, electric shock-like, shooting pain

∙           Deep burning or cold in the feet or legs

∙           Numbness, tingling or weakness in the feet and legs that doesn’t go away

∙           Radiating pain down the legs and into the feet

∙           Muscle spasms and deep muscle pain

∙           Depression

∙           Sleeplessness

∙           Fear and anxiety

∙           Inability to perform normal daily activities

∙           Reduced social interaction with friends and family

∙           Loss of bowel and/or bladder control and sexual dysfunction

That’s quite a laundry list of symptoms.  If the patient doesn’t appear to be really physically active or a manual laborer, your first thought probably isn’t going to be a herniated disc.  You might be considering some type of neuropathy but not likely compressive neuropathy caused by a herniated disc.

Doctor and PatientBut maybe you should move both conditions a little farther up the list of possibilities.

To get started, do a thorough history, physical and a complete battery of tests based on their symptoms.  Once you have your diagnosis, you can begin educating and treating your patient.

Explaining What The Discs Do

A well informed patient is a more compliant patient.  If your patient has a desk job and doesn’t engage in any strenuous physical activity, it will be harder for them to understand how they developed a herniated disc and compressive neuropathy.

First, explain to them exactly what the discs do. The bones in the spine are separated and cushioned by small discs that act as shock absorbers. When they function properly, they allow your spine to remain flexible.  But when they’re damaged, which is much more likely as we age, the discs can bulge or rupture and that is what is known as a herniated disc.[2]

Any number of things can cause a herniated disc – plain old fashioned wear and tear, sitting too much or traumatic injury from lifting too much weight and lifting it improperly.

If your patient sits for long periods of time and frequently experienced minor back pain and chronic back tiredness before they came to see you with more advanced symptoms, they are a great candidate for developing a “wear and tear” herniated disc. Something as simple as bending over to pick up a piece of paper, a minor fall or even a sneeze can be all it takes to cause a disc to rupture.

If their job or lifestyle requires them to do frequent heavy lifting and they lift with their back instead of their legs, they’re a herniated disc waiting to happen.  Educate your patient extensively on the proper way to lift to avoid damaging their back in the future.

So…They Understand Herniated Disc But Where Does Compressive Neuropathy Come In?

Here’s a good analogy to use when explaining why herniated discs can causes compressive neuropathy.

Tell them to think of the spine and the nerves that run along the spine like a water hose.  When the hose is running wide open, the flow is smooth and uninterrupted.

Now put a kink in the hose.  The flow of water all but stops.

The herniated disc is the kink in the hose.  It puts pressure on the nerves and stops the proper flow of blood and oxygen and that results in nerve damage.

And nerve damage results in compressive neuropathy, usually in the feet and legs.  If the pressure is not relieved, the damage to the nerves can be permanent and you can end up with life long issues.

Treatment Options

When you’re diagnosed with a herniated disc and compressive neuropathy, the first goals of treatment are:

∙           Pain relief – first and foremost

∙           Address any weakness or numbness in your feet, legs and lower back

∙           Prevention of additional injuries

As a NeuropathyDR® clinician you have access to and training in a specialized protocol that’s ideal for treating the patient with a herniated disc and compressive neuropathy.  A good starting point for treatment is

∙           Bed rest followed by increased, prescribed and controlled activity

∙           Chiropractic manipulation to get the spine back into proper alignment and take pressure     off the herniated disc and nerves

∙           Treatment with the neurostimulation to open up nerve channels and stimulate nerve repair

∙           Exercises to reduce pain and strengthen the muscles in the back

∙           Dietary counseling to address any other underlying medical issues

As a health care professional specializing in neuropathy you can offer these patients the best chance possible for avoiding permanent nerve damage from their herniated disc and the best chance for sparing themselves future pain.

Let us help you reach these patients in your private practice and treat them.

Are You A Licensed Health Care Professional? Grab Your Free NeuropathyDR Professionals Information Kit!

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My Behavior Affects My Neuropathy Dr. Jones?

My Behavior Affects My Neuropathy Dr Jones?”

“Wow. You mean how I act around my family, and even my health care professionals has an impact on my peace of mind, my health and maybe even my neuropathy treatment?”

“Mrs. Smith In a word, yes…”

This may be a very difficult discussion for some of us in healthcare to directly handle with our patients but a very important one. In the clinic, we call this dealing appropriately with “illness behavior”.

Lets break it down. When you were a little kid, and you got those scrapes from falling down, or maybe the assault from a bully. Or even something worse. Just like me you learned that being “sick” certainly brings more attention to us. And in an emergency, rightly so! NOT letting the correct people know you need help in a crisis is just as bad!

But problems arise when patients carry these inappropriate learned behaviors from childhood over into adulthood. Often it begins unconsciously. Being diagnosed with a new health problem, like peripheral neuropathy, having a genetic disease or major accident is life changing.

"I just want someone to listen to me, and figure out whats wrong..."

These all require a period of time to uncover real choices, treatment options, etc. And in neuropathy treatments especially this is true now more than ever as more and more neuropathy claims are being made.

Here’s my point. When patients display illness behaviors, the biggest negative effect is on them! If we tell our subconscious mind how sick we are, what do we get? More sickness! Of course the same is true for our patients!

This in no way demeans anyone suffering from a serious or life threatening disease. But plenty of studies even in really sick patients tell us as neuropathy treatment specialists that when your patients have a healthier outlook, and a healthy set of behaviors to match, the better chance we have at really doing really well with their treatment success!

We also know that our attitudes and behaviors affect our immune systems, our sleep, and yes even our aging process.

