the virginia voice€¦ · care did so for symptoms associated with musculoskeletal ailments –...

1

The Virginia Voice“Unity in One Voice” Spring 2008

FDA Alert:Bisphosphonate Therapy Linked to Risk for Severe

Musculoskeletal Pain

Temporary or permanent discontinuation of bisphos-phonate therapy should be considered in patients who

present with severe musculoskeletal pain, the US Food and Drug Administration (FDA) recently warned healthcare professionals. Overlooking bisphosphonate therapy as a causal factor may delay diagnosis, thereby prolonging pain and/or impairment and the use of analgesics. In contrast with the acute-phase response that sometimes accompanies initial exposure to bisphosphonate therapy, some patients experience severe and sometimes incapacitating bone, joint, and/or muscle pain that begins months or years later. The incidence rate and risk factors for this re-action remain unknown, according to an alert sent from MedWatch, the FDA’s safety information and adverse event reporting program. Moreover, discontinuation of therapy may not lead to complete relief — some patients have reported slow or incomplete resolution of symptoms. Over the next 6 months, the FDA will be evaluating reports of severe musculoskeletal pain as-sociated with bisphosphonate use. In the interim, pa-tients reporting these symptoms should be monitored, and alternative causes for pain should be considered for those who do not experience a lessening or resolu-tion of symptoms after bisphosphonate withdrawal. Bisphosphonates are indicated for the pre-vention and treatment of osteoporosis and for treat-ing hypercalcemia of malignancy and Paget’s disease. They also are beneficial in patients with mul-tiple myeloma and bone metastases from solid tumors.

Currently marketed oral bisphosphonates include risedronate sodium tablets, alendronate sodium tablets, iban-dronate sodium tablets, etidronate disodium tablets, and ti-ludronate disodium tablets. Injectable bisphosphonates include pamidronate disodium injection and zoledronic acid injection. Adverse events related to bisphosphonate use should be reported to the FDA’s MedWatch report-ing program by telephone at 1-800-FDA-1088, by fax at 1-800-FDA-0178, online at http://www.fda.gov/medwatch, or by mail to 5600 Fishers Lane, Rockville, MD 20852-9787.

House Calls for ImmediateCommissioning of Chiropractors

Into US Armed Forces

U.S. Representatives Neil Abercrombie (D-Ha-waii), Thelma Drake (R-Virginia), Robert Brady

(D-Pennsylvania), and Ron Paul (R-Texas) have intro-duced a resolution that calls for immediate establish-ment of a career path for doctors of chiropractic as com-missioned officers in the United States Armed Forces. House Concurrent Resolution 294 states that although the Secretary of Defense has statutory authority to commission DCs as military officers, the Pentagon has failed to do so. The resolution specifically expresses the view of Congress that the Secretary of Defense take immediate steps to appoint doctors of chiropractic as commissioned officers in the military health care system. A concurrent resolution is a formal proclamation that states the opinion of Congress, and does not require the president’s approval and thus does not have the force of law. According to Reps. Abercrombie and Drake, mili-tary personnel in combat theaters of operation are in urgent need of access to the widest possible range of health care options, especially for nueromusculoskeletal conditions. Fur-thermore, a 2007 report from the Veterans Health Adminis-tration indicates that nearly 45 percent of veterans returning from the Iraq and Afghanistan who have sought VA health care did so for symptoms associated with musculoskeletal ailments – the top complaint of those tracked for the report. For years, the Virginia Chiropractic Association has joined other organizations in championing the effort to more fully integrate chiropractic care into the military and veterans’ health care systems. Doctors of chiropractic and those inter-ested should contact their member of Congress immediately and ask them to cosponsor House Concurrent Resolution 294.

3

Come On Down to the Corner!Spring 2008 ConventionVirginia Chiropractic AssociationApril 25-27, Westin Hotel, Tysons Corner, VA

DC Program DetailsAdjusting Protocols/Lower Extremities

By Mark N. Charrette, DC

In this fast-paced program, Dr. Mark Charrette will begin with an introduction and review of terminology relevant to lower ex-

tremity discussions. He will review soft tissue characteristics and biomechanics of the foot and ankle, lower leg, knee, and hip. He will also discuss serial distortion of the lower extrem-ity: pronation/supination syndromes, Genu Valgus, leg length inequalities, muscle imbalances, plastic deformations, and pos-tural abnormalities. Both examination procedures (orthopedic tests, neu-rological tests, and muscle testing techniques) and stabilization procedures (supportive devices) will be discussed and demon-strated. Dr. Charrette will also pro-vide in-depth instruction on extremity adjusting of:• The foot (pronation protocol and other foot adjustments),• The knee (Patella Alta, Patella Baja, Fibula, Wrist Extension Thrust Tech-nique and rehabilitative exercises), and• The hip (internal rotation, external rotation, Zindler anterior femur adjustment and hip mobiliza-tion). Dr. Charrette has conducted over 800 presentations throughout the US for state and national associations, chiro-practic colleges, FCER, NCMIC, and others. Subjects have fo-cused on extremity adjusting, bio-mechanics, and spinal adjust-ing techniques. We were thrilled that he was able to work our convention into his busy schedule. Dr. Mark Charrette received a BS in Education with High Honors from IL State Univ. and his chiropractic degree from Palmer College of Chiropractic in Davenport. His long list of awards includes Dr. Monte Greenawalt’s Chiropractic Excel-lence Award, inclusion in Who’s Who in Am. Colleges and Uni-versities, and The Master Circle’s Outstanding Citizen Award. He has practiced chiropractic in NV, IA and CA. He is currently a post graduate faculty member at Parker College of Chiroprac-tic in Dallas; Palmer College of Chiropractic in Davenport; and Cleveland College of Chiropractic in Kansas City. Sponsored by Foot Levelers, Inc.

How to Treat Athletic InjuriesUtilizing Functional and Kinetic Treat-

ment with Rehab, Provocation and Motion (FAKTR-PM)By Thomas E. Hyde, DC, DACBSP

Dr. Hyde uses his vast experience with sports chiropractic as the basis for functional testing of the Spine, Shoulder, Knee, Ankle,

and, if time permits, Elbow. He will systematically move from one body part to another. After speaking about a specific area, he will take someone from the audience to act as his patient. Using the Shoulder as an example, he will proceed through this outline:

Functional Assessment1. - Assess shoulder in various positions.- Place person into position of provocation.- Have person move shoulder and look at firing pattern of mus-cles.- Decide if provocation requires motion or no motion, resistance or no resistance.- Utilize low tech rehab equipment to actually treat along the kinetic chain.Treatment with FAKTR-PM2. - Low Tech rehab.- Graston Technique/Nimmo/MFR/Cyriax.- Kinetic chain.

Dr. Thomas E. Hyde received his DC degree from Logan College of Chiropractic in MO and a BA in biology from FL State Univ. He currently practices in FL. Dr. Hyde served as the chiropractic coordinator for the US Powerlifting Federation, Intl. Powerlifting Federation, and US Weightlifting Federation for many years. In 1986 he was selected to attend the two-week Sports Medicine Internship in Colorado Springs’ US Olympic Training Center. In 1987 he was selected as the chiropractor for the Pan American Games. He served on the Governor’s Council on Physical Fitness and Sports and was ap-

pointed to serve on the Pan American and Olympic Task Force for the state of FL. He served as president and executive director of the ACA Sports Council for eight years and served as the secretary general for the Federation Intl. de Chiro-pratique du Sport (FICS). He is currently the liaison between FICS and the World Olympians Assn.

Up to 18 Type 1

CEUs for DCs in

Virginia!

Continued on page 4

4

Dr. Hyde was twice named Chiropractor of the Year by the Dade County Chiropractic Soci-ety. He worked as team physician for several high schools and one major college and served as the chiropractic consultant for the Miami Dolphins. He has written many peer-reviewed articles and two chapters in two different books, and he co-edited Con-servative Management of Sports Injuries. He is currently writing the second edition with other contributors. Dr. Hyde has lectured all over the US, Canada, Hong Kong, Japan, Mexico, Argentina, Denmark, the UK, Wales, Bra-zil, Portugal, France, Switzerland, Australia, and South Africa. His personable style provides a relaxed atmosphere for open discussions and maximum learning. Sponsored by NCMIC.

An Introduction to Spanishfor Chiropractors

By Nelson Marquina, MSc, PhD, DC

The Hispanic population is the fastest growing demographic in Va. If you want to better serve this important group, you

won’t want to miss this unique course. Dr. Nelson Marquina will introduce basic skills in the Spanish language to facilitate the interaction between a doctor and office staff and Hispanic speaking patients. The class will present the phrases and ex-pected responses that typically occur in a chiropractic office. For example:1. Basic anatomy, physiology and neurology terms2. Salutations3. Eliciting subjective findings4. Physical examination dialogs5. Report of finding dialogs6. Giving bad news to patient and/or relatives7. Reviewing lab and X-Ray results8. Financial and insurance matters9. Mispronunciation that could lead to embarrassing situations Dr. Nelson Marquina is the president of USA Laser Bio-tech Inc. and an Assoc. Professor of Physics at Va. State Univ. He is a consultant to the Natl. Foundation for Alternative Medi-cine in Wash., DC and a developer of biophotonic and bioelec-tromagnetic systems and treatment protocols. He earned an MS in statistics from Worcester Polytechnic Institute and doctoral degrees in electrical engineering from the Univ. of Houston and in chiropractic from Logan Chiropractic College. Dr. Marquina is a former Senior Scientist at NASA/Johnson Space Center and Dir. of Research at Logan. He was Dir. of Information Systems in Mars, Inc. and former Partner in Coopers & Lybrand’s Infor-mation Technology Consulting Services in New York City. Dr. Marquina has chaired national conferences in expert systems, robotics, and computer vision. He is a former member of the editorial board of the Journal of Expert Systems. He has served on the faculties of the Univ. of Houston as Asst. Professor of Systems Engineering, the Univ. of RI as Research

Assoc. Professor of Electrical Engineering and the Univ. of MN as Lecturer in Electrical Engineering. In addition, Dr. Marquina has held positions with GE, Honeywell, and Lockheed Electronics in ad-vanced technology, research, development, and management. He is the medical director (pro bono) for the Adult Rehabilitation Center (ARC) of Richmond, a drug rehab and life transformation center. Dr. Marquina possesses a unique combination of medi-cal and technical knowledge, training and facilitation expertise, and personal experience as a practicing U.S. Chiropractor for whom English is a second language. This wide-ranging perspective en-ables him to give you a “crash course” in “Chiropractic Spanish” that is both efficient and helpful. Each attendee will receive a glossary of terms and phrases of specific value to the chiropractic office. The session is designed with doctors in mind, but CAs might also find it of interest and benefit. Sponsored by USA Laser BioTech.

CA Program Details

Neurology for Chiropractic Assts.

This session will help CAs to understand how the musculoskel-etal and neurologic systems are interrelated. The CA will learn

some basic information about the Brachial and Lumbar Plexus, the Cranial Nerves, and the Autonomic Nervous Systems. This course will include hands on work in understanding and testing reflexes, sensation, and muscles to help determine and understand nerve root level involvement. The CA will be able to work more closely with his or her doctor, as well as better understand the conditions they may be working with.

