A day in the life of a San Francisco chiropractor

Detox/Purification Day 17 of 21

2011-01-24T09:21:00.000-08:00

Almost there! Only 4 days left, and feeling fine!

Some things I've learned: 1) if you want more weight loss, drink 3 smoothies/day instead of 2. 2) refined carbohydrates ARE bad for you. Seriously. There's no use arguing about this anymore. When you eat them, you feel sluggish and bloated and mentally dopey. 3) I am capable of making a salad every day (I know some of you were already capable of that, but I am a busy woman. This was new for me). 4) Meat is a valuable part of my diet. 5) Butter is better for you than canola oil if you are cooking it (I already knew that, but this process reminded me).

All in all, this has been a great process so far. It has proved to me that I am capable of eating well, as long as I make it a priority. It is when I get lazy that the food quality goes south. I do have extra of the SP Complete powder, but I think that is because I have only been drinking 2 smoothies per day since the first week. I plan to continue using it in smoothies even after the detox is officially over.

Today's food: 2 smoothies with berries and sweet potato, an apple, 1/4 red bell pepper, salad (green leaf lettuce, alfalfa sprouts, beet greens, red cabbage, carrots, red bell pepper and balsamic vinaigrette), turkey; dinner will be stir-fried carrots, broccoli and chicken. Yum!

The Battle Rages On...

2009-11-18T09:15:00.000-08:00

This past Friday and Monday, I spent a large amount of my day preparing documents and making phone calls to deal with yet another difficult insurance company. This company (I can't legally tell you who it is, sorry) has been difficult from the very beginning, but their most recent requests have been absolutely ridiculous.

1) The patient presented asking if we were in-network with his insurance company. We are. So I got his information and called the company to check on his benefits and coverage. the results of this phone call were that he did have chiropractic benefits, including coverage for modalities like physical rehabilitation and myofascial massage. He did, however, have a large deductible that he would have to pay out-of-pocket prior to his benefits kicking in. No problem. We explained all this to the patient, who understood, and proceeded with care. The patient paid us out of pocket and we submitted our claims to his insurance so that they would go toward his deductible.

2) Then we started getting the letters. The company wanted our chart notes for EVERY treatment visit. Now, we are happy to provide our notes when people ask for them, but we were wondering why they would want notes when he's supposed to have chiropractic coverage already. Normally notes are only requested if the company is trying to determine if treatment is necessary beyond what they normally cover. At any rate, we sent all the notes as requested and asked that our claims be processed correctly.

3) Then the denials stated coming in. The insurance company had reviewed our office notes and decided that the first and second visits with the patient were not medically necessary, but that visits 3-8 were OK. WHAT?! So, it's OK for me to treat him, but NOT to do an initial examination in order to diagnose him and NOT to follow up with him after my initial treatment to determine his response to care? THAT MAKES NO SENSE! Surely, we thought, there had simply been an error in processing the claims. These things sometimes happen. So, we re-submitted the claims asking that they be processed correctly.

4)Then we started getting angry phone calls from the patient. He was understandably upset about the charges being denied, and had called his insurance company to complain. In the age-old tradition of passing the buck, the company told him the claims were denied because our office hadn't sent the notes they requested in a timely manner. Not true! And now the patient wants to know why we're deliberately trying to mess this up for him. After we talked him down, he was OK, but it was still a stressful and frustrating situation. We agreed to call the insurance company one more time and try to appeal the denials.

5) My phone call the the company was good in that I spoke with a polite representative who was knowledgeable in the company's denial process. She told me the claims had been denied at first because the records had not been received in time. I asked what "in time" meant since we always mailed the records within a day or two of receiving the request. She said that they like to get them within 10 days of writing the request letter. Because the company is based in New York, it is not surprising that they did not get their claims "in time". We would have had to air mail them to get them there in that time frame! She also said the claims were denied the second time because, after a review of the records we had sent, their company doctor had determined that the treatments were not Medically Necessary. As I said in #3, that makes NO SENSE, so I asked how I can appeal that decision. The answer: write a letter detailing the definition of each procedure performed on the date of service, including the method of treatment, the area of the body, the amount of time per service and a request that the records be re-reviewed accordingly.

6)So I sit down on Friday to write this letter of appeal. Let me tell you, this is the professional version of writing lines on the chalkboard in grade school. It basically serves to purpose except to annoy you. The insurance company already knows everything I'm writing because it's all in the treatment notes I already sent them. They just want it in a narrative format. So I spent about 2 hours researching the official definitions of all these codes so that I can quote them word-for-word in my letter, and then I write this exhaustively detailed letter containing all the information they asked for, including a definition of the amount of time we spent on each procedure. Again, these time units are an industry standard and the insurance company should not need me to explain it to them. They are just playing dumb to waste my time. Regardless, the letter got completed.

