Empowering Women in Chiropractic – Cultural Competence 101 for the Chiropractor Part 2

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Good afternoon. I’m Dr. Charmaine Herman and welcome to cultural competence. 101 for the chiropractor part two. We’re going to cover today, exactly what cultural competence is not as well as defining the term culture. So let’s go ahead and get on and move to the next side. Thank you so much ChiroSecure for allowing this program.

So we’ve been talking about cultural competence in our last episode. So as we move into the next part of part two on the next slide, we’re going to actually determine what we’re going to talk about today. So again, those of you who don’t know me again, I’m Dr. Charmaine Herman. I practice at Alpharetta Georgia. Agave Upper Cervical Health Center is the practice that I’ve been in now for almost 10 years. In addition to that, I teach at Life University. I am associate professor in the college of chiropractic in the clinical sciences division. So let’s see what our goals are for today. So on the next slide, our goals there to determine what cultural competence is not. What I found often is that when we start talking about training and talking about different topics, sometimes it’s easier to get rid of what things are not before we delve into what things actually are.

So some preconceived notions. Um, in addition to that, we’re going to actually define the word culture. What is culture? Why is it important? Um, why should I, as a chiropractor, be concerned about culture. When dealing with my patients, it’s not just a buzz word. It can actually affect how my relationship with my patient develops and help a lot with compliance to care. So let’s move on to the next slide. So again, our topic is what cultural competence is not, but also what it may include. So again, while eliminating certain things, we do want to know that some things can be part of our conversation. So cultural competence is not learning every culture in the world. I’ve heard people say that, how can you be culturally competent? Um, that means I have to learn the cultures of people in Asia and Europe and Africa. How can anyone learn all that information? Well, that’s not cultural competence. It’s not about learning everyone’s culture, cultural competence, narrows it down a little bit smaller than that, to a very simple aspect of what you need to know as a doctor of chiropractic. When working with people from various cultures, let’s move on to the next slide.


Cultural competence is not diversity. Training diversity training is important and is part of being culturally competent, understanding that we do have a very diverse community, a global community that we have to deal with even as doctors of chiropractic, not just in our communities, but also even outside of our communities, into the world, understanding how important the diversity is within our nation, within our world to think about it. If you had the same thoughts and everyone, you knew thought the exact same way, where’s the diversity in that? Where would be the inventions? What would be the ingenuity? There would be none of that because everyone would be exactly the same. So we ought to celebrate diversity and we, as doctors of chiropractic, definitely appreciate the diversity of our patients and what they bring to our practices. Okay, I’m the next slide? Cultural competence is not just being politically correct.

I mean, that’s a buzzword that a lot of people shy away from, but overall, when you’re dealing with people, not just in your communities, but outside of your communities, those who we want to reach as doctors of chiropractic being politically correct is helpful. We want to make sure we address people in terms that are not offensive to them, that we’re actually using words that people can understand and actually, um, agree with and attend and actually be an answer to. So whether you believe in and saying happy holidays or saying Merry Christmas, I mean, that’s all a person’s choice. So being politically correct means it’s accepting the person’s choice. If they want to say Merry Christmas or happy Hanukkah or happy holidays, then they’re being, that’s their personal opinion. That’s how they believe. That’s what they think. So being politically correct is just understanding that people do have the opportunity to express themselves in terminology that makes them feel more comfortable when addressing other people.

So being politically correct as part of also being culturally competent, it’s just a small piece. What is not the only piece now onto the next slide, we’ll see where cultural competence is not just sensitivity training. I like this slide because they use cats and I’ve never seen it before, until I was working on this presentation before, but it says, um, a black crap crossing the road that is bad luck, you know, and the person walking with this person happens to be a cat. So this person ends up in racial sensitivity training because that cat felt offended by them saying something about a black cat. It doesn’t matter whether the cat was black purple or green, or the fact is that they was still a cat. And the person said that that meant that they were bad luck. So sensitivity training also is not cultural competence training, but it is something that does come in play.

When we talk about being culturally competent, being sensitive to other people’s feelings and we’re working together. When we’re in a collaborative setting, when I’m working with a patient, I want to be sensitive to my patients feeling I don’t want to insult my patient. Um, when they’re sitting, laying on the table or what I’m scanning there, there’s fine. Or something like that. I want to say things that are actually going to be, um, commending and soothing and calming, but I don’t want to offend them. So being understanding that, um, sensitivity training is not culturally competence, what you should be sensitive to the feelings of those you work with and care for as a doctor of chiropractic. So let’s move on. So exactly what is cultural, the word is cultural competence. So I think it’s important to define both words separately in order to get a better understanding of the entire concept, where you’re dealing with cultural competence. So culture is defined. Let’s move on to the next slide as the way of life of a group of people, meaning the way they do things. You can also define culture as an integration and integrated pattern of human knowledge, belief, and behavior. Or we can also, um, define culture as the outlook attitudes, values, morals, goals, and customs shared by a society. That’s a lot of words. Every time I teach this class who said, boy, that’s a whole lot, but I put it this way on to the next slide.

Culture is the whole person. It’s what makes up every individual. My family was from Jamaica. So my Jamaican heritage is part of my culture, the foods I eat, um, the music I listened to, I grew up in New York. So the things I know about this country, um, where I live, I live in the South. So being Southern, everything that makes up the art, the music, the food, the clothing I wear, um, my faith, my belief, I’m a Christian. I mean my customs that I hold on to that my whole dear, all of this is my culture and everyone has their own culture. So a part of being cultural competent is understanding that everyone does have their own culture and the cultures that we espouse, we hold on to come so much from how we’re raised, where we grow up and the important things that our family has instilled in us.

So that’s what culture is. Culture is the whole person. As doctors of chiropractic, we talk about treating the whole person, looking at the nervous system, looking at the muscles, the how, the, how they respond, looking at all the different tracks and things like that. And assistant how everything works. So we look at the whole person we’re working with our patients. Culture is who that person is. Every person is their culture. So onto the next slide. So culture incorporates everything from a age, gender, identity, race, ethnic group, regional differences, social economic status, even education. I remember moving from New York to Alabama, where I went to undergrad and meeting people that were Southern. There’s a regional differences compared to the North and the South. And it was very interesting talking to students. I went to a historically black college, which was Tuskegee university. And I had a student tell me, well, you can’t be from New York.

Um, and again, this is a historically black college and I’m a stark, I’m a black individual. And she said, but you can’t be from New York because you’re not wearing, you don’t have gold teeth. You don’t have the earrings, the gold loops around your ears with your names. And I mean, this was back in the eighties when I went to undergrad. So it was amazing to me, the concepts of, and what people believed northerners looked like, especially black northerners at that time. And again, that’s based upon what the media showed them. And I actually said to her, I think you would watch a little too much TV, but people associate people based upon their culture and cultural corporates, their regional differences as well, as well as their education, which is very important, social economic status. So onto the next slide, please, for us as healthcare practitioners, um, chiropractic culture is very important.

When we think about how our patients actually see health and healing, if they’re raising a culture that believes that, um, healing is organic or whether healing is something done by traditional medical doctors or by, um, local, um, medicine, men, or healers in your community, that aspect of how they believe health and healing actually resides within each individual is part of their culture, their concepts of pain. There’s some cultures where showing pain, especially if you’re a man is not considered masculine. So how do they see pain as part of their culture? It also tells how people, what people believe as far as where chiropractic sits. Do they believe that chiropractors are actual doctors or because we don’t go to medical schools, we’re not doctors. All of that is part of a patient’s culture. And other people don’t even know what chiropractors are because their culture has never exposed them to that.

Growing up in New York, my father was in many car accidents and things like that. And he went to the doctor. It wasn’t until I graduated from chiropractic school that he actually told me he went to a chiropractor and I asked him, I said, when he said, every time I was in an accident, they sent me to a chiropractor. So at that time again, I did not know what a chiropractor was growing up in New York and the chiropractors he went to did not espouse for families to get under chiropractic care. It was only for the purpose of personal injury. So again, my exposure to chiropractic did not start until I actually started attending chiropractic school. So many people are, they grow up that way. They’d never met a chiropractor or they don’t know what chiropractors do. That is still part of their culture, their education, whether it’s the social economic status that they’ve not ever encountered a chiropractor or the no chiropractors in their communities that also shapes a person’s individual culture.

So culture does affect what we do as doctors of chiropractic, because it affects how our patients see us based upon how they were raised and the things that they were taught and the communities and homes that they grew up in. Let’s move on to the next slide. Now, there are many depths to culture. Culture can, again, like I said, be dressed food, language music, the gangs, people pay, play visual arts that they look at festivals that they attend, but there’s a depth that is invisible. And we’re looking at culture things such as, um, people’s notion of time, um, their personal beliefs, um, how they handle their emotions, um, that, uh, as well as how they feel about modesty. So even those lower depths of culture, for example, some cultures, people don’t are trained to not to look a person in the eye if they respect them.

So coming from another culture, you may take it as an insult of a person. Doesn’t look you in the eye because your culture says, look, every look that person in the eye, when you’re talking to them or another culture they’re taught out of respect, not to look people in the eye. So that’s a notion of concert as you can’t tell or see, but it is an invisible part of a person’s culture. Also, when you talk about communication styles, some people are very verbose and loud when they communicate, they’re a group of them get together and they’re excited and they’re having a great time where other cultures are more silent, more modest with their time with their, with their voices, very silent when they come together and you don’t even know they’re there. So even that notion of how people communicate as well as how people deal with time.

