Maximum Patient Benefit and Recovery- Patient Co-Treatment Plans

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.

The More Patients Do To Help Recover, The Smoother Your Clinic Runs

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.

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. learn way more at


Why a Specialty Practice in Todays World?

Make no mistake about it, businesses are being challenged to their core right now.

But, the reality is in a down economy you can OWN your market! Why? Because of how many businesses (practices) pull back, fail to market or maintain contact with people who likely could be customers for life!

I see this as a private practice consultant every day. Those who do all the right things in private health care right now are thriving, pulling together larger market shares all the time as weaker practices fold.

And one factor in our success clearly is the advantages of  developing a true Specialty Practice.

Specialists become experts by advanced training. Specialists get paid more. They especially get more referrals from generalists. Patients know this, then really sense it in the presence of their clinician.

As I watch in our 50 some-odd NeuropathyDR Clinics, those who continue to study, learn new techniques to help those whose lives have been devastated by serious disease and illnesses never want for new patients!

Real Specialty practices in particular have incredible “leverage”.  Staff always are learning newer and better ways of helping patients. Specialty practices have “staying power” when staff is trained properly, each system is perfected,  then marketed to their communities consistently.

And if by chance something is not working, its almost always just one of the above.

So, if you are on track to have an incredible finish to your year, I commend you.

If not, take a hard look at how your practice is positioned in front of your community from every angle. Give patients reasons to ONLY want to see you.

But above all, do this before your nearest competitor does.

It’s not going to be “easier” next year.

NeuropathyDR.The Treatment system Patients and Professionals ask for by name. (TM)











To learn more, click HERE




Are Your Peripheral Neuropathy Patients Taking Care Of Their Feet?

As a medical professional treating patients with peripheral neuropathy, you want to have a positive effect on your patients.

More than half the patients admitted that they walked around the house and even outside with no shoes.

You treat them…

You worry about them…

You advise them…

But are they really listening to what you tell them?

If your patients have peripheral neuropathy in their feet, chances are really good they’re not listening to you.  They hear you but they’re not taking what you tell them home.

A recent study that followed 41 patients with type 2 diabetes and peripheral neuropathy found that

  • 90% of the patients had been educated about proper footwear
  • 83% washed and dried their feet properly every day
  • 51% actually perform foot self-exams recommended by their doctors

But more than half the patients admitted that they walked around the house and even outside with no shoes.  And more than two thirds of them were not wearing appropriate footwear.  They were wearing shoes with pointed toes, high heels or flip flops, and even worse.

If you want to really get through to your peripheral neuropathy patients, you need to impress on them how serious they’re condition is and exactly what can happen to them if they don’t follow your instructions.

Step One  – The Thorough Foot Examination[1]

If you have patients with peripheral neuropathy in their feet, 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 peripheral 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. 

Here’s a good checklist to provide to your patients to remind them of exactly what they need to do to help themselves[2]:

  • 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.  Make sure they pat their feet dry – don’t rub them.   
  • 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 and cut them right after they bathe while the nail is still soft.
  • 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 peripheral 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 them 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 clinics on proper foot care for your patients with peripheral neuropathy in their feet. 

And offer your peripheral neuropathy patients an ongoing monitoring and follow up program.  Keep in touch and watch for any of the symptoms of peripheral neuropathy in the feet. 

Peripheral neuropathy in the feet impairs the ability to feel pain 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 to download a FREE E-Book Copy of my 5 star Amazon  “Living and Practicing by Design”.

Is Your Patient’s Statin Medication Making Them Sick?

Let’s say you have a new patient who presents with

Prolonged exposure to statins can cause serious damage to the peripheral nerves.

  • Burning pain
  • Sensitivity to touch
  • Tingling
  • Numbness
  • Prickling sensation
  • Weakness
  • Difficulty walking
  • Shooting pain in their muscles

For too long a time, they couldn’t figure out what was wrong with them.  They thought they were just tired or getting older or maybe coming down with something. 

Then they did some research and they think their symptoms may be some sort of neuropathy…

They’re not diabetic, they haven’t been through chemotherapy, they’ve never had shingles…

In fact, the only medical issue they have is high cholesterol and they’re taking statins.  And that can mean they may very well have is one of the fastest growing types of neuropathy…

Statin neuropathy.