7) I mailed the letter, along with copies of the bills for the relevant dates of service AND copies of the records for those dates, just in case they claim to have lost the ones I already sent them. THEN I sent a copy of the letter to the patient and called him to let him know that the letters were in the mail.

8) I am waiting.

All in all, it's a very frustrating experience for all involved. The patient feels he is being shorted, I waste my time on nonsense work, some customer service rep has to take their time explaining all of this to me and some doctor at the insurance company has to read my letter and (more than likely) re-deny my claims. But, I'm a silver-lining kind of person, so I will say that it's a good thing the customer service rep has a job and that the patient is standing up for their rights. I have nothing good to say about doctors who work for insurance companies. They are the health care version of indie punk rockers who sell out to pop, Britney-esq songs for a record deal. We all hate them, and I would be willing to bet they don't like themselves too much either.

My hope is that the new national health care plan will provide a source of comparison for these private insurance companies. Something to make them be held more accountable for their actions so that we have a standard to hold them up to. You never know, they may surprise me and be so amazed by my wonderful letter of appeal that they process my claims after all...but I really doubt it.

October Update

2009-11-09T09:53:00.000-08:00

I can't believe it's been a month since I last posted! It's been a busy one, as usual, but even busier in the office, which makes it hard for me to post here. (How's that for a run-on sentence?)

School is going well. The students had their mid-terms a few weeks ago and I had a few people fail but the average test scores were still in the B range, so I figure I'm doing OK. One of the failing students approached me and asked about extra credit. I thought about it a few days and asked Errol his opinion as well because, of course, I want to be fair. I didn't want to give anyone an unfair advantage, but I also don't want to give the whole class the opportunity for extra credit because I want them to study for their tests. What I came up with was a policy I'll use in all my classes from here on out:

Students who fail the mid-term and approach me about extra credit will be assigned a novel to read that relates to the subject matter they are learning. They will then write a paper on their impression of the novel and how it has affected their views and opinions of their future TCM practice and also western medicine. If they complete the paper, they will be graded on its quality and content with the maximum score being one that brings their grade on the mid-term up to but not exceeding a passing grade. I think this assingment will be enough of a pain in the butt that only people really committed will take the time to do it. I'm also hoping I don't regret this generosity at some point.

The office hasn't been particularly busy, it's just that there's been a lot of administrative stuff to deal with. Since I'm only here three days a week, it's been piling up on me a bit. Amelia is doing a little less than usual (which is not much to begin with) so I've been a little swamped. In particular, this one legal secretary is driving me crazy. I literally cringe when I see her on the caller ID. She is positively ruthless. She wants records and bills from us for a PI case from last year. We happily provided these things months ago, but she's still nit-picking them and driving me nuts while she's at it. She doesn't like the format. She thinks a page is missing. She needs an explaination. And I would normally be more than happy to help her with all of these things except that she calls 4 and 5 times per day leaving message after message asking about them. I've explained to her repeatedly that we don't have a front desk person and that Amelia and I are getting to her an quickly as we can, but she keeps calling! Finally on Friday I couldn't take any more and asked Amelia to return her latest call. They started yelling at each other and hung up, so I'm hoping that means she won't call again today. Please, please let that be true.

Back at work

2009-10-07T10:48:00.000-07:00

Last week was a good week. I worked in the office on Monday and then taught class Tuesday morning. I caught a plan Tues afternoon and visited with my friends up in the Seattle area for the rest of the week. I've written before about the close-knit community of chiropractic, and this trip was just one more example: I was visiting my friends, John and Michelle. They just had their first baby and I couldn't wait until our trip up at New Year's to see her. John and Michelle went to chiropractic school with Errol and I. John and Errol were in all the same classes and Michelle and I were in all the same classes. John and Errol are Asian, Michelle and I are white. John and Errol are extremely business-savvy and hardworking. Michelle and I like to read romance novels and take vacations. So, we have a lot in common. They're good friends and it's always nice to see them.

I got to visit their office in their town of Bonney Lake, WA. It's a beautiful practice and very impressive. Currently, Michelle is on maternity leave. But normally they have enough patients to keep three doctors busy. They hired another friend from school, Maya, as an associate about a year ago and that has worked out well. The chiropractic portion of their office isn't even the most impressive part, though. They also employ several massage therapists and two naturopaths! Their clinic focuses on total wellness care and offers nutritional supplements, detox packages and even personal training with the doctors. It's truly amazing what they've been able to build in just a few years and I know they'll continue to grow and improve.

It was great to visit with Maya as well. She's a chiropactor who focuses on athletes and sports-nutrition. She is a total powerhouse when it comes to exercise and that makes her the perfect doctor for anyone looking to improve their physical performance.

