Fibromyalgia- A Breakthrough in Treatment for Patients and Clinicians?

If you treat patients who suffer from pain, fibromyalgia is probably a term you’re familiar with, if only in passing.  Nearly 4% of patients suffer from fibromyalgia, making it one of the most common pain syndromes in the world!  Female patients are 70% more likely to suffer from fibromyalgia than males, but the condition hits everyone.  Like neuropathy, fibromyalgia can profoundly impact a patient’s quality of life, from mobility and strength to learning to live with chronic pain.  NeuropathyDR® can help you determine whether a patient has fibromyalgia, and is a great resource to learn the best way to treat their symptoms! In Fact, we recently trained our members in a protocol that is showing great promise!


The most common indicator that your patient suffers from fibromyalgia is pain and sensitivity to pressure on their skin.  Most patients describe the pain as stabbing and shooting, and it can occur all over the body.  Fibromyalgia pain is often worse in the mornings, and can vary based on restlessness and even temperature/humidity.

Neuropathic symptoms very frequently accompany fibromyalgia.  Patients may also be experiencing tingling in their extremities, numbness, the sensation of clothing running over their skin when none is there, and difficulty determining hot and cold in addition to the telltale pressure-sensitivity.  Of course, these symptoms can themselves contribute to other problems, such as sleep disturbance, disruption of appetite, and bladder-control problems.

Many Drugs just don't stand the test of time in Fibromyalgia Treatments


The true cause of fibromyalgia is a point of some debate, and has never been decisively established; some researchers even point to the lack of physical abnormalities as evidence that it’s a distinct condition.  There are commonly-held theories, though, which include:

  • Dopamine dysfunction- one of the most common theories explains why fibromyalgia presents so frequently in cases where a patient suffers from restless leg syndrome and sleeplessness.  These are conditions which result in part from insufficient dopamine in a certain part of the body.  For this reason, researchers generally agree that a dopamine deficiency contributes to fibromyalgia, as well.
  • Stress- Fibromyalgia shows up frequently in patients who suffer from irritable bowel syndrome, post-traumatic stress disorder, fatigue, and depression.  This has led many researchers to conclude that there is a distinct link between a patient’s stress level and his or her risk of developing fibromyalgia.
  • Genetic predisposition- Recent research has suggested fibromyalgia may also have a genetic component. The disorder is often seen in families, among siblings or mothers and their children.
  • Physical trauma- Physical trauma can act as a trigger for fibromyalgia, research suggests, since it tends to show up for the first time in many cases where a patient is suffering from an acute illness or injury.


Fibromyalgia is traditionally treated with a variety of medications ranging from simple pain relievers, antidepressants, anti-seizure medications, and even dopamine agonists.  Since the root cause of fibromyalgia is not entirely understood, treatment with pharmaceuticals is a game of trial and error at best.  Understandably, this has led many doctors and researchers, including NeuropathyDR over the past decade to advocate alternative, non-pharmaceutical treatments.

Some of the more modern methods for fibromyalgia treatment include exercise, cognitive behavior therapy, adjustments to diet and lifestyle, some forms of electrotherapy, and even massage therapy.  Extensive research over the past few years even points to chiropractic adjustments and other manual therpies and acupuncture as potential routes for effective treatment.

NeuropathyDR® promotes newer methodologies for treatment, and discourages medications that could be ineffective, temporary fixes, or even lead to additional complications.  Our methods reflect the latest developments for treating the symptoms of neuropathic pain and fibromyalgia in ways that are more effective and reliable than dated pharmaceutical techniques.

Every patient who has fibromyalgia experiences different symptoms, so it’s very important that they be evaluated one-on-one with a clinical expert.  NeuropathyDR® is an indispensable resource to help you find the best ways to treat fibromyalgia and neuropathy patients; we can help you take the guesswork out!  Don’t hesitate to contact us if you have any questions.


A Nutrition Intro For Your Neuropathy and Chronic Pain Patients

Diet can be a main factor in many of the cases of peripheral neuropathy you see.  Neuropathy is linked to diabetes and other conditions where daily intake of sugars and nutrients is important, but your patient’s diet can also influence the condition of nerves in more direct ways, such as in cases where a nutritional deficiency is

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

causing neuropathic damage.