Injury Prevention for CAs

This section will teach CAs how to prevent injury while perform-ing normal work duties. It will include proper biomechanics and

other helpful tips. As an added bonus, attendees will be able to pass this valuable information on to their patients.

Nutrition for CAs

In this session, Dr. Plotkin will review some of the more common supplements which have been scientifically shown to help with

various conditions that CAs may encounter in their doctor’s prac-tice. It will teach proper diets to help keep the body out of a con-stant state of inflammation and to function more optimally. The class will benefit the CA in both his or her work and personal health and diet planning.

Free Bonus: While the CA program formally starts with the Friday evening Welcome Reception, registered staff are welcome to sit in on the Friday afternoon Spanish class for DCs.

By Larry Plotkin, DC, CSCS, CSNC, CNC

Dr. Larry Plotkin’s expertise in chiropractic, training, team-building, and communications come together for a particularly dynamic

and beneficial CA program. He has been a

Continued from page 3

Continued on page 6

5

NCMIC is trusted by more than 36,000 D.C.s

One of the ways we earn our D.C.s’ trust is by constantly monitoring their needs to make sure they have the best possible coverage.

The result? A new policy with additional bene�ts, many at no extra charge. For example, we added a $25,000 endorsement to protect against proceedings and reviews by governmental authorities.

As always, our doctors trust NCMIC to provide broad scope-of-practice coverage including:

ß Chiropractic treatment of children and pregnant women ß True consent to settle feature ß All malpractice legal fees paid outside policy limits ß And more

You, too, can count on us because “We Take Care of Our Own®.”

For more information call

1-800-769-2000, ext. 3810

www.ncmic.com

Trusted.

www.ncmic.com ß 14001 University Avenue ß Clive, IA 50325-8258

6

practicing chiropractor since 1994 and enjoys teaching and mentoring chiropractic office staff. Dr. Plotkin graduated from National College of Chiropractic Summa Cum Laude, second in his class. He did his undergraduate training at Towson Univ. graduating Magna Cum Laude.

He has been certified as a Strength and Conditioning Specialist (CSCS) by the Natl. Strength and Conditioning Assn. (NSCA). He was also certified as a Nutrition Consultant (CNC) and as a Sports Nutrition Consultant (CSNC) by the Am. Fitness Pro-fessionals and Associates (AFPA). He teaches cont. ed. for the Steiner Education Groups (Baltimore and Va. Schools of Mas-sage), the Am. Massage Therapy Assn. (AMTA), the Md. Chi-ropractic Assn., and Anabolic Labs. In 2005, he starting work-ing as the Team Chiropractor for the Univ. of Md., where he works with all the sports teams and travels with the Md. Terrapin football team. He teaches in the Kinesiology Dept. at the Univ. of Md.. Dr. Plotkin is currently the Strength and Conditioning Coach, and Nutrition Consultant for the Catonsville YMCA Bar-racuda Swim Team. CA program sponsored by Anabolic Laboratories, Inc.

Location

After a recent $22 million renovation, the Westin Tysons Corner offers all the personal touches you need to retreat

from the rigors of travel and emerge revitalized, renewed, ready to learn and have some fun. VCA convention attendees enjoy a special room rate of $119 + taxes. Call 703-394-2106 for reservations and identify yourself as part of the VCA group. AFTER MARCH 31, hotel reservations are on a space and rate available basis, so make your reservations now! For details on The Westin’s amenities and nearby attractions, visit www.westin.com/tysonscorner.

Program-at-a-Glance: DCsFriday, April 25 2:30-6:30pm FREE BONUS PROGRAM! Intro to Spanish for Chiropractors by Nelson Marquina, MSc, PhD, DC6:30-8:00pm Welcome Reception for All Registrants, Mem bers, Guests, Family, Exhibitors; Live Music

Saturday, April 267:30-8:00am Continental Breakfast in Exhibit Area8:00-11:45am DCs: Adjusting Protocols/Lower Extremities by Mark Charrette, DC11:45am-12:45pm Special Profession Updates: Educational Trends and Multi-Disciplinary Clinical Opportunities in Chiropractic by Frank Nicchi, DC, President, New York Chiropractic College; VCA Business/General Membership Meeting:

Committee, Public Relations, Legislative, C-PAC, Board of Medicine, Other Timely Reports12:45-1:45pm Walkaround Lunch in Exhibit Area1:45-4:45pm Lower Extremities by Dr. Charrette Continues4:45-6:30pm Treating Athletic Injuries Utilizing FAKTR-PM by Thomas Hyde, DC, Begins6:30pm Evening on Own

Sunday, April 277:30-8:00am Continental Breakfast in Exhibit Area8:00am-1:30pm Treating Athletic Injuries by Dr. Hyde Continues1:30pm DC Program Adjourns

Program-at-a-Glance: CAsFriday, April 25 2:30-6:30pm OPTIONAL FREE BONUS! The CA program officially starts with the Reception; however, all registered CAs are welcome to sit in on the DC Spanish class, if desired, at no add’l charge6:30-8:00pm Welcome Reception with Exhibitors for All

Saturday, April 267:30-8:00am Continental Breakfast in Exhibit Area8:00am-12:15pm Injury Prevention for the CA by Larry Plotkin, DC12:15-12:45pm Neurology for the CA Begins by Dr. Plotkin12:45-1:45pm Walkaround Lunch in Exhibit Area1:45-5:30pm Neurology Concludes

Sunday, April 277:30-8:00am Continental Breakfast in Exhibit Area8:00am-12:15pm Nutrition for the CA by Dr. Plotkin12:15pm CA Program Adjourns

Clothing Donations forOrphans Requested

VCA Members Drs. Nelson and Sher-ron Marquina are traveling to Peru in June to con-

duct a seminar on laser therapy. There is an extremely high number of orphanages in Peru and the Marquinas use their teaching trips to Peru to help out, working in partner-ship with the Chandler Sky Foundation, an organization with an orphanage near the city of Cusco in the Andes. The Marquinas are requesting donations of shoes and clothing for children from one to fifteen years old. The little ones are in the greatest need. Any “sur-plus” of donations is sent to other area orphanages. Dr. Nelson Marquina is teaching a Chiropractic Span-ish class and his company, USA Laser Biotech, is exhibiting at the upcoming convention in Tysons Corner. If you are inter-ested in donating shoes/clothing , please visit the USA Laser Biotech booth or call Nelson Marquina, DC at 804-377-2234.

NOT ATTENDING CONVENTION?

Feel free to just stop by to drop off your donationor to send it with a colleague who is attending.


7

DC and CA Registration Form Virginia Chiropractic Association Spring 2008 Convention April 25-27 - Westin Hotel - Tysons Corner, VA

Your Name:_____________________________________________________________________________________________________________

If Staff, DC’s Name:______________________________________________________________________________________________________

Street:__________________________________________________________________________________ Suite:__________________________

City:___________________________________________________________ State:___________________ Zip Code:_______________________

Phone:______________________________ Fax:________________________________ E-mail:________________________________________

Payment: $___________ Fee from Below __Check, Payable to VCA OR Charge: __Visa __MC __Discover

Card #:____________________________________________________________________ Exp.:_________________ 3 Digit Auth. #:__________

Billing Address:__________________________________________________________________________________________________________

Name on Card:__________________________________________________ Sig.:__________________________________ Date:_____________

Registration FeesPlease Check By 3/31 After 3/31___ VCA Member DC $325 $375___ Non-Member DC $425 $475___ 1st CA from VCA Member DC Office $155 $185___ Addl CAs from Member DC Office, each $130 $160___ 1st CA from Non-Member Office $185 $199___ Addl CAs from Non-Member Office, each $155 $185

Fee covers all educational sessions, reception, continental breakfasts, lun-cheon, and breaks outlined under “Program-at-a-Glance” on page 6

Cancellations: If written notification is received at least 72 hours prior to convention, registration fee will be refunded less $25 processing fee. No re-funds or credits issued w/in 72 hours of program.

FAX completed form and payment to540-932-3101 or MAIL to

VCA, POB 15, Afton, VA 22920.

Questions? CALL 540-932-3100 ore-mail [email protected].

Increase Your Buying Power

VCA Members can benefit from savings on supplies and services though Chiropractors Buying Group

(CBG): x-ray film, face paper, treatment supplies, office supplies andmore. CBG provides the following items ab-solutely free for all VCA members who enroll in CBG: waiver of the annual membership fee, package of 100 pa-tient greeting cards, product samples, patient giveaways, additional vendor savings coupons and ongoing discount offers. To start saving today, call the VCA at 540-932-3100 or visit the VCA website for an enrollment form [go to www.virginiachiropractic.org, scroll down to CBG logo, click on form (membership password required)].

Health Insurance Benefits

As a member of the VCA, you now have many health insurance plans available all under one roof. Through

MassMutual Financial Group’s health insurance division, The Financial Group of Virginia, VCA members have access to professionals who can help with important decisions when it comes to purchasing health insurance. Let them help you choose the type of plan, benefit options deductible amount and co-pay that best fits you, your family or your employees’ needs. PPOs HMOs, HSAs and group plans with tax advan-tages are available. Founded in 1851, MassMutual is a mutually owned financial protection, accumulation and income management company headquartered in MA. It is a premier provider of life insurance, annuities, disability income insurance, long term care insurance, retirement planning products, income management and other products and services for individuals, business owners, and corporate and institutional markets. The Richmond office owns The Financial Group of Virginia, its in-house health insurance division, and has been offering individual and business clients quality healthcare and service since 1985. For more information and personal assistance, call Dana Harrison at 1-888-324-1602 X 739.

9

AMA Issues Correction toImpairment Ratings Guide

After ACA Complaint

The American Medical Association (AMA) has an-nounced that it will issue a correction to all pur-

chasers of its Guides to the Evaluation of Permanent Impairment, Sixth Edition, after the American Chi-ropractic Associaiton’s (ACA’s) legal team ques-tioned the legality of restrictive language related to evaluations by doctors of chiropractic and accused the AMA of violating the permanent Wilk injunction. In a February 20th letter to ACA, AMA’s le-gal counsel writes that the text in question “is in-correct and warrants immediate correction.” AMA’s action comes in response to a Febru-ary 7th letter in which ACA asked for an immediate withdrawal of restrictive language in the text that lim-its evaluations by doctors of chiropractic to the spine only. The ACA was also in the process of contacting the Federal Trade Commission and the U.S. Department of Justice regarding concerns about the new guidelines. In response, the AMA will take the fol-lowing “immediate and visible steps to counter-act any potential confusion” regarding the language:

The AMA will send a letter to all pur-• chasers of the guide, for whom it has ad-dresses, informing them of the correction. A similar letter will be inserted into all • manuals prior to shipment in the future. The AMA will post a notice in the AMAPress On-• line Catalog as well as on the Guides’ web page. The correction will be announced in • the next issue of the Guides Newslet-ter scheduled for publication in late March. Future printings of the Sixth Edition of • the Guides will include the correction. An errata sheet for the Sixth Edition, which will • be issued in late March, will contain the correction with special highlighting to give it greater visibility.