We also know that even in really severe illness, our behaviors have a huge impact.

And the most difficult but important behavior of all?

Asking for professional and spiritual guidance, or in a word, acceptance.

And supporting your patients in this regard is one of the most powerful things you will ever do. God bless you for caring enough to do the right thing by your Mrs. Smiths today.

To learn more about the HUGE opportunities in specialty practice done right, go to

What’s Most Important To Seriously Ill Patients?

If your patients suffer from neuropathy, one of the most important things for them to realize is that “no cure” is never the same as “no help!”  It’s an unfortunate truth: so far, peripheral neuropathy (sometimes we’ve seen it referred to incorrectly as ‘neurophy’) has no actual cure, and most nerve damage is permanent.  That’s an awfully grim prospect for most patients to hear, but the chronic nature of neuropathy only means that our developing options for treatment is even more important, not less.

When you apply the NeuropathyDR® methods for neuropathy treatment with a patient, you will really be addressing two things: managing the patient’s symptoms, and improving their overall quality of life.  The two are interconnected in almost every way: never forget that improving the quality of life for someone with a chronic condition like neuropathy is often the very best treatment we can provide!

In addition to the often-discussed pain, neuropathy has the potential to greatly impact a patient’s mobility.  Between motor neuropathy (which affects the strength in the limbs directly), difficulty walking due to foot pain and joint stiffness, and difficulty with manual dexterity and fine motor skills, it’s no wonder that many neuropathy patients have trouble doing simple tasks they once found easy; things the people around them still have no trouble at all doing!  The frustration that goes along with mobility loss can be almost as bad as the pain itself.  A clinical study from Queens University published in Anesthesia & Analgesia even suggests that the impact of neuropathy on a patient’s mood aloneis enough to be considered a serious symptom!

Your Patients Need Your One on One Expertise To Get Well!

NeuropathyDR® clinicians use a neuropathy treatment method which includes several known techniques and we are continuously testing newer technologies too! NeuropathyDR® Clinicians actually take new courses every single month, so they are never “stale”!

Every patient’s case is unique—no two cases of neuropathy are exactly alike—so it’s important that develop your treatment plan together with each patient.  Be sure to pay attention to any information your patient may provide, and Don’t forget to ask for feedback!  Be sure to ask what seems to be working, what eases the patient’s pain, what helps their overall mobility, and what might not be having any effect at all.  All these things are important, and will inform the best way to approach a case.

Our patient, Beverly, came to us about six months after major surgery.  Beverly had been undergoing radiation for breast cancer, and was experiencing severe pain in her hands and feet, as well as tightness and inflexibility in her spine and limb joints.  Over the course of 5 weeks, we treated Beverly with electro- stimulation, among other therapies to address her pain and range of movement.

Beverly’s pain lessened only incrementally over the time we treated her, but she let us know that the real improvement she experienced was in her range of movement!  Sure enough, our examination found that her range of movement had increased measurably (in some areas as much as fifty percent), and overall tightness in her back was reduced.  Needless to say, being able to move more freely will greatly impact Beverly’s quality of life—many patients stress that their mobility is what they miss most of all while living with peripheral neuropathy.

One of the factors that allowed us to help Beverly as much as she did was that she was very forthcoming about her symptoms, her improvement, and—also importantly—when a treatment wasn’t helping.  Neuropathy is complex, and different patients will benefit in various ways from different neuropathy treatments.  In Beverly’s case, we were able to provide her with a home care kit which she was able to use to treat her flexibility and pain at home.  Even though she still lives with neuropathy, Beverly now knows how to make sure her condition won’t keep her from getting on with life!

Helping patients control symptoms and improve their overall quality of life is what we’re all about at NeuropathyDR®.  If you treat patients like Beverly, we’re here to help you give them the best care.  Don’t hesitate to get in touch with us if you have any questions about how to help the people in your care live to their fullest!


Motor Neuropathy- A Different Game Plan

If you read the NeuropathyDR® blog frequently, you know that we tend to focus on bringing you the latest research and methods as they apply to treating neuropathy pain.  As you are aware, though, with peripheral neuropathy, pain is only one component.  This week, we’re going to talk about how neuropathy can affect a patient’s muscles, also called motor neuropathy.

There are essentially three kinds of motor neuropathy.  The first is the overall weakening effect of the muscles, especially in a patient’s extremities, which often accompanies peripheral neuropathy.  This can occur because the nerves which control motor function in the muscles have become damaged, or—in the case of a compression neuropathy—constricted.  The second kind is called multifocal motor neuropathy, and takes place when a patient’s immune system itself begins to attack their own nerves, as can happen after a series of infections or after an illness.  The third kind is Hereditary Motor Sensory Neuropathy, which, as the name suggests, is genetic in nature.  Hereditary Motor Sensory Neuropathy, or HMSN, occurs when there is a naturally-occurring deterioration in the nerves that control a patient’s muscles, causing those muscles to not be used, become weak, or even atrophy.

Motor neuropathy usually starts in the hands and feet, and can affect the full extension of a patient’s fingers and toes.  In addition to the dexterity problems this obviously causes, it often also has a visual appearance of “clawlike” fingers.  The condition is degenerative, getting worse over a period of months and years.  Twitching and spasms can also happen in affected limbs.  While motor issues associated with peripheral neuropathy usually accompany pain, tingling, and numbness, multifocal motor neuropathy involves no pain (only the motor nerves are affected).  Generally, none of the varieties of motor neuropathy are life-threatening.  Nevertheless, they can all severely impact your patients’ comfort and quality of life, especially if they are left untreated.