For me as a doctor of chiropractic, I try to be on time for all my patients. I don’t want them to have to wait, but there’s some cultures where quality of time is different from quantity of time. So a person who is in conversation with a relative at that time, when they should be in your office, that quality of time they’re taking with that relative discussing a situation is more important for them to be at your office at three o’clock precisely. So they may run a little late because that quality of time was more important than your quantity of wanting to be there at three o’clock. So I’ll get people’s notion of time is also part of their culture. So we, as doctors of chiropractic also should understand that our patients culture, each individual one has one. So we should try to understand that everyone does not think and believe the way we do.

So we should give some, um, some credence or just a little bit of understanding to incorporating a person’s culture. And we talk about our patients and the things that tend to occur when we’re in practice onto the next slide, please. Now, for example, people that look alike may not always have the same culture. Now I have a lot of Asian friends. I know a lot of Asian chiropractors people that I went to school with, um, people that I see, even my students that are Asian today, and because they’re Asian, I should not assume that their culture is the same, whether it’s from Seoul, Korea, or whether they’re from, um, Hong Kong or Taiwan, or many of the chiropractors that I know who grew up in the United States, I should never assume that because they look alike that their cultures are the same. And I think we tend to make that assumption too often when dealing with patients culture again is individual. And in most cases, if I’m not sure there’s something I really should do before I make an assumption onto the next


I should never assume when it comes to culture, it is better for me to respectfully ask. So just because someone looks the same, whether it’s they look like me or they look like another Asian person that I know, I should never assume that their culture is the same as the other Asian doctor. I know that maybe from Korea or that the PR was a doctor, I know this from Taiwan. I never should assume that a person’s culture is the same because they look the same, whether it’s their skin color, whether it’s just the way that they have resemblance, I should never make that assumption. You know what they used to say about when you assume so? I should never assume anything. When it comes down to culture, I should always just ask respectfully. So I understand that that person is not the same as the other person that I know who seems to be of the same culture, because I think they all look alike.

So that should, that’s a careful gap ground to tread upon. So it’s better to just ask and people appreciate when you ask. So when I look at culture, I have to defy the side who I am. So I do that a lot. So I always have my own cultural words. I’m a woman. I have certain agenda pronouns. I believe I am. She, I am her. Those are my gender pronouns. I’m black, I’m a wife. I’m a born again Christian. I’m a Jamerican is which I tell a lot of people cause I was born in Jamaica, but I grew up in the United States. So I have both of those cultures that I live with quite often, I tend to be urban. I am Southern. I’ve lived in the South more than 30 years of my life. I’m a chiropractor as a cultural bias itself, as well as being an educator or a teacher. So when I look at myself, I describe myself in my culture words, everyone has their own culture words. So I challenge you for this next few weeks until our next session to think about what your culture words are. So here’s your homework. Next slide.

So look in the mirror, look at yourself. Think about who you are, what are your culture words? How can you describe yourself? Those cultural words are important because if you understand who you are, your culture, it’s easier to respect and understand other people’s culture. And this is just the beginning of being culturally competent, knowing who you are, knowing your culture and understanding and respecting your culture, because you want people to respect who you are. So that’s the beginning of becoming culturally competent. Right? Next slide please. So that’s all that I have for today. Our next episode, we’ll actually define what cultural competence actually is. In addition to that, we’ll also talk about how cultural competence can be applied to healthcare. Again, we’re chiropractors. How can I use culturally competent cultural competence then? How can I become culturally competent? So that will be our next episode of cultural competence. One, one Oh one for the chiropractor. Thank you so much for your time, but a special thanks to ChiroSecure for allowing these programs and our, and hopefully have you join us next week. We will have another guest, I guess next week would be Dr. Chen Yen. Thank you again. And hopefully you’ll join for Dr. Yen next week. It’s been my pleasure. Have a great week.

Empowering Women in Chiropractic _ “How to Connect with the Sensory Defensive Child” Monika Buerger

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Disclaimer: The following is an actual transcript. We do our best to make sure the transcript is as accurate as possible, however, it may contain spelling or grammatical errors.

Hello and welcome to another amazing ChiroSecure Look to the Children’s show. I am your host today, Dr. Monika Buerger. And I am super stoked to bring you this information because we’re getting a lot of questions out there about how do I work with that? A little fiddle, fart that is, um, and crazy chaos, and then like a sensory storm to get that amazing adjustment. So I want to bring you some tools and tidbits on that. Um, so let’s head on over to a little slideshow that I put together for you and let’s rock and roll. First of all, um, I want to thank Kairos pure again for giving us this amazing platform and being so, um, great for our profession and everything you do for us. Kara secure, thank you so much. And they have your back. If you want to work with these little fiddle farts.

So here we go. Um, so a child’s neuro expressive behavior, or anybody’s neuro expressive behavior is really a window into their neurological integrity. So we have to take what they are telling us when they’re in our offices in particular. And what does that mean? Sometimes we can get frustrated, um, because they are a little bit difficult or challenging to work with, but we have to understand where they’re coming from and that’s what we want to try to do today. So I want to get, actually today, I want to focus on what are some things we can do to calm the storm, calm the chaos that’s going on in their brain to get that adjustment. And then next month we’ll poke our heads into what does certain behaviors mean? That sounds like a plan. So neurological signs and symptoms are merely a sequella of brain dysfunction, not the cause of it.

So what are the signs and symptoms mean? So, one thing I wanted to do is, again, we want to adjust into calm, not chaos and in today’s world, there’s a lot of not, not just your little fiddle, thoughts are coming in and chaos, but your adults as well. So how can we minimize that for anybody in our practices to maximize the effect of the adjustment? All right. A lot of these kiddos that are in sensory chaos, uh, in a sensory storm are coming in with their brains in chaos. So we’d like to calm them down in order for their nervous system, to be able to even accept that adjustment. And how do we do that? What’s the magic bullet. I mean, give you a few magic bullets, actually. So first of all, what I want to do, I’m giving you a bit of homework. I want you to go your offices. And when do this in two different spaces, one when nobody’s there, maybe just your staff.

So walk into

Your office through the front door, not the back door, if you tend to come in through the back door, but through the front door, um, on any given day when your staff is there, the lights are on just like, it would be a normal functioning day, but no patients there. And I want you to stop look and listen. When you walk into the office, what is it? What does it sound like? What does it feel like? Um, do you normally have the radio on and is it blasting, uh, do you have a video playing? What are the, what are the lights like? Um, is it dim and calm? Is it bright and, and, um, blaring take, just stop, look and listen. What it feels like in your office, expecially, from a standpoint of individuals that, um, get into sensory chaos very easily, then do that on another day.

Maybe you have to slip out the back door to go in the front door when patients are in there, because put yourself in their brain. By the time they get back to your office, are they in a ready as sensory defensive mode? Is it too bright, too light, too much noise, too much sound. And by the time they get back to you, they’re, they’re hunkered down and they are trying to defend themselves against all this chaos. That’s not going to be the child that you’re going to be able to connect with and, um, and, and, and adjust. Okay. So stop look and listen. Um, couple of tips on that waterfalls. I have a wall mounted ticket for me, wall-mounted waterfall, um, desktop and so forth. Those little fiddle parts can, can climb up into your, on your front desk or on a, on a table or something and get into a little bit of trouble with those.

So wall mounted where it’s higher, it’s safer, but, um, co noise, uh, water is calming. It’s soothing. If at all possible, switching out your lights, fluorescent lighting has a buzz to it and can flicker. And that can be, um, over stimulating for your PTSD patients for your post concussion patients for you, a little bit of arts with sensory dysregulation and like your autism spectrum. They see that flicker and they hear the buzz, which we may not, but they do. And that can be very, um, sensory disturbing to them. So look at your lighting, if you can switch them out for incandescent lighting, and that can be very helpful or turn the lights off and use just natural lighting through windows, but figure out a way around that they do have, um, covers for if you have the fluorescent panels, they do have a variety of covers that you can put over the lighting over those panels to, um, calm the, um, calm the visual storm from those fluorescent lighting and get them on Amazon.

So just again, um, maybe the, the, your telephones have them on a lower ring tone. So when the, when the calls are coming in, cause you’re a busier than heck it’s not allowed ring had maybe some rocking chairs with where those with vestibular needs can sit and rock and calm before they get back to you. Just little considerations like that can really help. Um, now for your kiddos, I want to show you a couple of things that I do in my office. You can do them, you can have your CA do them. You can have parents do them. You can do this from across all ages and all stages. I just happened to in those videos, be working with in this case, Elizabeth, who usually joins me and Elizabeth is in my suitcase right now. Don’t don’t, uh, don’t call, uh, child protective services on me.

I was traveling and I brought Elizabeth with me. So it’s usually, sometimes she shows up on the show, but she’s in the video here. So you can use on babies, on your post-stroke, your post-concussion again, across all ages, all stages, but these are very calming. Proprioception is, um, very calming to the nervous system. It’s grounding, it’s calming. So your kiddos that might be sensory defensive. They don’t want to be touched. They pull your hands or push your hands away. They are running around like tornado. Kids will give you something a little bit different for the tornado kids, but, um, they’re very sensory defensive. This can be very grounding and calming to them so that you can get your hands on them and do an adjustment.

Okay? So for some extra proprioception, what we can do is what I call lateral stretches. You’re going to just start opposite arm, opposite leg and gently traction and hold for like 10 to 20 seconds. And then you’ll do the opposite side and then I’ll do same side. This just helps with what we call body positional awareness and proprioception, but knowing we have two sides of the body, um, and then it gives some proprioception as well. So you do that. And then if you have an extra person on hand, one would do the arms and one would do the legs the same time, um, like, uh, you know, the quarter four seat kind of thing. So that is, um, ladder out of these stretches or bilateral, um, awareness or, and, or avoid positional awareness, knowing if both sides of body as well as some from reception.