The objectionable language is published on page 20 of the AMA guide in a section titled “Fundamental Principles of the Guides.” Specifically, Item 6 of Table 2-1- states: “A licensed physician must perform impair-ment evaluations. Chiropractic doctors, if authorized by the appropriate jurisdictional authority to perform rat-ings under the Guide, should restrict rating to the spine.” In his original complaint to the AMA, ACA Gen-eral Counsel Thomas R. Daly wrote: “In our view, the action of the AMA in issuing this standard unlawfully re-stricts competition and excludes a competitive rival, i.e. doctors of chiropractic from the provision of impairment ratings. We note that neither the ACA, nor any other ma-jor chiropractic group, was approached or provided in-

put in the standard setting process that established this new restriction.” ACA’s letter also reminded the AMA of the Wilk decision and stated that the “recent action which imple-ments a new and onerous restrictive standard on the prac-tice of doctors of chiropractic violates existing antitrust law as well as the provision of the permanent Wilk injunction.” ACA has also identified other offending portions of the publication and is urging the AMA to remove or re-write all restrictive language related to doctors of chiropractic.

AMA’s 6th Edition Guides: What’s New?

By Arthur C. Croft, DC, MSc, MPH, FACO

Stirring the sturm and drang of interprofessional politics, the newest iteration of the AMA’s Guides to the Evalua-

tion of Permanent Impairment is hot off the press 4. It will set you back about $170 at Amazon, and early editions are likely to become collector editions among the geeks of medicole-gal evaluation. Well, maybe not. Perhaps having an original printing with all of the discriminatory terminology and edito-rial blunders won’t be quite the same as a rare coin minted without a date, but, after some legal threats and wrangling, the ACA has apparently gotten its way, and the AMA has prom-ised to remove the offensive wording for future printings and send errata sheets to early customers. However, if the lag time is anything like what it was for the 5th edition, it may take a while. And there are some fairly serious errors in this edition too. This editorial is a brief synopsis of my initial reading of the musculoskeletal sections of the new Guides and some ideas as to how they can be used, aside from the obvious. Interestingly, the authors of this new edition seem to be going out of their way to justify their approach, as though the previous edition had been soundly criticized. And I sup-pose there was a lot to be critical of. The new authors utilized a modified Delphi panel that relied, when it could, on pub-lished works-don’t laugh, this is something of a novelty for the AMA Guides-grading that work on a standard hierarchy of evidence, with meta-analysis of randomized controlled trials (RCT) at the top, followed by RTCs, non-randomized inter-ventional studies, observational studies, and so on. Through-out the first few chapters, the almost apologetic tone for the failings of earlier editions, with a recurring hopefulness that this edition might rectify some earlier shortcomings was pal-pable. Does the 6th edition manage to live up to these prom-ises? Is it truly a “paradigm shift” as promised? Only time and real field experience will answer that question, although the hackneyed term, paradigm shift, is probably a bit grandiose from what I can see. And, along with admissions that previ-ous consensus-based editions were flawed, the new method-ology, they concede, “must await further empirical testing.” By the way, in case you don’t read the trade jour-nals (other than this one), you may be Continued on page 10

10

wondering what this sturm and drang was all about; what had the ACA’s legal counsel brisling and jousting with the AMA’s legal counsel? The language of the text sounded occasionally discriminative. The Guides, it was said, “were written by medical doctors for other medical doctors.” In another section it was said that chiropractors should be limited to issues of the spine. These were discriminatory in my view, and patently wrong in the case of limiting us to the spine, so kudos should go to the ACA for their quick action. I hope this inspires non-members to join the ACA. It needs everybody’s support. I note that, as in previous versions, none of the Contributors to this 6th edition of the Guides were DCs, although there were some DCs listed as Reviewers (two were DC, MDs). (One wonders whether any of them groused over the aforementioned discriminatory language.) So what is really new in the 6th edition of the Guides? The Guides now incorporate the World Health Or-ganization’s International Classification of Functioning, Disability, and Health (ICF) and, as elsewhere, the authors went to great lengths to point out the advantages of this thinking, although, at least from the standpoint of the spi-nal rating sections, its exact contribution is somehow ob-scure. In any event, here is how the new system shakes out. All of the impairment areas share a generic template which has five classes of impairment (0-4). The percentage impairment is based initially on these classes and varies with the diagnosis. In this sense, the system resembles the old 5th edition DRE classes. But, unlike the old system, we

now have severity grades A through E, with A being the least severe and E being the most severe. These levels determine the variability within the classes of severity. These interclass levels are determined by algebraically subtracting the class number from a number related to grade modifiers for func-tional history, the physical examination, and clinical studies. And say adieu to the DRE. Now we have diagno-sis-based impairments (DBI), and they even have one that includes whiplash. Note also that pain-related impairments (PRI) can be made when no clear cut DBI can be applied. The authors of this PRI chapter willingly accept and dis-cussed the controversy of this practice. Some experts dis-courage PRI, they noted, while others believe it is a neces-sary adaptation. In any case, the lengthy discussion in this chapter is fairly moot since the maximum rating for pain is capped at 3% WPI. One simply doesn’t get much credit for pain, no matter how severe or disabling, without a more objective DBI. So let us not skip ahead to Chapter 17, the Spine and Pelvis and take a closer look under the hood. In the interest of brevity, I will only discuss the cervi-cal spine here. The other spinal levels are similar in terms of the mechanics of the rating. Note that range of motion is no longer used since, according to the authors, it is not a reliable indicator of pathology or functional status. That is not precise-ly true in the context of whiplash. Outcome studies have di-rectly correlated ROM with recovery, and others have shown that initial ROM predicts outcome as well 2,3. But, I’ll skip the tangential discussions. Here is how the new system works. The first thing to do in the cervi-

Paul Power & Brent Herauf

Call Paul @ 757.288.4185 Call Brent @ 757.580.7993

x-ray imaging

of chesapeakeXRIC

…The Clear Choice For Your Practice

Increase Your Profits with…

Call For All Your Analog& Digital Imaging Needs.

Film processing chemicals • Lead markers • X-ray film New and refurbished CR readers • PACS solutions • ID cards

Viewboxes • X-ray film disposal • Silver recovery • Lead apronsX-ray film processor service • X-ray cassettes • X-ray filing products


Continued on page 11

11

cal impairment rating is to choose the appropriate impairment class or DBI. For the cervi-cal spine there are 7. These include (1) the non-specific chronic or chronic recurrent neck pain (which includes whiplash), (2) alterations of motor segment integrity (AOMSI) and disc herniation, (3) pseudarthrosis (which relates only to postoperative conditions), (4) spinal ste-nosis, (5) fractures, (6) dislocations and fracture/dis-locations, and (7) postoperative complications (e.g., deep wound infections, chronic osteomyelitis, etc.). Once you have settled upon a DBI, then you choose the appropriate class (0-4). For example, in the case of chronic neck pain due to whiplash or strain/sprain injury, only class 0 and class 1 are available. For all other conditions, Class 1 allows for a range of whole person impairment (WPI) of 1% to 8%, but in the special case of chronic neck pain, no more than 3% can be assigned. That is also the cap based on the PRI, so it is at least logi-cal, if questionable on clinical grounds and real world experience. In other words, if the patient does not have AOMSI, disc herniations, fractures, etc., but does have chronic neck pain, an award could never exceed 3% WPI. The next order of business is to consider the modifiers or the “adjustment grid.” There are three for the spine and they include functional history, physical ex-amination, and clinical studies. Each of these has 5 modi-fier levels which correspond to no problem (0), mild problem (1), moderate problem (2), severe problem (3), and very severe problem (4). For each of these, examples are provided in tables. For example, a functional capacity level 2 would imply pain and symptoms with normal activity. In the case of functional capacity one can also utilize the pain disabil-ity questionnaire (PDQ), which is provided in the Guides as an appendix. They tell us that it is also permissible to use an “alternative validated assessment,” although none others were mentioned by name that relate to the cervical spine. One that would probably be acceptable would be the neck disability index (NDI), since it is so widely used and has, in fact, been validated 5. Examples of physical examination modifiers include the SLR test and other nerve tension signs, sensory changes, reflexes, etc. Ex-amples of clinical studies modifiers include needle EMG or imaging studies, although, if the imaging study was used to place the person in the DBI (e.g., MRI to diag-nose disc lesion) it cannot be used again as a modifier. Finally, the number corresponding to the DBI class is subtracted from each modifier number and the three values obtained in this way for the three modifier classes are algebraically summed. If the sum is equal to 0, then there is no net movement within the class. If the sum is 1, the severity within the class is increased one incre-ment. If the number is negative, the severity is decreased. Take class 2 in the cervical spine as an example. It carries a potential WPI of 9-14% across all 7 of the DBIs (with

the exception of chronic neck pain for which only class 0 and class 1 are possible). This range, 9-14, is represented by the letters A-E. One always starts in the middle of the range, C, which, in the case of the class 2 category, corresponds to 11% (9 10 11 12 14). Mathematically inclined idiot savants will immediately notice the missing 13. No mention or explana-tion was provided, but it does leave 11 (or C) in the center as the default value. So, if the sum of the modifiers is 2, then you

move two places to the right and go from a C se-verity rating to an E. But, no matter what the modifier number is, you never migrate out of the original class: these inter-class modifiers can only reduce the severity as low as A or increase it as high as E. S o u n d s simple, right? Well, appar-ently it wasn’t that simple for the authors who were, apparent-

ly, not idiot savants themselves; and were perhaps even a bit mathematically challenged. Actually, I’m sure these were just glaring boo-boos, but one somehow expects more for $170, especially with such a large number of re-viewers who all, theoretically, should have caught these errors. For the benefit of those of you who have this new edition, I will point out a few errors that I found. And, as a bona fide dyslexic myself, I feel downright hypocritical in pointing out the typos of others, and I would also make no guarantee that I spotted all the errors. But there they are: In Figure 17-6 there is an illustration of how one is to determine lumbar motion segment abnormality, with an algebraic summing of (+8)-(-8) equaling 26. The minus value should obviously have been -18. On page 586 the authors provide an example of this tedious business of subtracting the DBI class from the three interclass modifier values and come up with a 0. But their math was faulty and it should actually have been -2, which would have made the thing an A instead of the C they reported. Another addition error ap-pears on the next page with a -1 and 1 summing, incorrectly, to 2, and resulting in another erroneous rating value. These are given to the reader of “examples.” Of what, one wonders? An important feature of the new Guides is the figur-ing of AOMSI. In the cervical spine, one can have a trans-lation of greater than 20% of the AP

Figure 1. The AB ratio remains one of two or three methods for determining AOMSI in the 6th edition of the Guides. If the dis-tance A is more than 20% of the distance B, instability exists.