There is no substitute for appropriate PT and Rehab in Motor Neuropathy

When we met our patient Robert, he complained of a steady and declining loss of strength in his feet, which he had experienced over the past 4 years.  Robert had had cancer during that time, culminating in having his prostate removed.  His motor neuropathy caused Robert to have trouble walking or standing for long periods, and he even had trouble feeling his feet on some occasions.  He also complained of shooting pain, tingling, and soreness in his feet, all typical calling cards of peripheral neuropathy.  Since in cases of multifocal motor neuropathy, the sensory nerves are usually unaffected, Robert’s pain and numbness ruled that out.  Sure enough, when we performed a battery of tests, we found that Robert’s sensation to vibration was all but absent in several places on his feet.

Robert did not respond with the typical level of relief we usually see after treating a patient with electro-stimulation.  Over the course of three treatment sessions, Robert’s level of strength and comfort in his feet did not change in any meaningful way.  While this is unusual, it highlights an important theme: neuropathy is a complex problem with many symptoms and manifestations, and no single therapy technique or tool—even those with a very high rate of success—can stand on their own as a complete treatment.  For us to help our patients effectively, we have to encourage broader, overall adjustments to their lifestyle.

We designed just such a treatment for Robert, intended to produce more long-term benefit, as his short-term progress was not substantial.  Motor neuropathies require an extensive level of treatment, sometimes pharmaceutical and sometimes homeopathic, and usually involving some level of regular exercise and controlled diet.  Robert is currently improving steadily, and is seeing his NeuropathyDR® clinician as prescribed to monitor his condition and progress.

If your patients are complaining of weakness or pain in their limbs, they might have peripheral neuropathy.  If so, we can help you provide the best care possible.  Contact NeuropathyDR® right away and we will help you answer their questions and train you to provide therapy and treatment for specific neuropathy symptoms.  We can even put patients in touch with you who will benefit from your help managing their neuropathy.


Can You Really Help Guillain-Barre Syndrome?

One of the more rare acute types of peripheral neuropathy you will encounter in patients will be Guillain-Barre syndrome, also sometimes called Landry’s paralysis or Guillain-Barre-Stohl syndrome.  This autoimmune disorder causes the immune system to deteriorate the nervous system, which in turn causes the muscles to weaken very fast.  Due to its autoimmune nature, Guillain-Barre tends to present most frequently in people who have recently recovered from another type of infection, like a lung or gastrointestinal sickness.

The condition only affects about one or two in every 100,000 people, far fewer than most of the more common neuropathy types, and it most commonly targets patients between 30 and 50.  Because signals travelling along the nerves of a patient with Guillain-Barre are slower, it can sometimes be detected through nerve-conduction studies, as well as by studying the cerebrospinal fluid.

Most patients with Guillain-Barre present with ascending paralysis (loss of strength in the feet and hands that migrates towards the core), along with typical polyneuropathy symptoms such as pain and tingling in the extremities.  Perhaps most serious of all, Guillain-Barre syndrome often presents alongside autonomic neuropathy, making it very dangerous to the overall health of a patient’s internal organs.

There is still a lot we don’t know about Guillain-Barre syndrome, such as why it attacks some patients after an infection and not others, or what actually sets it in motion to attack the nerves.  We currently refer to it as a syndrome, as opposed to a disease, since there is no disease-causing agent we can prove to be involved.  As of yet, there is also no known cure, but with proper treatment, clinicians who are trained in the NeuropathyDR® methodologies are able to manage its symptoms and restore quality of life to their patients who suffer from it.

Our patient Louise was diagnosed with Guillain-Barre Syndrome over 20 years ago.  The onset was sudden; Louise just woke up one morning and her foot felt funny; by the end of the day she was having trouble walking unassisted.  In only a few days, Louise needed two canes just to get around.  For two decades, this was how she lived; in constant discomfort from the neuropathies common with Guillain-Barre, every day worried that the condition would degenerate and that her legs would just stop being able to bear her weight (even with support).  Even simple things like crossing her legs or driving were difficult.  Fortunately, Louise found a NeuropathyDR® clinician who was able to help!

By the time she came to us, Louise had been living with Guillain-Barre and its complications for more than 20 years.  Her mobility had continued to deteriorate, and she was now also experiencing pain in her lower back and difficulty turning her neck.

You can offer your patients the best chance possible with proper training...

We treated Louise with our NeuropathyDR® methods of adjustive procedures to restore mobility in the affected joints, as well as ultrasound and the use of electronic stimulation to affected nerves.  Over a five-week period, Louise’s painful neuropathy symptoms subsided drastically and mobility began to re-emerge in her legs and back.  At a checkup two months later, Louise was starting to regain feeling and continuing to improve!

After her treatments with NeuropathyDR® , Louise wrote to us that, in light of her newly-regained mobility, she finds herself afraid to hope that she will get feeling back in her legs after all this time.  She has been following-up with her clinician as scheduled, and her condition is continuing to improve.  There is hope that you can help your patient, no matter how long they may have been living with Guillain-Barre or any other type of neuropathy.

If you treat patients who have been diagnosed with neuropathy, or conditions that contribute to it such as Guillain-Barre syndrome, we want to help you treat their case more effectively.  NeuropathyDR® is an invaluable resource to clinicians; we have the information and training you need to be your most effective.  We can even help refer patients to you in your area who could benefit most from your care. Don’t wait to start helping your patients get—literally—back on their feet;  contact us and we’ll get started!

