Don’t Make Private Practice Harder Than it Needs to Be

But don’t mistake the title either. Those of us who’ve been in private practice for a longer time understand the numerous challenges we face every day.


Furthermore, the sheer amount of challenges and personal responsibility needed to be truly effective and profitable has risen dramatically in the last 10 years.

Now, not all this is bad!

Certainly things like patient privacy and advances in EMR, which are too often burdensome to implement can interfere with overall “quality” of health care.

Without essential systems we tend to spend more time on these tasks rather than hands-on time with our patients.

All of this can become an interference with your chief goal, which as the CEO should be first and foremost to ensure excellence in care and adequate in-patient time.

But you must also set aside and engage in continuous private practice expansion, profitability, and serving the needs of your community.

The real reason too many find private practice difficult is the sheer lack of organized and focused business plans.

You know what? It’s not your fault.

This is simply because most of us do not have any training or backgrounds in the business of private practice.

And in today’s private practice, this hurts substantially.

The fact of the matter is now more than ever, maintaining profitability and growth in private practice demands a higher skill set and entrepreneurial vision.

This also requires taking care of each and every facet necessary. For example; basic compliance is a project in and of itself.

Staffing is another huge issue which far too many have little or no experience or training in.

The good news is all of these skills are learnable.

But you must remain teachable and seek out proper systems and guidance.

But most of all you need to carve out a unique place for your private practice, to ensure future prosperity of yourself and your family.

Let us help! Join us on Facebook !

It’s Monday Morning—What’s Your Game Plan In Practice?

What likely separates any private practice owner from ultra success is a fully developed game plan!

Traditionally, a lot of Monday morning quarterbacking and speculation goes on surrounding fall sporting events. Why did some coach do this, what if this player did that, and so on.

doctor holding glassesMonday also is the day that pro athletes watch their video performances from the weekend. Literally, they fail their way to success. Yes, that’s right—they are not afraid to make mistakes and continuously learn by them. The more valuable and achieved the player, the more mistakes they make.

Often, you don’t see them, because only their wins are highlighted. The fact of the matter is that winners in any game or business are IN the game more. When you play more, not only do your failures increase, but your wins increase to a greater extent!

This is a numbers game, which great businesses and sports fully realize. The numbers get better with better quality game plans.

Watch the greats in any sport profession, and the rules are basically the same. If you think about championship teams, they’re always working on their game plans.

Any great game plan includes contingencies, training and coaching systems, marketing, fan-based activities, and rules for expansion!

Your private practice really is no different.

But what likely separates any private practice owner from ultra success is a fully developed game plan worked out with coaches who have experience in the game—the ability to work, and move gracefully on the sidelines.

This is one of the most important, often ignored, key tickets of success. And make no mistake it is a ticket, with a price.

In fact, my coaches have a lot more experience and make a lot more money than I do. For the time being, anyways. This is deliberate. It’s part of Living and Practicing by Design™.

You see, I don’t take advice from people who are less successful than I—I go straight to the top.

Napoleon Hill called this gaining “specialized knowledge”.

And it has always served me extraordinarily well as my private practice game plans become more and more elaborate.

How about YOU? Got “Specialized Knowledge”?

Join the conversation on Facebook!

Where are YOUR Patients Getting Their Health Information?

Understand that in private practice one of your biggest jobs is to be a resource.

Like it or not, the vast majority of patients who visit you in private practice expect you to be an authority. They expect you to be an expert on a vast array of topics regarding their health.

In this day and age, this is one of the reasons that patients are willing to pay out-of-pocket for Hands Typing on a Keyboardhealthcare advice and treatment.

This of course, is one of the reasons that some find private practice so difficult and challenging. It is not for the faint of heart because, in private practice, there is no “authority” or board of directors to hide behind. Indeed, for those in health care, like in other segments of society, the barrage of regulatory BS grows every day.

It makes no difference what your chosen profession is. You see, as the third-party system undergoes a literal implosion, society is sicker than ever, and demanding answers. (If you doubt me on this, look at the significant challenges to Obamacare raised by many states.)

But for those in private practice who position themselves properly, this is a grand opportunity. In reality, this is a very pioneering time to be in private practice!

No longer can any private practice owner ignore these facts. So what is the astute practice owner to do?