I also had a treat because two more friends from school, Cara and Franchesca, came up from the Portland area for a day. Cara's practice is also doing well. She's hired an associate and continues to expand while making sure her practice still allows her to focus on the things she values in life. Franchesca is currently in practice with a doctor who specializes in a form of microcurrent therapy that patients literally travel the globe to get and in her free time she helps teach interns in the school's clinic AND is training to become a fire fighter. These women mean business!

All in all, it was a nice visit with everyone. As usual, we talked about practice and research we've read and rumors we've heard about the new healthcare legislation and continuing education we'd like to look into and the direction we want our practices to take, all while relaxing and catching up on the other things in life like Franchesca's engagement, Cara's son, Michelle's new daughter and all of our families.

Next week is mid-term exams at school. My Pharmacology class voted for a 50-question test instead of 100. I hope they don't end up regretting it!

The small world of chiropractic

2009-09-21T14:44:00.001-07:00

It has been impressed upon me many times how small the world of chiropractic really is. I think it's probably the same for all niche professions, but it still never ceases to amaze me.

Last Tuesday, I went to a CCA meeting hosted by Insight Imaging. It was at the Campton Hotel, which, let me say, was wonderful. Many times the CCA meetings are not in venues I particularly like: they're hard to get to, the parking is expensive, the room is too crowded... But the Campton was beautiful. We has a spacious room that didn't feel overly large, the tables were set so that we didn't bump into each other and the IT equipment worked flawlessly.

At any rate, the point of this meeting was to go over a brief bit of CCA business, including notifying us of the the website www.chirovoice.org which is supposed to provide canned letters for patients to send to their congresspeople asking them to include chiropractic in the new government-sponsored healthcare plan. Then we got down to the real business of the meeting which was to have the radiologists at Insight give a talk on reading lumbar MRI films. It was a good talk: informative, entertaining and short. It reminded us all of the point in ordering MRIs and of the general landmarks we should be looking for. In all honesty, most of what the doc said was review for me, but it's always nice to be told you've been doing things correctly. The only thing I was really hoping to get out of the talk was how to tell if you have neuroforaminal encroachment on an axial view. Unfortunately, my conclusion was that I should leave that one to the experts. Without going into too much detail, the problem I have is knowing whether the patient is laterally flexed, causing me to see one nerve root but not the other, or if it is in fact discal encroachment. You'd think the signal strengths would be different enough to make that an easy thing to spot, but I've always had trouble with it.

The meeting was good, though, all in all. The meal was wonderful, and free, making it even better. The reason for the title of my post, though, was what happened in the elevator when I was heading home.

The meeting was supposed to go until 9pm, so when I saw that we were done at 8:30, I was psyched. When I went to get into the elevator to go back down to the lobby, another guy who had been to the meeting rode down with me. I mentioned to him how much I like it when the meetings end early and he agreed. He introduced himself as Dave and I asked where he practiced. Wouldn't you know, he works for my old boss! He's at Executive Express under Dr. Eben Davis. Well, we had some stories to share, as Dr. Davis is a very interesting person to work for. I told him I couldn't take it for very long at all, and ended up moving to a different job after only 6 months. He's currently on month 4, so I wished him luck. Turns out Dave is new to the area, having just moved up from Long Beach. We didn't talk for too long, since it was a week night, but we've emailed since then. I hope we'll be able to spend some time together at some point and talk business. I know how isolating private practice can be, so I always try to reach out to fellow practitioners when I can.

So, it really is a small world. Chiropractic is especially small just because of the way the schooling works. There are about 13 chiropractic colleges in America, only one or two in Canada, one in South America and so on. Plus, while you're in school, you become pretty close with your fellow students. You can't help it because you are with them almost 24 hours a day for 4 years. Because of that, when you graduate you tend to want to meet people from other schools, too. Find out what they know and how it's different from what you learned and see if you can help each other become better doctors by sharing different perspectives. This naturally progresses into a very tight-knit community where everyone knows everyone else, or at least has heard of them.

Sometimes it's nice. Sometimes it's not. When I have a patient moving away and need to find them a chiropractor we can both trust in their new home, it's really nice. Or, as has happened in the past, when a patient is traveling but still needs to be adjusted, their chiropractor at home can call me and know that I'll take good care of their patient while they are in SF. But then there are times when you wish it wasn't so close. Like when you hear about a doc who's being sued for sexual harrassment, or who's receptionist just quit or who's computers were stolen, thereby compromising the safety of all of their patients' personal information. Those times you wish you could pretend those people have nothing to do with you; that you're immune to such things and that those sorts of misfortunes only happen to "bad" people who "deserve it".

But like it or not, it is a small world.

Work-a-day Business

2009-09-09T12:25:00.000-07:00

It's been a pretty typical week for me. I taught yesterday morning and it went pretty well. I wish I had prepared a little better for the lecture, but I at least got all my major points across to the class. I'll have to beef it up a bit for next week because the students are asking more detailed chemistry questions than I was prepared to answer. The funny thing is, I purposely designed this course so that chemistry would be a minor topic. It's not as if we need to know the chemistry in our daily practices because we cannot prescribe the medications anyway. But, it's what this group seems to be interested in, so that's where I'll put my focus.