“Susan’s pain was so bad that she had trouble telling hot from cold, and even experienced trouble walking.”

A lot of your patients have heard that there is no cure for neuropathy, and they get discouraged.  As someone in the medical profession, you want to be able to dispel this misconception that your patients will just have to live with their symptoms!  NeuropathyDR® can teach you the non-pharmaceutical means to lessen their pain and improve their life.   “No cure” isn’t the same thing as “no help!”

A great example of a patient we have been able to help with the NeuropathyDR® methodology is Susan.  Susan is a diabetic in middle age who has suffered for more than twenty years with neuropathy symptoms.  Most prominently, Susan has tingling and severe pain in her feet, with the same problem less severely in her hands and arms.  Susan’s pain was so bad that she had trouble telling hot from cold, and even experienced trouble walking.

When she came to us, Susan was taking prescription-strength Advil several times a week for the pain in her hands and feet.  Medication has its place, and can be effective in some cases, but it is too often the first—and last—course of action medical professionals resort to when it comes to neuropathic pain.   NeuropathyDR® promotes newer, non-pharmaceutical methods that have been proven to reduce pain and numbness in cases like Susan’s.  After we applied the NeuropathyDR® protocols, Susan’s symptoms subsided drastically and her quality of life began to improve.

Especially in the short term, we want to help reduce the overall level of chronic pain and restore any mobility that might be lost.  In a case like Susan’s, the NeuropathyDR® protocols target three specific areas of treatment:

  • Specifically-directed manual therapies to correct aberrant motion or misalignment in areas of the spine and pelvis, as well as addressing the soft tissue contractures in the neck, legs, feet, arms, and hands.
  • Our NeuropathyDR® nutrition protocol, consisting of a daily regimen of combined nutrients that have been proven to be supportive of the nervous system in slowing the progression of neuropathy and healing damage.
  • Finally, the application of neuro-stimulation in the affected areas.  We use a waveform treatment in the office and at home that opens up nerve pathways to let them heal.

Susan’s treatments recurred three times a week for five weeks, for a total of fifteen treatments.  Following each treatment, Susan reported that the level of pain and tingling had subsided by two-thirds or more.

Powerful Manual Therapies are Key…

After applying the NeuropathyDR® protocol, Susan noticed a terrific improvement in her lifestyle.  In her own words, her energy level tripled, and the inflammation and pain in her feet had reduced by ninety percent.  Our objective tests, going by a round before and after the treatments, showed that Susan’s spasms in the lumbar and thoracic paravertebral muscles had improved by seventy percent.  Her range of motion without pain had also increased by seventy percent, and her ability to sense heat, cold, and vibration had drastically improved.  Perhaps the biggest lifestyle-boost of all, Susan experienced much less pain when walking after applying the NeuropathyDR® methods for five weeks.

We followed up with Susan three months after her treatments with us, and she was continuing to do extremely well.  She has been diligent about keeping up her assigned home-care treatments, and she visits her clinician as-needed for checkups.  Especially in-light of her twenty-year struggle with neuropathy, the degree of Susan’s success is remarkable.

If you treat patients like Susan who suffer from neuropathy symptoms, we are a valuable resource to help you treat them.  Contact us with specific questions and to learn the NeuropathyDR® methodologies we have developed.  Our protocols are proven to work—don’t let your patients go without proper care!

Another Niche: Become an expert in Entrapment Neuropathy Care!

Entrapment Neuropathy:  More Than Just Carpal Tunnel!

Last week we discussed carpal tunnel syndrome (CTS), one of the most common forms of neuropathy affecting a single nerve (mononeuropathy).  What many of your patients might not know is that carpal tunnel syndrome is only one of the entrapment neuropathies common in the upper limbs.  The other entrapment neuropathies are not as well-known in the mainstream as CTS, and so patients who suffer from nerve symptoms in their forearms and hands frequently jump to conclusions!  We’re here to help you set the record straight.

An entrapment neuropathy, also called nerve compression syndrome, occurs when a nerve is wedged or “pinched” against a bone, inflamed muscle, or other internal mechanism in the arm.  Aside from the median nerve (the one associated with CTS) there are two main nerves that help to control the arm and hand: the radial nerve and the ulnar nerve.  Both are susceptible to compression, and the results can be painful!

Entrapment occurs under a number of conditions, most commonly:

  • When there is an injury originating at a patient’s neck or a disease of their cervical spine
  • When your patient’s elbow has been injured due to fractures or improper use
  • When your patient’s wrist has been injured due to fractures or Guyon canal alignment problems
  • An aneurysm or thrombosis in the arteries

    Make no mistake, entrapment neuropathy patients need non-surgical specialist care!

  • Factors commonly associated with peripheral neuropathy, such as diabetes, rheumatism, alcoholism, or infection

The radial nerve runs the length of the arm, and is responsible for both movement and sensation.  Radial neuropathy usually occurs at the back of the elbow, and can present with many of the common symptoms of neuropathy such as tingling, loss of sensation, weakness and reduced muscle control (in this case, your patient will often complain of difficulty in turning the palm upwards with your elbow extended).

A number of palsies affect the radial nerve, such as:

  • Saturday night palsy (also called Honeymooner’s palsy), where the radial nerve is compressed in the upper arm by falling asleep in a position where pressure is exerted on it by either furniture or a bed partner
  • Crutch palsy, where the nerve is pinched by poorly-fitted axillary crutches
  • Handcuff neuropathy, wherein tight handcuffs compress the radial nerve at the wrists

Two main conditions affect the ulnar nerve: Guyon’s canal syndrome and cubital tunnel syndrome.  Guyon’s canal syndrome is almost exactly the same in symptoms as carpal tunnel syndrome (pain and tingling in the palm and first three fingers), but involves a completely different nerve.  Guyon’s canal syndrome is caused by pressure on the wrists, often by resting them at a desk or workstation, and is frequently experienced by cyclists due to pressure from the handlebars.