Okay. So again, um, this is great to, um, foster optimal nerd brain development, right side left side brain, body, body brain connection. Um, but again, it can be very, very calming for those that are sensory defensive. Um, or you can just do some deep joint com. You can do that and then do some deep joint compression, just compress all the way up the arms and legs and squeeze my, some of my kiddos call them squeezies. Um, but that will calm them in order to get the adjustment you can use. Um, also use like weighted blankets. So I, I practice Gonstead. So I will on the older kiddos do, um, see the cervicals. So I made put a blanket, a weighted blanket over their lap. Of course, if you do supine, or if you’re doing cranial work, having a weighted blanket rule of thumb is about 10% of the body weight of the, of the individual that can be very grounding and they would just lay there and let you work on it.

So our ultimate goal is always to get that life changing adjustment. And I want to give you tips on how to do that. So that’s why we’re here today. So the other thing you can do now, I get these little sensory brushes on Amazon. Um, I give them out actually to, uh, my pregnant mamas or once the, the little ones born to do this, to foster optimal neurodevelopment sensory input, um, to, to, for, for, uh, proactive purposes. But again, if you had that tactile sense of kiddo that, um, is you’d go to touch, especially cervical spine, you start to touch them and they just push your hands away. Um, this is a good, good tool to use. Sometimes if they’re older, I might have them sitting up in mom’s lap and, um, I will just do their arms or legs. And then after I’m done doing this, I will let them hold that sensory brush in their hands as I adjust them or do cranial work. It’s just continuing that stimulus that is calming for them. So Amazon, you can get them by the dozen. Um, I tell some docs, you can, even if you want to give them out, get a sticker of your office logo and name on it and put the little sticker inside the brush handle right in here, um, right inside there. And then it’s got your office logo and so forth on it. Um, so their friends can see, Hey, look at my chiropractor gave me great PR for you. So let’s take a look at this.

What I show you here is it can use for may facets one or calming, get the settle down, particularly before you’re doing Jessica. Cause that’s the ultimate thing, right? It’s getting them awesome, lifesaving adjustment, but I also use it to enhance the sensory, give this for parents to do it at home, especially for the self little parts that aren’t meeting their Maura milestones are leading me to go to language milestones. Um, because we know that motor development fosters language development. So we want to do this, not just the parts that are showing average neuro development, but to foster an optimal mode about it. So we can do different things. We can use a brush, second brush, Amazon, okay. Rule of thumb. You put another pressure. So you slightly bend the bristles or you can use, I usually use a smaller ball in that. I just don’t have that here right now.

I house, um, a little massage at home. And what you can do is you can go start, um, from the Palm, preferably open Palm, um, on one arm and we can come on and just stroke. And then you go down the leg and then he would do the other side. Now this is going to help that we call that around knowing right from left, which is a key core, fundamental step for body position awareness, proprioception, visual, motor visual, spatial development. And then we go across the body. We go one arm across the leg. Okay. And then I would do get a smaller ball and I would do so you give me it’s different sensory sensations, prayerfully, Nudie oriented diaper. Okay. So you’re going to go one side of the body, the other side of the body. And this is for all ages. Now, this is really great for your little, little parts that don’t know, right from lap.

Let’s say they’re five or six years old, and you want to foster ladder reality knowing right from left. Um, this could be an issue with kiddos with dyslexia and it’s just crossing the midline. So, um, again, we do the same side, same side, cross lateral hostile, different textures. Um, I also also, um, advocate a lot of tummy time nudity, you know, getting a lot of sensations. I’m getting them up on a boppy. You can do it again on the posterior side. Um, and so these are some good techniques that we should all be mindful of in order to foster offer neuro development, but also intervene if you see average motor and sensory velvet.

So there you have it again, this is, I give this to parents to do at home because it can help, um, foster that sensory defensive, get them out of that sensory defensive mode. But I do this in the office as well, um, in order to calm their nervous system and ultimately get that good adjustment. So it takes you, you know, in a minute or two, you can do that. And then usually they’re so relaxed that they’ll just like, okay, you can get that adjustment done. So you can do this on the move too. So some of those kids that are in that tornado storm, I’ll show you something else here. Um, this one is actually, I think we’ll do it. We’ll do it from bad. We’ll do this one on here. So this is, um, one of my older autistic kiddos that was, that was diagnosed on the autism spectrum, but, um, has come a long way.

And so I have her supine right here and you see how I kind of modify things. Um, this, I call the cranial nerve integration and I cannot tell you how many docs when I met lectures and I give this, I’ll get, uh, an email or message back that, Oh my gosh, this has saved the day. So many times for so many kiddos. So we’ll look at a supine here and then we’ll look at it how you can modify it again. It’s chiropractic on the move. A lot of times we have to adapt our body and our responses to there’s. One thing is we don’t ever want to seem bigger than they are. So for instance, like if they don’t like eye contact, don’t force them to make eye contact with you. Um, if I match their, um, their, their tone as well, some kids want me to speak a lot louder and they want me to be silly and some kids that’s too sensory overwhelming.

So I will calm myself down. So learn how to match their sensory cues if they’re covering their ears a lot. Um, and, and you notice they’re sensitive to noises and you close the door and they’re startled, bring things down a little bit. Okay. Um, if they tend to talk louder, um, you know, you, you might be able to bring your volume up, um, get down on their level, get on the floor with them, match them at their, their body posture, their body, you know, they’re, they’re smaller and they’re crouching down. You make yourself smaller match their, um, their specific needs. Uh, then you gain their trust and then you can start to do things like this.

So this is the cranial and, and integration had procedure. This is to help calm kiddos down. Um, the premise is to what we call it, drive the cranial nerves home, but it’s very calm and relaxing. And sometimes they do this before. Um, trying to Jessica that’s put it in their shoulders layers or bat your hands away. So you’re going to put your start with one hand right here and put it on the forehead. And you’re just going to do a sweep down to the back of that, that as a premise that you’re taking here and driving home the brainstem. So you’re going to do two passes like that, and you can do this lying down or seated or any way to get them do that. Then you’re gonna start at the forehead and have you use it for me. So when you show the people how to do this, can you relate still there, sit up. I’m going to start at the forehead and go up over the years and drive them home. Or you’re asleep that cheeks up the, that chin and get all the long term up over the years and down the back of the neck, driving home, you’re going to two houses here, two houses, and then you’re going to take all three fingers. You have a shin cheeks, forehead, chin, cheeks, or head and drive in home. Okay. And that’s a crayon of friction.

That one is amazing. You guys, um, you can do this on the move and it just sets the tone, especially if you want to get a good cervical adjustment. So again, tools, tricks, tidbits, um, ultimately to get that gold, you’ll see here on this one, how I do this, I combine what I call the respiratory diaphragm. The respiratory diaphragm is, um, think of the Vegas nerve. It comes from the brainstem down at branches out underneath the diaphragm. And it branches out to, um, all the visceral, the neurovisceral sensations, which is a big sensory, um, organism as it is. So, um, that where it branches out underneath the diaphragm is so incredibly powerful. So I’m going to show you how I combine a respiratory diaphragm hold and the cranial nerve integration that the little fiddle fart, we’ll all look at this video on the left here, this little guy, um, very, very sensitive defensive. When he comes in, like I couldn’t even touch his skin. So I worked with them and you’ll see at the end, I was actually able to get my hands skin to skin. And then after that, I was able to get him up on my pelvic bench and adjust them. And he was cool beans cafe. So I just want to show you that and we’ll do a combo.

What can you see at books and front? They’ll try you see snake snake. Now what you can do is again, the cranial nerve integration, swipe white over the eyes, down to the brainstem cheeks down, chin up around them. Do that twice, keep him entertained. He was a handful. I could not catch him at all. And I just go with this and then you can go back to the respiratory diaphragm earlier when he was pulling my hands away. And I had to put a shirt down, put my hands over his shirt, and then he could tolerate it again. Now I’m skin to,

So what it is as you see this picture right here, this is where the little guy supine, and basically what you’re doing is your hands are parallel between, um, the under ones under, um, the last few ribs, depending on the size of the child, right? Sometimes your whole hand takes up the whole cavity. So one’s going to be underneath and one’s going to be over that, um, the diaphragm area. And you just pretend like here, you just pretend like there’s a water balloon between your hands. Don’t overthink it, get your left brain out, go right, brain, close your eyes if you have to. Um, but just pretend there’s a water balloon there. A lot of times I’ll close my eyes and it’s pit, you’re just resting very lightly, like the pressure of, um, uh, really ripe tomato or the pressure you would put on your eyeball eyelid.

Um, and let your hands just pivot and move as the body wants to two to five minutes is kind of the key time, um, used to be two, two minutes and they see that five minutes that myofascial release releases better. That Paschal release better after five minutes, the tissues warm up more, and then you always want to end your hands where they’re parallel. Um, but that w it ha that’ll help with that bagel tone and calming, and again, get them calm. Then sometimes what I’ll do is I’ll, while I’m doing it, or afterwards, I’ll hand them a sensory brush and they can brush themselves, or they just like to feel it and bam begin and then get the adjustment. And that’s what it’s all about. So these are great tips and tidbits, um, to ultimately get that optimal adjustment. So I want to leave you with one, um, what I call a whiteboard wisdom, kind of pulling this all together and then, um, go out and just practice.