Well, for starters, understand that in private practice one of your biggest jobs is to be a resource.

More than that, you need to be the patient’s chief healthcare options educator.

The good news, it is not necessary to do this all by yourself.

There are significant resources that are available—including ours—which help you communicate to your patients on a regular basis about a wide variety of health care issues.

This is exactly why our web and social media presence has grown so much. In all our client offices, their patients subscribe to our published health-related materials every day.

This is having a tremendous impact as we now take many calls, emails, and notes every week from these patients.

This is, in fact, one of the biggest reasons that private practice owners employ our services.

Because trying to do this all by yourself can be a nightmare! We are here to help serve you when you are ready.

Join the conversation with clients and patients alike on Beating Neuropathy!

This is REAL Health Care Reform!

My work with peripheral neuropathy patients and incredible powerful social media communications with them has taken some very interesting twists and turns lately…

This has all caused me to take a real hard look at what really reforming health care should mean.

Take for example, the following communications I have received from patients in some on-line forums.

“In order for this to be an option in a state where you don’t have doctors trained in this, am I understanding that I would have to have my doctor talk with Dr. Hayes and co-ordinate therapy that way? Also, my neuropathies have been diagnosed as idiopathic peripheral neuropathy but are probably genetic as mom has same issue…I am on a plethora of meds and yet am wheelchair bound when out for any length of time because of the pain. Also, have had the Dellon Procedure with no help. Would appreciate any info you could offer….”

“I suffer from neuropathic pain in my feet and legs from a spinal cord tumor. Everything I read talks about peripheral Neuropathy from diabetes. I wondering if their are different kinds of neuropathy? And what kind I have to determine what kind of treatment I should look for. Anything will be helpful…”

Success and healing are both so formulaic…

“Hi all, I Live in …, 5 Years ago I was told to suffer about a Neuropathy, I feel pain on my face and my teeth…It’s like to have my face completely blocked..Anyone else has some symptoms as me?? ..I tried Gabapentin, Patiox, Laryxol ,and now I’m trying with Cimbalta …but without result. Thinking to stop taking pills. Any suggestions?
My neurologist always tells me my bloody values are ok..but still suffering..
Thanks for any help you can give me and sorry for my bad English…Hope someone understood…”

These are but a few of the communications I now receive daily from around the world.

I do my best to answer all of these inquires, mostly by messaging, though more and more patients from around the world are reaching out with phone calls about our work.


And these comments are only on one condition I have had the opportunity to share with doctors and patients during the last year.

Nonetheless a few months back, this really got me thinking.

What do patients really need from their doctors, nurses and physical therapists?

And I can tell you, more than anything else just a simple human connection.

The ability to ask questions. The ability to engage in meaningful conversations. The ability to have a frank discussion about treatment options, and when less treatment is better, the very best things they can do at home to help themselves recover.
Interestingly, when questions are answered, in my experience and I’m sure yours as well, the utilization of more expensive procedures can be reduced and sometimes eliminated.

All because the basic human need of being heard is met.

However, there is little if anything in the current system, which fosters, let alone allows enough of this very basic doctor-patient communication.

In many cases, it seems extended consultations with our patients are becoming a lost art. This is one reason many patients are increasingly turning to the Internet for their answers.
So, what can you do?  I would suggest you start by making your practice, more powerful and effective in its communication with the outside world. Really go to great lengths to educate your patients in the community, through modern tools.  Like content rich and friendly Social Media. Like Instant Patient Newsletter.

Offer services like telephone and e-mail Consultation services. And yes, in most cases you should be charging for these.

Because, in reality, it is these conversations which often lead both doctors and patients to the greatest treatment breakthroughs.

Videoconferencing and telemedicine are another very real option. Instant messaging is another very powerful tool, which currently is under utilized.

And what about converting your traditional education materials such as in office workshops to on-line events. If they are good, patients will readily share these with their friends and families. From one computer and cell phone to another!

All in the comfort of their home, or even anywhere else they choose.

Doctor, in my opinion this is a real healthcare reform.  It has enormous benefits to you, your patients and community but only if you take the steps to learn and start implementing all these modern tools in your practice.

Really strive to make practice more user-friendly.

Go out of your way; use those little human touches combined with significant doses of effective multimedia technology.