One of the most common links between neuropathy and nutrition is that a deficiency in B vitamins, particularly vitamin B-12, can itself lead to damage of nerves and disruption of nerve functions.  Your patients can avoid neuropathic symptoms by eating foods like meat, fish, and eggs that are all high in B vitamins.  There are many kinds of fortified cereals that contain substantial amounts of B vitamins as well (in addition to supplements, which we’ll talk about in a moment), so be sure to advise vegetarian and vegan patients that there’s no reason to go without!

The Mayo Clinic recommends a diet high in fruits and vegetables for your patients with neuropathy.  Fruits and vegetables are high in nutrients that have been shown to be effective in treatment.  Additionally, in patients who suffer from diabetes, fresh produce can mellow blood sugar levels.  A good suggestion to patients is to keep pre-cut fruit and vegetables at the ready, so they don’t have to worry about the stress involved with preparing them if the pain or numbness in their extremities is severe! Be sure to teach them about glycemic loading-easy on the fruits!!!

A deficiency of Vitamin E can happen in cases where malabsorption or malnutrition are taking place, such as the case with alcoholic neuropathy.  According to, some breakfast cereals, whole grains, vegetables and nuts are all excellent sources of vitamin E, and are good recommendations in cases where a deficiency may be taking place.

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

Lean proteins are also an important part of a healthy diet for neuropathic patients.  Saturated fats and fried foods increase risk of diabetes and heart disease, in addition to aggravating nerve decay from lack of nutrients.  A variety of foods—skinless white-meat poultry, legumes, tofu, fish, and low-fat yogurt—are good sources of lean protein.  In diabetic patients, lean proteins also help to regulate blood sugar levels.  Fatty fish such as salmon, tuna, mackerel, and sardines are good for maintaining levels of Omega-3 acids, healthy fats the body needs but cannot produce on its own.

For specific types of neuropathy, research shows that specific antioxidants may help slow or even reverse nerve damage that has not existed for too long a time.  For HIV sensory neuropathy, Acetyl-L-Carnitine has demonstrated good results, and Alpha lipoic acid is being studied for its effects on diabetic nerve damage.  For the latest research and ways you can apply it to help your patients, contact NeuropathyDR®!

Considering these factors, it is very important for your patients to monitor their diets.  A great piece of advice that can also reveal telling information to you about their overall lifestyle health is to suggest they keep a food journal.  A patient should record everything they eat at meals, for snacks, and any vitamin supplements.  Of course, food journaling is a great way for your patients to meet other health goals, as well.  If they have a goal for weight loss, weight gain, or better overall energy, those are other areas in which keeping a food journal can help!  Other great suggestions include: cooking at home as opposed to going out to restaurants, keeping a shopping list instead of deciding what groceries to buy at the store, and consulting a nutritionist about the best ways to control nutrition-related symptoms.

Dietary supplements can also help your patients manage neuropathic symptoms and nerve degeneration.  Supplementing B Vitamins, particularly vitamin B-12, can help patients regulate their nutrient levels and prevent neuropathy symptoms.  Supplementing with fish oil can help replenish Omega-3 fatty acids, which are important for type-II diabetic patients.  Don’t hesitate to contact NeuropathyDR® for specific recommendations about how to advise your patients about supplementing their diet!

If you have any questions about talking to patients about their diet, let us know!  NeuropathyDR® is a resource to help you help the people who depend on you.  For this and other neuropathy-related questions, we’re here to help!



Neuropathy and Exercise/Rehab For Your Specialty Practice

Neuropathy and Exercise

Pain, muscle control problems, and overall health complications can make even everyday activities for your patients suffering from neuropathy harder to manage.  For some of those patients, the prospect of exercising will seem not only unrealistic but an almost ironic misplacement of their priorities.  As you know, though, exercise is important for everyone. In your patients, it can actually help control blood sugar and slow down the progression and symptoms of the condition.

Exercising regularly greatly decreases anyone’s risk of diabetic neuropathy, and has been shown to control symptoms and deterioration in neuropathy patients  by elevating overall blood flow to the limbs and controlling cardiovascular atrophy.  Depending on a patient’s specific type of neuropathy, the areas affected, and the extent of their damage, neuropathy patients should be advised to adjust conventional workout routines to accommodate their condition.  Advise patients with neuropathy to consult you before they begin any workout program.  When they do, be sure to inspect their feet and legs for signs of potential problems, and make sure their shoes are properly fitted so as to avoid neuropathy-related injuries.  Contact us if you have any questions about how to advise patients interested in starting a fitness program; NeuropathyDR® has resources that can help.