12

Carrick Institute for Graduate Studies203-8941 Lake Drive, Cape Canaveral, FL 32920

(321) 868-6464, Fax (321) 868-6468www.carrickinstitute.org

Carrick Institute for Graduate StudiesPresents

AccreditedNeurology Diplomate Program for Chiropractors

Harrisburg, PA

Who is the Certification Board and are they Accredited?The ACA recognizes the American Chiropractic Neurology Board as the Sole Authority for Credentialing in Neurologyfor the Chiropractic Profession. The ACNB is fully accredited by the National Commission for Certification Agencies,the International Standard for Accreditation and is recognized by the National Organization for CompetencyAssurance.Will this program help me?Yes. This program will help you help others in a superior fashion by increasing your abilities to serve humankind. Theincreases in your clinical abilities will prepare you to serve more people and act as a consultant to other professionals.There are not enough trained and credentialed clinicians in this specialty areaWhat will I learn?Our learners become fluent in the ability to describe the process of neurological diagnosis with an emphasis onapplication of treatment specific to the nervous system of humankind. Applications are largely non surgical and nonpharmaceutical approaches to a brain based treatment system.What conditions will I learn how to Diagnose and Treat?Our learners are trained to understand, diagnose, treat and manage the spectrum of neurological disorders that areassociated with the integrated sensorimotor system. These disorders include dizziness, ototoxicity, balanceimpairment, gait impairment, tremor, postitional vertigo, migraine, labyrinthine contusions, vestibulopathy, Meniere’sdisease, cerebellar degeneration, cortical degeneration, anxiety, motion sickness, syncope, ocular motor disorders,dystonia and othersWhat is the Program Structure?Our program is a practical one of hands on learning. Clinicians work with patient scenarios and develop a mastery ofthe diagnostic and therapeutic modalities necessary in modern practice. Our instructors demonstrate procedures, whichare practiced by the clinician. Our practical sessions are complimented with weekend residencies and on-line learningto ensure that the breadth, depth and application necessary for the specialty are mastered.How long is the Program?You must complete a minimum of 300 hours of credit in order to be eligible for the ACNB examinations. Manycandidates attend all knowledge area modules or just the ones most relevant to their learning needs. We present ourmodules in convenient 15 hour 2 day and 25 hour 3 day immersion blocks so that our learners can complete theirstudies in a minimum amount of time.Using a tried and tested formula of weekend residencies and online learning, clinicians can attend all the modules orjust the ones most relevant to their learning needs.Do I need to take the entire Program?No. Many learners elect to study certain courses, which allow them to become better clinicians without entertainingBoard Certification in Neurology.

April 12-13, 08: 802 - Neuromuscular Applications:May 17-18, 08: 824- Chiropractic Adjusting Techniques for Chiropractors:June 21-22, 08: 803 - Peripheral Nervous System:July 19-20, 08: 804 - Spinal Cord:August 23-24, 08: 805 - Reflexogenic Systems:September 20-21, 08: 806 - Autonomic Nervous SystemOctober 25-26, 08: 807 –Cerebellar CorticesDecember 6-7, 08: 808 - The Brain and Its Environment

Persons who are Board Certified Neurologists recognized by the American Chiropractic Neurology Board, or who areeligible to sit for the Board exam, receive a tuition discount.

Tuition for (800) Series Modules:Learner Full Tuition: $375 per 15 credit hour module.

Learner Tuition $325 per 15 credit hour module if received 30 days in advancePre Payment Discounts available through the Office of the Registrar

You can find complete information, including course descriptions, requirements and tuition costs on-line at www.carrickinstitute.org .You can call us at 321-868-6464 or you can send us an inquiry at [email protected]

13

diameter of the body of the verte-bra above, measured on either flexion or extension radio-graphs, Figure 1. Notice the word “or.” I have, in the past, debated with many in this profession and the medical pro-fession-including several radiologists-over this methodol-ogy 1. I point out that the original study by White et al., from which this measuring of AP translation was derived, made it clear that one was not to add the anterior transla-tion to the posterior translation, but rather to use one or the other, whichever is greater 6. But some clinicians still incorrectly add anterior and posterior translation together. At first blush, it appeared that the authors of the Guides had tried to clear this confusion in the 6th edition. But did they? Under a section titled Cervical Spine AOMSI, they describe the 20% AB ratio method illustrat-ed in Figure 1 and then informed us in that “(Figures 17-5 and 17-6 describe [a] similar technique for [the] lumbar spine.)” In Figure 17-5, however, they illustrate a lumbar spine and describe the AP translation mensuration method introduced in the 5th edition: if there was more than 2.5 mm of AP translation in the thoracic spine, more than 4.5 mm in the lumbar, or more than 3.5 mm in the cervical spine, it implied AOMSI. And, in the 5th edition of the Guides, if you had more than 3.5 mm of translation in the cervical spine, that put you into a DRE IV category which carried a 25-28% WPI. So, some ambiguity remains after all. Did the 6th edition authors intend to remove the cer-vical portion from the caption of Figure 17-5, or did they simply fail to describe this method under the Cervical Spine AOMSI section? One thing that is clearly different in the 6th edition is that this greater than 3.5 mm translation finding is only worth a class 2 rating (4-8%) if there was a radiculopathy at that level that has resolved, or a class 3 rating (9-14%) if there is an ongoing radiculopathy. So the value of the finding has been significantly downgraded. The 11 degree angulation rule from the 5th edi-tion-also given to us by White et al.-remains with us in the 6th edition as an indicator of instability. Alternatively, AOMSI can also result from a loss or near-loss of mo-tion due to developmental fusion, or from a successful or unsuccessful surgical fusion surgery intervention. The authors stated, incidentally, that AOM-SI is to be measured only by “plain film radiographs.” This statement may have been directed at users of vid-eofluoroscopy or upright MRI bending studies. Of

course, VF is radiography, so as long as one can capture high quality images at the extremes of motion, the other differences between plain film radiography and C-arm VF are irrelevant since the 20% AB measurement is a sim-ple ratio and thus unaffected by differential magnifica-tion. Will that argument fly in court? Not always, I’m sure. In the end, the Guides are new and improved, al-though “Paradigm Shift” overstates things just a tad. From a practical standpoint, I think the Guides are not particularly helpful in personal injury. And, while most jurisdictions in the U.S. do not use the Guides for matters of personal in-jury litigation, it is interesting to note that the authors men-tion that the province of Ontario adjudicates personal injury claims using the Guides, as do doctors in New Zealand and many parts of Australia. And don’t fail to notice that the new Guides even feature a DBI that mentions “whiplash” by name. I suspect there may be a push in that direction. In the meantime, I find the Guides useful in some respects and do measure plain films for evidence of instability. I don’t apply the impairment rating, but I will make note of instability that is incorporated within the framework of the AMA’s Guides.

References:1. Croft AC. New research, the AMA Guides, the cervical spine DRE-IV, and ligamentous subfailure: disentangling some serious misconceptions. Dynamic Chiropractic 2007;25:18-41.2. Dall’Alba PT, Sterling MM, Treleaven JM, et al. Cervical range of motion discriminates between asymptomatic persons and those with whiplash. Spine 2001;26:2090-4.For all references, email [email protected].


14

Medicare Updates from McClelland Consulting

NPI News

Effective March 1, 2008, all 837P and CMS-1500 claims must have a National Provider Identifier (NPI)

or NPI/legacy pair in the required primary provider fields. Failure to include an NPI will cause a claim to reject. On March 1, 2008, Medicare claims submitted by physicians and other practitioners, laboratories, ambulance company suppliers, Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) suppliers and others that bill Medicare are required to include their new NPIs. Providers must use this information when they submit their claims to Medicare carriers, A/B Medicare Administrative Contractors (MACs) and DME MACs when they use certain electronic and paper Medicare claims (specifically the X12N 837P electronic claim and the CMS-1500 paper claims). For more information, go to http://www.trailblazerhealth.com/Tools/Notices.aspx?DomainID=1&ID=12301. As of May 23, 2008, the NPI will be required for all HIPAA standard transactions. This means that for all primary and secondary provider fields, only the NPI will be accepted and sent on all HIPAA electronic transactions (837I, 837P, NCPDP, DDE, 276/277, 270/271 and 835), paper claims (UB-04 and CMS-1500) and SPR remittance advice. The reporting of Medicare legacy identifiers in any primary or secondary provider fields will result in the rejection of the transaction. Now that the NPI is required on all Medicare claims in the primary provider fields, if your claims are being successfully processed with NPI/legacy pairs (and most are) now is the time to begin testing claims using the NPI alone. If the Medicare NPI Crosswalk cannot match your NPI to your Medicare legacy number, the claim with an NPI-only will reject. You can and should do this test now! If the claim is processed and you are paid, continue to increase the volume of claims sent with only your NPI. If the claims reject, go into your NPPES record and validate that the information you are sending on the claim is consistent with the information in NPPES. If it is different, make the updates in NPPES and resend a small batch of claims 3-4 days later. If your claims are still rejecting, you may need to update your Medicare enrollment information to correct this problem. Call the Customer Service Representative at your Medicare carrier, FI, or A/B MAC enrollment staff or your DME MAC to discuss your situation and, if necessary, have it investigated. Have a copy of your NPPES record or your NPI Registry record available. The contractor telephone numbers are likely to be quite busy, so don’t wait. Doing this testing now will allow time for any needed corrections prior to May 23, 2008, the date

when only the NPI will be accepted in all provider fields. Still not sure what an NPI is and how you can get it, share it and use it? As always, more information and education on the NPI can be found through at www.cms.hhs.gov/NationalProvIdentStand on the CMS website. Providers can apply for an NPI online at https://nppes.cms.hhs.gov or can call the NPI enumerator to request a paper application at 1-800-465-3203. Note that all current and past CMS NPI communications are available by clicking “CMS Communications” in the left column of the www.cms.hhs.gov/NationalProvIdentStand CMS webpage.

CMS-1500

Susan McClelland recently offered the following helpful basic instructions for the CMS-1500:

You need FOUR numbers:Your old Medicare provider number.1. Your old Medicare group number.2. Your new individual NPI.3. Your new group/corporate NPI.4.

In a nutshell:Until you are properly crosswalked, you will need to 1. enter your numbers in pairs. The provider number (1) and the individual NPI (3) are one pair. The group number (2) and the group NPI (4) are the second pair.When appropriate, the individual pair of the ordering 2. doctor will go in 17a/17b.You will always need an individual 3. pair in 24J. Use the pair that belongs to whichever doctor provided that particular service.You will put the group/corporate pair in 33a/33b.4. 24I will contain the qualifier for the old provider 5. number (1C).33b will contain the qualifier as well. Enter “1C,” then 6. a space, and then the old group number.

The New ABN

The new ABN form is available for use now and will become mandatory as of September 1. Please be sure you understand the form and its use before implementing it. Visit http://www.cms.hhs.gov/BNI/02_ABNGABNL.asp.


Partner with a CertifiedCollections Agency!

I.C. System, VCA’s endorsed collection agency, recentlypassed a third-party audit to maintain its status as a Certified

Agency. I.C. System was among the first 10 agencies worldwide to be recognized by the American Collectors Association Intl.

for completing the highly regarded program.Put your trust in a certified agency. Contact VCA-endorsed I.C.

System at 800-279-3511 or visit www.icsystem.com/vcahtm.

16

DR (Direct Radiography) is now available and affordable to theChiropractic Professional.

Advanced technology incorporates CCD Technology onthe wall stand for an ef cient and cost effective solutionwhich eliminates dark rooms, lm and chemistry. Highquality digital images are produced in less than sixseconds without the need for cassettes.

System includes a doctor’s workstation with viewing•software, stitching, and archive capability.Versatility - Detector can be mounted on any angle•depending on your room layout.Ef ciency - Image preview in less than six seconds•improves patient throughput.Affordability - Complete DR systems utilizing cesium•iodide detector technology along with the longestwarranty in the industry and lease payments as low as$1,200.00 a month.