And you’ll likely never have to worry about keeping your reception area filled.

John (:

When you ready to step up and learn to help these patients, just go HERE


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!

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!



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


Helping Patients with Alcohol Induced Neuropathy

One of the most serious—but rarely discussed—conditions resulting from extended alcoholism is alcoholic neuropathy.  One of the reasons for its relative obscurity in the public discourse, aside from difficulties inherent in any discussion of substance abuse, is that much of the empirical evidence linking neuropathy and alcoholism is somewhat vague.  Still, there is ample correlation to assume a causal link.

Alcoholic neuropathy presents in patients similarly to other forms of neuropathy, with tingling and numbness in the extremities, loss of heat and cold sensation, loss of fine motor control, impotence in men, and so on.  All this is accompanied by the chronic pain typical in cases of peripheral neuropathy.  Because of the areas of the mind and body targeted by the alcohol, it is common for alcoholic neuropathy patients to exhibit outward signs of intoxication even when sober, such as slurred speech, stumbling gait, and clumsiness.  The American Journal of Clinical Nutrition says that, in severely affected patients, the legs and hands may be nearly useless to the point of paralysis and sensation may be entirely absent in extremities.  In these cases, the skin can also be dry and atrophic.

The specific causes of alcoholic neuropathy are difficult to pin down, and thus, the case can be tricky to diagnose.  If a patient has a known history of alcohol abuse, that is, of course, a good place to start.  Generally, a pattern of heavy alcohol use for a period of ten years or more will be accompanied by neuropathy symptoms.  A leading theory contends that the cause of alcohol-related neuropathy may be the combined effect of direct nerve-poisoning by the alcohol itself, coupled with the long-term poor nutrition that often accompanies alcohol abuse.  Alcoholics typically exhibit erratic eating habits, resulting in poor overall nutrient intake, and the damage to organs reduces the absorption of nutrients from food.  Of course, difficulty in motor control resultant from neuropathy often exacerbates the malnutrition, as the patient becomes socially uneasy about mealtimes and self-conscious about feeding themselves.

Nerve damage from alcoholism is usually permanent.  The first order of business in treating patients with alcoholic neuropathy is to bring the drinking and nutrition problems under control.  If alcohol consumption is not severely limited and adequate nourishment is not supplied, additional treatments will be futile and symptoms will almost invariably compound. Beyond this, treatment seeks three main goals:

  • To control symptoms
  • To maximize and restore function (quality of life)

    Alcoholic Neuropathy requires extraordinary measures to slow or treat…

  • To prevent further injury to the patient due to neuropathic vulnerabilities

Most treatments address these three tenets simultaneously.  Pharmaceutical treatments include the use of painkillers, either prescription strength or over-the-counter (such as analgesics).  When treating patients with alcoholic neuropathy, it is advisable to recommend the lightest use of pain medication possible, as the patient in question is by definition susceptible to habitual substance abuse.  Be sure to monitor use of any medications very carefully.

Because of the underlying nutritional deficit usually at the root of alcoholic neuropathy, some patients may benefit from a system of nutritional supplements.  A dietician or other qualified staff person in your office should be consulted to ensure the proper replenishment of nutrients necessary to prevent the spread of neuropathic symptoms.  Parenteral multivitamins are also useful in many cases to assist nutrition.

Several new lifestyle habits can help patients adjust to living with alcoholic neuropathy, such as carefully monitoring the temperature of bathwater to prevent burning, inspecting themselves and their clothing and footwear for points of rubbing or wear on the skin, and so forth.  In alcoholics, the establishment of these habits (which are themselves advisable for all neuropathy patients) can be instrumental in the replacement of the undesirable dependency that caused the problem.

Although nerve damage is usually permanent, the prognosis for sufferers of alcohol-related neuropathy can be very good if the alcoholic successfully refrains from indulging the dependency and works to replenish nutrition.  It is important to emphasize to patients that substantial recovery from degenerating neuropathic symptoms will not be seen for a period of several months.  Of course, subjective improvements in lifestyle and health will begin almost immediately when abstaining from an alcohol dependency as a result of general detoxification.

If you have patients you believe could be suffering from alcoholic neuropathy, we are here to help you determine for certain how best to proceed!