Here are some general guidelines to pass along to patients, to help them avoid neuropathic complications:

  • To use silica gel or air midsoles
  • To use polyester or polyester/cotton blend socks to keep their feet dry
  • To avoid any workout clothes that rub against their skin in the same area.

Ann Albright of the Division of Diabetes Translation in Atlanta cautions that neuropathy patients will want to steer clear of most repetitive or weight-bearing exercise, such as running, walking, or extensive weight training (although some sources advocate weight training as beneficial, in moderation).  So which exercises are the most beneficial while reducing risk?

There is no substitute for appropriate PT and Rehab in Specialty Practice

Swimming is one of the best exercises to recommend, as it is an activity adaptable to any age, fitness level, or degree of neuropathy symptoms.  Swimming is also a full-body, “no-impact” workout, and so is less harmful to a patient’s joints, legs, and feet than most other forms of exercise, without sacrificing circulation.  As such, it is highly recommended for almost anyone.

Bicycling, rowing, and use of a stationary bicycle are other excellent, low-impact activities that can be safely integrated into a neuropathy treatment program.  Some organizations have even developed exercise programs for senior citizens suffering from neuropathy, incorporating a heavy emphasis on seated exercises.

In the event a patient does not have regular access to facilities or equipment for more extensive exercise, there are some basic exercises you can teach that can help your patients control their dexterity and neuropathy symptoms:

  • For hands, touch the pad of your thumb with your index finger, running the finger down to the base of your thumb. Then, repeat the movement with the index, middle, ring, and little fingers. Do this exercise several times.
  • For legs and feet, straighten one knee and point your foot.  Flex your ankle five times, then circle your foot five times in each direction, clockwise and counterclockwise.
  • To increase balance, try this exercise: from a standing position, rise up slowly on your tiptoes, and then rock backward onto your heels. Keep your knees straight, but try not to lock them.

Additional precautions are vital for neuropathy patients to observe.  Advise patients that, after every workout session, they should remember to check their feet and any relevant extremities for blisters, irritation, or sores. These could be vulnerable to infections, which themselves could elevate risk for amputation.

It is especially important for neuropathy patients to be mindful of their heart rate and blood pressure.  Especially if they suffer from autonomic neuropathy, which can greatly increase risk of heart failure or cardiac arrest, advise them of their limitations when it comes to exercise.  There is an appropriate level of exercise for almost everyone, even those with heart risks, but the degree of exercise you advise will obviously vary on a case-by-case basis.

Finally, be sure to make your patients aware that neuropathy sufferers are at high risk when it comes to overheating, since some types of neuropathy can reduce the body’s ability to temperature-control.  Advise them to keep a close monitor on their body temperature, and to let you know immediately if their sweating seems overly profuse or the opposite, less than normal.

If you have any questions about how patients diagnosed with neuropathy should exercise, contact us. NeuropathyDR® can answer your questions and has the resources you need to help your patients stay fit, healthy, and active while living with neuropathy!,,20189334,00.html,,20188832,00.html


The FULL Imact of Sleep, Sleep Apnea and Neuropathy


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

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

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

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

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

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

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

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

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

Do You Engage in Dabbling or Mastery?

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

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

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

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

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

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

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

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


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

But why?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Pull Back or Leap Forward in 2012?

Pull Back or Leap Forward in 2012?

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

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

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

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

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

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

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

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

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

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

It’s your choice.

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

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

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

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

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

How Are You Going To Practice in 2012?

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

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

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

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

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

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

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

I look forward to hearing your success story this year!

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

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Overlooked Opportunities in 2011?

Overlooked Opportunities in 2011?

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

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

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

By the next staff meeting, they will be fixed.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Alternative Therapies for Your Chemotherapy Induced Neuropathy Patients

Alternative Therapies for Your Chemotherapy Induced Neuropathy Patients

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

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

–       Shooting pain

–       Burning and numbness

–       Tingling in the hands and feet

–       Inability to sleep because of the pain

These Patients Require All Your Skills!

Can you imagine the frustration?

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

For many, their symptoms last well beyond their chemotherapy.

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

What Else Can They Do?

