Empowering Women i.n Chiropractic – Making the Invisible…Visible

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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 everybody. Dr. Julie McLaughlin here, I am super excited to be with you today. And we are here with empowering women from ChiroSecure, and we want to make sure that we thank them. We want to do little hearts. We want to do thumbs up because they have made this possible for us to bring you great information of all the things we’re doing. So we are going to be talking about how to make the invisible, visible, and I have a few slides for you that I’d like to share and let’s get started. So when we’re talking about making the invisible visible, right? What’s with that. So what’s the most important thing you can do right now to improve your health and your practice. That’s my question for you today. What is that most important thing? Now we know that, you know, in 2020, we got a big invisible.

The COVID no one saw it coming. You, you can’t see it. It’s a virus. Of course, it’s something that’s invisible, but guess what, what if we knew about it? What if we knew what to do about it? What if, what if we could see it? Right. So think about this in 2020 COVID deaths was the third top deaths in the country, right? In the United States. It was third, but it was third. And this is a global pandemic. We’ll get the first two heart disease and cancer. We had more than double. The number of people die from cancer and heart disease. Then they did have COVID. And guess what? Before the pandemic, we had people dying of heart disease and cancer, and you know what? Those are invisible things too. Aren’t they, nobody wakes up and says, today’s the day I’m going to have a heart attack.

Today’s the day I’m going to have cancer. Nobody says that. But what if you could get clues would, if you could make it visible and get clues to know, to predict it, that it may be coming, or did you even at risk for it, or it was even a possibility. And if that was the case, what if you could fix it before it ever happened? I think we can really, really lower our death rate in this United States to take a look at this. This is from the fourth quarter of 2019, all the way to the third quarter of 2020. And this is overall death rate in the United States. Now we see in that last quarter that the death rate went up, right? And you can say, well, that was because of COVID. But wait a minute, guess what? COVID wasn’t the only thing increasing the cause of death.

Guess what it is. It was heart disease. We had a 4.8% increase of people dying from heart disease. And the last quarter of 2020, we had a 10% increase of people dying from diabetes and unintentional injuries. Now, what do we treat? We treat injuries, right? What about diabetes and heart disease? Those are things that are total preventable. Why did that happen? Why is this happening in our country? Where we had these conditions that increased during a pandemic? Well, guess what? People stopped getting care. People thought the only thing that was around in the world was COVID and we all know way before COVID happened. They all had heart disease and they all had diabetes, but they weren’t getting care from it. They all had back pain and they weren’t getting care from it. They, things were shut down. Like you’re in Illinois, everything was shut down.

Or maybe in your state that people would just weren’t coming out. Maybe you were open and they weren’t coming out, but people stopped getting care and that’s really, really caused a huge problem. So what if we could make the invisible visible, right? The invisible gain momentum when no one was paying attention when no one was monitoring it when no one was checking it. Right. So when was the last time you had your blood checked? I ask all my patients is in doc. I’m asking you this because it’s time to take care of you, because if you don’t take care of you, you’re not going to be around to be helping anybody else. So when was the last time, because guess what? Having your labs done is how you’re going to make the invisible visible. And I’m going to show you just how that happens. I’m going to show you a quick case study here, how we do things in our practice, right?

And how we do things with vital health protocols. You know, we do the same thing that we do with our chiropractic patients. We do a little risk assessment, a personal history. We get all their demographics or family histories. If they’re taking medications or supplements, we get all the there day one stuff, right? So here we have a 54 year old white menopausal woman she’s in normal BMI. So she wasn’t obese. She didn’t gain the quarantine 15. She came in just for a wellness or yearly check, um, with her labs, she is taking a statin, but she doesn’t have any allergies. She’s a nonsmoker, occasional drinker exercises twice a week. She does have a family history of heart disease and diabetes. But overall she’s super, super healthy. We’re just doing it to find out how her wellness is so we could predict and we can prevent.

And when we look at this, we looked at some advanced lab markers and come to find out two of the three. She has some markers for heart disease. She has some markers for blood clotting, which can lead to stroke. She didn’t know it, right? So this was invisible. Now she woke up and she had a heart attack. She wouldn’t have known like, why, how did the start? But now we can work on turning it off because we know those things are no longer invisible to us. So when we looked at her cholesterol, her class overall was really high. Her bad cholesterol was really high. The quality of the bad cholesterol was really high, right? She’s taking a Staton. How could this be? Right. I thought statins cured this, right? That genetic marker. The statins can’t touch it. So still she’s at risk, but there’s things that you can do with lifestyle.