Contact NeuropathyDR® and we can give you even more information about how to help your patients suffering from alcohol abuse-related neuropathic symptoms.




How To Reassure Patients with Severe Symptoms

If your patients are presenting with tingling, numbness, burning sensations, or motor function issues, they may be suffering from peripheral neuropathy.  Neuropathy can be tricky to diagnose, but becoming as informed as possible about its symptoms, treatments, and which of your patients are the most susceptible will equip you to effectively recognize this painful and often dangerous condition.

The main symptoms of peripheral neuropathy with which you and your patients should be familiar are:

  • Shooting pain or burning sensations
  • Weakness or loss of dexterity in the arms and legs

    Falls Due To Sensory Impairments are Frightening...

  • Tingling and numbness, especially in the extremities
  • Loss of fine motor control (dropping things frequently becomes an issue)
  • False sensory signals (reduced ability to sense temperature, sensations of being touched or wearing gloves, hats, or stockings when they are not

Other symptoms can also occur, of course, resultant from the above: sleep deprivation, restlessness, inability to sit still, irritability and nervousness, and so on.

So many groups are at-risk for neuropathy, it is practically guaranteed that learning to identify, diagnose, and even treat the condition will be a valuable asset to your practice and to the lives of your patients.  Spotting neuropathy early in a patient can mean the difference between debilitation and a comparatively normal life!

Some of the most common causes of neuropathy include (this is a partial list!):

  • Diabetes
  • Chemotherapy (increasingly over the past few decades, as cancer treatments become more and more effective)
  • Kidney disorders
  • HIV
  • Nerve damage from injury or surgery
  • Shingles
  • Genetic diseases such as Ataxia, or even hereditary neuropathy

Discussing Neuropathy with your patients can be challenging.  Start by making certain your patient understands whatever underlying cause is behind the neuropathy (diabetes, for example, is the most common).  Explain the symptoms of neuropathy, and encourage the patient to identify any they may be suffering, even intermittently.  Don’t forget to reassure them that, while there is no miracle cure for neuropathy, it is both common and very treatable in terms of pain.  Also, be certain to emphasize the importance of monitoring their condition for signs of further degeneration or additional symptoms (as these could be signs of dangerous progression).

Medical Treatment options for neuropathy vary widely, and are rapidly changing with technology and as we learn more about the condition. Some studies recommend non-steroid painkillers such as Motrin or Aleve for mild cases of pain, whereas cases involving more pain usually require prescription  pain reducers containing morphine or similar.  Surgical treatments also utilize implants.  Of Course external therapeutic devices should always be applied by the most qualified neuropathy treatment specialists.

Where your patient’s neuropathy is resultant from chronic or persistent illness, management of that underlying illness is, of course the priority.  Proper control of diabetes, appropriate physical therapy after an injury or surgery, or treatment of other relevant conditions will, in almost all cases, help to minimize neuropathic injuries.

Patients suffering from neuropathy are already familiar with its discomfort, and inconvenience to their lives.  It is important for you both to realize that many types of neuropathy can also be very dangerous, even life-threatening.  It is not uncommon for neuropathy to be degenerative and, if left unmonitored or untreated, it can cause intestinal blockages or complications in the function of bodily organs.  Needless to say, take no chances!

While there’s no cure for neuropathy, there is plenty you can do to help your patients enjoy healthier, full lives while living with the condition.  Early intervention with a NeuropathyDR® clinician is the best route; we put at your disposal all the resources you will need to effectively treat and advise your neuropathy patients.

For more tips on your patients or growing your specific practice, contact us at


Click ON AIR to Listen To Our Radio Show 730PM EST Every Sunday

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

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



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







Helping Patients with Acute Kidney Failure

Most people think that acute kidney failure would present with symptoms too obvious to ignore.

They expect to be bedridden…deathly ill…in and out of the hospital…

What they don’t realize is that acute kidney failure often doesn’t cause noticeable symptoms.  Many times it’s detected when the patient is already in the hospital for something else and evidence is found through tests.

As a clinician, especially a NeuropathyDR® clinician specializing in treating patients with neuropathy, that makes your job especially tough in reaching out to these patients and getting them in for treatment before it’s too late and permanent damage is done.