At work it's been a pretty typical day also. I'm currently waiting for a patient to arrive and then I'll be treating pretty much all afternoon. This morning I only had one patient, but it gave me a chance to update the office bulletin board for September and catch up on some paperwork from last week.

This morning in my in-box were some EOB's from two different insurance companies that my boss had left for me to investigate. Lucky for me, they were easy. One was a zero payment that I've already followed up on. I spoke with that company last week and they assured me they would re-process all of the patient's claims and issue payments accordingly. So, hopefully that will actually happen and that will be that. The other ones were for a patient who is working on meeting his deductible. This means he's paying out of pocket for care until he's reached a certain dollar maximum. In this case, it's over $1000, so it's not an issue I really need to worry about right now. There are a few of his claims that were denied for "not having enough information" on them, so I have to call and complain about that. I mean, seriously, how could the standard insurance form that I use for EVERY other insurance company not have enough information on it? It's just another ploy on the part of this company to try to defer payment. So when I have time on Friday I'll give them a call and make them fix the problem.

All in all, though, not too bad as weeks go.

Tonight I am going to the gym for the first time in a long time on a "2 weeks free" pass. I'm hoping they don't take all my work-out time up with orientation and trying to sell me on a membership. We'll see how it goes....

Front Desk Blues

2009-09-02T13:28:00.000-07:00

Last week was a really busy one for me. Amelia was out of the office, so I saw her patients and mine, which meant I had a completely full schedule. That wouldn't be a problem at all except that we don't have a front desk person so in addition to treating all the patients, I was checking them in and out, charging credit cards, submitting billings and returning phone calls with every free moment I had. Plus, because I was completely booked there were several patients who were not able to get in for an appointment. In our office we ALWAYS try to fit people in, even if it means double-booking a slot. But when I'm by myself I feel like double-booking cheats both me and the patient of the attention they deserve. Nevermind the fact that it puts me behind no matter how speedy I am and thereby inconveniences the entire rest of the day's patients. When Amelia goes on maternity leave we're going to hire someone to help me out, so that will be really nice.

In addition to it being busy at work, my cousins came to visit. So, on my off days from the office I was trekking around the Bay Area showing them a good time. We had fun and it was nice to spend some time with them. It's funny because I always think of them as younger, but they're 18 and 22 now, so I guess I have to alter my perceptions a bit. Matt just finished undergrad and it taking a year or so off to work before heading to grad school and Rachael just began her first year of college. My mom was here for a few days as well so between all of us we took them to Fisherman's Warf, Chinatown, Japantown, Ocean Beach, the Sunset, the Castro, the Haight, the Embarcadero, and of course we also toured them around Napa a bit. They got to ride Muni and have a chowder sourdough bread bowl and Vietnamese food, drive down Lombard street and have a few nice dinners at home talking about our crazy disfunctional family. All-in-all it was a great visit and I actually miss them more than I had expected. I'm hoping they'll find the time to come back again soon.

My schedule at the office today kind of fell apart on me. I was supposed to have a few blocks of patients with a good chunk of time in between to get some office work done and I've ended up having a bunch of people cancel on me. Of course, those last-minute cancellations don't help me much because I don't have that many projects that only take 30 minutes. In the end, this kind of day just makes me feel like going home and goofing off instead of staying and doing the paperwork I know is waiting for me. So I'm doing the next best thing and writing a blog post:)

School started again this week. My first class was yesterday. It went pretty well, I think. The student I had to fail returned and doesn't seem to hold it against me. I hope he's able to work harder in this class. I've got another new group Saturday morning, so we'll see how that goes.

Sunday morning I'm coming in to the City to do marketing at the Lululemon Athletica. I'm hoping I sign at least one person to make it worth my trip. Amelia and I decided last time that we both don't need to be at these events, so I'm taking this one so she can have a full long weekend. She said she'll do the next one, but I think I'm going to volunteer to do it because she's going to have to do an event by herself a few days before while I'm going to be in Seattle visiting the new baby Brieanna and her proud parents.

Tomorrow I'm meeting with my friend Andrea again. I'm sure we'll discuss business since it hard for us not to, but we're really getting together to paint some pottery. I've never done that before, so we'll see how it goes. I think it'll be fun.

Grades, Marketing and Vacation

2009-08-19T11:08:00.000-07:00

So I was a very good instructor and passed in my grades at school last week just two days after the students took the test. Yay me! The lousy thing is that I had to actually fail a student for the first time.

I'm getting over it now, since it's been almost a week, but I was really upset at the time. It's so frustrating! I want all of my students to succeed and I work hard to make sure the material is at a level they can handle, at a speed that's not overly demanding and still has content I can feel good about. I know it's not my fault that they failed because I've taught the course before with the same information and format AND I can compare this to my other courses over the last trimesters and I know that my courses have a "B" average. Even this class had a "B" average, but this one student failed.