Nearly everyone has experienced cubital tunnel syndrome: it’s the “dead arm” sensation we’ve all felt when we wake up after sleeping on top of our arm!  Sleeping with the arm folded up compresses the ulnar nerve at the shoulder, causing it to effectively “cut off” feeling to your arm.  As you and your patients all probably know from experience, this sensation is unsettling but temporary.

Diagnosis for all compression neuropathies is fairly consistent.  We advise a visual and tactile examination of your patient’s arms, wrists and hands, along with a test of the patient’s independent range of motion (as mentioned before, difficulty extending the elbow could indicate radial nerve damage).   Blood or nerve tests can help establish underlying conditions that may contribute to neuropathy.  The Tinel and Phalen tests will also help determine loss of dexterity and sensation that could indicate a compression neuropathy.   MRI or x-ray scans are common to pinpoint the specific location of a compression.  Contact NeuropathyDR® if you have any questions about your patient’s symptoms or the correct way to check for compression neuropathy.

Similar to carpal tunnel syndrome, most cases of entrapment neuropathy are mild. Treatment for these mild cases involves ice, rest, and a change in habits of motion or stress that are causing the symptoms.  For more severe cases, you might choose to prescribe painkillers or anti-inflammatories, and in extreme cases, a surgical solution is sometimes justified.

If you would like to know more about how to treat patients who suffer from compression syndrome or other types of neuropathic pain, NeuropathyDR® can help!  As a training resource we can help you treat your patients, as well as help the patients you can benefit find you!


Autonomic Neuropathy: More Dangerous than You Think

Autonomic Neuropathy: More Dangerous than You Think

If you read our articles often, you know that we usually talk about peripheral neuropathy in terms of the pain and inconvenience it can cause for your patients.  We usually write about quality of life, but it’s also important to know about a much more serious element that can threaten the lives of the people you treat: autonomic neuropathy.

Autonomic neuropathy is the term that means damage has been done to the nerves that control the automatic functions of your body.  These functions include blood pressure, heart rate, bowel and bladder emptying, and digestion.  When the nerves are damaged, these functions can start to behave incorrectly.  It can be dangerous and even life-threatening when this happens.

If your patients are presenting with symptoms of nerve damage like numbness or tingling, loss of motor control, sexual dysfunction, dizziness and sweating, or loss of hot and cold sensation, they may also have more serious damage to the nerves controlling your organs.

Nothing builds a powerful specialty practice like incredible results!

Many cases of autonomic neuropathy accompany cases of peripheral neuropathy that have more easily-noticed symptoms.  With autonomic neuropathy, a patient’s body can have trouble controlling their blood pressure, they might not digest food correctly, or they could have problems regulating their body temperature.  These conditions are dangerous!

Make sure your patients know they could be at serious risk!

Autonomic neuropathy isn’t a disease of its own, and it’s not caused by any one thing.  If your patients  suffer from injuries, have had an amputation, or even spend long amounts of time sitting still, they can be at risk of developing nerve damage.  As you probably know, though, autonomic neuropathy goes along with a disease or condition, such as:

  • Alcoholism
  • Diabetes
  • Cancer (specifically, chemotherapy)
  • HIV or AIDS
  • Lupus

If you work with patients who suffer from any of these conditions, be on the lookout for autonomic neuropathy.   Don’t rule out a patient just because he or she doesn’t have any of the “peripheral” symptoms!  Even if they are symptom-free, a patient might have damage threatening their organs.  We can’t emphasize enough that catching neuropathy early, especially the autonomic kind, gives you more treatment options and is the best way to help your patients.  Don’t forget: we’re talking about a life-threatening condition!

How can you determine if a patient’s organs are in danger?

Ask questions.  Patients can be shy about their lifestyle, exercise, diet, habits, and so on, but they’re the best source of information.  Remind them that you are here to help, not to judge.  It is vital to know any symptoms they might have, or any relevant medications or existing conditions that might contribute to neuropathy.

If you have any questions about how to examine a patient for signs of neuropathy, contact us! NeuropathyDR® has the resources you need to detect autonomic neuropathy early.  Most commonly, an examination of the extremities for infections or sores is a good first step, along with testing for blood pressure irregularities.  For autonomic neuropathy in particular, an ultrasound can help determine if the internal organs are functioning correctly.  There are also a number of other tests that are specific to certain organs such as the bladder, stomach, or lungs.

For autonomic neuropathy, taking the best care of your patient can mean a couple of different treatments used together to keep them healthy.  Several kinds of medications are available which will help slow the effects of nerve damage and reduce the symptoms.  Contact us for guidance on specific medications that might help; it can vary from patient to patient.

It can also be helpful to instruct patients about ways to make your everyday routine more conducive for living with neuropathy (again, NeuropathyDR® is a valuable resource for you in this area).  Patients usually have to adjust their diet, and certain kinds of exercise may be more dangerous to people with neuropathy.  We can help you find the best foods to recommend to your patients, as well as help develop exercise plans that are safe and beneficial to them.

There’s no absolute cure for neuropathy, but becoming a NeuropathyDR® doctor will equip you to help your patients when it comes to keeping them safe from the different kinds of neuropathy.  Remember, don’t wait!  The earlier you catch neuropathy, the better you can help!