Most of the time, you won’t see these patients until they have[1]

∙           Swelling, especially in the legs and feet

∙           Cramps, muscle twitching or muscle weakness

∙           Little or no urine output

∙           Thirst and a dry mouth

∙           Dizziness

∙           Rapid heart rate

∙           Nausea, vomiting and loss of appetite

∙           Confusion

∙           Anxiety or restlessness

∙           Pain on one side of the back just below the rib cage but above the waist

∙           Fatigue

These are all symptoms of acute kidney failure.  And the root cause of many of these symptoms is a serious complication of kidney failure – uremic neuropathy.  Uremic neuropathy or neuropathy associated with kidney failure is a very common complication of kidney failure.

The sad thing is that by the time they’re exhibiting several of these symptoms, their uremic neuropathy may have already done serious damage to their body.  If you have patients with conditions like lupus, diabetes or hepatic (liver) failure, they’re especially prone to acute kidney failure and uremic neuropathy.  Your best bet to treat them effectively and keep them off dialysis and off the transplant list is to educate them.  The more they know about the possibility of developing uremic neuropathy from acute kidney failure, the more likely they’ll be to show up in your office for help before they have irreversible problems.

First, explain uremic neuropathy…

What Is Uremic Neuropathy[2]?

Uremic neuropathy is a type of neuropathy caused by an increase in uremic toxins in the blood (the toxins urine usually removed from the body when the kidneys function properly.) The severity of their uremic neuropathy is directly linked to the severity of their kidney failure.  If their kidney failure is acute, their uremic neuropathy is pretty serious.

How Can Kidney Failure Lead to Neuropathy?

Neuropathy is one of the worst results of chronic kidney disease.  Acute kidney failure damages the kidneys.  When the kidneys are damaged fluids, waste products and toxins build up in the body.   Because many organs and bodily systems (particularly the nervous system) are directly affected by this build up of toxins, acute kidney failure leads to overall poor health and inflammation and nerve damage.

Once the nerves are damaged, they cease to function properly.  One complication leads to another and, in 20% to 50% of patients with acute kidney failure, they’ll develop uremic neuropathy.

Treatment and Prognosis

Your patient’s best course of action is to catch their kidney issues before they become acute and they develop uremic neuropathy.  Unfortunately, once the kidneys are that severely damaged, dialysis and possible kidney transplant are virtually inevitable.

That’s why you need to impress upon your patients how vitally important it is that they not ignore symptoms and that they seek treatment immediately once they notice a problem.  Acute kidney failure and uremic neuropathy are not conditions that just get better on their own.

As a NeuropathyDR® clinician you have a wonderful protocol to assist you in working with your patients and their whole medical team to treat and manage your underlying condition before they become acute.

Some programs you can offer your patients are:

∙           Diet Planning and Nutritional Support

They need to give their bodies the nutrition they need to heal.

A low protein diet is best for patients with kidney disease.

If your patient has diabetes, they need to follow a diet specifically designed for diabetics and to control their blood sugar.

∙          Individually Designed Exercise Programs

If your patient is experiencing dizziness, rapid heart rate, extreme thirst or issues with impaired sensation in their feet and legs, they have to be very careful with their exercise program.  You can design an exercise program specifically for them that will allow them to exercise but not push them beyond what their body is capable of.  And, even more importantly, continually monitor their progress and adjust the program as needed.

These changes in conjunction with medications and possibly more involved medical intervention will make it easier to live with acute kidney failure and uremic neuropathy. Early intervention with a NeuropathyDR® clinician is still the best policy if they have any of the underlying conditions that can cause uremic neuropathy.  If they already have symptoms, start treatment immediately.

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








Caring for Patients With Sexually Transmitted Diseases and Peripheral Neuropathy

The peripheral neuropathy patient population is growing.

That’s understandable when you look at the increase in

•      Diabetes

•      Cancer

•      Autoimmune diseases like lupus, Guillain-Barre’ Syndrome

But there is another fast growing peripheral neuropathy patient population that often goes unnoticed.

Patients with sexually transmitted diseases or STD’s[1] such as:

•     HIV/AIDS

•     Genital Herpes (or any one of the large number of herpes-simplex viruses)

•     Gonorrhea

•     Syphilis

•     Chlamydia

•     Hepatitis B and D

•     HPV (Human papillomavirus infection)

Or some combination of these diseases.