And you can both be thankful they landed in your office.  As a NeuropathyDR® clinician, you probably have an excellent chance of recognizing, diagnosing and treating statin neuropathy.

What Is Statin Neuropathy?

Statin neuropathy[1] is nerve damage caused by exposure to cholesterol lowering medication.  By lowering cholesterol, statins also affect the cholesterol rich membranes that surround the nerves.  Prolonged exposure to statins can cause serious damage to the peripheral nerves. While that may not sound like a big deal, it can ultimately affect your patient’s

  • ability to breathe
  • ability of their heart to function properly
  • ability to control many of their bodily functions

The Difficulty of Diagnosing Statin Neuropathy

Patients with statin neuropathy often present with very subtle pain or mild weakness.  Because their initial symptoms are fairly mild, it’s harder to pinpoint a diagnosis.  When symptoms are more pronounced and painful, there may be a lag time between the exposure to the toxin and the onset of significant symptoms.  The symptoms come on so gradually that it’s harder for the patient to give the clinician a clear picture of exactly when they started.

The difficulty in diagnosing statin neuropathy is one of the reasons that it is so important for them to consult a healthcare provider who specializes in treating neuropathy, like a NeuropathyDR® clinician.  Because this is your field of expertise, you are more likely to pick up on subtleties that will allow a faster diagnosis.  Faster diagnosis means faster treatment and that means less chance for permanent nerve damage.

What is the Treatment for Statin Neuropathy?

As a NeuropathyDR® clinician, your initial goal will be to confirm the diagnosis and then help your patient control their underlying medical condition and get off their statin medication[2].   

The next step is to devise a treatment plan.

One of the benefits to the statin neuropathy patient of being treated by a NeuropathyDR® clinician is your hands on approach and specialized training in treating their statin neuropathy.  You can advise them on the necessary safety precautions to avoid falls and potential injury caused by nerve deficits as well as providing nerve stimulation and manual manipulation of their skeletal system to get their body back into alignment and alleviate their nerve pain.

When you’re trained and ready to treat statin neuropathy patients, let us help you reach them.

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

A Priceless Gift for Your Peripheral Neuropathy Patients – Quality of Life

As a medical professional treating patients with peripheral neuropathy, you know how to deal with their medical issues…

Have your staff provide your peripheral neuropathy patients with some reference materials to help them get the most from their time with you.

Physical therapy…

Nerve stimulation for regeneration and repair…

Prescriptions for pain…

But what might not be as well versed in is helping them maintain or regain their quality of life[1].

Helping your peripheral neuropathy patients recoup some of the intangible things they’ve lost to their illness can be incredibly rewarding, both for you and your patient.

And it can help you build a practice that goes beyond the medical issues and gives your peripheral neuropathy patients a priceless gift…

Giving their lives back.

Helping Your Patients Help Themselves

As part of your new patient intake procedure, have your staff provide your peripheral neuropathy patients with some reference materials and suggestions to help them get the most from their time with you and to help you know what their issues are from the outset[2]:

  • Give your patients some articles and reference materials to read and educate themselves about their condition.  If they know more about their condition, they’ll be more realistic about what they should and shouldn’t expect from treatment. 
  • Ask your patient to write down a list of questions they have about their peripheral neuropathy.  Suggest that they bring someone with them to their first appointment who can write down the answers to their questions for them so they’re not distracted and can really listen to what you tell them.
  • Have your peripheral neuropathy patient provide you with a list of all their medications (both prescription and over the counter – including vitamins, minerals and herbal supplements) so you’ll know how what they’re taking may be affecting their condition and causing some of their issues.
  • Take note if they are having particular issues that might warrant occupational therapy in addition to physical therapy.  Be proactive in making a referral for occupational therapy if you think it’s warranted. 

Listening for Signs of Depression and Other Conditions

No two peripheral neuropathy patients are alike.  Just as their daily lives and routines are different, the effect of peripheral neuropathy on their quality of life is going to be different.  Some patients will require closely monitored pain management therapy.  Others will need to be watched more closely for the signs of depression and withdrawal. 