Helping Your Diabetic Neuropathy Patients

If you have patients who are living with diabetes, chances are you are no stranger to making diagnoses of neuropathy.  While some patients (even those who do have nerve damage) might experience no symptoms at all, about 60 to 70 percent of diabetics experience pain, soreness, loss of sensation, tingling in the extremities, and even digestive problems—or other conditions related to organ complications—all symptoms of peripheral neuropathy.  Diabetes is, in turn, one of the most common causes of neuropathy overall.

A patient’s risk of developing diabetes-related neuropathy actually increases with age and extenuating health considerations (such as being overweight), partially because patients who have problems with glucose control for extended periods of time—25 years or more—are more susceptible.

The best defense against diabetic neuropathy is to get and keep blood sugar under control.

So, what causes a patient who has diabetes to develop neuropathic symptoms?  Research is occasionally unclear on the subject, but it is generally agreed that exposure to high blood glucose (high blood sugar) has a negative effect on nerve condition.  Of course, this is in addition to other conditions or lifestyle factors commonly associated with causing or exacerbating neuropathy, such as injury, metabolic inconsistencies, inherited traits, or substance abuse.

There are a few kinds of neuropathy associated with diabetes, the most common being peripheral neuropathy (this is the type usually referred to when people simply say “neuropathy;” but we’ll get to the other types in a moment).  Peripheral neuropathy is characterized by pain, numbness, tingling, and loss of motor function, among other sensation-related symptoms.  This type is written about extensively, and can greatly impact quality of life for its sufferers.  Most treatments available to medical practitioners target peripheral neuropathy, so the good news is, there are plenty of ways for you to treat this type.

Focal and proximal neuropathy result in muscle weakness and pain, and typically target a specific nerve grouping.  These types of neuropathy are commonly characterized by weakness in the legs, causing difficulty standing and walking.  This type of neuropathy often accompanies peripheral neuropathy, so be on the lookout for patients who experience weakness alongside loss of sensation or soreness.

Autonomic neuropathy, as the name implies, causes changes in autonomic bodily functions.  These include bowel and bladder functions, sexual responses, and digestion.  Autonomic neuropathy can be life-threatening in extreme cases, as it also affects nerves that serve the heart, lungs, and eyes.  Especially troubling to diabetic patients is the resulting condition of hypoglycemia unawareness, which can obliviate the symptoms most diabetics associate with low glucose.

It is recommended for any diabetic patients to receive at least an annual foot exam.  If neuropathy has already been diagnosed, a patient’s feet should be examined much more frequently.   Additional to diabetic amputation concerns, you should test your patient’s protective sensation by pricking their foot with a pin, or running monofilament across their skin.  If your patient has lost protective sensation, he or she could be at risk to develop sores that might not heal properly, leading to infection.  If you have any questions about the proper methods to use in examining diabetic patients for neuropathy, contact NeuropathyDR®.  We can be sure you have the tools and knowledge you need!

For other types of neuropathy, properly-trained clinicians should perform a check of heart rate variability to detect how a patient’s heart rate changes in response to changes in blood pressure and posture.  Ultrasound imaging is also useful to diagnose autonomic neuropathies and to ensure other internal organs such as the kidneys and bladder are functioning properly.

To control diabetic neuropathy, it is important to advise patients to maintain a tight blood sugar control and a healthy diet (this methodology is advisable for diabetics in general, of course).   Even if a patient does not have symptoms of neuropathy, regular checkups are wise.  NeuropathyDR® can train you to spot warning signs of factors that could endanger your patients’ nerve function or even be life-threatening.  In addition, we can help you treat pain symptoms by providing valuable information about appropriate medications.

If your patients have diabetes, they are at risk!  Don’t let neuropathic symptoms go unchecked.  Remember, the sooner neuropathy is diagnosed, the easier it will be to treat and to slow the progression of this degenerative condition.  NeuropathyDR® clinicians are trained to identify the various types of neuropathy and recommend the treatments that help their patients retain their quality of life.  If you have any questions about treating patients who have or might have diabetic neuropathy, contact us!



Maximum Patient Benefit and Recovery-CCTxs

Patient Co-Treatment Plans CCTxs

One of the biggest clinical lessons that has come from our work with peripheral neuropathy patients is just how powerful “Patient Co-Treatment Plans” can be.

Traditionally, we might think of patient components of recovery from illness as a relatively passive home care program such as “just take these twice a day” or “do these exercises”.

Clinical Co-Treatment Plans (CCTxs) involve much more specific, multifaceted approaches to patient care, that not so surprisingly yield often greater results in several areas than just professional advice or professional treatment programs alone.

Some of the keys to CCTxs success lie squarely in getting the patient to accept responsibility for all the components needed to foster maximum results. Commonly observed side benefits may include enhanced family support, approval and greater involvement of other health care providers and especially reduced use of pain and psychotropic drugs.

CCTxs typically consist of dietary advice, timed exercise and stretches, massage, oral and topical medications and supplements and in the neuropathy patient, use of the Clinical Co Treatment Kit.

You CAN Learn to Help More Patients with CCTxs

With just a little foresight, the same principles can and should be applied to a vast array of health conditions.

We have found it extraordinarily beneficial to specifically package CCTxs with custom iPhone®/ipad® Apps, DVDs and books, newsletters and exercise books or sheets.

Be sure that any supplementation or medication is always supplied with detailed written instructions. We attach specific, written and sometimes color coded instructions to each bottle or applicator.