Don’t overthink it. Um, on your cranial nerve integration, respiratory diaphragm, you can do those. You can put toys on the pelvic bench and let them cruise along the pelvic bench. As you’re moving along with them. Um, have a mom mom’s lap. Um, I’ve done it in the waiting room with really sensory defensive kids that don’t want to come down the hallway. They don’t trust me yet. And you might have to do this the first half a dozen visits in your office until that little fiddle fart gets to know your office, what it feels like, what it smells like. Um, don’t have burning candles and all those things to, they feel safe in your environment. And I’ve actually come out to the waiting room and that’s all we’ve done for the first four to six visits. And then they trust me and then they’ll come down the hallway into an adjusting room. So, um, don’t take offense to it. They’re just really expressing their, their neural storm, their sensory storm in their brain. So let’s chill, chill with this real


A sensory defensive child.

Our sensory experiences will shape the way we respond to our environment and well, everything in life. Really, in fact, we have eight different kinds of sensory input into our brain. Five of these senses come from outside of our own body. They are taste, touch, smell, auditory and visual three senses come from within our body. Those are vestibular proprioception, and interoception now for some people, certain sensory information can be too much or too little. This causes an imbalance of information within the brain and body and can lead to an overwhelming sense of insecurity, sensory information that is too much. It’s like a little cup of caffeinated coffee. It fills up too fast and souls over in this situation, the brain can be on hyperdrive with too much information bouncing around, but nothing is organized or making sense or sensory information can be like a very bigger cup of decaffeinated coffee that will never reach the top.

In this situation, the brain will not be getting enough sensory input like being on hypo drive, making it hard to know what’s really going on in the person’s external environment and within their body, either one of these scenarios will lead to anxiety, fear, and a maladaptive response to the world. Now for the doctor of chiropractic, it is important to understand that a child’s behavior is a window into their neurological integrity and a window into their ability to regulate and organized sensory input into the brain. Here are some simple steps that can help chiropractors working with children to better connect with the child in order to better serve them through chiropractic care parks, pause, stop talking, suck charting notes, stop everything, and take a quiet minute to just observe the child. Second ponder. What is the child’s behavior telling you about how they are perceiving and adapting to their environment?

Third proceed. Once you understand what sensory input the child is trying to screen out or trying to upload, you can proceed with ways to provide them with what they are innately, trying to find. And once you’ve done the three PS, you can to three seeds first call help the child regulate their nervous system based on their needs. If they are hypersensitive, decrease their sensory load by such things as turning down, lights, lowering your voice and avoiding eye contact, deep pressure to the joints and muscles can provide appropriate susceptive input, which will also help screen out other unwanted sensory input. Now for those high boat, sensory children providing a little vestibular and proprioceptive input can help regulate the sensory chaos in their brain and help them call once the child’s sensory needs are met. Find ways to connect with them through touch words, or play a chance to feel safe, understood, and excepted. Third chiropractic once a child’s defensive system is lower and their nervous system is ready to accept input. You can proceed with a life-changing chiropractic adjustment. Now it may take a few visits before this is possible, but setting the stage with the three days and the three C’s will be goal to learn more about how to best serve children with sensory and other neurodevelopmental challenges. Join the intersection for life movements, intersect for life changing lives, changing the future.

Let me have it three PS, three CS, um, easy to remember, just start practicing with it. Um, once you, once you do it more, you get more comfortable and, um, maybe just try the cranium live integration, and then do the ladder alleys stretches and then combine them. But, um, again, our mission is to ultimately get that life-changing adjustment. And I hope that you got a few pearls to add your Pearl necklace, to, um, add to your, to your, uh, patients and help them receive that ultimate chiropractic adjustment. So next month, June, we’re going to be in June already. Holy Hannah boats. Um, Dr. Erik Kowalke is with you the first Thursday of every month. And I will be back the third Thursday, and let’s have some more fun and until then, keep changing lives, keep changing the future and ChiroSecure again. Thank you for being amazing and giving us this platform. You guys keep changing lives. We’ll see you next month.

Today’s pediatric show children.

Empowering Women in Chiropractic – Epigenetics, Chiropractic and the Future of Precision Health

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Disclaimer: The following is an actual transcript. We do our best to make sure the transcript is as accurate as possible, however, it may contain spelling or grammatical errors.

Hi everyone. I’m Dr. Melissa here with you today at the impact factor show. This has been fun today. You know, technology is one of the things we’re going to talk about today. It’s one of our greatest leavers to be able to truly scale and grow our reach and our impact, but it can also create curveballs like it did today and getting this show out. So we had to improvise right now, I’m with you on my phone. However, the great thing is, is I’m dedicated to still bringing you wonderful content. All right. So let’s kind of jump in today. Um, you know, I feel there’s some very important conversations that, um, that need to be brought to the forefront right now, especially in our profession. One of the things that’s so beautiful about chiropractic, you know, is of course we are profession founded on principle, natural health from above, down and inside out.

I can remember being in school many years ago. I won’t say how long ago. And at that time there was this huge debate between if you were straight or you were mixer, and there was really this division line and it meant something to just be straight hands only. And while I absolutely love our foundational principles, understanding that we are a profession that uses our hands, we are B, we are able to truly come in and connect with another human being, to assess what is happening in their body to be able to detect and correct where there’s interference, right, where there’s interference with that life force is of course, what we know as subluxation and this idea of removing the interference and allowing that life force that innate intelligence to kind of do what it does. Well, of course that’s what we were based on, but we are now living in a really interesting modern world.

Are we not? And so I’m going to invite you today. I have no idea if you went to school in a time, or maybe this is still part of your reality, if there’s a conversation around straight or mixers, but today I want to invite you into the fact that we all, whether we like it or not have to be mixers by the very fact of using technology like this, we’re coming into a time where things are rapidly changing and the future is faster than you think. I have been fortunate enough for really the past almost decade to be, um, kind of an early adopter into the field of epigenetics and then into precision health and medicine, and really looking at genetics as the human blueprint and understanding epigenetics to me really is an extension of chiropractic because it’s the science and the understanding of how right, our outer world and our, our interactions within it, isn’t forming our very genetic codes.

So I like to think of it as the communication highway between the outer world and the inner world in each and every moment, the body is always on the lookout to determine, is it safe to go out there and thrive? Or is it not? And of course, based on the external conditions, well, that’s laying down information. It’s laying down, literally marks methylation marks that are placed and given to the next generation. Now these are not genetic mutations. They’re literally like marks and pencil to say, Hey, this is what’s happening on this day in time. Now, why am I telling you this? Because, because of my ability to be in this environment of precision health, through epigenetics, I want to pose a couple of things. First and foremost, epigenetics understands that outer world is informing inner world. Well, that’s exactly what above, down and inside out understands there’s information coming from the outside in that’s impacting and affecting our ability to express our innate potential.

And so I pose that chiropractors are perfectly positioned to truly be the leaders in this conversation around epigenetics and moving into more of a precision based model when it comes to health and human thriving. And because the future is faster than we think because of modern technology, because of things like unexpected pandemics, we are now seeing an influx and a rapid uptick in of course tele-health. But what I want to share with you today is not just telehealth and being able to have a way to communicate with clients and patients through our phones and through zoom and computer screens, but something even more exciting is happening, which can impact us as providers. And I want to let you know about this. So right now we are really less than 18 to 24 months away from new technologies being leveraged and utilized in health verticals that will forever change how healthcare is being delivered.

One such methodology is virtual reality, virtual reality, and augmented reality are two tools that are coming in. They are readily, they’re already being used in some therapeutic settings, but they’re getting ready to come in and be deployed if you will, at a global scale, um, beginning in as little as 18 to 24 months. And it’s going to be something that is really can be something I’m telling you, not for us to be, but to understand that technology is coming in and it’s going to be used and can be leveraged for us as providers as a tool. If we understand it, if we can become early adopters, if we can really realize that, yes, we are rooted in ancient principles and teachings for natural health and healing, and yet the world is advancing more and more every day through technology. So how do we, instead of being at odds with it back to the mixers in the streets, how do we find common ground and how do we actually begin to think as early adopters?

How do we, you know, I look, and I can tell you, I believe that chiropractors and the field of chiropractic was really quite a visionary approach while yes, it’s all about innate natural healing. What we as providers have in today’s modern healthcare landscape is an advantage to what most doctors of other degrees have. And what I mean is this, because I’ve worked with every type of provider over the last decade, plus in the integrative health and wellness space, I have a whole network of incredible friends that are MDs and dos and NDS, and, and of course, DCS and NPS and NAS. I mean, there’s all the degrees, right? All the people out there. But if, if, if a provider has come from a traditional allopathic teaching background, they don’t quite understand in the healing, right? It wasn’t part of their vernacular. It wasn’t part of the philosophy of what they were taught.

Um, it was more input output. And so if there’s a symptom, then there’s a pill, right? If you have this, you’re going to give this and, and modern science has had to, or, uh, rather, um, allopathic care has to kind of be that way yet the truth in when I say chiropractors were visionaries, what we have always understood, even if, well, over a hundred years ago, the diagnostics weren’t there to validate it. There was a knowing that wait, it’s more than just one input equals one output. This system is dynamic is complex. And so now where we’re at, I’m going to keep kind of stay with me. I’m weaving these elements together. And I’m going to give you some thoughts to consider about how you can really look at your own opportunities as a doctor of chiropractic, to really leverage technology, to continue to be a trailblazer, to continue to go out and really be the leader, not only in your local community, but on a larger level, if you choose.