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

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

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

–       Cancer treatment specific diets

–       Herbal supplements

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

–       Acupuncture

–       Massage therapy and Reflexology

–       Exercise

–       Homeopathic and ayurvedic medicine

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

Involve Their Oncologist

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

Why These Complementary and Alternative Medicine Treatments Work

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

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

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

Treating the Whole Patient By Working With The Whole Team

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

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

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

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



Doing Everything You Can For Your Cancer Patients

Cancer brings many challenges into the lives of your patients…

Treatment options…

Disruption of normal activities…

Fear, anxiety and depression…

When treating your cancer and post chemotherapy peripheral neuropathy patients, it’s easy to become focused on just the disease itself and the symptoms.  But don’t overlook their emotional and psychological issues.  These can be as debilitating as the disease itself and seriously affect treatment outcomes if not addressed.

Depression caused by chronic pain and frustration can derail an otherwise successful course of treatment.

When treating your cancer patients, strive to become a one stop shop for addressing not only their post chemotherapy peripheral neuropathy and other physical side effects from treatment, but also a great resource for supportive services and information that can provide a tremendous benefit to your cancer patients.

Help them address some of the serious obstacles to successful treatment that most health care professionals don’t think about.

Patient Information Resources[1]

Make your office the one place your cancer patients know they can go to for current patient information and education about cancer treatment options, specific types of cancer, long and short term side effects of their chosen course of treatment.  When preparing your patient information materials, include education on cancer diagnosis, treatment, clinical trials, treatment side effects from chemotherapy or radiation and questions they should ask their doctors.  Provide them with a list of local resources that are available to assist them with the challenges they face as a cancer patient.

Support for Lifestyle Changes

A cancer diagnosis can mean serious lifestyle changes for your cancer patients.  Smokers will probably have to quit smoking; athletes will have to curtail some of their physical activity; patients who live alone may have to stay with family members while undergoing treatment.  All of these changes can lead to serious emotional issues.  Provide counseling to your cancer and post chemotherapy neuropathy patients on dealing with these lifestyle changes proactively.  Provide tips on what they should expect and the best ways to handle these short term challenges.

Don’t Be Afraid to Talk About Money

For cancer patients with no insurance or even less than adequate insurance, a cancer diagnosis can be especially devastating.  They may forego necessary prescriptions or even skip appointments. When trying to pay for their cancer treatment, they may find it difficult to even pay for the most basic necessities of life.  Become familiar with programs in your area that can assist your cancer patients with paying for medications, providing home health assistance, or even services that can help them with transportation to and from their health care providers.

Any assistance will help.  Fighting cancer is hard enough without the added worry of financial issues.  Just knowing that there are resources available to help might ward off the serious depression that can make recovery that much more difficult.

Keeping Track of Medical Information[2]

When a patient is undergoing chemotherapy, radiation or other treatment for cancer, they have mountains of information to keep track of.  They need to monitor when to take their medication, how to take it, keep up with medical appointments, monitor their symptoms, and make note of any and all side effects their experience.  They need to keep a written record of everything.  Provide them with a record book or specific forms to make it easier for them to write everything down and keep it in one place.  It will not only make it easier for your cancer patient to manage their medical information, it will make it much easier for you just having all their notes together in one place.

By providing all these additional support services to your cancer and post chemotherapy peripheral neuropathy patients, your practice will become their go to health care provider for information and support.  Two things that they desperately need and will greatly appreciate.

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

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



The Post-Chemotherapy Cancer Patient – A Growing Chiropractic Patient Population

A cancer diagnosis is terrifying.

The questions, the fear and the concept of facing their own mortality are enough to paralyze even the strongest individual.

In the not so distant past, the standard was surgery, chemotherapy, or radiation or some combination of the three and that was it.

Then the patient played the waiting game to see what, if anything, worked.

What people didn’t realize was that the end of a course of chemotherapy was not the end of the healing process.  They would be dealing with the lasting effects of chemotherapy long after their hair returned and the nausea ended.

And one of those lasting effects is post-chemotherapy peripheral neuropathy.

Fortunately for the chiropractic community, cancer patients are quickly learning that chiropractic, nutrition and often the correct forms of nerve stimulation when combined in the hands of a skilled chiropractor can help alleviate the symptoms of their post-chemotherapy peripheral neuropathy.