But the real key to success is indoctrinating your staff and patient families from the outset that your approach to treatment mandates CCTxs.

You see, when you mandate patient co-operation as part of case acceptance, patient compliance is usually greater. There are also far fewer questions about fees, length and extent of care. The value added benefits of dealing with your office as opposed to a competitors becomes readily apparent. Most of all, your role as teacher with these patients can reduce office stress levels and interrupting phone calls dramatically!

But another less thought of benefit from running your professional health care practice in this way becomes positioning and marketing.

When the community understands the depth of your concern is far greater than making payroll, referrals seem to magically follow. It becomes Disney-sequel- patients can’t resist telling others. New Patient flow tends to come like a freight train with patients and their families who are clamoring for this type of care.

Of course, this is especially true as we move towards a public system of healthcare in which these “touches” have all but vanished forever.

So, how do you actually implement CCTxs in practice?

Obviously, take a look at what’s out there and don’t reinvent he wheel. If you are a neuropathy clinician, we’ve already done all the work for you!

By the same token, if you have an idea, first sketch it out. Be sure to include all the components needed to foster not only patient recovery, but also compliance.

Keep in mind, today, you must build in all the appropriate self-care tools, including books, DVDs, and now especially those that will “push” information in a consistent, replicable manner.  Timed information and self-help content that will also allow for patient (or a family caregiver) self determined interaction.

I’m clearly talking about automated SMS (mobile device text communications) and mobile device apps, which will have an ever-expanding role in private health care practices.

In the coming days, I’ll be showing you precisely how all of this technology can be tied together seamlessly with CCTxs to not only educate your patients, but also become part of the vast repertoire of social media as well as traditional marketing and private practice development and management.

The future success of private practice will mandate such an approach.

Stay tuned to

Marketing the Specialty Practice in 2013

You know the issues…

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

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

•       Sports rehabilitation services for the athlete

•       Recuperative and NeuropathyDR® Treatments for seriously ill patients


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


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

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

It’s not a lost cause…

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

Get In Front Of Your Prospects

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

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

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

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

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


What’s In It For The Patient?

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

Emphasize what’s in it for them.

Greater mobility, playing golf, or enjoying the grandchildren…

Less pain…

Success and healing are both so formulaic…

Literally, getting their freedom or their life back…

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

Don’t Forget The Power Of Referrals

Referrals can be an invaluable resource for building your practice.

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

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

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

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

They are your target market.

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

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

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

Designing Treatments for Lupus Patients


As physicians, we’re accustomed to a certain amount of variety in treating different patients with the same illness.

After all, we’re treating individuals.

But when you take on lupus patients, you’re taking the concept of variety in symptoms and outcomes to a whole new level.

Granted, there are specific symptoms to the various types of lupus, but no two lupus patients are the same.

Lupus is an ever changing illness with periods of activity and rest that are as different as the patients they affect.

Those differences can make developing a treatment plan difficult to say the least.

And when you add peripheral neuropathy caused by lupus to the mix of symptoms[1], you have an even more complex set of issues to treat and, hopefully, stay ahead of.

If you have any hope of preventing serious neuropathy complications in your lupus patients, you have to be diligent in monitoring your patients’ symptoms and, even more importantly, your patients have to be very conscious of their symptoms and keep you advised of any changes as soon as they happen.

That means you need to educate your lupus patients on their illness and peripheral neuropathy.

Helping Patients Lupus and Peripheral Neuropathy

Because the peripheral nervous system can be affected by lupus, every system of the body that is regulated by the peripheral nervous system can be damaged[2].

That means the nerves that control involuntary body functions like heart rate, blood pressure, digestion and perspiration.  Your patients need to understand that their body many not be able to regulate their heart rate or blood pressure, they might not be able to properly digest food,  their  kidneys can be damaged and they could develop urinary problems.

And even worse, lupus can cause serious problems with inflammation.  That can lead to:

–          Inflammation of the sac around the heart

–          Diseases of the heart valves

–          Inflammation of the actual heart muscle

–          Inflammation of the tissue around the lungs or pleurisy

Now, imagine having any of these issues and having peripheral neuropathy, too…

The peripheral nervous system isn’t functioning properly and can’t send the proper signals to the brain to let them know they have a problem.

It’s easy to see why this could be serious.  By educating your patients on these possible problems and the symptoms they present early on, they can keep a watchful eye out for any symptoms and get in to you see you before they have a potentially deadly problem.

Treating Lupus Patients with Peripheral Neuropathy

Once you take a very thorough history and physical (preferably one following the NeuropathyDR® protocol for lupus patients), you’ll have a better handle on your patient’s condition.  Pay particular attention to their symptoms, when they began, the severity of the discomfort, and any and all medications they currently take (including over the counter medications, herbal supplements or vitamins).

Once you’ve complete the history and physical, the next step in the NeuropathyDR® protocol will be to order some tests. Depending upon your patient’s actual symptoms and which systems seem to be affected, these tests might include:

∙           Neurological exam

∙           Electromyography

∙           Nerve conduction velocity test

∙           Antinuclear antibody test

∙           Blood tests

∙           Urine test

∙           Skin biopsy

Once the tests are completed and you determine your patient has peripheral neuropathy associated with lupus, you can design a specific treatment program based on your patients’ specific symptoms and adjust it as they enter periods of remission or as their symptoms change.

Lupus is not curable and your patient should understand this from the outset.  Your NeuropathyDR® treatment protocol should focus on relieving pain by reducing inflammation, repairing any nerve damage with nerve stimulation, slowing joint and bone damage and improving your patients’ ability to function with their disease.