These patients can be some of your most challenging.  Many are reluctant to discuss or even acknowledge that they have an STD.  By the time they’ve developed symptoms of peripheral neuropathy and seek treatment from a specialist in treating neuropathy, they could be facing serious nerve damage.

You could be playing beat the clock to head off permanent damage.  Your first order of business is to educate them on peripheral neuropathy, how they developed it and what they need to do to help themselves.

Explaining How Their STD Caused Peripheral Neuropathy

Many sexually transmitted diseases are caused by viruses or bacteria[2].  Viruses and bacteria can attack nerve tissue and severely damage sensory nerves. If those nerves are damaged, your patient is going to feel the pain, quickly.

The virus that causes HIV, in particular, can cause extensive damage to the peripheral nerves.  Often, the progression of the disease can actually be tracked according to the specific type of neuropathy the patient develops.  Painful polyneuropathy affecting the feet and hands can be one of first clinical signs of HIV infection.

Any of these viruses or bacteria can cause nerve damage and the resulting peripheral neuropathy.  Many patients understand the more common symptoms of their illness but they don’t understand why they would have nerve damage.  Once they understand exactly why they’re having

•     Muscle weakness

•     Muscle cramps

•     Inability to feel sensation

•     Numbness or tingling

•     Burning

•     Loss of reflexes

•     Blood pressure problems

•     Sweating too much or too little

•     Heart rate issues and inability to feel chest pain

•     Bladder control issues

•     Diarrhea or constipation

•     Difficulty swallowing because your esophagus doesn’t function properly

•     Bloating

•     Erectile dysfunction

•     Heart burn

•     Inability to feel sensation in your hands and feet

They will better understand why you’re recommending the treatment your recommending.  Chances are that when they were diagnosed with a sexually transmitted disease, they understood how it would affect their sex life and the more intimate aspects of their lives.  They had no idea that their STD could cause serious nerve damage as well.  Understanding exactly how these illnesses can cause peripheral neuropathy and serious nerve damage will make for a much more compliant patient.

The Best Course of Treatment

If your patient presents with any of these diseases and they’ve developed peripheral neuropathy, start treatment immediately.  The earlier you start treatment, the less likely they will be to develop permanent nerve damage.  Your NeuropathyDR® protocol offers one of the best chances these patients have for minimizing or even avoiding permanent nerve damage from peripheral neuropathy.

In addition to the NeuropathyDR® protocol and specific drug therapies designed for the particular condition, you also need to work with your patient on lifestyle issues.  Specifically,

•     Getting plenty of rest

•     Pacing themselves and limiting their activities

•     Exercising  regularly – walking, swimming and yoga are great exercises for neuropathy patients

•     Take care of their skin and limiting exposure to the sun

•     Quitting smoking

•     Eating a healthy, well balanced diet

•     Keeping high blood pressure under control

•     Always practicing safe sex to protect their partners and themselves

As a NeuropathyDR® clinician you can offer these patients the best chance possible for avoiding permanent nerve damage from their sexually transmitted disease.

Once you’re trained in the NeuropathyDR® treatment protocol and ready serve this challenging and fast growing patient population, let us help you reach 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




Good Foot Care – Keeping Your Diabetic Neuropathy Patients Healthy

Help Diabetics with Better Care


Diabetes is one of the fastest growing illnesses in America.

That means that if you don’t currently have patients with diabetes (unlikely, but possible), you will soon.

And that means you’re going to be treating patients with diabetic neuropathy, particularly in their feet.  According to the American Diabetes Association, one in five diabetes patients end up in the hospital with foot problems.  All too often those foot problems lead to amputation or raging systemic infections.

The best way to prevent these problems in your diabetic neuropathy patients is by educating them on how important it is to take care of their feet and to intervene as early as possible when they do develop problems.  Determine the extent of your diabetic neuropathy patient’s problems and then educate them on proper foot and diabetes care.

Step One  – The Thorough Foot Examination[1]

If you have patients with diabetic neuropathy, even if they don’t present with foot issues, you need to be proactive as their physician and ensure that you see them at least once a year for a complete foot examination.