Your Practice...Is Digital Imaging In Your Future?Blue Ridge X-Ray Co., Inc. Offers Cost-Effective DR Solutions.

Blue Ridge X-Ray Company, Inc. ~ 1.800.642.0640 ~ www.blueridgexray.com

Orthotic therapy represents an integrated approach to chiropractic case management. Effectively

addressing problems of the spine requires considering the musculoskeletal structure as a series of interrelated components, with the feet as its foundation. In seven out of ten cases of back pain, postural fatigue and spinal strain are frequent causes of discomfort. (1) The stress can often be traced to altered foot biomechanics that lead to pelvic and spinal distortion. (2) Flexible, custom-made orthotics are useful in correcting abnormal biomechanics in the lower extremities and enhancing the effectiveness of chiropractic care.

Biokinetic Interaction

The spine is one link in a biomechanical kinetic chain, where movement at one joint influences movement at other joints in the chain, (3) extending from the feet to the spine. Locomotion demonstrates the complexities of biokinetic interaction and the risk of imbalance or structural deficiency that leaves the spine vulnerable to destructive torque, bending and shearing stresses. (4,5,6) Locomotion is comprised of two phases: stance, when the foot bears weight; and swing, when no weight is borne. When the foot hits the ground, changes occur that can have detrimental effects if pedal imbalance is present.

Advantages of Orthotic TherapyBy Mark N. Charrette, DC

The stance phase is divided into three subphases:1. Contact. A natural inward rotation of the subtalar

joint produces pronation. The tibia rotates internally, with the femur moving slightly.

2. Midstance. Forefoot loading occurs as the foot supinates, accompanied by external rotation of the tibia and femur while the knee unflexes.

3. Propulsion. For toeing off, the foot remains in supination and leg bones rotate externally.

Clinical Implications

If pronation is maintained into the midstance phase of gait, the tibia and femur will remain in the inward rotational configuration. This places the patello-femoral complex in immediate jeopardy – the structure that is the most frequent source of knee disorders. (7) Rotation of the lower extremity transmits to the pelvis, causing an inward hip rotation commonly associated with myofascial back pain. (8) Inward rotation of the femur brings the greater trochanter forward and outward, stretching the piriformis muscle. The sacrum may be pulled into a subluxated anterior and inferior position. (2) The gluteus maximus muscle contracts to compensate for the downward and forward pelvic tilt. The innominate at its iliac portion rotates to the Continued on page 17

17

posterior, producing a typical pelvic distortion. The sacrum’s anteroinferior position causes the L5 vertebral body to gravitate and rotate toward the low side, initiating structural scoliosis. (2) Excessive pronation results in abnormal firing of muscles and inaccurate proprioceptive nerve impulses. This also interferes with the toe-off phase, resulting in less-efficient propulsion.

Correcting Postural Imbalance

When the gait is affected by excessive pronation the pelvis and spine must compensate. The specific way in which each patient adapts to abnormal support from the lower limbs is very individualized. This explains why patients often notice so many areas of improvement when their pronation is corrected with orthotics. Flexible, custom-made orthotics help enhance biomechanics of the lower extremity and modify minor deficits that inhibit the integrity of the pedal foundation. (9) Orthotic therapy seeks to control – not restrict – motion within the pedal structure, particularly of the subtalar joint. (10) Restricted subtalar joint pronation affects the knees, hips, and back. (11) Custom-made orthotics can also improve back pain caused by walking with an abnormal gait and poor toe-off. (12)

Summary

Postural instability is a direct result of imbalance in the pedal foundation. As the arch rolls inward, the tibia twists, the knee strains, the femur rotates, and spinal curves are affected. Custom-made, flexible orthotics address problems of pedal imbalance and related postural instability. When used as an adjunct to chiropractic care, orthotics enhance postural stability and protect the integrity of musculoskeletal structures. Dr. Mark N. Charrette is a 1980 summa cum laude graduate of Palmer College of Chiropractic. He is a world-renowned expert in extremity adjusting. Over the past 15 years Dr. Charrette has lectured extensively on spinal and extremity adjusting throughout the United States, Europe, the Far East, and Australia – performing over 1,000 seminars. Don’t miss Dr. Charrette’s presentation on extremity adjusting protocols at VCA’s April 25-27 Spring Convention in northern Virginia.References:1. Brunarski DJ. Chiropractic biomechanical evaluations: validity in myofascial low back pain. JMPT 1982; 5(4):155-161.2. Schafer RC. Clinical Biomechanics: Musculoskeletal Actions and Reactions. Baltimore: Williams & Wilkins; 1983.3. Gross MD, Davlin LB, Evanski PL. Effectiveness of orthotic shoe inserts in the long-distance runner. American Journal of Sports Medicine 1991; 19(4):409-444.4. Farfan HF. Muscular mechanisms of the lumbar spine and the position of power and efficiency. Orthop Clin North Am 1975; 6(1):135-144.5. Cappozzo A. Compressive loads in the lumbar vertebral column during normal level walking. J Orthop Res 1984; 1(3):292-301.

6. Adams MA, Hutton WC. Mechanical factors in the etiology of low back pain. Orthopedics 1982; 5(11):1461-1465.7. Foot Levelers Educational Division. Clinical Chiropractic Biomechanics. Roanoke: Foot Levelers, Inc., 1984.8. Greenawalt MH. Spinal Pelvic Stabilization, 4th Ed. Roanoke: Foot Levelers, Inc., 1990.9. Steindler A. Kinesiology of the Human Body Under Normal and Pathological Conditions, 3rd Ed. Springfield: Charles C. Thomas, 1970.10. Christensen KD. Orthotics: do they really help a chiropractic patient? ACA Journal 1990; 27(4):63-71.11. Gastwirth KD et al. Electrodynographic study of foot functions in shoes of varying heel heights. J Am Podiatr Med Assoc 1990; 81(9):463-472.12. Dananberg HJ, Giuliani M. Chronic low-back pain and its response to custom-made foot orthoses. J Am Podiatr Med Assoc 1999; 89:109-117.

Lead Author of Spine ArticleDiscusses Findings on Neck Pain,

Stroke, Chiropractic Treatment

The February 15, 2008 issue of Spine featured a new Cana-dian study entitled “Risk of Vertebrobasilar Stroke and Chi-ropractic Care: Results of a Population-Based, Case-Control and Case-Crossover Study.” In this study, led by principal in-vestigator Dr. J. David Cassidy, the team of researchers con-cludes that there is “no evidence of excess risk of VBA stroke associated [with] chiropractic care compared to primary care.” For a recording of a recent audioteleconference on this study by Dr. Cassidy, call FCER at 800-622-6309.


18

Update on 18VAC85-20 Re:Requiring DCs in Virginia to Have a 4 Year Doctoral Degree

By Valerie Hoffman, DC, Chiropractic Representative to the BOM

The Notice of Intended Regulatory Action (NOIRA) for the Board to consider requiring a four-year degree

from a college or university for chiropractic licensure was recently completed. In this first phase of a compli-cated and lengthy three-part process, the BOM approved that, effective 2012, individuals must have a Bachelors Degree in order to obtain a DC license in Virginia. A clause requiring pre-matriculation was not included. Next comes phase two, the “pro-posed” phase. In this stage, the BOM will draft a specific regulation for a proposed regulatory change and solicit comments. There were numerous letters sent to the BOM during the last comment period both for and against the change. For those of you who still have questions regarding the change, here are a few things you may not know about the requirements for licensure in our neighboring states:

North Carolina: • Bachelors degree required, must pass a jurisprudence exam administered by the state and must pass Part IV of NBCE with a minimum score of 475 (100 pints higher than Virginia requires for passing score).

Tennessee: • Bachelors degree required.West Virginia: • Bachelors degree required, oral jurisprudence and interview with the Board, Part IV NBCE score of minimum 475.Maryland• : Bachelors Degree required, jurisprudence exam.

The concern of many is that in reviewing these require-ments, Virginia could easily be labeled the mid-Atlantic state of

minimal competency when it comes to licens-ing DCs. I encourage you to study this impor-tant issue and participate in the next comment period. Please express your feelings that we should not be the state in a five-state area that holds our DCs to the most minimal standards. For additional history on this proposed regulatory change and VCA’s recommen-

dations as voted on by the VCA General Membership, see the 11/05/07 issue of VCA’s Member FYI (back issues of all Member FYIs and Virginia Voice newsletters are always available at www.virginiachiropractic.org in the Publica-tions section) or email [email protected] for a copy.

19

From time and cost savings to improved cash flow, and from better use of office staff to fewer claims-related mistakes, electronic claims filing is a “must-have” for successful professional practices. Now, MD On-Line makes it easy for VCA members to transact business electronically with a suite of products that allow for the easy submission of claims and so many other healthcare transactions. Sign up now and begin submitting electronically today with this special offer.

Call MD On-Line TODAY at 888-499-5465 and identify yourself as a VCA member. We’ll answer all your questions. Or, visit the VCA/MD On-Line website

at www.vcamdol.com and sign up online.

Isn’t it Time You Benefited from Electronic Claims Filing?

FREE Start-Up FREE Electronic Claims Processing to Participating Payers for TWO MONTHS

Scheduled Contributions to the VCA for Every Claim SubmittedFREE

Grow Your Practice with Posture AssessmentBy Steven P. Weiniger, DC

Posture assessment is visual palpation. Observing a patient’s biomechanics to deduce how the head is bal-

anced over the torso, the torso over the pelvis, and the pelvis over the legs requires using your eyes, instead of your fingers, to find the key structural distortions and adaptations at the root of biomechanical problems. Palpation and posture assessment are both what I call “fuzzy indicators”—imprecise but nonetheless sig-nificant. Some proponents of hard-line, evidence-based medicine argue that palpation is subjective and unreli-able as a clinical tool. However, experienced DCs pal-pate every day and find invaluable information, liter-ally at the tips of their fingers. Similarly, even though some studies cast doubt on the reproducibility and rel-evance of postural observations such as a high shoulder or pelvis, observing posture can give clinicians valuable functional information about a body’s biomechanics. Reading posture is tricky as well as somewhat subjective, but there are concepts to help understand and explain the correlation between symptoms and bio-mechanical problems. We use five Posture Principles to explain kinetic chain biomechanics to patients, as well as to correlate their complaints with their posture:

Motion: The body is designed to move 1.

Balance: Posture is how 2. we balancePatterns: To balance, the 3. body moves in patternsCompensation: The 4. body compensates for habits, injuries, and painAdaptation: Over time, 5. compensation causes physical changes in the body

Patients understand the significance of posture assessment when we explain that posture is quite literally how the body balances, and that we balance from the bottom up in four bio-mechanical posture zones:Zone 4: Head and neck, balancing on Zone 3: Torso and upper extremity, which balance onZone 2: Low back and pelvis, which balance onZone 1: Lower extremities As long as a body is not falling down, it is mechani-cally balanced, albeit imperfectly. As Continued on page 20

20

a result, posture dis-tortions are often noted which are distant from the area of complaint and/or initial injury. Compensation to maintain balance means that a posture observation may be the cause, the effect, or a cause of another ef-fect further up, or down, the kinetic chain. For example, a posture picture of the sedentary patient who presents with neck tightness and sits ten hours a day may show a marked high right hip and low right shoulder. This assymetry is a tip-off of an adaptive shortening of the right psoas, probably with compensat-ing left lumbar curvature. This will add stress to the cervical area and set the stage for injury and the resulting complaint, suggesting a target for muscle therapy in addition to adjustments. Besides providing valuable clinical information, from a marketing perspective posture assessment effec-tively differentiates the posture-based practice. A research-oriented, posture-based patient education program creates value in patients’ eyes by demonstrating how posture can truly provide a window to health and aging. And when care plans incorporate posture exercise along with chiro-practic, patients not only feel better but they get excited when they see positive changes in their posture pictures. Clinical posture pictures are a first step toward

creating a Patient Choice Posture Practice, with posture-conscious patients who value care enough to pay for it, often on an ongoing basis, even in the absence of insurance reimbursement.