If you know what to look for. And if you know what’s wrong and guess what? She’s pre-diabetic she had no idea. We let this go. I’d say three months, like the end of the last year, quarter, right? She’d be full-blown diabetic. Now she was taking supplements. You can see she’s taking vitamin D. She was taking B12. She was taking folic acid, but she still had these silent things going on in the background. She hadn’t been checked in a long time. And even her liver enzymes were up. She had a liver inflame. Now, no one’s going to walk in your office and like, Hey doc, my liver is bothering me today. Right? They can’t feel it. It’s invisible once you uncover it. There’s something you can do. I think about this 80% of our cholesterol is produced in the liver. Of course the liver’s inflamed. She’s got an issue there.

So you want to make recommendations to reverse and prevent chronic disease. Just like we do with our musculoskeletal subluxation patients, we want to reverse what they have going on right now. And we want to prevent them from having any issues in the future. That’s why we have maintenance care. It’s the same thing with the stuff on the inside of us. Right. But to do this first, we had to see that invisible. We had to be able to predict the risk, right? So you wouldn’t know what was wrong with the patient, unless you examined them. If, unless you palpated them, unless you work them up, find out what’s causing them. But what if it’s invisible? Right? We can feel with our hands, we have the best hands in the world as chiropractors. And we can feel these problems with our hands. But what if someone blindfolded you and you couldn’t touch that patient and you couldn’t, couldn’t examine that patient would you know it was wrong with them?

No, but by not looking at your own labs, that’s what’s happening. Right? So I want to tell you, I want you to see the invisible. So if you have not done your labs doc in the last year, I want you to get them done. If you or your family member or friends are suffering with chronic health issues, I want you to get them done because really what are you waiting for? And the implication of not doing this is what we really need to think about. So how are we going to live with that disease? If we’re not going to check it, you better start thinking about, well, how am I going to live? If I had a stroke or a heart attack or heart disease or diabetes, think about what that would look like, right? Because we’re not going to drug our way back out of this problem and banking on a cure for all the causes of chronic disease is like planning for your retirement with lottery tickets, right?

You may win big, but chances are, you’re not going to, to why not look and see what’s there because it’s a starting line, it’s a baseline and you can reverse it. So it’s not out of your reach. It’s easy, it’s inexpensive. And it could just save a life, including your own. So if you have any questions, I, you know, I’m happy to help. I’m happy to answer questions because I really, really want as a profession to be the healthiest profession out there. Um, one of my friends was recently telling me some statistics that an insurance company told her, and that is chiropractors. You know, we’re creeping into me. You know, that mainstream where we’re not as healthy as we should be as healthcare providers. So as healthcare providers, we should be the healthiest out there. And we want to, of course, always look at the musculoskeletal system, always get adjusted, but we also got to look at that invisible. So thank you, Kyra secure having us. And I want you guys to be sure to join in two weeks again with empowering women, sponsored by ChiroSecure. So have a great day and you guys get your labs checked. Okay. Bye bye.

Join us each week as we bring you the best in business growth, practice management, social media, marketing, networking leadership, and lots more. If it’s about women in practice and business, you’ll hear it here. We hope you enjoy this week’s Facebook live event. Please like us on Facebook comment and share. We look forward to seeing all of you next week for another episode of empowering women in chiropractic. Now go ahead and hit the share button and tell your friends and colleagues about the show. Thank you for watching. Have a beautiful day. This has been a ChiroSecure production. [inaudible].

Empowering Women in Chiropractic Doc, Whose Talking Care of You? Julie McLaughlin, DC

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Connect with Julie: drj@vitalhealthprotocols.com

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, everybody. Welcome to Empowering Women sponsored by ChiroSecure. I am your host today, Dr. Julie McLaughlin from Vital Health Protocols. And we are going to be talking about you. We are going to talk about Doc, Who’s taking care of you because really, if you’re not being taken care of, you’re not going to be around to be taking care of your patients. And we know that this is a real issue in our profession because so many docs are having to quit practice, retire early, take a leave because they’re not taking care of their own health. And so let’s talk a little bit about that and how we can help support you. And you can support yourself in taking better care of your health. So I have a few slides, so let’s get started with showing the slides.