When you’re examining their feet, make sure you:

•         Examine each foot between the toes and from toe to heel.  Make extensive notes in the chart of any problems by drawing or labeling the finding on the foot diagram.   If your patient has skin that is thin, fragile, shiny and hairless, they could have problems with their circulation and that means possible nerve damage.

•         Ask the patient if they’ve noticed any change in how their feet sweat.  If their feet don’t sweat as they normally would they can develop dry, cracked skin and those cracks can become infected.

•         If your patient is wearing nail polish, take it off.  Check for ingrown toenails, deformed nails or any type of nail fungus.

•         Make notes on the diagram and in the chart of any areas on the feet that are noticeably dry, red or warm to the touch.

Step Two  – Patient Education

In order to prevent serious problems, your diabetic neuropathy patients need to know how to care for their feet and what to watch for so they can come in to see you before they reach a point  of no return.

They need to:

•         Check their feet every day.  Look at their bare feet to make sure they don’t have any sores, blisters, or swelling.  If they can’t see the bottoms of their feet, they should use a mirror or ask someone else to check them.

•         Wash their feet every day and dry them completely to eliminate the possibility of fungus growth.

•         Use a good lotion on their feet to keep skin smooth and prevent dry, cracked skin.  Don’t use lotion between the toes – it will keep the skin there too moist and that breeds bacteria.

•         Trim their toenails but not too short.  Cut them straight across and file the edges with a nail file to prevent ingrown toenails.

•         Always wear shoes and socks – even inside the house.  If they have neuropathy, it’s just too easy to step on something and injure their feet without even feeling it.

•         Wear comfortable shoes, preferable shoes designed for people with diabetic neuropathy in their feet.  Check their shoes before they put them on and make sure the lining is intact and smooth and that nothing is in their shoes.  Talk to them about Medicare assistance with purchasing special shoes.

•         Never put their feet in hot water.  Always check the temperature of their bath water with the elbow before stepping into it.

•         Never use hot water bottles or heating pads on their feet.  Neuropathy makes it harder to sense extreme temperatures and they can burn their feet without even knowing it.

•         When sitting down, they should prop their feet up to keep the blood circulating.  Move the toes and ankles to keep the blood pumping.

•         Never cross their legs when sitting.

Don’t just tell them what they need to do and take it for granted that they understand what you’re telling them.  Ask your patient to demonstrate the steps to proper foot care so you know they know what you’re saying and that they are physically capable of doing what you’re telling them to do.

Offer your diabetic neuropathy patients an ongoing monitoring and follow up program.  Keep in touch and watch for any of the symptoms of diabetic neuropathy in the feet.   Diabetic neuropathy impairs the ability to feel pain in the extremities and they may not notice the problem until it’s too late for successful treatment.  It never hurts to have a fresh pair of eyes (yours) keeping watch over them.

When you’re trained and ready to treat them, let us help you reach 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


Private Practice “Valuenomics” and My Neuropathy/RSD Patients


Private Practice “Valuenomics” and My Neuropathy/RSD Patients

Whats Your Valunomics Like?

I’ve had a lot of fun in the clinic this week, taken in several very interesting new patients. Tough, chronic neuropathy cases and a very unique RSD Case.

The RSD is another patient who experienced miraculous relief after 1 session. But more on the clinical stuff another time. Funny thing is, I have not run an active ad for about a month, but instead continue to trickle market (with Instant Patient Newsletter and snail mail) as I teach my clients.So, this morning while doing mid-year financial planning, I’m running some numbers.

Here’s the deal: If I followed “guru” practice building advice, I’d have to treat one typical musculoskeletal patient 75 times (!) to net what just ONE of these cases has netted the practice already.

My wonderful new patients this week are largely pre-paid, always with a grateful smile, no bitching about insurance-co-pays or referrals.

And NEVER question my fees that as a specialist easily command more. Because they get their LIVES back!

HMMM, why would anyone choose to practice like the “gurus” still preach? No wonder we have “issues”.

If you are serious about your future, then carefully carve out YOUR ND Specialty area before a competitor does.

I’m here to help you do that!


Hope for Your Patients With Infectious Diseases


What can you do for your patients with infectious diseases?

They’re miserable and their misery is understandable.