While you may not be a mental health professional, part of treating the whole patient requires that you pay close attention to their mental state.  Their mental attitude and how they’re adapting to their peripheral neuropathy and the changes it brings to their lives is crucial in a successful course of treatment. 

  • Encourage your peripheral neuropathy patients to share how their feeling, not just physically but emotionally.  Keep a list of support groups available to refer your patients to that can help them deal with their pain and the impact it has on their lives.
  • Encourage your peripheral neuropathy patients to get out and socialize with other people as much as possible.  Joining a support group for neuropathy patients or even for chronic pain sufferers will give them people to talk to who will have a real understanding of what they’re dealing with.
  • Work with your peripheral neuropathy patients on learning to set priorities with their daily routine.  Making a list of tasks to be accomplished and being realistic about them will cut down on frustration and help them fight their depression.

Helping Your Peripheral Neuropathy Patients Adapt

Quality of life is a measure of how a patient adapts to their physical condition.  The pain in their hands and feet can make it difficult to grasp even the smallest object or to keep their balance when they try to walk. 

Imagine how that must disrupt their lives…

In addition to helping them with their medical and emotional issues, there are tips you can share with them that will help them adapt to the practical considerations of dealing with peripheral neuropathy:

  • Using thick, rubber handled utensils in their kitchen will make it more comfortable for them when they prepare meals.
  • Using long-handled “reachers” (like the ones they use in retail stores to get items off top shelves) to reach for objects on shelves or even to pick things up off the floor.
  • Using button hooks to button or unbutton clothing.
  • Using devices that assist with putting on and pulling up socks.
  • Wearing shoes that have closures that make it easy to put them on and take them off.
  • Using devices designed to help pull up zippers.
  • Making sure they never leave anything lying around on the floor that they could trip over.

Help for Your Weekend Warrior Patients with Shoulder Pain

If you specialize in treating patients with nerve damage, you’re probably used to seeing patients with

Don't Forget The Cervical Spine and Shoulder Pain





Any of those illnesses can cause nerve damage and peripheral neuropathy.

But another less chronic patient population you can serve are the weekend warriors…

Those sports enthusiasts who live to play baseball, football, volleyball or even for kayaking.

This patient population is more prone to shoulder injury and the resultant shoulder pain caused by suprascapular neuropathy than the average person.

Patients with suprascapular neuropathy can be especially challenging because

They often wait to come in for treatment until they have a serious problem; and

Part of their treatment will need to be rest and not participating in their favorite pastime

In order to give you a better chance for having a compliant patient, they need understand exactly what they’re dealing with.

They need to understand that they can’t just muscle through the pain and “work it out.”

What is Suprascapular Neuropathy?  Suprascapular neuropathy is nerve damage to the suprascapular nerve – the nerve that runs from the brachial plexus (a group of nerves in the neck and shoulders) to nerves that help the body fully rotate the arms. Suprascapular neuropathy is a common cause of shoulder pain and weakness and can lead to career ending nerve damage for professional athletes or stop weekend warriors from doing what they love. 
Exactly What Causes Suprascapular Neuropathy?
As the suprascapular nerve passes over the shoulder blade, it can be compressed and stretched. When that happens repeatedly over a period of time, the nerve can become damaged and neuropathy develops. The first symptoms are usually pain and weakness when they try to rotate the shoulder.

If you experience any of these issues, contact your doctor or your local NeuropathyDR® clinician immediately to determine if you have nerve damage. You’ll need to start treatment immediately in order to prevent permanent damage.

Devising a Treatment Plan
The treatment for suprascapular neuropathy depends on

What caused the suprascapular neuropathy

How severe the patient’s symptoms are

How long the patient has had symptoms

The result the patient wants to achieve

Your first step will be to limit the patient’s activities. Once they’ve rested the shoulder, you can start them on an exercise program designed to increase their ability to use their shoulder, regain some flexibility in the joint and strengthen the rotator cuff. Once you’ve achieved a degree of relief for your patient, you can modify the exercise program to fit their sport of choice.

The ultimate goal should be to regain their range of motion in the shoulder and strengthen the muscles in order to prevent future nerve damage.