And so now here’s a few things you already knew that system was complex. Most allopathic, clinicians and physicians don’t really understand that it’s not until they go out into practice and they do one input equals one output and they recognize, well, the pills aren’t actually correcting the ills. And so then they have to give more pills and more pills. And of course there is no lasting solution, right? And so it’s when they go far enough down that path, or they become disillusioned that they kind of pull back and say, well, wait, what’s really going on here. And I will tell you, and of course you probably know this more and more clinicians of all backgrounds and types are understanding that this human system is complex and dynamic. And there is more than just a single, even a single adjustment doesn’t allow for all of the inputs that single adjustment does remove interference, but where did the interference come from?

Where is it present in their daily lives, in their environment? And what is the full impact, the full impact that, that subluxation and many of us have people that come back again and again and again. So there’s chronicity. Why are there chronic subluxations? Why is there chronicity of who’s showing up in our practice? And this is again, the science of epigenetics is the fact that we are complex bioinformatic organisms, that a single input does not create a single output. And this is actually good. This is actually good because you’re going to be able to leverage this in a way that can take you into the virtual space. It can allow you to use tools like AR and VR. It can allow you to create more of a precision model within your current practice. So stay with me. I’m going to continue to thread this needle for you.

And as we’re going, I don’t know if I can see questions, but if you guys have them, I’d love for you to drop anything in the chat. Um, you know, if there’s something specific you want to know about, then I would love, love, love to be able to have some kind of dialogue with you. If I’m not able to answer it here alive right now, of course I will absolutely come back and communicate. Um, because I’m all about wanting to make sure that you, my fellow peers have this information and these resources. So let’s go back to kind of where we’re at. Um, so obviously more over the past year, right? Tele-health has really increased and people are not coming in as frequently. People are still coming into our practices, but people are now understanding, well, wait, is the, is there something else? Is there another way?

And so, um, when we realize that what major companies are doing right now is putting literally billions of dollars into leveraging technology so that healthcare can become instead of a one size fits most into precision. So let’s keep going down. This lane of what’s coming with the future is faster than you think I’m going to connect it back to the epigenetics, and I’m going to connect it back to your office. So with the understanding that our genetic code, the fact that we can now order a 23andme test kit, and we can get back information on our very genetic blueprint, our blueprint is potential. It’s not our destiny, just because you have the code doesn’t mean the code expresses what informs the code or the signals from the outer world, all these myriad of inputs, not a single input, but all these inputs, right from the air, we’re breathing, the foods, we’re eating the relationships.

We’re in the bed. We sleep in the products we put on our skin, the quality of our air outside, the how much sunlight exposure we get on and on and on and on the list goes every millisecond there’s inputs coming into our system, that’s informing our genetic potential. Now this is where it gets super interesting. So in the field of advanced science and futures faster than you think what’s happening right now is that, um, you may or may not know, but there are things like gene editing and gene therapy, we’re literally research dollars are going into looking at genetic mutations, being able to take out part of that code to completely eradicate like sickle cell is one of the very promising, um, genetic diseases that within really the next five to 10 years, we’re going to be at a time where gene editing is going to be very normal.

And we’re going to, it’s going to be part of, kind of a clinical solution depending on how children are born into the world. So we’re going to have things like CRISPR at our fingertips to be able to look at working with that genetic code. We have nanotechnology that’s coming in that literally. I mean, it really is. It’s, it’s so fascinating. The things that are coming, um, but nanotechnology are, is going to be able to go in. So right now we have wearable technology, things that we wear on the outside of our body. Maybe you use them, maybe you don’t more than 526 million people use wearable devices, wearable devices, to have a better understanding about what’s happening in their system. And what I personally love about wearable technology is it’s an interface between the outer world and the inner world. So think about how many people have zero awareness, right?

Or minimal awareness between their head and their body. Like they’re in denial that they’re stressed, they’re in denial. That there’s anything wrong, right? Like they’re in denial that they are exhausted that they’re behind, they’re beating their body up and wearing it down, which we know as doctors and clinicians, that if they keep wearing their bodies down, if they don’t take the time to rest and reset, right. Healing cannot. So they come to you saying, Hey, I heard give me an adjustment and fix me. And they expect you to do it in one or two or three visits, but they’re not willing to take ownership over their own health. You are not the person that’s supposed to fix them. They have to become empowered and engaged and an advocate to their own health, which is what wearable technology is now able to do and facilitate because their brain, they may be in denial to themselves.

But the moment they look down at their wearable tech and they see their HRV stress score. And they’re like, Holy crap. I didn’t think I was stressed, but I’m really stressed. They see their oxygen saturation, they see their body battery and they cannot deny the fact that they’re not recovering, that they’re not getting deep sleep, right? They’re not getting these essential ingredients that are important to you as their doctor to be able to leverage and educate on so that they can do more than take two steps forward. And three steps back. You are not here to just be a symptom manager, right? As a doctor, you are a teacher. You’re an educator. You’re a guide on this process, not just a healing because we’ve been living in a world of surviving and just getting by of symptom management. And most of the dollars when we look at the pie of healthcare, the majority of the dollars are spent on the 20% of the population that has sickness and disease.

The 80% that does not yet in sickness and disease that is saying, Hey, what’s out there for me. There’s, there’s very little right now. That’s actively out there for them because all the dollars are spent on sickness and disease. But guess what? There’s a larger piece of the pie that doesn’t want to become sick. They don’t want to become disease. And they’re also not buying into the story of maintenance and prevention prevent. I don’t want it like who wants to think about preventing a heart attack? I’d much rather go out and be unstoppable. I’d much rather go out and be vital and vibrant. I want to be optimized. I want to be at my peak. So the narrative and the story that we have been sharing for so long as clinicians, it’s not resonating anymore. So there’s a big mismatch and this 80% that doesn’t want to get sick and disease, there’s really no path for them.

I want you to think about that. What could that mean for you? What could that mean for you to really go into precision health and optimization? Instead of look sick, people are still going to come in. You still get to work your magic on people that are, are in a state of dysfunction. Because if we now come back again, stay with me, I’m going to weave all of this together and put it in a nice, pretty bow before we wrap up here in 10 minutes. And so now all of a sudden, right, like what I wanted you to know is we have this wearable technology that people are using, but it’s going to go even deeper than that. The nanotechnology is going to be able to come into the system and read the system real time where we are heading is precision. The way that AR and VR is going to be utilized is in, in pairing with the moment there’s the genetic blueprint and they understand the potential and they understand, Oh, you have a propensity to have insulin dysregulation.

Let’s just go with that. This is a really, this is a really normal one. And then of course the foods that we’re eating, the stressors that we’re putting ourselves under are fueling that blueprint of potential. That’s already innately there, but it’s like we put gas on the fire every day. And it’s more than just the food. That’s another talk for another time. But what happens is now like with the AR the augmented reality, if you’ve ever watched, um, a Marvel superhero movie, if you know who Tony stark is, Tony stark had the glasses, right. And inside of the iron man suit, there was those feedback that the feed out, um, what am I trying the readout, right? Like Jarvis is talking to him and you can see all the little things. Well, that’s what augmented reality is. We’re going to be able to have these glasses that we’re able to project and see things within current reality and add to it.

And so now you go into a restaurant and it understands your genetic potential. And it’s also now reading your, your HRV, your stress levels. It’s, it’s, um, getting feedback time on your pulse and your heart rate. And it’s seen that you’re in a stressed situation and you’re wanting to go for the ice cream and chips, or, you know, a hamburger and French fries and what the AR is going to have the capability to do is to remove those items from the menu so that you actually only see the items that are most optimal for your system at that time and gang, no, I’m not sitting here telling you science fiction. I’m telling you what is in development. I know this because I’m in partnership with a large company out of Europe, that they are the forerunners in the health and wellness and lifestyle space with AR and VR.

I’ve, I’ve seen the plans. I know the, the billions of dollars that are flooded into this company. And this is just one of many, just one of many. And they’re in the field dedicated to thriving health verticals, entertainment, sports education. Um, and so now we’re coming into a time, again, the big point I’m wanting you to know, is it lots of money is being spent on technology for precision medicine, but you can already begin to get precise in your practice today. And if we really get honest with ourselves as providers, and now we think through the lens of I’m a chiropractor, I assess for interference to the system. I’m looking for these subluxations, where’s the interference. So now let’s go back to epigenetics is the communication pathway between the outer world and the inner world. What to the, to the degree that the quality. Now, we’re going to think about the quality of information.

The quality of the inputs coming into the system are in direct correlation to the expression of the system. Okay. The expression of the cells of our biochemistry, of our nervous system, of our parasympathetic parasympathetics of our, of our neuro-transmitters of our hormones. It’s all in communication. And yes, we work with the spine that pathway between brain and body. Yet, if you stop for a moment and say, great, here’s a subluxation here’s interference. I’m going to go in and precisely remove it. But then they go back to their environment, filled with all of these inputs that are going to come back in and continue to accumulate. And what is the quality of those signals? Meaning how is their daily life informing their very expression of sickness and disease of balance and homeostasis of health, of thriving, flourishing. There’s a scale from unbalanced all the way to enhanced.

And oftentimes we’re only toggling on the one side, just trying to get them out of unbalanced, out of symptomatic. I’m just back to homeostasis. But what few of us have realized, we’ve talked about the wellness continuum and maintenance, but guess what? There’s so much more than just getting to homeostasis and balance our systems embedded in our very genetic code is literally the code of life that is designed to evolve. And evolution is more than just homeostasis. And why I’m telling you this is, remember that 80%. Who’s not sick and diseased yet. Okay. They want to, they want to be super human. They want to be optimized. They want to perform at their peak. They want to be ageless. They want to live to one 50 and beyond. There’s a lot of people out there I’m in the longevity space. Like, and I’ll tell you the biggest group of biohackers, like our 30 somethings are all about saying, I want to get to one 50.