I thought at first that maybe I should curve the scores, but I firmly believe that you should only curve if the class average is below a "C". Then I thought maybe I would ask the administration about offering the student extra credit work to make up the points he needed. In the end, I defered to the expertise of the woman who hired me, Jane. She looked at his scores and said, "No, he needs to fail." He failed the mid-term and then failed the final. One other student failed the mid-term but brought up his score on the final by 20 points, which allowed him to barely pass the class. If this student had showed a similar effort at improvement, I might have fought more for him. But I know that in reality he didn't fight for himself, and that' s the really important thing.

So, maybe I'll see him in class next tri and maybe he'll decide acupuncture school isn't what he was hoping it would be and he'll move on to another program or career. Either way, the hard part for me is going to be treating him without bias if I do have him in class again. I hope the fact that I realize that challenge will help me to remain fair and impartial. It really is important to me that I treat all my students the same.

On another topic, we've been marketing fiends in the office lately. Last week was the Chronicle visit, which went very well. We have several new patients inthe office because of it, and we'll be asked back there again in the future. All in all, a very good use of our time. This past weekend we went to a DSE race to offer foot and shoe evaluations to the runners. It didn't go very well. There was a large croud, but no one wanted to come talk to us. At least it was a nice day, though.

When we were done with the event, I had a few hours to kill so I hung out, reading on the grass at the Palace of Fine Arts. When I was done there I changed and headed over to Oakland for the graduation for the school. It was a very nice ceremony, with lion dances and a few speeches. I was disappointed that more faculty didn't show up ( I was the only one who didn't have to be there for speaking or something) because when I graduated I always really appreciated the teachers being there. I did see a few of my students, which was nice. It's always good for the graduates to feel that people acknowledge their achievement.

Today we are going to the YMCA-Embarcadero for gait and posture analysis. We've got two scheduled at 4 and 5:30, so hopefully I'll be heading home by 6pm. Even though I had the day off yesterday, the weekend full of events really took it out of me. I'll be glad to head home a little early.

Since school is on break, I have a mini-vacation also. Yesterday I stayed home and did some laundry. Errol helped by cleaning the kitchen, so the house looks pretty good. Tomorrow I have to put on the finishing touches because we're having company come on Saturday night. It's my cousins and my mom for a few days, which should be fun. I'm looking forward to showing them all the City.

Finals

2009-08-12T09:09:00.001-07:00

So, this week is finals week at school. This past weekend I spent a good chunk of time writing up final exams for both my classes, plus I created a competency exam for a student who is trying to test-out of Pharmacology AND I had to compile the dermatology assignments for my Western Science II class. It was pretty busy.

I gave the two tests yesterday, and a quick glance shows that the students did pretty well. My tests usually carry a B average, so I'm hoping that remains true of this trimester. I'm a little worried about some of the Diagnosis students because some of them really sucked out on the mid-term. Excuse my language, but that's what happened;)

The Pharm competency thing has been interesting. This student approached me two tri's ago asking if he could test out of Pharm because the school offers a 3 hour course and he already had 2 hours from another school. I told him it was fine with me if it was fine with the administration. He got the OK, and so I told him to let me know when he wants to take the test. I was even really nice and provided him with my personal complete notes for the class. I could have done what profs always did at my school and tell him to read the book or to contact former students to get the notes from them, but I figured I'd be nice. Plus, I figured if I provided him with my notes and he failed, he couldn't blame me for not testing to the material he studied.
So it's now two tri's later and he's planning on taking the test at the end of this finals week. Two weeks ago he starts asking me about the test. How many questions, what to study, etc. I gave him the info I could, but he's just not getting it. I told him the test would be about 150 questions and to focus on knowing the drugs, not the body systems affected by the drugs, since that is the bulk of the material. He's all "Wow, that's a lot of material" and I said, "Well, it's an entire class. Of course it's a lot of material." Last week he's asking what he needs to know about the drugs. I said he needs to know what's in the notes: indication, contraindication, side effects and interactions. Again, he complained that that was a lot to memorize. I reminded him that he doesn't need to take this test if he doesn't want to and that he could always just take the class and learn all the material over a trimester.

So he'll be sitting for the test this week. We'll see how he does. honestly, I'm not hopeful. But seriously, he's been annoying me because this is supposed to be a COMPETENCY exam. What kind of prof would I be if I let him take a test that did not actually TEST HIS COMPETENCY in the subject?! It's so frustrating to be teaching a student who doesn't actually want to learn the material and just wants to skate by. This situation is exactly why I teach grad school and not high school. I hate having a student who doesn't want to do the work it takes to succeed. Besides the fact that I feel an obligation to their future patients to make sure they are as prepared as I can make them for the real world. If my students don't pass my class or my test, I want it to be because they truly don't know the material. And it should show them that they need to work harder to master the material or they'll have to take the course over again.