Look at what they’re dealing with[1]:

•     Extreme fatigue

•     Headaches

•     Painful, swollen joints

•     Anemia

•     Fever and chills

•     Swelling in your feet, legs or hands

•     Pleurisy

•     Rashes

•     Hair loss

If they have lupus, Lyme Disease[2], Varicella Zoster (aka Shingles), HIV/AIDS, Legionnaire’s Disease or any other infectious disease caused by a virus or bacteria, these symptoms can be just the beginning of their problems.

If they’ve delayed treatment, the next problem they could be faced with is

peripheral neuropathy and everything that comes with it.  Other than getting busy treating them to avoid peripheral neuropathy and nerve damage, one of the first things you need to do is educate your patient.

Explaining How Their Illness Can Cause Peripheral Neuropathy

Many infectious diseases are caused by viruses or bacteria.  Viruses and bacteria can attack nerve tissue and severely damage sensory nerves. If those nerves are damaged, your patient is going to feel the pain, quickly.

The virus that causes HIV, in particular, can cause extensive damage to the peripheral nerves.  Often, the progression of the disease can actually be tracked according to the specific type of neuropathy the patient develops.  Painful polyneuropathy affecting the feet and hands can be one of first clinical signs of HIV infection.

Any of these viral or bacterial disorders can cause indirect nerve damage and bring on conditions that we refer to as autoimmune disorders.  Autoimmune disorders cause the body’s immune system to go on the offensive and attack its own tissues.  These assaults by the body on the body damage the nerve’s protective covering.  Think of it as “internal friendly fire” – misdirected but potentially serious.

Many patients understand the more common symptoms of their illness but they don’t understand why they would have nerve damage.  Once they understand exactly why they’re having

•     Muscle weakness

•     Muscle cramps

•     Inability to feel sensation

•     Numbness or tingling

•     Burning

•     Loss of reflexes

•     Blood pressure problems

•     Sweating too much or too little

•     Heart rate issues and inability to feel chest pain

•     Bladder control issues

•     Diarrhea or constipation

•     Difficulty swallowing because your esophagus doesn’t function properly

•     Bloating

•     Heart burn

•     Inability to feel sensation in your hands and feet

They will better understand why you’re recommending the treatment your recommending.  Hearing that they have a virus or bacterial infection can be very misleading – they think all they need is medication and they’ll be fine.  Understanding exactly how these illnesses can cause peripheral neuropathy and nerve damage will make for a much more compliant patient.

The Best Course of Treatment

If your patient presents with any of these diseases, start treatment immediately.  The earlier you start treatment, the less likely they will be to develop peripheral neuropathy and nerve damage.  Your NeuropathyDR® protocol offers one of the best chances these patients have for minimizing or even avoiding nerve damage from peripheral neuropathy.

In addition to the NeuropathyDR® protocol and specific drug therapies designed for the particular condition, you also need to work with your patient on lifestyle issues.  Specifically,

•     Getting plenty of rest

•     Pacing themselves and limiting their activities

•     Exercising  regularly – walking, swimming and yoga are great exercises for neuropathy patients

•     Take care of their skin and limiting exposure to the sun

•     Quitting smoking

•     Eating a healthy, well balanced diet

•     Keeping high blood pressure under control

A Few Words To The Wise

Each of these conditions is very different and caused by different organisms.  For that reason, patients with different infectious diseases must be treated differently.  They’re nerve damage has resulted from different causes.

There are a few things to consider when treating these patients:

•     For female patients, it’s particularly important to be cautious about birth control.  Any of these infectious diseases can cause serious problems during pregnancy.

•     Make sure they receive vaccinations for flu and pneumonia to help prevent additional or secondary infections that could compromise their progress.

•     If they’ve been treated with corticosteroids for inflammation, make sure they are closely monitored for osteoporosis.

•     If your patient has lupus, make sure they receive regular eye exams.  Lupus can have an adverse effect on vision.

•     Lyme disease is on the rise so educate your patient population on the warning signs of infection – a tick bite followed by a bulls-eye shaped rash close to the bite site.

As a NeuropathyDR® clinician you can offer these patients the best chance possible for avoiding permanent nerve damage from their infectious disease.

Once you’re trained in the NeuropathyDR® treatment protocol and ready serve this challenging patient population, let us help you reach 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