Focus on:

∙           Rest and stress management.

∙           Exercise programs designed specifically for your individual patient based on their physical limitations.

∙           Pain medication as needed.

∙           Drug therapy as needed.

∙           Safety precautions to deal with the possible loss of sensation, especially in the hands and feet, due to peripheral neuropathy.

The NeuropathyDR® protocol is ideally suited to treating lupus and the peripheral neuropathy it can cause.

Early intervention with a physician well versed in treating lupus and peripheral neuropathy, like a NeuropathyDR® clinician, is their best course of action.  While you can’t cure them, you can help them achieve a better quality of life and lessen the chance of severe and possibly fatal complications.

When you’re trained and ready to work with them, let them know you’re there.

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




Treating Patients with Hypoglycemia and Autonomic Neuropathy

If you’re treating patients with diabetes, chances are very good that you’ve also got patients with hypoglycemia.

Many patients with diabetes are so accustomed to their symptoms that they don’t pay attention to the subtle changes that can present with hypoglycemia.  Often, they won’t have the very dramatic symptoms like loss of consciousness or diabetic coma.

More often, they have milder symptoms like[1]

∙           Tremor

∙           Sweating

∙           Heart palpitations

None of these are that severe and they might just write them off as a response to something going on in their everyday lives.  No big deal…nothing to worry about.

But they do have a problem and a potentially serious one.

That problem is hypoglycemia.

Hypoglycemia can occur in anyone with diabetes if they’re taking medication to lower their blood glucose.  If you have type 1 diabetes and you’re insulin dependent, you stand a good chance of developing hypoglycemia.

So how do you get these patients to come to you when they first notice these symptoms so you can help them with a proactive approach to their illness?

Educate your diabetes patients on the signs and symptoms of hypoglycemia and make sure they understand that the symptoms may appear to be mild but they can be physically devastating.

Understanding Why They May Not Recognize Symptoms

If your patient has type 1 diabetes, when their blood glucose levels fall, their insulin levels don’t decrease and their glucagon levels don’t increase.  They just reflect the body’s absorption of insulin.  It gives the body a false sense that all is right when all is wrong.   Because their body doesn’t register a problem, it loses its first two lines of defense against the imbalance in your system.  Their body’s normal response is impaired.

What Causes the Impairment?

Several things –

∙           The brain may have become used to hypoglycemia because it’s been dealing with it for awhile. If they’ve had frequent episodes, the system in the body responsible for transporting adrenaline to where it’s needed no longer senses a great need.  It just doesn’t respond.

∙           They may be using medications that mask their hypoglycemia symptoms and not even know it.  For example, if they take medications that are beta blockers, they’re designed to lessen the effects of adrenalin on the body.  They may not experience the tremors or heart palpitations that a normal person would during a hypoglycemic episode.  Beta blockers also block the liver from producing glucose so they’re giving the body a double whammy to deal with. Always ask your diabetic patients if they’re taking beta blockers as part of your history and physical.

∙           They may have autonomic neuropathy.  Explain to them that it’s a type of peripheral neuropathy that affects the nerves that control involuntary body functions like heart rate, blood pressure, digestion and perspiration.  The nerves are damaged and don’t function properly leading to a breakdown of the signals between the brain and the parts of the body affected by the autonomic nervous system like the heart, blood vessels, digestive system and sweat glands.  And, in their case, it may be inhibiting their liver from producing insulin.

Diagnosing and Treating Autonomic Neuropathy

Once you take a very thorough history and physical (preferably one following the NeuropathyDR® protocol for hypoglycemic and diabetic patients), you’ll have a better handle on your patient’s condition.  Pay particular attention to their symptoms, when they began, the severity of the discomfort, and any and all medications they currently take (including over the counter medications, herbal supplements or vitamins).

Watch for signs that they are not being completely up front about their diet, alcohol intake, frequency of exercise, history of drug use and smoking.  If they don’t tell the truth, you don’t have a clear picture of your physical condition.

Treatment and Prognosis

If you use the NeuropathyDR® protocol, you will find the treatment regimen ideally suited to treating diabetes, hypoglycemia and autonomic neuropathy.

Diabetes, hypoglycemia and autonomic neuropathy are chronic conditions but they can be treated and your patient can do things to help relieve their symptoms.

You can help them by offering[2]:

∙           Diet Planning and Nutritional Support

The body needs the proper the nutrition to heal.

If they have gastrointestinal issues caused by autonomic neuropathy, they need to make  sure they’re getting enough fiber and fluids to help the body function properly.  Provide them with a diet plan that ensures they get enough fiber, whole grains and drink enough      water.

If they have diabetes, work with them on a diet to control their blood sugar.

Devise a meal schedule as part of their dietary planning to keep their blood sugar levels as steady as possible.

∙          Individually Designed Exercise Programs

If your patient experiences exercise intolerance or blood pressure problems resulting  from autonomic neuropathy, develop an exercise regimen for them that will allow them to take things slowly but still work some physical activity into their daily routine.  Treating neuropathy patients requires specialized training in the design and monitoring of  exercise programs.  The NeuropathyDR® clinicians are specially trained in designing  exercise programs to meet the needs of the neuropathy patient.

Early intervention with a physician well versed in treating diabetes, hypoglycemia and autonomic neuropathy, like a NeuropathyDR® clinician, is still the best course of action. While you can’t reverse your patient’s condition if they have already developed neuropathy, you can help them achieve a better quality of life and lessen the chance of severe and possibly fatal complications.

When you’re trained and ready to work with them, let them know you’re there.

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