On one hand, I'm in the business of creating acupuncturists, so I need to pass these people. On the other hand, I can't in good conscience send an unprepared health professional out into the world. In short, I am REALLY hoping I dont' have to fail this kid, but I will if that's what it comes to.

On another topic, we're off to the SF chronicle offices today to offer chiropractic care on-site. It's a first for us, so we'll see how it goes. I'll let you know!

Image

2009-08-07T09:17:00.000-07:00

One of the tricky things about being in a health profession is that you have to live by example. This is tough because I like to eat unhealthy foods and I like to do fun things, but not actual exercise. I do try to maintain my weight and fitness to some extent, but I am a fundamentally lazy person, which makes it hard.

In two weeks, Errol's Rotary club is having an outing where they will be doing some mountain biking. This sounds fun on the surface, but as a chiropractor I have several things that occur to me, in no particular order:

1) I haven't ridden a bike in over a year
2) Out bikes need to be tuned up
3) The last time I rode a bike I was sore for a week
4) I don't want to look like I'm stuggling in front of these Rotary people I don't know that well
5) If I look like I'm struggling, some people might think it's because I'm not that commited to health
6) If they think I'm not that commited to health, maybe they'll think that I'm not that commited to chiropractic
7) If they think that I'm not commited to chiropractic, maybe it will affect their view of my profession and they'll discount chiropractic as a healthcare option
8) If someone ends up hurting themselves on the ride, Errol and I will be able to help

So, you see it's not as simple as just hopping on a bike and going. And the thing is, maybe I'm over-thinking this and maybe I'm not. I do tend to do that, but sometimes I think it's called for.

Too often in my profession, someone with D.C. after their name does something stupid and the papers get to print a headline like "Chiropractor caught selling meth to toddlers!" and it makes us all look bad. I know I'm probably taking it to the extreme, but I really feel that how I live my life in the public's view will effect their opinion of chiropractic to some extent. So I try very hard to live up to what I think a good doctor is.

In the end, even if I do struggle on the ride, I'm still going. If nothing else it will show that doctors are people too, with flaws and hang-ups, just like everyone else:)

Professional Interaction

2009-08-06T19:01:00.000-07:00

Today I spent the day with my friend, Andrea. We had a good visit walking around downtown Vacaville, just catching up. This is the perfect example of how I like to communicate with the chiropractic community. Maybe I should explain:

Andrea and I went to school together. She is a chiropractor who now runs her own practice in Carmichael, outside Sacramento. She and I have a lot in common in terms of our goals for practice and life, in addition to both being white girls married to Filipino boys. She supplements her chiropractic practice by using and distributing Mona Vie, a nutritional supplement drink. She also happens to be the mother of my favorite child on the planet, Teah.

It's always nice to catch up with a friend, but the thing about chiropractors is that we always end up talking about business. It's not that we're boring, it's just that we're passionate about health and wellness. I always have fun when I'm with Andrea. She helps me see things I might not have noticed in my own practice and I hope I do the same for her.

Today we talked a bit about our relationships with our patients, a bit about making time in our lives for the important things while still running a practice, stopped in to learn a little about an organic fertilizer company, looked for grape-flavored latex gloves for my TMJ massage patients, discussed the power of intention, thought and attraction, she recommended a book I might like called the Biology of Belief (I think...I'll have to double check that title), and she sold me some Mona Vie that I had asked for.

That's what's so great about friends in the business. We can chat and catch up AND do business at the same time, and it's not weird or awkward. It's just our lives.

We're going to try to do this once per month, and I'm hoping we stick to it.

On a related note, another chiropractic friend is going to have her first baby in a few days, so she and I made plans for me to come visit after the baby is born. I am very excited to look at plane tickets to Seattle.

Tomorrow it's back to work at my office. It's a slow patient day, which means I'll spend most of it working on marketing materials for some events next week and then the rest of the time on office work like insurance billing and patient follow-up. Fun!

Getting Back on the Wagon

2009-08-05T11:34:00.000-07:00

I know, I know, it's been forever since I've posted. I'm making a new effort, though.

Here's a little update:

So the diet plan Errol and I tried worked really well. We both lost a bunch of weight and felt great. The only problem was that it was taking us so long to actually prepare and plan our meals. On top of that, we don't really have jobs with the kind of schedule that allows you to stop and eat every few hours. So, in the end we had to quit. We've maintained a few of the changes we made, like replacing beef with turkey and not putting cream or sugar in coffee or tea, and we eat more vegetables. At this point we've gained back most of what we've lost, but we're not continuing to expand, and that's a plus:)

In September I began teaching two days a week at the acupuncture school in Oakland, the Academy of Chinese Culture and Health Sciences. This has been AWESOME! I work at my office Monday, Wednesday and Friday and then I teach at the school. Teaching is so much fun for me, and my students seem to enjoy me, as well. I have four courses there that rotate, depending on the trimester. I teach Western Diagnosis, Western Pharmacology, Western Science I and Western Science II. See a theme? Well, it is after all a school for Traditional Chinese Medicine. But acupuncturists are now primary care providers in California, so they need to know how to diagnose all forms of patients complaints, not only those related to TCM.