The post-chemotherapy peripheral neuropathy patient is becoming an enlightened consumer of complementary therapies that go beyond traditional medications and standard medical treatments.

A new-enlightened approach to treating their peripheral neuropathy symptoms gives the chiropractic community an ever-expanding patient population to serve.  Treating these patients who have already walked through an experience most people live in fear of can be incredibly rewarding.

To get them in your office though, you need to show them exactly how your chiropractic and specialty care can improve their quality of life.  It’s not just about marketing the traditional chiropractic care that people associate with whiplash or sports injuries.  It’s about educating the potential post-chemotherapy peripheral neuropathy patient on a three-pronged approach to their medical issues:

First, Chiropractic- It’s Not Just About Adjustments

Chances are that your potential post-chemotherapy peripheral neuropathy patients have never been treated by a chiropractor.  They may think they know what a chiropractor does but they may not understand everything that chiropractic can do for managing their condition.

Traditionally, chiropractors have been associated with treatment of injuries and illnesses affecting the bones, muscles, ligaments, tendons and joints.  In educating the post-chemotherapy peripheral neuropathy patient, recognize that they can be dealing with gait problems, muscular weakness or even issues caused by radiation.  The stress of dealing with any of these conditions cannot always be addressed by standard chiropractic techniques. 1

Chiropractic by itself cannot prevent or cure cancer, but it can help the post-chemotherapy neuropathy patient deal with the symptoms and pain associated both with their cancer and their course of treatment.  Often, by carefully mobilizing the spine and related tissues, we stimulate a healthier nervous system and that’s a basic building block for regaining their pre-cancer health and alleviating their nerve pain.


Chemotherapy and other cancer medications can wreck a patient’s digestive system.  In the process of killing cancer cells, it can also damage healthy cells and that’s what brings on the side effects of chemotherapy.  This can affect not only affect their ability to eat but also prevent the body from getting the nutrients it needs.

Talk to your post-chemotherapy peripheral neuropathy patients about their nutrition issues.  They can be dealing with any number of symptoms ranging from nausea and loss of appetite to dry mouth and changes in their sense of taste and smell.  Offering nutrition information and dietary planning services is another way to serve this patient population.  Good nutrition will boost the immune system and let it do its job in fighting off illnesses brought on by chemotherapy.

Potential post-chemotherapy peripheral neuropathy patients may not realize that this is an area of their recovery you may help with. So, if you are trained in this specialty, make sure you include nutrition information in your patient education materials.  Post-chemotherapy peripheral neuropathy patients need to make sure they’re getting nutrients to prevent or reverse nutritional deficiencies, lessen the side effects of treatment and improve their quality of life.  Without appropriate, simultaneous nutrition, other treatment protocols have no chance of success.

Appropriate Nerve Stimulation

Once a course of treatment has been designed and a nutrition plan established, the final piece in the overall treatment of the post-chemotherapy peripheral neuropathy patient treatment plan is nerve stimulation.

There are some nerve stimulation techniques to help peripheral neuropathy patients.
But some are potentially harmful. Misapplication is dangerous. Learn the correct ways, and then educate your potential post-chemotherapy peripheral neuropathy patients on the options available to them.

Some patients may have adopted an attitude of “I went through chemotherapy and my cancer is gone.  I shouldn’t complain about nerve pain.  I should just be thankful to be alive”.

What they need to know is that they don’t always have to just live with sleeplessness, pain, and balance and walking issues secondary to their treatment. Your chiropractic practice, when specially trained and equipped can offer them hope for a more normal life without debilitating pain.  Yes, they survived cancer but they can beat their post-chemotherapy peripheral neuropathy, too. 2

Precise combinations of chiropractic, nutrition and often nerve stimulation are showing great promise in helping post-chemotherapy peripheral neuropathy patients return to a pain free life, without the debilitating effects of neuropathy.

Serving this courageous patient population can be incredibly rewarding. But it is a subspecialty that takes some study and time to learn.

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



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

Marketing the Specialty Medical Practice – Part 3

When it comes to marketing your specialty medical practice, it’s easy to overlook a treasure trove of new business that is right before your eyes:

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.

Marketing the Specialty Medical Practice – Part 2

When devising the marketing plan for your specialty medical practice, whether it’s chiropractic, physical therapy, pain management, whatever your specialty happens to be, always remember that the most important point to get across is…

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…

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?”