So, first of all, we’d like to thank ChiroSecure because we wouldn’t be here giving all this awesome information week after week, without them among many, many other things that they do so well for us. So everybody let’s give a little bit of love, like hearts, thumbs up likes, um, to kind of secure because they are just an awesome, awesome, uh, insurance company. And they literally have our backs. So when we think about chiropractors, we know that we all get adjusted, but what else could we do to be taking better care of our health and let’s face it. I know there’s a lot of docs out there not even getting adjusted. So I care about you and I care about that. You’re taking care of yourself and who’s taking care of you, right? Because what’s your story. Why did you become a chiropractor? Right? It is an absolute noble calling and we have the privy to the innermost details and vulnerabilities to people’s lives, right?

And it requires great compassion and empathy. And only certain people are capable of delivering this day in day out. And you, my friend are one of them, but you know what? We as docs have those same vulnerabilities. We have those same little details. That can be a problem. And so there is a dark side of practice because carpenters are being forced into early retirement due to the lack of their taking care of their own health. They’re getting health problems. And when we see this, we don’t actively seek out care because we don’t live in that allopathic model. We won’t seek that out unless our house is on fire. And by then, it’s too late. And I have treated to many of my colleagues that have found themselves in this place. They, they, they thought I’m in perfect health. I’m good. I, I see patients all day long and one day they woke up and that’s not the case anymore.

And that really is a dark side of our profession. And I don’t want you to ignore this any way and any more anyway, because it’s very, very simple to predict, prevent, and yes, even reverse chronic disease that every chiropractor in the U S has a potential to having. So we are going to talk about what we can do about it, because I always say this to my patients, and I’m going to say this to you just because you don’t feel sick. Doesn’t mean you’re healthy. No one wakes up and says, today’s the day I’m going to have a heart attack. Today’s the day I’m going to have diabetes today. I’m going to get diagnosed with cancer. No one says that you wake up today and say, Oh, what do I got to do? I got this many people. I got to do this. I got to do that.

But guess what? You have to take care of you. You have to take care of you. You’re probably taking better care of your car. Then you’re taking care of your health. And so what’s the risk, right? Sometimes we think we’re invincible. We hear people’s problems all day long, but we don’t even know what the real risk is to our own health. So I have a little risk assessment. I’m going to show you three questions. I want you to answer as we go along. So does anyone in your family have heart disease? And when I’m talking to heart disease, I’m talking high blood pressure, high cholesterol, God forbid that they had a stroke or a heart attack, right? Any of those things, or most importantly, does anyone had an early onset heart disease event? Like, do they have a heart attack before the age of 50 or before?

The age of 60? Those are huge, huge risk factors. In fact, even if it’s not your own health and you just have those risk factors, you need to know because did you know that someone in your family having a heart disease early onset is the number one risk. We know heart disease is the number one killer, and let’s face it. We treat people in pain all day long. We know it creates inflammation in their spine and their muscles, everything that we treat, but also creates it in their cardiovascular system. The difference is heart attack will kill you, right? We can get rid of that pain, but a heart attack will kill you. I want you to know your risk because if you have a family member that has early onset heart disease, that doubles your risk of having the same thing. If you have somebody in your family that had a heart attack or a bed or heart disease before the age of 35, that 10 times your risks.

But guess what? If you know that information and you know where you are, we can turn those numbers off, but I need you to look at it, right? What about this? Do you, or your spouse or your significant other snore, right? You think snoring? Like, what the heck? What’s, what’s up with that? Why are we talking about this? Right. But we know sleep is super, super important to your health, but did you know snoring has a higher cardiovascular risk than smoking or obesity and combined, right? That’s right. So if your, your spouse’s over there, snoring, they have a harder, a higher risk of having a heart attack than if they smoked and were obese. Right? And so the only way you’re going to know this is by looking at blood work and docs. I know what I am talking to all my friends. They’re not getting their labs done.

And I’m very worried about all of you. That’s why I am doing this because, you know, we take care of our patients, but we need to take care of each other. And that’s what I really want you to know. What about this? Do your gums bleed when you brush your teeth, right? Do you see like a little bit of blood when you spit out that toothpaste into the bowl, did you know that periodontal disease or bleeding gums will double or even triple your risk of heart attack or stroke? You need to know your lab numbers because it’s silent. You’re not going to come in and go. I think you know this right artery over here has got a little cholesterol in it. You’re never going to come in and do it. You have to know, but these are little signs that we don’t think of.

You think of, Oh, I brushed my teeth too hard. Or maybe I got, you know, adjustments to my Invisalign or whatever you’re doing. We always have an excuse, but the reality is double or triple the risk of a heart attack. Cause your gums are bleeding. So we need to make sure that you’re being taken care of because it’s just not just our patients. Right? We as providers are affected too, 90% of providers feel that healthcare is on the wrong track. I think you guys can all agree, right? We’re dealing in sick care and not in healthcare. And 74% of chiropractors are forced into early retirement due to health problems. That is just criminal. We need more chiropractors in our profession. We need more people helping people with what we do. And 50% of chiropractors have been reporting burnout due to poor self care, right? How many days can you go into the office?