Re-Branding Chiropractic. The demo-graphic and economic trends of aging boom-ers along with unprecedented advances in biotechnology will strike our healthcare sys-tem in a perfect storm, and create a unique op-portunity for chiropractic Posture Practices. As boomers age and become more focused on staying active, boomers will resonate with ideas like Move Well to Age Well. As their pos-ture degenerate and they hunch over with age, a consumer desire for posture solutions will

grow. “Research suggests that vertebral fractures have been over-rated as a cause of height loss and hunching. Another big reason may simply be bad posture.” (The Harvard Medical School Adviser ) Also, in addition to the intuitive benefits of good posture, poor posture is being implicated as a risk factor for serious health problems. Consider:A 20 year University of London study looked at over 4,200 men aged 40-59 and found strong correlation between los-ing height and mortality. The authors speculated that slump-ing over postures caused a physical restriction of breathing which significantly increased risk of



21

PRESIDENT’S MESSAGEDear Colleagues:

As the year 2007 draws to a close, I want to take this opportunity to personally thank you for your membership support. Thanks to your dues investment, participation in educational programs, involvement in committees and task forces, and ongoing input, we’re heading into the New Year on a positive and productive note.1. We’ve launched VCA’s Celebrate Wellness! public relations campaign, providing you with professionally produced

editorial pieces and audio clips that you can use to grow your practice and spread chiropractic’s positive message. (Pages 2-3)

2. We’ve established an alliance with MassMutual Financial Group and their health insurance division, The Financial Group of Virginia. VCA members now have access to professionals who can help with important decisions when it comes to purchasing health insurance. (Page 8)

3. We’ve entered into an agreement with McClelland Consulting to increase your access to accurate and timely answers to your coding, documentation and Medicare questions, along with discounted rates should you require more in-depth consulting.

4. We’ve partnered with the Chiropractic Buyer’s Group to provide members with dramatic savings on chiropractic products and services such as x-ray film, face paper, treatment supplies, office supplies, and more. (Page 27)

5. We’ve partnered with Alternative Medicine Integration Group (AMI) to expand outcome-based chiropractic value measurement in order to better demonstrate to patients and payers alike that chiropractic can improve health and reduce healthcare costs.

6. We’ve joined ACA’s efforts to solicit and compile documented examples of managed care abuses so that we can strengthen our position with the regulators and policy-makers that can effect change.

7. We’ve become active players in the formal review process of the Council on Chiropractic Guidelines and Practice Parameters’ mission to examine all existing guidelines, parameters, protocols and best practices in the United States and other nations to construct an equitable chiropractic “best practice” document. (Page 6)

8. We’ve taken steps towards greater state unification through increased communications and joint educational and legislative initiatives with the Virginia Society of Chiropractic.

9. We’ve joined a consortium of the states that participated in the Medicare demonstration project and other chiropractic organizations to ensure the best possible outcome of the demo (“As Medicare goes, so does insurance”).

I’m sure I’ve left something out. However, the main point is that, thanks to you, the VCA is serving you, your patients, and the profession better than ever before.• What else do you need from us?• What can we do better?• Can you join a VCA committee to help move Association initiatives and benefits forward?

ExerciseyourmembershiprighttoguideanddefinetheAssociation’sfocusandpriorities.

If you have any questions, comments, complaints or suggestions, please feel free to call me at 540-371-0474 or send an e-mail to [email protected]. In the meantime, here’s to a happy and prosperous 2008!

Sincerely,Bill WardWilliam B. Ward, DC, CCSPVCA President

22

C-PAC ContributorsBy Charlene Truhlik, DC, C-PAC Chair

Thank you to the following doctors for getting on the band wagon and starting their 2008 C-PAC

contributions early (as of March 24, 2008):

Scott Banks, DC Larry Bompiani, DCKenneth Bowman, DC Don Bresnahan, DC Robin Bresnahan, DC Chris Brown, DCChristopher Bruno, DC Edward Carlton, DC Paola Carlton, DC Karen Cerwinski, DCGarry Collins, DC Danny Joe Dales, DCElliot S. Eisenberg, DC Wm. Todd Fisher, DCChristopher Frey, DC T. H. Gillenwater, DCMichael Haas, DC Robert Hedgepath, DCCarmen Johanning, DC R. LaBarbera, DCSusan Martin, DC Christopher Oliver, DCMathias Pastore, DC Stewart Rawnsley, DCThomas Skelton, DC Lonnie Slone, DCGlenn Stark, DC Jan S. Sumner, DCWilliam Thesier, DC Robert Thomas, DCSteven VeGodsky, DC Jerry Ray Willis, DCJohn Willis, DC Adam Wilding, DCHoward Wilson, DC

Burt Rubin, DC has contributed to the Robert Bowie Foundation.

bill’s patron asked the House Health, Welfare and Institu-tion’s subcommittee to “strike” his bill, defeating it for 2008. We were also successful in the House Rules Commit-tee’s DEFEAT of two identical measures calling for the Joint Commission on Health Care to study “continued competency” by those licensed by a Board under the Virginia Department of Health Professions, including chiropractors. Pushed by AARP, the study called for development of “continued com-petency” as a means for re-licensure and/or participation in health insurance plans. One recommended approach was to follow the MD model and to suggest Board Certification (and periodic certification renewal) for relicensure and/or third party insurance participation. VCA’s position was that while the Board of Medicine already has ample tools available to ensure the continued competency of its licensees, it should be up to the respective health care professions and their associa-tions to consider appropriate means to ensure continued com-petency. With the many differences between various health care professions, we noted it is best to have such studies take place by the respective professional associations rather than legislators serving on a Joint Commission. We can expect this issue to surface again in that AARP has indicated this is a major priority for them across the nation. Likewise, I’m confident VCA will embark on discussion as to the best means to ensure continued competency by your profession. I remain impressed with the growing credibility amongst legislators regarding your profession. Likewise, all VCA members are encouraged to remain and increase rela-tionships with members of the General Assembly. Despite your years of clinical training, we must remember your scope of practice, your ability to participate in third party insurance plans, and virtually every aspect of your profession and your practice is determined by 140 State legislators. And remem-ber too, please consider a sizeable contribution to C-PAC.

VCA Legislative ReportBy Bruce Keeney, The Keeney Corporation

VCA Legislative Counsel

As VCA’s lobbyist, after the Governor acts on vari-ous bills in mid April, I’ll provide the VCA Board

with a comprehensive report on activities of the 2008 General Assembly. However, I thought the VCA mem-bership would appreciate learning of two major success stories of direct benefit to the chiropractic profession. For the second consecutive year, we were suc-cessful in joining a coalition in DEFEATING legislation to restrict the use of the term “physician” to those with a MD or DO degree. The defeat of this legislation pro-tected chiropractors’ use of the term “chiropractic physi-cian.” Perhaps even more important, we recognized that many third party insurance plans would no longer include chiropractors under their provider directories of “physi-cians/medical specialties” had this legislation passed. Should your profession be removed from this category used by many medical insurance plans, patients would not be aware of chiropractors participating in their health plans. Opposition to this measure was so strong that the

Dear VCA Members:

As you can see from Mr. Keeney’s report, the two major issues facing our profession were defeated this year. In addition to Bruce’s hard work, a big portion of our suc-cess came from individual doctors getting involved with their legislators and C-PAC contributions. I again ask that you consider making a big contribution to C-PAC to help us continue our efforts, as next year is an election year. Remember that C-PAC gives to the leadership as well as other key figures that may not represent your dis-trict. C-PAC contributions also help make Mr. Keeney’s job easier as he represents our interests. So please, if you have not contributed to C-PAC yet this year, please send a check today. If you have already contributed, THANKS -- and please consider contributing again. It’s an investment in your future, so please do it today!

William R. Thesier, DCVCA Legislative Chair, C-PAC Board Member

23

And Still Under $10,000.00

2 Channel Combo w/Cart

Regularly $3,670.00 Special Price. $2,695.00

Alan G. Day Corporation Your source for Equipment, Tables & Supplies

TerraQuant SUPER-PULSED LASER

Simplicity in design and ease of application sets the TerraQuant apart.

∑ State of the Art Super-Pulsing Laser ∑ 5 pre-programmed treatment programs ∑ Easy custom programming with the touch of a button ∑ Simultaneously operate two separate emitters ∑ Variable treatment protocols

4 Radiances From One Emitter ∑ Super-Pulsed Infrared Laser Light ∑ Pulsed Broadband Infrared Light ∑ Pulsed Red Light ∑ Static Magnetic Field Starting at $3,495.00

More than decompression… More treatment options, More patient solutions.

Alan G. Day Corporation VCA Vendor Member 1-800-634-5084

Introducing

SuperPulsed Laser W/AIM (Area Identification Matrix)

THE ONLY REIMBURSABLE LASER SYSTEMTHE ONLY REIMBURSABLE LASER SYSTEMTHE ONLY REIMBURSABLE LASER SYSTEM

In Stock Ready for Immediate Delivery

24

VCA Classified AdvertisingVCA DC Members may place a classified ad in The Virginia Voice and on VCA’s website free of charge. Fee is $55 for non-member DCs and all Suppliers. Limit of 35 words may be imposed. For deadlines, display ad info. and/or to submit your listing, e-mail [email protected].

[Listings as of 3/24/08]

PRODUCTS & SERVICES

ALL NATURAL ANTI-INFLAMMATORY PRODUCT: InfiAid naturally & effectively supports body in repairing tissue following an injury. Certified for Sport by the NSF. CAeDS The World’s First Guaranteed Nutrient Dely System. Please visit www.infinity2.com/ adme.

UNSECURED LOANS up to $100K at bank rates for as long as 7 yrs. Email your request & ph # to J Michael Becker, DC, an ACA, VCA, & NCCA mbr for >35 yrs: [email protected].

Trusted VoiceTM ON-HOLD SYSTEM builds yOUr practice when callers are on hold. Radio/TV voiceovers, in-ofc chiropractic radio, patient ed CDs also available. Endorsed by VCA, FCA, more. 10% VCA MEMBER discount! Visit www.trustedvoice.com or call 877-55VOICE.

SPACE

NOVA/CENTREVILLE. Seeking motivated dr who’d like to start own practice in well-equipped ofc. Lg rehab-based ofc currently used only 3 days/wk. Great opprty. Located among other health care profs. In same complex w/INOVA Urgent Care & 2 lg family practices. No equipmt/furniture to buy! Just step in & start growing yr own practice! [email protected].

CLINIC TO SHARE: Leesburg. Pay monthly rent or % based on gross collection. Full admin & billing support avail. Great for solo practitioner to share OH & for starting DCs. Email inquiries to [email protected].