Marketing the Specialty Medical Practice – Part 1

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.

Stay tuned for more tips on growing your specialty practice and living and practicing by design.

Harnessing the Power of Private Practice Email – Part 2

You can also use the power of email for:

1. Sharing Good News

When you have a patient with a particularly outstanding outcome, ask them for a testimonial and if they are willing to let you share their results with other patients.  Few things will ever build confidence in your practice faster than the timeless patient testimonial.  If you don’t want to send an email every time you have a great outcome, include them as part of a monthly newsletter to patients. These should ultimately end up on your blog and website too!

2. Special Events or Happenings

If you’re going to be speaking at a particular event or you’re being recognized by your peers for a particular achievement, let your patients know about it.  Everyone likes to know that they’ve chosen well in choosing their medical practitioner.  If something exciting is going on with your practice, include your patients on the list of “who needs to know”.

And, if your practice is growing and you’ve added staff or even an additional location, make sure your patients get an email about it.  Your new place may be more convenient for them or, better yet, more convenient for the new patients they refer to you.

Next time, we’ll give you two more final suggestions for creative ways to stay in touch with your patients.

Communication is the Key to Growing Your Practice – Part 2

When we think of communication, we think of the positive side of a good “bedside manner”.  But there are some serious  consequences of failing to communicate with patients as well.

Poor Communication Can Destroy The Doctor/Patient Relationship

On the other hand, if you communicate poorly with your patients (i.e., lecture instead of listen, fail to explain the treatment program in a way that your patient can understand, don’t address patient concerns openly, etc.), the doctor/patient relationship may suffer irreparable damage.  You don’t get more than one chance to truly build trust with your patients.

Design your client communications with the end result of open dialogue and mutual trust in mind.  Approach your patients like you would any partnership, with respect, commitment and make sure you stay on the same page with the end result of treatment foremost in both your minds.

What Drives Your Practice? Part 2

Turning Obstacles Into Opportunities

Knowing the purpose of your practice allows you to see the larger picture and meet obstacles head on and plan for a successful resolution to problems.  Every practice, regardless of size, location or specialty, faces obstacles.

Do any of these potential problems sound familiar?

  • Funding
  • Staying ahead of competition from other physicians and specialties
  • Planned growth and expansion
  • Managing patient outcomes and measuring success of treatment

Once you’ve determined your overall purpose and goals, you become more of a “big picture thinker” – anticipating problems and planning solutions before they occur.  If you know where you’re going, you have a better idea of how to get there.

Having a clear picture of your purpose allows you to do your homework and take appropriate action when opportunities present themselves.  You don’t circle the drain, studying the problem, asking for more information and letting opportunities pass you by while you “think about it”.

More Chronic Care Caveats

More Chronic Care Caveats

Your patients have been through a lot. In fact, unless you or a loved one have been through a protracted illness, it can be difficult to imagine. This is where compassionate care can really help recovery.

They want to finally be free from pain. Not just medicate it away! If there are good treatments and physical modalities that help, explain the hows and whys, use good tools, and make sure your staff knows all about these too, so they become educated ambassadors of health!

They want their lives back! Yes! This is key to not only getting results, but also to getting to the heart of lifestyle problems such as obesity and immobility and poor fitness levels.

But they must completely understand the process, game plan, and their responsibilities in recovery.

Broad Skills Development are Keys to Success in practice

You must take control, fully assess their intentions from the outset, and involve yourself completely in their treatment.

And then watch your referrals and practice revenues growing every week.

It’s a win for everyone involved.

Secrets of Treating Patients With Multiple Health Issues – Part 3

Today, we’ll talk about the third and final piece of the treatment of multiple health issues puzzle – making sure your patients understand what to expect in their treatment and what the process entails.

Third – Explain The Healing Process

Take it for granted that no one before you has really explained the physical causes of their pain and/or loss of sensation.  At least not in a way they could understand.  All they know is that they’re in pain.

Neuropathy and chronic pain patients very often don’t understand their suffering because nobody ever took the time to explain the basics. And this is even more true for patients having been treated in large institutions!

For example, we suggest that you use multimedia tools. I’ll very often use simple diagrams aided by powerful interactive software to demonstrate that nerve cells being deprived of oxygen causes them to shrink, widening the synaptic junction between the nerves and preventing the impulses from reaching from one nerve to the next.