Day after day? If you feel really bad yourself, it’s not even feasible. And then we have burnout, but what really is those underlying causes, right? That’s what we want to know. All we have to do is look at the statistics of the American population to see how crazy this is. Because one out of two Americans will suffer chronic disease. And I got to tell you, chiropractors don’t have an immunity to this. We don’t have like, well, it’s not going to happen to me. We all think we do, but we don’t because chronic diseases responsible for seven out of 10 deaths, right? We’re not just talking about pain here. We’re talking about things that are absolutely could kill us in 84% of healthcare dollars go towards chronic disease. Two thirds of Americans are overweight and a one in three are obese, right? It’s really crazy. And you know what, it’s the same thing in our chiropractic population of docs, auto immune diseases have tripled over the last 50 years, not to mention a pandemic, right?

And over half Americans are taking medications. How many patients do we have saying, you know, do you have any cholesterol problems? Nope. I don’t have a classroom problem. Why? See you’re taking a stat in here. Well, yeah. That’s why I don’t have a cholesterol problem. You do have a cholesterol problem. That’s why you’re taking the Stockton. We can’t put our heads in the sand anymore because you know what I need to make sure as this profession goes on, I’ve been in this profession a long time that we have docs who are able to take care of people. So we got to take care of you, right? Because you will never change things by fighting the existing reality to change something, build a new model and make the existing model obsolete. Right? That’s what we need to do. This is my absolute favorite quote is by Buckminster fuller.

And I just love that. So what are we going to do? I want you to know this, that every chiropractor, every chiropractor in every state in the United States is licensed to order blood work. I’m not telling you, you have to order, you know, draw blood in your office, but you are licensed to order it. And you’re licensed to order it on yourself, right? You are the patient. We want to take care of you. We want to help contractors learn this additional paradigm. We want you to start out and be the patient. We want you to take care of your families. Look at what they’re doing. Because if you started to do this, even in your practice, if you said, I’m just going to do it on me and your family, that’s awesome. We need that. If you sit down, I’m going to do it with my patients.

One doc, doing this could help more than 30,000 people. That’s huge. A movement like that could change the healthcare of this United States. And when was the last time you had your labs done? That’s what I want to know. When was the last time put it in the chat? Tell me, was it a year ago? Was it five years ago? Or was it like, you know, I really don’t remember. I don’t like going to the doctor. Right. But guess what? You can order it yourself on yourself and you can help prevent, predict and reverse any chronic disease. It’s super, super affordable. The cash prices are not, not, you know, expensive at all because we know that that can be a barrier, but no, one’s going to come in and say, Oh, I think my liver’s off of today. Right? You have to measure it. What measured gets measured gets managed.

And so is this for you? I want you to think about, should I get my labs done? Should I get the labs done on my family? I have the ability in my license in every state to order it. So if you are family or friends are suffering from a con chronic health issue. Absolutely do it. If you have any risk factors, absolutely do it. If you haven’t had your blood done in the last year, absolutely do it. You have to know, think about if you went and you didn’t get adjusted in a year or five years or however long it’s been, since you had your labs done, that would be really bad. Right? I always say, if someone told me I could never get adjusted again, I would die. That would be like the worst thing ever, right? This is super, super important. And this is for you.

And it’s to save your life is to save. Your practice is to save your family is to take care of you docs because nobody else is doing it. We have to make sure that our chiropractors are healthy and we’re taking care of each other. And so it’s not out of our reach. It’s easy, it’s inexpensive. It could save a life and it could be your very own or someone in your family. So please, please docs take care of you. If you want to learn more, if you want to learn what you can do to take care of yourself, let me know. Here’s my email, drj@vitalhealthprotocols.com, because let’s face it. We have to keep this profession going and we have to stay healthy to do it. So that’s it for today. Um, I want to thank ChhiroSecure again for sponsoring this. And I want you to join us again in two weeks with empowering women and Dr. Nathalie Beauchamp. We’ll be speaking to all of you. So have a great day and I’ll see you soon.