CLINIC TO SHARE: Sterling, fully equipped office available, perfect opportunity for you to

share OH. Pls email [email protected].

CLINIC TO SHARE in Manassas, Rosslyn/ Arlington, & Annandale, VA. Pay monthly rent or % based on gross collection. Full admin & billing support avail. Great for solo practitioner to share overhead & for starting new DCs. Email [email protected] & visit www.rapha-clinic.com for address.

SEEKING POSITION

X-RAY TECH, LTD LICENSE, VA. AVAIL IMMED. Grad VCA’s Ltd Lic xray tech certification prog & exam. Also Certified Med Asst, First Aide & CPR/AED Certification, 13 yrs exp as a business prof, PR background, proven ability to maintain clientele base, mgmt & supervisory exp. Ext exp in patient/clinical care & ofc mgmt/support. For full resume w/job history, exp, ed, & refs, call Roxane Shifflett, RT-L, CMA, 434-831-2531 or 434-996-4732.

POSITION AVAILABLE

Sport & Spine Rehab, rapidly growing Chiro, PT & Rehab co seeking highly skilled/ethical DCs w/exc clinical/interpersonal/comm skills to be clinic dirs/partners. Opening 3 mo clinics w/in 12-18 mos. Base $36-$50K dep on exp/skill. Bonus 1% of collections when goal met. Ed Reimb $500 yrly. License reimb, Malpractice, Health, LT Disability, SSR pays 100% after 90 days. 401K after 1 yr & 1000 hrs. Max yrly contrib $12K. Co matches up to max of 4%. Vacation 10 days, sick 5 days, bday, New Yrs, Mem Day, July 4th, Labor Day, Thanksgiving, Christmas off. Partnership: After 24 mos, earn 5% equity ownership up to 20% at NO COST. Ownership/sweat equity. Contact Dr Greenstein, 301-518-1006, [email protected].

HAMPTON: Rapidly expanding practice is seeking an enthusiastic, caring, motivated dr proficient in diversified. PT & rehab knowledge a plus. Future opprty to be Clinical Dir of a satellite ofc for right dr. Email resume to [email protected] or Fax to 757-827-9089.

LOOKING FOR ASSOCIATE: 3-5 yr buy-in/buy-out option. Location Short Pump/Inns-brook in Richmond. Pls send resume/photo to [email protected].

NOVA: Immed opening for Chiro phys in rapidly expanding Clinic 30 mins frm Wash DC. Exc base salary, bonus system, health benefits, malpractice ins bens, profit sharing pension plan. Come join our expd prof Chiropractic family. Must have Va license, exc adjusting skills & willing to contribute to our winning team. Email resume to [email protected].

NOVA: Outstanding assoc position available for principled, subluxation-based, hi vol, growing & expanding wellness practice. Masters Circle dr w/>26 yrs of exp will train & mentor. Seeking hi energy, team player with awesome people skills & strong passion for chiropractic & serving patients. Exc benefit pkg! Send resume to novachiroassociate@ verizon.net.

CHIROPRACTIC CTRS OF VA!! Who has a proven track record of turning assoc Chiros into successful owner Chiros? Don’t throw away yr future gambling on promises & unproven systems. If ownership is yr goal, look to proven systems of CCVA rather than wannabies who think YOU are going to build THEIR practice! We have the BEST systems for success, just ask any of the 5 assocs who now own their own practices! Most competitive salaries, retirement bens, pd malpractice, 80 hrs vacation/yr, CE, great health ins, on & on & on. Visit www.chirocenters.com! If you’re looking to control your future & willing to learn systems, processes & procedures of proven success, email pic & resume to drmac@ chirocenters.com or fax to 804-523-8025. Seeking 3 assocs (owners-to-be) for 3 new practices in Richmond area.

VA BEACH: Estd 22 yo practice looking for exp’d DC proficient in Diversified & Drop tech to be primary treating doc. 2550 sq ft ofc w/x-ray, PT, Rehab & Triton DTS decompression. Must have min Continued on page 25

cardiovascular disease, stroke and respiratory mortality . Women with a jutting forward head posture were found to have almost half again the risk of dying during the course of one 4-year study . Being the Posture Expert is a perfect market iden-tity for DCs, whether they focus on disc and low back problems, subluxation-oriented wellness, sports, rehab, or just old-fashioned pain relief. And regardless of tech-nique, taking posture pictures at the beginning of care, and then comparing those images to new pictures taken after a course of treatment, creates a marketing edge for such practices by showing people something they know they have a problem with (their posture), and then dem-

onstrating improvement with care.

Dr. Weiniger has trained thousands of doctors and other health professionals in the StrongPosture™ protocols for re-hab care and keeping patients moving well as they age. He is managing partner of Bodyzone.com, the online health re-source and referral directory for posture exercise profession-als, DCs and MTs, and PostureZone.com, which offers tools for the clinical posture practice. For more information, visit www.BodyZone.com or call 866-443-8966. Don’t miss Dr. Weiniger’s 12-hour seminar for DCs and staff, Clinical Posture Assessment, Therapy and Exer-cise, June 21-22 in Norfolk. Sponsored by the VCA. CEUs in Virginia. Visit www.virginiachiropractic.org for details.


25

1 yr exp. Oppty for buy-in. Salary

+ % & benefits. Send inquiries & resume to [email protected].

IMMEDIATE: Looking for Chiro Drs in Rosslyn & Manassas. Clinically strong, notivated, self-starter, interested in practicing in group setting. Competitive salary, profit sharing w/partnership opp. PT, Rehab, Acupuncture training a +. Email CV to [email protected].

SEEKING MOTIVATED ASSOCIATE for Leesburg clinic. Hrs M-F 12-7 & Sat 8-1. Pls email resume & questions to mistypauldc@ aol.com or call 703-777-2532.

INDEPENDENT CONTRACTOR: Seeking ind contractor to share overhead. Turnkey situation. Estd 11 year practice in Loudoun Cty’s northern Va. Fax resume to 703-406-8688 or email to [email protected].

OPPORTUNITY IS KNOCKING. Want to run/operate yr own business? You cld be the next Chiropractic Care Specialist we are lking for. Booming practice just outside of Richmond in the prime of all locations. Patients flocking to door. If you’re a Palmer Grad lking to own yr practice, send CV & picture. Oppty won’t last long. Email Dr David Donofrio at [email protected]. Any serious inqs w/CV & pic gladly accepted. Get ready, Get set, Let’s Go! Don’t let this one slip by. Our team is looking forward to meeting you.

ASSOC DR needed for busy, evidence-based, rehab practice. Multidisc setting in orthopedic, spine & sports med facility where we work hand in hand w/physicians & PTs. We’re on staff w/the sports med dept of local univ where we treat student athletes on-site w/a multidisc team for optimum in getting them well & back on the field. Looking for a DC to work as a tandem assoc in this setting. Prefer sports & rehab background. Email or fax resume ([email protected], fax 757-220-0162).

CHIROPRACTOR WANTED: Position avail now in beautiful SW VA for a motivated self-starter w/interest in making an impact in the community. Multiple practice grp looking to expand. Competitive salary w/oppty for significant growth. These practices are well estd w/long history of patient focused, quality care. If you are interested in practicing in a team environment w/other DCs to help patients, pls email yr CV to raytuck@ tuckclinic.com.

COMPASSIONATE, DEDICATED, MOTI-VATED DR needed to join our estd Richmond practice. We are a growing family practice seeking a chiropractor to join our team. If you are interested in delivering excellent care & quality svc using a wide variety of comprehensive chiropractic & wellness services… We Need You! Base salary, bonus, health ins, 401(k). Email cover letter & resume to [email protected].

STUDENT EXTERNSHIP position in No. Va, near Wash, DC. Lking for energetic, highly motivated, willing to learn. Techs = Div, Cox, Act, Palmer. Practice incorporates nutrition, exercise, vitamins, gen wellness. Extern has long-term interests living in VA & possibly becoming an assoc. Contact Dr. Gary Dennis, 703-273-7733, [email protected].

SEEKING ASSOC: Martinsville area. Fax resume to Dr Hill at 276-632-1882 or email [email protected].

EQUIPMENT

SUMMIT QCP PROCESSOR for sale. 1 yr old. Used very little. Maintained by Kane X-ray. Pls call Ricci Chiropractic at 540-662-1237 or email [email protected].

RICHMAR AUTOSOUND 7.6 Combo Premod, Interf, Galvanic, Russian, Manual & hands-free Ultrasound, $1750. Call Dr Chris Brown at 276-988-4265, email chirochrisva@ hotmail.com.

IMPULSE ADJUSTING INSTRUMENT: Gently used, purchased 8/07. White w/dual Stylus Pkg & case. $650 + shipping (new $789). Go to www.neuromechanical.com & click on “Impulse” for more info on instrument. Contact Robert Thoma, DC at 757-348-7207 or [email protected] if interested.

BENNETT X-RAY SYSTEM: Model T-325 single phase w/storage cabinet, AFP imaging cord – mini-med 90, red light, lead apron, name plate scanner, 2 12x8, 4 12x12, 4 18x15. 1 case fixer, 1 case A2 developer. Well maintained – svcd every 4-6 wks since purchase ‘97. No use the past yr. Best offer 703-406-8686 or [email protected].

TRANSWORLD 325V X-RAY UNIT: Exc working order, purchased in 96, have never had any problems. Also, Konica QX70 processor w/2 8x10 & 2 14x17 cassettes, red light, stamper lead gown. Whole x-ray pkg for $4000 obo. Email [email protected].

1 OMNI BIOPHYSICS ADJUSTMENT TABLE (used), gd cond, 4 drops cervical, thoracic, lumbar, sacral; asking $2200 ($5000 new). Also 1 blue stationary cervical ext traction chair, very gd cond, asking $400. Pls contact [email protected] if interested.

X-RAY UNIT/PROCESSOR/EQUIPMT: Hardly used ‘04Summit x-ray 20 kHZ hi freq generator w/anatomical digital input keyboard. No settings, just punch in patient measurements & everything is auto calibrated w/min patient exposure. Hope Micro-Max film processor. Film bin, all sz cassettes, film, dark rm equipmt, lead operator shield w/glass lead window & lead curtain, measurement calipers, lead apron, etc. Basically all you need to have x-ray in yr ofc. Asking 10K OBO for all. Will consider selling items separately. 703-379-4055, Dr Solomon.

OMNI TABLE W/DROPS. Great condition,

$2400 OBO (sell new for $5000) Call Short Chiropractic at 540-464-5800.

TABLES FOR SALE: 3 Winco bench tbls & 2 Petitbon wood tbls. All the tbls are grey & in good condition. I will sell them either separately for $150 a piece or ALL 5 for $500. You pay for S&H. Pls contact Dr. Dennis P. O’Hara, phone 703-368-8800, email drohara@ comcast.net.

FREE ADJUSTING BENCH: Combo pelvic bench/cervical chair, gd condition. You pick up from our Front Royal ofc. Call Leighann Miller, Berman Family Chiropractic at 540-636-8770 or email [email protected].

NEW HOPE MICROMAX PROCESSOR & 1994 UNIV X-RAY MACHINE w/lead wall & cassettes all inspected & ready to go for $3500 obo. Must make rm in ofc so priced to sell quick. Pls contact Andrew Reno, DC at 540-785-0200 or [email protected].