They’re not focused on it. They don’t want the story of, I want to be identified with the disease and be broken, and I need to be fixed. They’re saying, I want to be unstoppable. I want to be amazing. I want to be limitless. I want to be optimized in every way. So is there an opportunity for you and your practice to begin thinking about how can you create a story, a narrative, a deliverable that you can deliver with and through technology that people don’t have to just come into the practice. They can come into the practice, but then they can have an experience. I call it the visit beyond the visit. What touch points can you begin to think about now creating what types of content and programs that can support what you’re doing in your practice, but they speak to what happens when somebody leaves your practice.

They speak to all of these epigenetic leavers that are found in their daily lifestyle. That’s what I want you to consider and think about now, a lot of the work I do. So yes, I have a large brand in the longevity and optimization space. I do work with people’s very genetic blueprints. I get very precise and I design incredible optimization programs for them. And a lot of what I do is online. I also leverage technology. I do a lot with neurofeedback biofeedback. I do a ton with helping to optimize that parasympathetic sympathetic response, really still working through the central nervous system, right? The autonomic nervous system. And of course, chiropractic adjustments are amazing for that. But what do we do when they leave? How are you supporting your people to continue to harmonize them, optimize that vagal tone, that parasympathetic response, the more we can get them in parasympathetic and sympathetic, great, the greater, their healing, the greater their opportunity to get to homeostasis the faster you get somebody to homeostasis.

Then the fun really begins. Then you get to move into this optimization lane. So today I’m inviting you to obviously consider, okay, what is coming and, you know, are there ways that I can start looking at technology, thinking about how technology is going to continue to inform my practice and the people I care for? Are there things that I can do now that can create an even more efficient and effective experience for my current patients and clients? And is there a way that I can also have some freedom I can scale? I don’t have to just be one-on-one and my success and failure depends on how many people come through my door. Is there a way that I can start to scale my expertise into the digital space? So beyond my front facing programs and work that I do with all my longevity programs, I do mentor and work with our fellow peers, right?

Just like you, really purpose driven, mission minded, health, preneurs, that understand, I don’t want to be left behind. I want to really be able to understand what is coming and how to stay ahead of it. Remember getting well over a hundred years ago, look, BJ D D they were visionaries. They were trailblazers. They saw something that nobody else saw and they jumped in and they went out and they started to talk about it and to be about it. And they built an entire profession. We are the storytellers. The question is, what story are you going to keep telling? Is it one of limitations, sickness and disease, or are you going to get curious about the technology that is here and coming and how rapidly it is coming and how it’s no longer about let’s find the root cause what we are here? Because look, AI is going to out diagnose any of us in every field of medicine and wellness.

So it’s no longer just our beautiful brains that people are going to come to us for really what people are going to continue to need more than ever is how they retain their humanity in the face of technology. How do we leverage and harness technology to enhance thriving and flourishing? How do we continue to evolve forward into greater States of health and wellbeing? It’s all here and it’s available to each and every one of us. And I just really want to encourage you guys like understand you are leaders in the story that you get to tell can be uplifting and empowering and inspiring. And it doesn’t have to be about you’re broke. You’ve got to come to me to fix you. You’re not here to fix anybody because nobody’s broken. The system is intelligent by design. And your job as it’s always been is to identify the interference, not just in the spinal cord.

Okay. Where is that interference? And this is the epigenetics coming from the outer world that is accumulating and informing the inner world. And then the byproduct. Right? Of course, there are times that there are subluxations from physical trauma, trauma aside, acute impact aside. What’s happening with these chronic visits to your office. It’s all what happens when they leave. And I’m going to tell you, there is no fad diet. That’s a one size fits all. There’s no cure, all supplement that what drives the system. It’s so primal. It is, there is a code of life in our DNA. And it’s very simple mechanisms from out here that inform our expression of thriving in here. And the faster you learn about this and understand how you can share this, the greater side-out leader, you will continue to be that’s who you are, keep doing what you’re doing.

I’d love to be able to share with you any of my resources. If you want to know about more mentorship programs or resources, by all means, you can visit me over at docmelissa.com. That’s primarily my front facing site for my clients, but that’s going to be the best way. I’ve got a ton of resources over there. docmelissa.com. It’s super easy for my clinical programs and the stuff I’ve been doing with my fellow health preneurs like you for years is over at practiceimpactmasters.com. Either way you can find me in both places. I hope this conversation today has been insightful, inspiring, intriguing, and uplifting. And now it’s your turn to really go out there and get curious, understand that you are here to be that true

Early adopter, that trailblazer at leading the way so that you can continue to make a lasting impact in your community, your clients, and all the lives that you serve so that you can go out and have both a business and life you love.

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Empowering Women in Chiropractic – The #1 Biggest Mistake That Keep Associates From Being Busier

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Good everybody. My name is Michael Miscoe with Miscoe Health Law. I’m happy to join you today for today’s ChiroSecure’s Growth Without Risk presentation. A couple of things we want to talk about. We’re going to talk about two totally different topics, but, uh, um, only because the first really isn’t going to take enough time to make it worthwhile you tune in. And that topic is thinking about the end of the, uh, PHE, the public health emergency that was declared in response to, uh, uh, COVID. Now, as you know, there’s been, uh, there’ve been a number of, uh, rural changes, most notably in telehealth, um, where, um, uh, office or other outpatient evaluation management services can be reported, uh, for, um, non face-to-face encounters. Um, the, uh, a variety of, of tele-health, uh, mediums, uh, the old role required, um, synchronous communication. The patient had to be in a special site, um, and, uh, there’s all kinds of licensure issues.

And, and, and because of the PHG, um, and trying to drive, uh, encounters as much as possible into a remote, um, type of environment for public safety concerns, uh, there has been an enormous number of rules, uh, especially in the Medicare side, uh, which has spilled over into the commercial payer, uh, realm where, uh, a lot of exceptions to the normal rules relative to tele-health have come out now what we have to everybody’s getting used to this environment and billing these services this way and using appropriate modifiers and whatnot, uh, but understand once the public health emergency ends, uh, for federal health care programs, certainly all of these exceptions, um, that CMS has granted the permit, um, the services to occur the way they’re occurring now, um, you know, via, uh, relaxed, medium requirements, um, billing, uh, uh, regular ENM services for telehealth or telemedicine, uh, conducted services that all goes away and it’ll go away instantly, and you need to be prepared for that on the commercial payer side, um, there will be rural changes as well.

So to the extent that commercial payers are granting exceptions through the normal rules to allow this to occur in response to the PHC, expect those rules to roll back somewhat as well. Now on the plus side, um, there have been, um, uh, payers are starting to the value of, uh, tele-health. Uh, so I would expect, uh, you know, a continuation of some form of telehealth going forward, uh, that is in a more relaxed, uh, environment than, than what existed before the PHG, but just be very mindful that the moment that, that PHE, uh, uh, declaration is rescinded, a lot of rules are going to change rather instantly. And you need to be prepared for that. Now, switching over to, uh, the other topic, which will carry us through, uh, the remaining, uh, five to 10 minutes of our presentation today. One of the talk about some post-payment enforcement trends that, that I’m seeing, um, you know, as I provide, uh, uh, representation to clients involved in post-payment audits, and this is, uh, both, uh, commercial payer, as well as, uh, Medicare, uh Tri-Care um, and, and other, uh, Medicare part C plans.

Um, you need to be certainly vigilant to watch your billing profile, um, suspect, uh, coding patterns, uh, on the chiropractic side, um, billing for, uh, nine, eight, nine, four twos, always going to get attention, um, nine, eight, nine splitting out, uh, extremity manipulation, uh, frequently, um, which I would say means more than 10% of the time, uh, is probably going to get an alert anytime that you separately report manual therapy from spinal manipulation, uh, with a 59 modifier, uh, same thing with massage. Neuromuscular reeducation is often, uh, miscoded, uh, as massage or manual therapy services. And that that code gets a lot of attention. Um, and, uh, uh, obviously, uh, billing for a number of procedures. Um, a lot of one-on-one, um, especially insofar as massage or manual therapy is being performed by others, build under the provider, um, that raises some incident, two issues that we’ll talk about it in a minute, but those are things, uh, four units of massage, four units, manual therapy.

Those are things that are going to get a payer’s attention and put you on the radar screen. Nobody gets audited randomly. There’s always a reason. And usually that reason is generated based upon data analysis. Um, some other trends that you need to be mindful of, um, is, um, visit frequency issues. You would think that too much is, is problematic. Actually, it’s the opposite, uh, where your visit frequency, your average visits per week, uh, drops below one, meaning you’re doing episodic or once a week, or once every two weeks type of care, that’s indicative of, uh, what would be considered palliative preventive wellness, or maintenance care, which is uncovered, um, and, and providers, uh, that exhibit billing patterns along those lines, those cases, uh, tend to be audited, uh, with some degree of frequency because it’s low hanging fruit. I mean, there’s not much that can be said about your chances of achieving significant durable improvement in the patient’s condition when the patient’s coming on an ad hoc basis.

Um, other things they look for is, uh, your diagnosis reporting, uh, where you consistently use a symptom and subluxation, um, you know, ICD 10 reporting guidelines require you to cease using symptomatic diagnosis is once the, the condition causing the symptom is known, which should occur on the first visit. Uh, so for example, if a patient’s neck pain is due to a sprain strain with a, an encroachment syndrome and maybe ridiculousness, um, those are much more powerful diagnosis is to report. And obviously if you diagnosis follow your exam findings and diagnose the condition based upon what your exam findings tell you, you’re going to get diversity in your diagnosis, and you’re not always reporting the same thing, uh, from patient to patient. Um, so those types of consistencies in, in diagnosis reporting will, will, are very easily identified, uh, with data analytics, visit frequency number of services per visit.