Join us each week as we bring you the best in business growth, practice management, social media, marketing, networking, leadership, and moms more. If it’s about women in practice and business, you’ll hear it here. We hope you enjoyed this week’s Facebook live event. Please like us on Facebook comment and share. We look forward to seeing all of you next week for another episode of empowering women in chiropractic. Now go ahead and hit the share button and tell your friends and colleagues about the show. Thank you for watching. Have a beautiful day. This has been a ChiroSecure production.

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Empowering Women in Chiropractic – Managing Moro Across all Ages & Stages – 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, happy Thursday. This is the third Thursday of January. Welcome to the amazing ChiroSecure, uh, platform. Big use of ChiroSecure again for giving us this opportunity to bring you, um, the Look to the Children’s show. So under house, Dr. Monika Buerger, hopefully you’re all doing fantastic. This, um, great, uh, third Thursday of January, 2121. So today I want to hang out a little bit. I’m getting a lot of questions and emails and blasts on social media and et cetera about what can we do for our little fiddle farts that are so stressed out these days. We are, um, we are in a time where not only the kiddos are stressed out with the adults are stressed out. So today I want to talk about how some things that we might see manifesting in our patient population group. And one of those is primitive reflexes.

So we throw this term around a lot, but one thing to keep in mind is this isn’t just for our little ones. This is really across all ages and all stages. And what I mean is, um, we’re going to see this happening in our adult population as well. And why is that so important? Why do you want to talk about that with on a peat based to show because our kiddos are going to feed off of their parents and the adults they’re around. So we have, um, adult stress ramped up anxiety, um, this unsettling, um, future that we’re trying to look at. So the kiddos are going to pick up on that and that’s especially true with during the prenatal period. So those pregnant mom was out there right now that are high stress. The, the, the, the, uh, the child will actually inherit mom’s stress patterns, mom’s stress resolve moms, um, the way she’s going to respond to her environmental stressors.

So I wanted to pick Moro reflex for, uh, this topic. Uh, the Moro I say is kind of the, uh, head honcho of the reflexes or the head honcho of actually of the sensory motor systems. And what I mean by this are primitive reflexes. Each primitive reflex kind of represents the maturation has part to do with the maturation, um, of our sensory motor systems and how we respond to sensory different sensory cues, sensory feelings, and the Morrow really represents maturation of all of our sensory systems. So the, the ability to respond in a good neuro, uh, integrity to all of our sensory environment, vestibular visual, tactile auditory, that moral reflex kind of runs the roost. So it’s a big kahuna. So when we’re in times of stress, when our resiliency goes down, those primitive reflexes can emerge. So a person, a child, a, the Mar reflects in particular integrates it should no longer be active.

So to speak after the age of about four months. However, if our overall, um, neuro adapted to their ability to handle stress is compromised because of infectious of traumas, whatever those re those reflexes, even if they were integrated, can reemerge. And this can be true with our adult population as well. It’s particularly true after, um, concussion, head trauma, et cetera. So, first lesson first take home. Pearl is we can use this information to assess all of our patients across all pages. And especially if you’re working a family practice paradigm, because if mom or dad are ramped up and stressed out, those kiddos are going to follow, um, and all stages of neural integrity. And what I mean by that is I’m going to show you different ways to assess the Moro reflex. Many of you are, um, first on the trust fall way, but I’m going to show you a couple of different ways, and I’m going to talk about different ways to integrate it depending on a person’s neuro functional capacity.

So let’s dive in and let’s have some fun. All right. So again, the more we flex sometimes has been in the past is referred to as the startle reflex, some will, um, there’s, there’s some controversy on that, um, on using it as the, the term, the startle reflex, it is a, it, the precursor to the Mar reflex, um, is called a fear paralysis reflex, and that develops in utero, and it should be integrated in uterus. We shouldn’t be born with it, but those two kind of go tandem together. And we work with them in the same manner, but again, the more reflects should disappear or integrate it at about four months of age. Um, if you see a little fiddle fart that six, eight, nine months a year old at a still very, um, start very easy, one telltale sign is when you try to go lay them down, they might be asleep and calm in the arms, but you’d go to lay them down.

And that head drops a little bit and they, they wake up and they start all, and then they’re inconsolable after that, they won’t go back to sleep. Um, they’re crying. They’re very much, um, dysregulated and disturbed. Okay. So that’s a telltale sign that that’s, that moral may be still too active. Um, if retained, this is very important. The moral tends to drive us in a more sympathetic dominant state, all the primitive reflex as well, right? Because they’re going to drive us back to that. The brainstem, that primitive part of the brain, these are brainstem reflexes. They don’t have cognitive control. It’s a reflux that makes me want to always break out into that song by the clash we flex. I won’t sing on this. So those would be that know me like the dummy in person I like to sing, but it doesn’t work out well, usually.