FOR SALE: 2007 Pro Adjuster, 4 mos use, like new, all opts, warranty, (Foot Leveler’s) orthotic scanner, $29,000 OBO; Hill Anatomotor Traction, 4 mos use, gray, all opts, $4000 OBO; Human Touch Massage chair, tan leather, cost $1995, $799 OBO, pics avail; [email protected], Dr Dan Wymer @757-560-5515.

SUMMIT X-RAY PROCESSOR: Safe light, flasher, stand, chemical containers, 2 8x10 & 2 14x17 Blue Cassettes. Leftover film & chems. Processor <3 yrs old. Warranty exps 12/07. Kane X-ray ests value at $2000. In great shape. Asking $1000 for all. Contact Chris DeGraw, DC, South Boston, [email protected].

CHIROPRACTIC TABLES, ELEC-TROTHERAPY, ULTRASOUND, X-RAY, IST: New, used & reconditioned. HF Hill & Assoc, visit www.UsedChiroEquip.com, call 800-434-4551.

COVERAGE

COVERAGE FOR VA/MD/DC by licensed Natl grad w/PT privileges & over 6 years of clinical exp. Includes free orientation visit. Half & full day rates available. Contact Rachel Ash, DC @ 301-512-8756 or via email at [email protected].

DC AVAILABLE for coverage work in Va. Grad’ Life Univ in 2000. Licensed in VA since 2005 w/active 2/4 mil NCMIC ins policy. Skilled adjuster in many techniques incl extremities. High vol no problem. Very reasonable rates. Call Dr Ben Fitzer, 757- 268-2646.

VACATION – MATERNITY – RELIEF COVERAGE: Dependable ofc coverage. Long/short term. 14 yrs chiro exp. Flat rates, no travel fees, state wide. Palmer grad, NCMIC insured. Various techniques. Call Mary Hodal, DC at 321-960-7056 or email [email protected].

COVERAGE DRS WANTED. ChiroCover Inc is now hiring qualified DCs licensed in PA,



26

VA, MD and/or DE; applicant must

carry malpractice insurance. Call 800-367-5707 or apply at www.chirocover.com.

COVERAGE DR: Personable, reliable, prof, skilled coverage dr available. Licensed/insured in VA & MD. Rest assured knowing yr patients & practice will be cared for in a friendly, prof manner. Refs avail. Call 703-598-8875 or e-mail [email protected].

COVERAGE DR AVAILABLE: 20+ yrs experience, well-versed in most techniques, avail to provide coverage for you. Willtravel, licensed in VA, NY & MD. Call Dr Ira Abrams at 443-472-8972 (cell) or email [email protected].

COVERAGE POSITION WANTED: Extremely personable, energetic recent grad desires coverage or part-time assoc position. Diverse patient contact history due to varied clinical rotations. Exp w/toddlers & children. Currently in private practice. Willing to travel in Southside & Shenandoah Valley regions. Member VCA. Call 434-792-8725 or email [email protected].

NEED TO GET AWAY? WANT TO JOIN

OUR STAFF? Secure Relief is a natl network providing temp & permanent chiropractors & PTs to join yr practice. Call 1-800-TEMP-DOC, email [email protected] or visit www.securerelief.com.

Call Now - Today - RELAX & ENJOY YR TIME OFF! Trust a dr who truly cares about yr practice. Lic, own malpractice ins. Very expd in relief/correction/maintenance/wellness care, accident cases, sports injs, acute/chronic pain mgmt, musculoskeletal conds, high/low vol practices. Avail Sats. Call Dr Steven Ozrovitz, 540-562-2226.

VACATION RELIEF SVCS: Keep yr ofc open. Yr practice run yr way. 16 yrs exp ofc coverage. Proficient in many techniques. NCMIC insd. Statewide coverage. Refs. Rea-sonable rates. Call J Terry Fowler, DC at 770-953-2002 (vm), 770-597-2872 (c), or 678-494-1523 (h). Email jtfowlerdc@ yahoo.com.

PRACTICES

SOUTHEASTERN VA: 18 yr largely cash family practice. 1800 sq ft ofc in town center. Underserved market. Tenured, trained staff. Owner relocating for family reasons. The Paragon Group, 800-582-1812, info@

eparagongroup.com.

PORTSMOUTH, VA: Dr relocating/family reasons. Fully equipped, modem, positive cash flow. PI, cash & insurance family practice. Reasonably priced for quick sale. Ideal for new grad w/low OH. Call 276-632-3334.

NORTHERN VA: Fully equipped, Diversified practice w/60% profit! 2000 sq ft facility in upscale area. 25 new patients/mo, annual collections $700K. Professional Practice Advisors, Inc., www.practiceadvisors.com, 800-863-9373.

FARMVILLE: Priced to sell, dr relocating, 12 yr old diversified practice. Great demographics, beautiful ofc, very low OH. Avg collections last 3 yrs working 18 hrs/wk: $135K. Asking $79K; >$20K below appraised value. Willing to facilitate quick/smooth transition for new dr. For info call 434-610-2103 or e-mail [email protected].

ROANOKE AREA: High net profit! 100% cash practice! 5+ year old, fully-equipped Thompson/diversified on major thoroughfare. Dr works 2 full days & 2 half days, collections $217K+. Professional Practice Advisors, Inc. 800-863-9373, www.practiceadvisors.com.

New members mean increased di-versity, expertise, and resources,

translating directly into added as-sociation strength and member ben-efits. Thank you for your support and participation and let us know how the VCA can serve you better.

[Joined 12/15/07-3/24/08]

Larry D Bell, DCLight ChiropracticLynchburg, VAP 434-384-8285www.light-chiropractic.comMembership Type: 1st yrSponsored by Todd MacDowall, DC

Christopher A Belluzzo, DCBlacksburg, VAP 540-449-2277E [email protected] Type: 1st yr

Wendy Brown, DCTuck Chiropractic ClinicRoanoke, VAP 540-563-0334


Welcome, New VCA Members!E [email protected] Type: 1st yrSponsored by N Ray Tuck, Jr, DC

Joseph P Cheff, DCCheff Chiropractic CareWoodstock, VAP 540-459-3900E [email protected] Type: 4th yr +

Stephen L Childress, DCChildress Chiropractic Spinal Rehab & WellnessLebanon, VAP 276-889-1314E [email protected] Type: 4th yr +

Geraldine Cruz, DCWilliamsburg, VAP 757-259-2339E [email protected] Type: Out of StateSponsored by Robert Pinto, DC

Tom Dickerson, DCHealthSource of Christiansburg

Christiansburg, VAP 540-381-5660E [email protected] Type: 1st yrSponsored by Jeremy Busch, DC

Robert A Duca, DCVA Diagnostic & Natural Medicine ClinicDunn Loring, VAP 703-641-4966E [email protected] Type: 4th yr +

Eric Etka, DCVirginia Wellness AssociatesRichmond, VAP 804-285-6325E [email protected] Type: 1st yr

Angela Ference, DCCharlottesville, VAP 434-409-0564E [email protected] Type: 2nd yr


27

Ben Fitzer, DCFitzer Chiropractic & WellnessNewport News, VAP 757-223-9915E [email protected] Type: 1st yr

Thomas P Genovese, DCFamily Healthcare Chiropractic CtrStafford, VAP 540-288-8880E [email protected] Type: 4th yr +

Robert D Green, DCActive ChiropracticRichmond, VAP 804-560-9355E [email protected] Type: 4th yr +

Thomas J Hennessey, DCPetersburg, VAP 804-732-8866E [email protected] Type: 4th yr +

Jeffrey A Hollar, DCHollar Chiropractic & RehabHarrisonburg, VAP 540-574-6166E [email protected] Type: 2nd yr

Jason A Kennedy, DCSlone Chiropractic ClinicRichmond, VAP 804-565-9551E [email protected] Type: 4th yr +Sponsored by Lonnie Slone, DC

Garry Krakos, DCSpine Arts CtrSpringfield, VAP 703-644-2222E [email protected] Type: DC Spouse

Catherine Leavitt, DC, LLCBelle Haven ChiropracticAlexandria, VAP 703-660-6770

E [email protected] Type: 4th yr +

K Christine Lim, DCSpine Arts CtrSpringfield, VAP 703-644-2222E [email protected] Type: 4th yr +

Bryan P Lowry, DCAdvanced Wellness CtrRichmond, VAP 804-359-1768E [email protected] Type: 4th yr +Sponsored by William Roodman, DC

James D McLelland, DCChiropractic Ctrs of Short PumpRichmond, VAP 804-360-2447E [email protected] Type: 4th yr +

Marissa R O’Malia, DCWashington, DCP 202-887-5375E [email protected] Type: Out of State

Marilyn PorrasCHIROCENTERS MANAGE-MENT CORPChesterfield, VAP 866-671-0136E [email protected] Type: Assoc/SupplierSponsored by Michael McCarney, DCChiropractic office billing for 3rd party payers & patients, including software.

David J Prymak, DCPrymak Chiropracitc PCWoodbridge, VAP 703-494-9922E [email protected] Type: 4th yr +

Kristen A Teagle, DCColonial Chiropractic PC

The Virginia Voice

Spring 2008

The Virginia Voice is the quarterly newsletter of the Virginia Chiropractic Association, PO Box 15, Afton, VA 22920, www.virginiachiropractic.org.

Staff: Julie K. Connolly, Exec. Dir.

Editorial Committee: William B. Ward, DC, CCSP, VCA President; Scott Banks, DC; John C. Willis, DC

Advertising: Call 540-932-3100 or e-mail [email protected].

Subscriptions: A subscription to The Virginia Voice is a benefit of VCA membership. Back issues are archived for members only on VCA’s website.

Editorial Policy: Articles published in The Virginia Voice are screened by the Editorial Committee. However, neither the VCA nor its officers or staff investigate, endorse, or approve any statements of fact or opinion, which are solely the responsibility of the authors/sources of information. They are published on the authority of the writer(s) over whose name they appear and are not to be regarded as expressing the views of the VCA. Articles accepted for publication are subject to editing.

Advertising Policy: Acceptance and publication of an ad in The Virginia Voice does not imply endorsement or approval of the company, product, or service by the VCA. It is recommended that readers use due diligence and/or consult with their state chiropractic licensing board for further info. on the use of advertised products or services.

Continued from page 26 Williamsburg, VAP 757-258-4500E [email protected] Type: 4th yr +

William P Turner, DCTurner ChiropracticCentreville, VAP 703-815-9500E [email protected] Type: 4th yr +

Ronald A Weinstein, DCPinecrest Wellness CtrAlexandria, VAP 703-354-2225E [email protected] Type: 4th yr +

Inside This IssueSpring 2008

Bisphosphonate Therapy • RisksHouse Resolution Re: Chi-• ropractic & Armed ForcesVCA Health Insurance• VCA PR Campaign• Posture Assessment• Calendar of Events• Cassidy Stroke Study• New Members & Sponsors• Classified Ads• Much More!•

Virginia Chiropractic AssociationPO Box 15Afton, VA 22920Unity in One Voice

the virginia voice€¦ · care did so for symptoms associated with musculoskeletal ailments –...

Documents