And, and the next thing I’m gonna talk about is consistency in the codes that you bill, um, looked at, uh, or have become involved in a number of fraud cases that are, are based in theory, at least on what the payer is alleging as cookie cutter treatment. Every patient gets the same treatment, no matter what the condition is, no matter what the mechanism is, they always get the same thing. Now, in response, again, superficially, when a provider has his or her hands and adjusting table a STEM machine and attraction table, I’m not surprised that most patients are going to get manipulation, STEM and traction, um, because it’s what the, what the provider has the cookie cutter treatment issue though, um, can be, uh, addressed even in that scenario when the type of STEM, uh, the type of traction, the location of the traction, the location, the STEM is not the same for every patient.

The codes may be the same, but, um, the protocol being used is going to differ varying or dependent on, on the patient’s presentation and condition. And that’s where, um, you know, more deliberate, more detailed treatment orders in your initial evaluation and treatment plan becomes so significant. And, you know, you may be doing a VMs burst on this patient. You may be doing high volt, uh, on that patient. Uh, you may be doing some type of, uh, uh, uh, pulse, uh, uh, DEMA reduc, reducing stim protocol on that patient. Some patients may be getting inner segment segmental traction, some may be getting a form of axial traction. Um, so, uh, varying the type of treatment, um, even though the code is going to be the same and the same false true with your exercises, you know, you should have a treatment order that details the specific exercises sets reps, um, so that you can avoid any allegations that every patient gets the same treatment.

And it’s kind of surprising that some payers are actually bringing this as a fraud theory, because it’s relatively easy to disprove, especially where the provider is, is, is documenting, um, the details as to how the therapy is being performed from one patient to another. Now, if your treatment truly is cookie cutter and every patient’s getting the same thing, understand that there’s risk there. Um, but they won’t know that, uh, they’ll, they’ll see it based upon your coding. Um, but just remember computers are very, very good at identifying, uh, patterns. Uh, so where things are the same, that’s easy to detect, uh, and it can increase your post-payment liability. The last thing, uh, that I would talk about relative to enforcement, there’s, there’s a lot, been a lot of effort on what some payers are calling pass through billing. Um, when in reality, um, it’s, it’s what we call incident to billing.

Now, what pass through billing is, is if you were to delegate the performance of an entire service to somebody else and bill it under you. So imagine you had an independent contract, um, chiropractor, renting space out of your office running his or her own practice under a separate tax ID, and they were providing services for you. Uh, and you were billing their work under your name. That would be an example of pass through billing pass through billing often happens with lab services or iLab gets specimens. And because of, um, insufficient testing capacity, they dumped the specimen off onto another lab, uh, who does all the testing work, sends the report, and the report ends up going back to the physician, but the, the, the lab that received the specimen initially does the billing, and then they pay, um, the, the lab that actually did the work.

That’s an example of what pass through billing is now in your office, when you delegate the performance aspect of a service to a staff member, or maybe another, an associate chiropractor or something like that. Um, that’s what we call incident to billing where the, um, the patient is evaluated, diagnosed. The plan of care is all that work is provided by a credentialed physician. And then say, for example, the, the therapeutic modalities, or maybe even some procedures, um, the performance aspect of that work is delegated to a staff member, uh, in, under the incident to rule that’s called an auxiliary person. And that work is billed, uh, then under the supervising chiropractor. And that chiropractor usually has to be, or physician has to be providing direct on-premise supervision of that work. Now, in these cases, it helps a lot, again, getting back to the detailed, uh, order for the therapy services, where you can demonstrate that the ordering physician, the credential physician actually wrote the order and provided all the who, what, when, where, why of how a therapy is going to be performed, if it’s exercises, the specific exercises to be performed, sets, reps, whatever, and then consistent with your licensure requirements, uh, you delegate, um, the performance of that therapy.

So if it’s a modality, um, you know, uh, an assistant is going to come in and put the pads where you tell them to put the pads, they’re going to switch the knobs to where you told them to switch the knobs. And, um, you’re going to stay in the building to provide supervision, and that commonly occurs. It’s not pass through billing, but it’s, what’s called incident to billing. Now, when you, you’re dealing with time-based services and you have, you know, rehab assistance or massage therapist, or somebody of that nature working under your direction, uh, as permitted by your licensure rules, maybe they’re, they’re certified chiropractic assistants, some places they’re called registered assistants. Um, that’s fine. Okay. But what happens is, is that when you have other people performing time-based services under you and you bill for those services under your name and NPI, it makes you look very busy and, and payers do what is called impossible day analysis.

Um, and so for example, in an extreme sense, say you’re one doc, and you have 20 assistants working for you, and you’re generating, um, 20 times four 80 units and hour of rehab, or let’s say manual therapy for getting the unbundling, a manual therapy or massage. If you run a big massage therapy practice and all of this stuff is being built under you, um, you need to be extremely cautious because, um, that billing profile a payer’s gonna look at it and they’re going to say, there’s no way that this one guy or gal can be doing this much service in this much time. Um, and, and they make refund demands as a result now with massage, especially, we have to deal with the fact that while these people may be licensed massage therapists, they’re not performing within the scope of their license when you’re directing what they do, which means you’re defining the technique, the location of performance.

And it has to be related to the areas of complaint, which usually means you’re not going to bill for units and massage those types of, uh, things. You know, if you’re going to turn a patient over or a massage therapist, either they’re going to build the services themselves, or it’s going to be cash. If you can’t get paid without billing it under you, then if you’re going to build those services out under you, you’ve got a couple issues. You’ve got to document a detailed order. Number one, you have to provide supervision. Number two, uh, number three, have to worry about whether that, uh, service can be separately reported. In addition to manipulation under the payer’s rules for reporting massage and manipulation under CCI, um, massage, always bundles with, um, uh, manipulation. And it can’t be unbelievable for that reason. Then some providers build their massage using manual therapy, and that may or may not be defensible depending on what techniques are ordered and whatnot, anyway, very complicated issue, but on the incident two side of it, it’s, it’s PR it’s possible, but you need to make sure that the documentation indicates that the physician did all of the didactic or physician relative work associated with the service.

The therapist, uh, went in and did what I like to call the Mike, the monkey boy component of the work, where you tell me exactly what you want me to do. And I go in and do what you said, and I don’t turn my brain on. And, um, and, and that way, um, the idea that it was a chiropractic service, as opposed to a massage therapy service, um, the person’s licensure as a massage therapist only means they have sufficient training to follow your orders. So, um, but I will tell you, it is a defense. It’s not a defense that payers react well to, um, they fight pretty hard. Um, so I would tell you keep your massage cash, but that’s an example of an incident to service and how it differs from pass through billing. But those are the issues that payers are beaten providers up on.

Just wants you to alert, uh, on that. And, uh, to the extent that you’re involved in those types of, uh, billing activities, just make sure your treatment orders are very precise. And so that you can demonstrate that you did all the physician relative work associated with any service that you delegate to another person. One last thing on incident two, uh, while the Medicare rule allows an auxiliary person to be another provider, most payers, um, do not agree with that because they require providers to be credentialed, um, with a new provider, uh, check with your payers to see if they will permit a new provider, undergoing crunch credentialing, uh, to perform, uh, incident to services under the direction, uh, in on-premise supervision of a credentialed provider. Some may, some will not. Um, so check with payers. If, if you know, you need to onboard a new provider, otherwise you’re going to have to plan in advance and get their credentials in place before you put them to work, uh, on patients of that particular payer that requires credentialing. That’s all we have time for today. Next week, uh, Dr. Judson Sprandel II will be up and I’ll look forward to seeing you next time. Thanks for your attention. Have a great day.

Empowering Women in Chiropractic – Action Steps to Take Now To Increase Your Practice Value

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Disclaimer: The following is an actual transcript. We do our best to make sure the transcript is as accurate as possible, however, it may contain spelling or grammatical errors.

Hello and welcome to today’s show growth without risk. My name is Dr. Janice Hughes, and I’m really excited today to talk about some things that I’m incredibly passionate about, and that’s about how to help you as a healthcare practitioner increase value within your practice. Now, before we jumped in and I start to share some ideas, I do want to say thank you to ChiroSecure. I love the opportunity to connect with chiropractors, particularly obviously the change in the world and know, you know, sort of in-person or physical seminars. It’s just really wonderful to connect. So like I said, I really want to chat today about something that I’m incredibly passionate about and that’s helping chiropractors or other health practitioners increase the value of your practice. Now I know that for us, it’s all about to give, to love, to serve, to help people, to work with patients, you know, to help them, to help people within our community.

For me, that’s a given. I know, and I love that aspect of our profession. What happens though? And I’m going to share from my own mistakes is that I didn’t do things early enough in my career to ultimately crystallize the value of my business. Now, what I mean by that is that you and the work you do and what your team does, you provide this incredible value. It’s an important asset for you. In fact, it’s likely one of your biggest assets. So what I want you to understand is that there are some simple actions and steps that you can take. I can take that any of us can take so that we in essence are increasing the value of our actual business. Now, heaven did this happen to you, but I was on the phone last week with the widow of a chiropractor that passed away unexpectedly.

Obviously, now they’re scrambling. What do they do? How do they value it? What does that look like? How did they get a great chiropractor in there now? I never want you to have to go through that. So I’d love you to start thinking now, even for some of you say, brand new in practice, what are the things you do early that actually adds value to the practice? So let’s start to talk a little bit about that. You’ll notice that, um, you hear a lot of people describe systems, you know, how to put systems into your practice. Well, not only is it important so that you can reproduce your results, but that’s also important so that anyone else could step in and reproduce those results. So that adds incredible value. Now we can call that or standard operating procedures and a lot of people start to panic, you know, well, wait a minute, does that mean I have to write every single thing down that I do?