The end game in treating patients with suprascapular neuropathy caused by sports injury should be to repair the damage they’ve already done and prevent them from doing damage in the future. That will require a little more in-depth involvement on your part.

You need to analyze your patient’s technique to see if they are using proper form and see if any changes need to be made to prevent recurrent injury.

The NeuropathyDR® protocol is ideally suited to treating patients with sports related suprascapular neuropathy. Early intervention with a physician well versed in suprascapular neuropathy, like a NeuropathyDR® clinician, is their best course of action.

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

1 http:// guides/shoulder-problems-and-injuries-topic-overview


Still Ignoring The Social Media Revolution?




Online articles…

Search Engine Optimization…

"How can I possibly do all this and run a practice.."

These terms are becoming as much a part of the modern chiropractic, medical or physical therapy practice as Preferred Providers and deductibles.

We all know that people are looking for everything online but chiropractors and physical therapists have been some of the last to join the Social Media Revolution.

But join they have and they’re using the internet like every other savvy business owner.

What Does This Mean To Your Chiropractic or Physical Therapy Practice?

Two studies conducted in 2008 showed that 41% of all the research medical professionals are doing is now done online (and that number was expected to double in 2009) and that the large pharmaceutical companies were gearing much of their marketing efforts to the online community as the best way to communicate with and educate their target audience – healthcare providers, including chiropractors and physical therapists.

Just take a look at some of the more popular social networking sites for medical professionals – Ozmosis, SocialMD and DoctorNetworking – each of these sites has literally thousands of members.

If you’re going to develop a presence online and reach your potential patient base, now is the time to do it if you haven’t already.

5 Trends In The Use Of Web & Social Media by Chiropractors and Physical Therapists

1.            Increase in Social Networking.

There are a growing number of sites that give healthcare providers the opportunity to connect with other professionals in their specialty to share knowledge, network, and support each other. Most of these sites are protected and allow users to communicate and share opinions and results in a safe online environment.  Check out our own NeuropathyDR site as an example.

2. Scholarly Medical Journals Have a Presence Online

Newspapers are not the only print media suffering the effects of online information.  Many scholarly medical journals have opted for an online-only format to save printing costs and to reach a broader base of readers.  Even beyond the convenience of their information being a mouse click away, many of these sites are increasingly interactive with Q&A sessions and even online classes and seminars for CME credit, perfect for the busy chiropractor or physical therapist trying to build a practice.

3. Blogs and Online Articles.

Many chiropractors and physical therapists are now blogging and publishing online articles to reach potential patients and educate the public about their particular specialty.  Where it used to take             months to be published in a medical journal, now you can set up your own blog, sit down and type a post (or have someone else do it for you), and you’re done.  This allows you to share a unique perspective about your specialty, local events, even the healthcare system.             All from the vantage point of a practicing chiropractic or physical therapy professional.  Your patients and future patients see you as a human with particular expertise and a voice they recognize.

4.            Twitter and Facebook.

Do you have a Twitter account? A Facebook page? If you don’t have at least one of these             social media tools working for you, you’re missing a huge marketing opportunity that’s             virtually free.  The only real cost is time.  If you don’t have the time to post to your own             Facebook page or send regular “tweets”, we’ll  do it for you!  In fact, I can help you get all of this done, and even get an ezine in the hands of YOUR patients for just pennies a day, automatically. “Frequent, relevant content” as my friend Nitin Chhoda DPT says, will keep you in constant contact with your patient base.

That puts you first in their minds when they, or someone they know, needs your specialty.

But if you are doing it all yourself, an important thing to remember about either of these tools – don’t use “doctor speak”             when posting your messages.  Imagine you’re talking to your next door neighbor at a             barbecue and keep that tone in your social media message.  You’ll get your point across             and impress rather than intimidate your patients.

When diving into the social media scene, the first thing to consider is exactly what you’re attempting to accomplish.  Don’t go in without a plan.  You’ll do nothing but send mixed and scattered messages.

Post strategically, wherever you post, and you’ll be amazed at how quickly you profit from this new social interaction.  Join the Social Media Revolution and make this year the best your chiropractic or physical therapy practice has ever seen.