Here's a breakdown: Western Diagnosis is focused strictly on diagnostic tools. I teach them how to take a medical history and perform a physical exam including range of motion, motor testing, neurologic testing, orthopedic testing, and evaluations of organ systems including the respiratory, cardiovascular and sensory. They learn how to take blood pressure, do an eye exam and how to interpret lab results like urine analysis and blood work. It's a fun class, and the students are usually enthusiastic. Yesterday we played Diagnosis Jeopardy to help them review for their final. It got a little cut-throat for a while, but they had fun.

Western Pharmacology is the reason I teach at the school. They needed a new instructor for this class and I called at the right time looking for a position. The course is unlike any other Pharm course I can think of . The purpose of the course is to help the students in real-life practice, which means they need to know about the medications their patients are using that have been prescribed to them by other doctors. Most Pharm courses teach a lot of chemistry because the people taking the class will be prescribing medications. Since the audience for this class is different, I modified the format to suit their needs. I went to the state and national acupuncture boards and found out what they want the students to know. I combined that with my own clinical experience and came up with a list of medications that I felt every acupuncturist should be somewhat familiar with. So, the end result is that the students aren't over-burdened with information they don't really need and I get to teach a class that also keeps me sharp for my own practice. Win-Win if you ask me!

Western Science I and II are survey courses. One is just a continuation of the other. They are supposed to combine all the Western medical knowledge the students have been given, including Anatomy, Physiology, Pathology, Diagnosis and Pharmacology into a cohesive format. We go by organ system, taking common conditions and breaking them down. For example, we will take coronary artery disease and discuss when to suspect it, how to diagnose it, how the disease process works and what treatment options are available. Because the emphasis is on Western medicine, treatment is often focused on medications or surgeries, but the students often suggest TCM interventions that they might try, depending on the patient.

All in all, I'm having a lot of fun teaching and it helps break up my week, which keeps me fresh for my patients.

At this point, I think this entry is a bit long, so I'll update you on practice and the rest of my life in my next post. I'm going to try for every week.

Later!

New Year...New Body!

2008-01-11T08:50:00.000-08:00

Well, it's 2008. My husband and I just had our first Christmas together as a married couple, and we had a a great time. I baked all sorts of goodies and we had a nice big meal with our local relatives. My family on the East Coast was buried under almost two feet of snow, and we had a pleasant 55 degreees, so things were good. That's where the cheer ends, however. We got our pictures back from Auntie Ivy and saw just how bad it had gotten...you can hardly see the tree behind our pudgy selves! Before Christmas, Errol and I had decided to try out a new eating plan, but agreed to wait on starting until after the holidays. (No point in starting out frustrated, right?)

I should start by saying that my husband I and LOVE TO EAT! We love food, especially various forms of meat with cheese on it and we like to add chocolate to pretty much any dessert. All of our memories of good times rovolve around what we ate and where. We know we need to do better, but our love for food can't be denied. So, we need a very plan of attack if we are going to lose weight and get healthy.

It is my firm belief that diets don't work. You end up hungry and grouchy and usually mess up your body's metabolism. It's a fast way to become unhealthy. So, we looked for a plan that would allow us to eat food, and plenty of it. It's just food cooked in different ways and with a mindfulness about calories and body types. What we found was the Body Makeover system. Go to http://www.mybodymakeover.com/ for more info.

As a doctor, I know how to create a diet that is balanced, aimed at increasing the metabolic rate, high in nutrients and tasty. As a human being, I can tell you that is a lot of work! I don't want to spend my whole life thinking up healthy recipes and meal plans...it takes enough time to cook food in the first place. That is why this program is so helpful for us. You start by identifying what you want to get out of the program: weight loss, toned legs, smaller waist, etc. Then you use that information to identify a meal plan that works for you. The program comes with two options that I LOVE: it provides a pre-written meal plan that works for everyday if you don't want to think about making one AND it has recipes for when you want to put some effort into your food. Also, my husband and I have different goals, but we can still share a lot of foods, which makes dinner easier. For example, the other night we had chili with mashed potatoes and salad for dinner. He can have twice as much chili as I can, but I can have more potatoes. The key is in balancing portions and in eating small meals frequently. I eat breakfast, a mid-morning snack, lunch, and afternoon snack and dinner. I could even have an after-dinner snack if I wanted to, but I am usually not hungry for it.