Break it down into terms they can understand.  Picture a motorcycle trying to jump from one side of the Grand Canyon to the other.  There is virtually no way it will make it to the other side.  That’s the same with nerve impulses trying to reach from one nerve to the next when the synaptic junction is enlarged.  Tell your patient that effective chronic pain care may help restore neurologic function, even where other systems have failed.  Often times you can explain to them that your treatments are like building a bridge back across the Canyon. And that like a bridge under construction, this is not going to happen overnight.

The Final Caveat

Trust and Empathy Helps Patients Get Better Faster

Your patients have been through a lot.

They want to finally be free from pain.

They want their life back!

But they must completely understand the process, game plan, and their responsibilities in recovery.

You must take control, fully assess their intentions from the outset, and involve yourself completely in their treatment.

And then watch your referrals and practice revenues growing every week.

It’s a win for everyone involved.

Secrets of Effectively Helping Patients with Multiple Health Issues – Part 2

In our last post we talked about treating patients burdened with the following symptoms following a major health issue, surgical procedure or chemotherapy:

Pain that is unmanageable, despite medications.

Loss of normal mobility., and inability to do even basic daily functions

Disability, as well as the financial and emotional strain that results.

Once you’ve done a thorough patient intake and discussed planned outcomes, you can move to phase 2 of treatment:

Address Any Underlying Metabolic Issues

Work with your patient’s other physicians and talk to the patient about any other underlying medical conditions they have.  Eliminate all other possible causes as much as possible. Get a thorough history and physical.  Chances are very good that they’ve been through a battery of tests with their regular treating physician.  If that’s the case, simply ask for the results.  If the results are current, you can save your patient a lot of time, money and frustration by not putting them through tests they’ve already had.

The Most Powerful Marketing Piece Ever (Part 2)

Now, I am giving you a whole new reason to disconnect, and kick up your heels! Regularly.

It will help you build an enormous practice! Why? Because you can use your play to market yourself while feeling more rested, creative and inspired to be your very best.

Yes, that’s right! Especially now a days while it’s so easy to create media. Flip Cams, iphones, you name it.
This recently was reinforced in my practice when I sent out a reminder card to patients. I uploaded an image of me sitting on my motorcycle with a caption “Time to ride on in?”

"Time to Ride on In?

Patients loved it, and it was one of the most effective recall pieces I have recently done. And I have lots of fun photos of my adventures and likes around the office for them to see too.

Here is a strategy any practice owner can use. Do this right, your practice grows, as does your wealth account.

Step 1-
Make sure your practice is set up around your life, NOT the other way around! What do you like to do outside of practice? Where do you want to live, travel to or experience? If it’s been a while since you’ve done this, take your time, and be honest with yourself. Be sure to write or dictate all of this.

Step 2-
Start recording snippets of your adventures in media- a smart phone (iphone) is idea because you can take decent photos, video, heck even record great conversational sound bites. Of course, its even better with a good camera and an HD cameral like the FlipHD.

Be sure to keep these devices with you all the time. Some of my best marketing pieces and images have come from weekend ski or motorcycle adventures, and of course my vacations. The more impromptu the picture or video the better.

Next, Make storage and organization of your files easy. That’s why I am very partial to the Mac products like imovie, and iphoto.

Step 3-
be sure to use this material creatively. Put photos in your office news, flyers and especially on the web. This is why Facebook and other social media can be so powerful. It helps make you a real person.

Step 4-
Get some help. Too often, there is no solid marketing strategy, steps to follow or calendar for team members to focus on.
You’ll do far better to have a staff person help you with the implementation, but you’ve got to have a strategic plan they can follow. This is one of the very first things we teach in our Platinum sessions.

Step 5-
carve out regular time to make sure you are living your dreams, and your practice is supporting it! This is crucial. It’s also
why administrative and creative time must be on YOUR checklist, every week, and if you really want to accelerate your personal growth, every day!

Living and Practicing by Design

This is living and practicing by design, not default (which gets stressful and ugly quickly).
Remember, we are here to support you with the personal coaching, systems and tools that help you create the practice (and thus life) of your dreams!

For a FREE Downloadable version of my 5 star Amazon Book, “Living and Practicing by Design-Saving the Hearts that Care for Our Lives”,

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