And the short answer to that is yes. The more you put things in writing, the more powerful your operations manual is the more powerful the ability to reproduce your results. So it’s great for team training. It’s also great because you can see that that’s going to add value. So now how do you do that? Do you have to sit and write, you know, manuals and no, like personally, I love that if any of you are already in a practice where you’ve got your team involved, start getting their help, write some things down from their perspective or audio, it, you know, start to talk through at a team meeting or with one of your great team members about what you do and the order of the things that you do. Now, you’ve got a record of that. Start to do things like videos. If you’re going to do training on a procedure, why not do a video and start to have a file where you save all of those procedures.

Now you notice that you’ve got it in an automated format. So gone are the days where you just think that you have to sit down and, you know, write every single step of the way or have checklists all the time. I like the idea of a, of a checklist or having this manual, but you could do that electronically. So what I want you to understand is that there is no one perfect system. I’m not asking that you do a system that someone else has trained you on. Or, you know, again, that you know is the one that brings the ultimate success. You know, it’s about your systems. What can you put in writing in video or an audio just about every single facet of your practice? And what I want you to understand is that does build your operations manual, your reproducibility, or what, you’ll hear more people in the business world, talk about the SOP, the standard operating procedures.

So I want you to see that you can get started with that. Now. I know one of the things I’m really fortunate, I go into life university and a few of the other schools, and I get to talk to some of the students about business procedures and practices and protocols. And we’ll literally provide them with some templates of those kinds of things. Not because I have one that is the answer that it often is just a starting place, please know, by all means through ChiroSecure, or just reach out directly to me if you want some of those kinds of ideas, but the power comes when you put it into your system, when you make it yours, you know, gone are the, I think a lot of people used to say, well, you can’t have a personality driven practice. Well, yes you can because your personality is a key part of your brand.

But what I want you to understand is that it’s not, you just doing things fly by night, you have a rhythm or a way that you communicate even beginning to do that in a video so that you have that basically as a template, you could start to train an associate. You could start to train other young docs. So pretend you’ve got someone following you or shadowing you. And you notice that then you’re putting it into a format that is reproducible. So I think it’s really important that we, we take some of those business terms like operating manuals and protocols and standard operating procedures. And we just start to think about, you have a unique brand and way that you do things, and that’s what brings great value to your practice. So by putting all of that, into this kind of format, now, I want you to see that you could train others to do that.

So let’s talk a little bit, say for a startup doc, the more you build that, now you can keep adding to that as you bring different team members in, you notice that sometimes when you hire one team member, one staff, they’re almost like a Jack of all trades, but there’s going to be different parts of their job. You know, PR or marketing outreach is different than here’s the protocols for the software program. So I want you to see that even if it’s one person, you know, that’s helping you, or for example, if you’re doing it all on your own, you know, there’s still different hats that you wear. So what happens when you are dealing with an insurance company or following up on some of your billings, what happens when your, you know, thinking in terms of the outreach within the community, just start recording those different pieces and parts of everything that you do.

Now, some of you listening that are not in startup that have these great practices where you have also a lot of teams, numbers stop and think about, do you even no for sure anymore, the things that they’re doing, one of the things that I often began to realize as I had great people on my team, and I’d really empowered them, sometimes I hadn’t touched base regularly with them about any sort of adaptations or slight changes that they’d been making to protocols. Some are good. And then some actually are taking you a little off brand of what you thought your team was doing. So it’s a great way to also review. I like to use the distinction says inspect to respect, if you can, all the procedures and the things that you and your team are doing now that allows everyone to completely respect the protocols, to get back on track.

If they’re slightly off track with things and it happens really easily and sometimes in ways that you would never even think, you know, it might be that you’ve run out of a certain manual or, or brochure that you often like to give to people. And then there was a photocopy mate and suddenly that photocopy wasn’t completely straight, or it doesn’t look the way you want it to look, little things like that can really start to impact negatively impact your brand. So it’s just a great opportunity to review a lot of those kinds of things. Now, if you’re not an early startup, it’s easier to begin to think about what I like to call that 10 year exit strategy. What are all the things you put in place now and begin to work on over the next few years that crystallize the value, but also allow you to think about how over time do you build more freedom and flexibility into the clinic.

So because you have that unique communication style, you have the way that you work with your patients. If you’re a sole practitioner, they’re not used to having you be away, you know, some of you that had to close for craziness with the pandemic and then got yourself open again and are more back on track. But before you know, it, we’re not feeling that we’ve got the freedom and flexibility to take time off. It’s almost like, well, everybody expects us to be there all the time. You know, those kinds of challenges mean that we need to start to think in terms of what, or how do we either bring other people in, or have people on your team that can do some other things for you? You know, one of the things that adds great value to the practice, I always say is that you really educate and groom and work with some of your team members to be able to do a lot of the parts or the pieces that you’ve been doing, but aren’t necessarily that you have to do that.

So let’s think about an example. Many of you use things like, you know, the insight scans, you know, some of you, if you do more functional neurology work, you’ve got people who maybe do some of the eye training techniques and the technology. You know, if you’re doing a little bit more functional med, you, you may end up having, you know, supplementation or, you know, questionnaires that you give to patients at a certain point. Well, do you need to do that? Or can you begin to train some great people on your team to do those pieces, not to make the diagnosis, not to take, you know, again, that clinical side away, but is it say some of the regular treatment pieces or checks and balances? You know, if you build an SOP, a standard operating procedure where someone on your team checks in every 30 or 60 days with someone, for example, that maybe you have on a certain supplement, number one, it’s better for patient care, but it also adds more value in the long run to your business because you have an operating procedure that not everything has to go through you.

So you notice that it’s a lot more subtle than we think that we can be enhancing and increasing the value of our practice even while we’re in it all day, every day. So a little bit of this, I want to, again, my background is a coach. I like you thinking, well, what can you be working on now? So the first thing is kind of pull out and take a look at what you have. Do you have a procedure manual? Some of you will call it a, you know, an operations manual. And when is the last time you actually even looked at that? I laugh because a few docs as I just do some complimentary consults for people, you know, I’ll ask them about that. And they’re like, well, I think I had one, or I think it’s stored somewhere. And they actually even have to search for where it is.

So a first step is just, if you’ve got something already, pull it out. If you don’t have anything yet, ask some of us for a template, ask a chiropractor that you know, and you like the way they do business and you like who they are. And maybe ask if they’ll share their operations manual now, because you’re going to copy it, that you’re going to look at it and use some of the categories and the ideas. Then it’s really engaging your team. Like I said, if you’re new into practice and you maybe don’t have a team it’s yourself sitting down and maybe putting a little bit of these things in writing, but ideally from many of you that have got great team members, it’s really get some of this in writing. A perfect example is what tends to happen as I even help people talk about their practice or their value, I’ll ask them for, you know, an equipment list or, you know, their furniture lists.

Most people don’t even have a list or a record of the kinds of equipment that they have in the practice. The same thing that could be an actual document that you guys are already working on now. So that if that is, is 10 years down the road, as an example, you can turn around and just updated or keep that active and updated all along the way. Another thing that I like you to think about now is just this idea about thinking in terms of your practice as an actual business. Could it be that if you’re a little disconnected, we’ve just gone through tax season. If you’re a little disconnected from the aspects of your practice that are a little bit more about the business, is it that you could take an action step to have a stronger look at that? Part of the reason is that you increase the value of your healthcare practice by knowing the numbers and taking a look at the things that you’re spending time on.

So let’s go back and use that example of some functional medicine. I know some practitioners that have some supplementation in the practice and they do some kind of an assessment, and they have patients that get on these different supplements, a great professional line. Then often they don’t have ways that they check back in with people. So that could be something that you add to some of your procedures, because like I said, it’s good for the patient. It’s also good for you that the other thing, taking a look at your P and L’s your profit and loss statements is how much does it cost you? Not only in the product that you’re ordering that in your time to have that within your practice, because sometimes you start to take a look at these things and you realize, wait a minute, there’s something that’s taking a lot of my time and, or my staff and team’s time.

And isn’t actually increasing the profitability of the business. Now, those are just a couple of ideas, ways that you can right now, take a look at where you at, where would you love to be? And then how do we increase the value of these different parts and pieces of your business, of your practice? So, like I said, it’s, it’s just thinking in terms of, from my perspective, it’s a, given that you, as a chiropractor or any healthcare practice that you’re providing great service, that you do great work, I’d like to increase the value of that. Because remember when someone is now gonna say purchase that practice or where you’re looking at down the road, selling the practice, you hopefully have generated multiple years of great profitability and revenue from the practice. I just want you to be able to prove that and show that so that you could then turn around and sell your practice as an actual asset.

So lots of different little ideas here today, but please reach out, ask questions. You’ll notice that ChiroSecure brings myself and other great people in to do the show growth without risk so that we can help you. We want to help you now. And the idea that I’m talking about is help you for the future as well. Speaking of future, please know that next week, the host for the growth without risk show is Mike Miscoe. So please by all means, make sure you’re checking in each week, each Tuesday with a great material and information that’s being shared. I want to thank ChiroSecure again for creating this opportunity for me to talk about some of the things I’m passionate about. I love helping chiropractors recognize and increase the value of their practice. The impact that you have is incredible. I want that to also be a great business asset for you. So thanks and have a wonderful week.