I have already lost some inches, as my clothes are fitting better. I can feel myself having more energy, which I know is my metabolic rate on the rise. All in all, I'm looking forward to the future.

The best thing is, right now I'm eating approximately 1300 calories per day. That is going to help me lose weight, but it is WAY to low for a healthly person to maintain a healthy weight. Once I have reached the size I am comfortable with, I can still eat all the SAME meal-plan foods and just increase my portion size to get to about 2000 calories per day. That way, we can stay on track with the meal plan long-term and maintain a healthy weight and lifestyle for the rest of our lives.

My goal is that, at next year's Christmas tree, you'll see our beautiful tree AND our healthy new bodies.

Here's to eating!!

Posture Evaluations at Sports Basement

2007-12-10T09:03:00.001-08:00

Yesterday, I did the first of three weeks of posture evaluations at the Potrero Sports Basement. It was really fun. For those who haven't been to a Sports Basement, they have several locations in the City. See their website for more details http://www.sportsbasement.com/. They are a great store for several reasons. They are laid back and just want to have fun with all the different sports people do. All their employees are knowledgeable in at least one of the activities the store sells equipment for, so you can always get advice from someone in the know. Plus, they had free hot cider! Yum! In the month of December, they are offering free yoga classes every Sunday. That's where I come in. Our office made friends with a great yoga teacher, Tony Eason, last year at the AIDS Lifecyle kick-off. Tony also works for Sports Basement and is organising the month of yoga. He thought is would be a great addition to the program if we gave free posture evaluations to the people who take the classes. Here is his website : http://www.ynottony.com/

So, off I went, armed with my Spinal Analysis Machine and goodie bags for the participants. I brought my husband, Errol, with me so he could see the store and shop around while I was working. We had a great morning and the participants were very excited to have a doctor available to answer their questions about posture and how it relates to their yoga poses.

So, if you want to try a free yoga class or just have your posture evaluated, check out this upcoming schedule :http://ynottony.com/Free%20Yoga%20Classes%20at%20Sports%20Basement.doc. I hope to see you there!

Thanksgiving

2007-11-26T13:03:00.000-08:00

I just hosted my first family Thanksgiving, and it went great! My husband and I invited all his local relatives over to our new house for the day. I made a traditional New England Thanksgiving dinner, complete with homemade apple and pumpkin pies, and his relatives brought the Filipino dishes I don't know how to make, like pancit, lumpia and puto. We had a great day and I'm already enjoying the left-overs!

For those of you who don't know a lot about Filipino food, here's a link to check out : http://www.seasite.niu.edu/Tagalog/filipino_food_glossary.htm

Kinesio Tape Technique

2007-11-15T11:26:00.000-08:00

I am so excited about this seminar I just went to. I learned about this taping technique called Kinesio Tape (See image). I had some exposure to it while I was in school, but I never had enough training in it to feel comfortable using it on a patient. Now, I do! And it has so many applications! The tape itself is unique. Most athletic tape is very rigid, with a goal of restricting joint motion. Kinesio tape actually has elastic in it, so it stretches longitudinally. This way, is promotes motion. It’s purpose is to support the muscles. When the muscles have the support they need, they can support the joint naturally. This is very functional taping. Patients wear the tape up to 5 days in a row. They can do all their normal activities, even swim, with it on. And, I can do massage or adjust them with the tape on. Talk about versatility!

I was so excited, I took some tape from the seminar and brought it back to the office to try on a patient whose continued foot pain was really frustrating for her and me. She always feels good when she leaves the office, but after a few days on her feet, they hurt again. I told her about the tape and she was willing to try it. The results were great! She didn’t even notice the tape when she was wearing it and even thought it might not be doing anything. But then, on the end of the 4th day, she took the tape off. 12 hours later, her foot pain was back! I know that some of you might be thinking the tape didn’t work because the pain came back. But to my way of thinking, this is indicative of a good therapy. If foot pain that was consistent for months goes away for 4 days straight, I pay attention. Plus, since the tape supports the muscles, if we continue to tape her for, say, another month, her muscle will be strong enough to do the job of the tape and her pain will be gone for good. This is exciting stuff! I can’t wait to try it on more people and see how it works for them.

I'm also looking for a place to buy the tape in San Francisco. I’ve googled, citysearched, yelped, superpaged and even gone through the yellow pages, but no one seems to stock it. It’s not a big deal for me to order it from a supplier, but I try to support the local guys when I can. Plus, it would be nice to send patients somewhere to buy it so they don’t have to get it through me. Again, I don’t mind ordering it for them, but it’s nice for them to have options. Please let me know if you know where to get Kinesio tape in San Francisco.

Also, visit the official website: http://www.kinesiotaping.com for more information.

2007-11-12T14:28:00.000-08:00

This is my first blog post. I'm still learning how to make all of this technological stuff work, but I have determination and patience, so I know I'll get it eventually:)