So anyway, um, so we, we shift, but the Morrow in particular leaves us in this fight or flight pattern. The Morrow is known as the first breath of life in the child. It’s responsible for that first breath of life in the child. When they’re born. I have seen clinically that, um, those little ones that are born, particularly with the cord around their neck or that, um, needed resuscitation afterward, or need oxygen or anything like that, having to deal with breathing that that Morrow tends to linger longer and tends to be more active throughout life. So just keep that in mind, if you’re looking at a history, um, areas that we want to look at from a spinal standpoint is looking at, um, uh, up regulate the parasympathetic nervous system. Since it will lead us into the sympathetic fight or flight shift, um, the respiratory diaphragm working the diaphragm, the rib cage can be huge because little, any individual that has this actively retained a Mar reflex might be breath holding a lot.

Um, they might not be expanding their red page. Um, well, and so we get some, uh, lack of oxygen, good oxygen flow concerns. This, um, also is very much tied with adrenal activity. When the adrenals tank out our immune system can be compromised. Um, we see things like allergies, eczema, asthma, um, and poor immune integrity associated with an active Mar reflex. So keep that in mind. Um, this can also really drive us into that limit, what I call limbic lock and load mode, and, uh, being held hostage by our amygdala, our fearmonger. So we can see anxieties and depressions and so forth associated with this constant Moro reflex, um, and very much, um, high, uh, muscle spasms, muscle spasticity, um, especially at the posterior muscles, the extensor muscles can be hypertonic and stress all the time, the posterior calf muscles. So these individuals, you might have them doing stretching routines as stretching routines, and you’re like, why can’t I get these muscles to relax?

They’re constantly stuck in that cortisol state because that morals fired up too much. So, um, Moro things like Annette, being able to unfold to not focus at one thing at a time, kind of that squirrel mode, okay. Poor impulse control, poor emotional maturity, um, easily distracted and that the poor impulse control and emotional maturity that comes because that prefrontal cortex is usually flipped off when we’re stuck in with these primitive reflexes. Um, so we’re stuck in that primitive part of our brain. So our executive functioning skills are not as great, um, aggressive, hypersensitive, anxious, startles, easy, a big one is having trouble paying visual attention to the center. They tend to pay attention to the periphery there everything’s distractive. So if we take this into the context of trying to sit and study or listen to in class, or as an adult, listen in a large lecture hall, we might be deferring our visual attention to the periphery all the time.

And, and so again, that squirrel attention. So we’re missing a lot of that information coming in. Um, they might crave sugar or caffeine, those stimulants to keep their adrenals driving because they’re, you know, burning out so much with their adrenals, um, things that, um, poor balance and coordination stamina we’ve talked, you know, brief some of this here already, um, blood sugar levels, blood sugar levels could be a big one because they’re constantly that sympathetic dominant shift. And, um, the adrenals are dysregulated, so they can, big times a blood sugar drops are between 10 30 and 1130 in the morning and three and four in the afternoon. So essentially after breakfast and lunch. So watch these individuals again, not just your kiddos, but your adults as well. Do we need to help supplement them with more blood sugar stabilizing snacks? Okay. Um, good proteins, good fats, et cetera.

They may be hypersensitive to light touch, sound, smell, or our sensory system, um, very troubled with adaptability. They want to make sure that they know what’s coming. They want to be the predictable situ in predictable situations. So, because they want to, they don’t change it. Routines is not a great thing because they want to know what’s going to feel like in the situation that they’re going to be presented in. So if they’re familiar, they know they’re going to be walking into their classroom and what that feels like, what it smells like, how loud it is and everything. But we switched that up and them and say open today, you’re going to go to Mrs. Jones class. Instead, they might come become unhinged because they’re always on guard and they don’t know what they’re going to feel like in Mrs. Jones is class. What’s going to fill out like to their brain.

Okay. Um, they can have trouble with hyperactive activity and fatigue. Um, because again, they’re being so drained. Tell me time is going to be a big, big milestone that we need. We need to look at with, um, helping to foster integration of the moral reflex tummy time. And then at about three months of age or so when they roll onto their side and they kind of kind of come together to midline, moral reflex is a core, it’s a core base centering reflex. Um, those of you that if you work on any energy or shock residents, a lot at solar Alexis area. Okay. So let’s go into some ways that we can evaluate the integrity of the Mar reflex. So let’s remember, I always say when I’m teaching, the more a reflex mimics an infantile response, that’s the it, the more active it is in that individual.

So in the, in the infant, we know that, um, they are going to inhale and everything extends. And then the exhale, like a, like a sigh of relief, the exhale, and come in into a flex position. So the Mo when you’re doing these testing patterns is T evaluations. You look for how much do they mimic that infant towel reflux? Okay. So it’s a good idea to get your hands on some little fiddle, farts, some newborns, and test that Mar reflex, you’re holding them. And basically you can drop them and you should see that inhale and then exhale. And they settle and come to come to inflection. The Murray flex was, has, um, been much associate with the vestibular system because of that change. It had movement. However, they’ve done some studies where they, um, basic what has basically shown that it’s very much associated with vestibular and proprioception, especially of the upper cervical spine.

Okay. So it’s an extension based stimulation that we’re looking for, that if it’s still active, we’re going to talk. We’re going to look at a few different ways to, uh, to look at this. One of them is actually in a supine position. You might not get these little fiddle farts that are, um, that have such an active Morrow to want to do the trust, fall maneuver, where they’re standing with feet together. I think I put a little video in here or a picture of that. Um, but that while they’re standing be preferably feet together, good posture. Cause we want to load up the system, especially at proprioception arms would be flexed elbow, slightly up the side, their head extended, and you ask them to fall back and you look, if they can, they do it with ease, do they hesitate? Um, do they, do they do this?

And then come back in. So the more amendments that mimics that infantile response, the more active it is in that individual that you’re evaluate. But I want you also to look at things like, do they flush? Do they have a sympathetic response? Do they get red? Do they get sweaty? Sometimes what I’ll do? Let’s say I’m doing the trust fall on a eight or 10 year old or an adult. Um, just make sure you can. You’re strong enough to match their body size. If you’re going to do the trust fall one. Okay. You can handle them if they, that dead weight comes back at you. Um, but my little fiddle parts I might say did that. And they, I see no action of their arms, no reaction. They just fall straight back. Okay. I will touch their PA. I’ll say, let me feel your hands. I want to feel that, are they breaking out into a sweat? Am I, am I picking up any sympathetic response? And I’ll also ask them, did that, um, how did that make you feel? Did that give you butterflies in your belly?

And some of them say, no, that was fun. Some might say you little, you know, and I’ll say little butterflies, medium, or a lotta meaning. Did that feel? Give them a feeling of being anxious. Okay. So you want to dig a little bit, um, you want to look for the overt signs, but you also want to did, like, is it maybe hanging out a little bit? Another thing you can do is you can walk into a room and you can either come from behind. If, if you feel it’s appropriate, if you know this person or, you know, they’re old enough, you think they can handle it, et cetera. And you can see if you can start a limb boot, um, or you can see, um, when you, some people say is, um, when you run up to somebody and meet them face to face, and if they’re equally to embrace you or they’re like freaking out, okay.

So those are some, some other subtle signs you might look for that is this moral hanging out a little bit, the older person or adult you might ask, how do you do somebody scares you? Or if you are, um, walking in front of the cards and we slammed slams or horn, do you like startle? And it’s hard for you to settle afterwards when Morrow integrates, it’s taken over by what this, what we call the stress reflex, where if I’m sitting here at a cafe, having a nice glass of wine with somebody in relaxing and conversing, and all of a sudden, I hear a loud crash behind me. I should appropriately take a breath in my shoulders. Go up. I turn, I look, I’m available, able to evaluate that I am safe. I’m okay. And I can come back and I can pretty quickly relax and calm down again with the adult, with the oldest child, do they startled?

And they have a hard time coming down and, and, um, self-regulating afterward. So those are some other things we want to look at if looking for an active Mark. So another way to test, we can do that the trust fall, but you can also have the person, the little fiddle part’s supine have, you know, a rolled up. You’re going to see on here, the rule that pillow under her shoulders. So you want the head about four or five inches off the table or the floor, depending where you’re at, put your hands underneath them. Their arms should be out to the side elbow, slightly bent with palms down legs extended and be fairly relaxed. And what you tell them is first of all, do it with the eyes open. Um, when I, as soon as I dropped your head, as soon as I let your head fall, I want you to cross your arms across your chest. First of all, make sure they can do this. Make sure they can, they know, understand the directions and they know how to do this. They can use both arms in a coordinated fashion

To do this. So

You simply hold their head. And at a given point, just drop it down and you see how fast they can react. Do they initially splay out like tomorrow and then come to midline appropriately? Do they hold their breath? Do they grimace? Do they flush? Are they sweaty? How active does that? Their motor pad, their response mimic an active model reflux. So this is another way we can do it. And then there’s also what we call the duck and pigeon walk. So what I’ll do is if I am not sure, or I see a very slight then thinking that’s kind of the slight active model, but I’m not sure I’ll put them in a duck and pigeon walk. And oftentimes you’ll pick it up here. And what that is is you have them stand. You have their elbows bent at a 90, 90 degree. As you see here, her thumbs are pointing inward and then her feet are pointing

Out

And you have them walk about 10 feet forward and 10 feet back up several times. And you see if they can keep that posture. The thing you’ll know is that they’re there, their thumbs or hands want to come out of that position. And, um, and then the pigeon walk, his feet are turned in toe to toe and thumbs are turned out and can again, can they keep that posture as they walk forward and backward? And so this sometimes will bring out that, um, that moral, that you’re not sure if it’s linear in there or not. So I do this on my older kiddos and my adults, if I’m not seeing, if I’m, if I do the trust fall, um, and or the supine, and nothing’s really sh I’m not sure. I’ll see if I can bring it out this way. So those are three ways we can evaluate the moral along with the things that we talked about, of, of, uh, history, questions, and presentation that might be indicating, um, an active Morrow.

And then look again at your history. Are they complaining of anxiety? Are they complaining of inattention, um, sleep issues, blood sugar dysregulation, look at those as well. So tie those into the picture. So how are some ways? So this is a pretty, um, standard exercise to help integrate Morrow. But again, we want to bring this across all ages and all stages. Not everybody can do this, right? So I’m going to hold your breath. Don’t hold your breath because it’s part of Morrow. Um, I’m going to show you some ways we can modify things to help those, those individuals, depending on their age and their functional integrity, how we can modify this. So I have this little one in, in a chair. You can do this either supine, or you can do it in a chair depending on their capability. And we, I call this the Venus fly trap.

It’s like that plant, right? That you drop something into and it eats it up. So I call it the Venus fly trap. I think some people call it the star flower. Okay. So you’re gonna see it called different things, but this little one’s in a chair everything’s extended. Okay. Palms facing outward. And then the first thing is they cross one leg. They cross the same arm on that side, and then they roll up. Now what I tell, because you also want that head to come into flexing and what their whole body to come in into flection. Okay. So what I tell them, as I tell them, um, cause you want the pump when they’re doing this, you want the Palm space in their face. So I tell them that pretend your hands are like butterflies. And that they’re always facing the butterflies are, are, are facing you.

Okay? And they’re flying right here because I want those palms open. And as a side note, sometimes you’ll see individuals that have an active, retained Morrow. They they’re fisted they’re there. They don’t relax their fists open. So palms open facing you. All right. Um, and then as they they’re going to cross and they’re going to roll and they’re going to kind of take the butterfly wing to their nose and then the unroll uncross. Okay. Um, and the reason I liked that I like having their eyes on their hands as well, because you’re now you’re getting some hand eye coordination built into this. Um, so it’s, it’s kind of killing multiple birds with multiple stones. So you have them do one side first and then unroll and uncross. And then the other side crosses over and they roll up. Now again, I start them out with these basic movements because that’s all they may be able to do.

And then I can add breathing with it. So as they extend the inhale as a flex, the exhale, and it’s great to do like a five count breath with that. So as a extend five count, inhale as a flex five-pack five count by point. Exhale. Okay. How many do you do on each side? It depends on the, on the person. Do they cook out? Do they get kooky brain after three? You don’t want to push the goat. So to speak on these because you don’t want to drive them into a sympathetic state where they don’t like doing these, especially with their kiddos, their excuse will be, Oh, this is dumb. This is stupid. This is too easy. When actually it’s really hard on our brain. So, um, you might be able to get three on each side for the first week and then they can do five and then they can do 10. You need to step them up as tolerable. Okay. Because who wants to feel cookie? Now I want to show you over. This will play okay. On the child that can’t do this. How can we start laying the foundation to help them do this?

Can you do this? Maybe your right leg comes over to your left. Okay. And then do you remember your right hand? CO’s over on top, but your left. Okay. And can you roll up into a ball or you can do a roll, everything up and the head comes up too. There we go. Awesome. Okay. Unroll and unfold unfold. And now the left side comes on. Talk. Is it like paper? Kind of, can you put the website on the top? The left hand on top. Okay. Remember it’s like, butterflies are looking at you. It’s like your hands are butterflies because you want always the palms to be facing the face. Okay. Okay. So that gives you just again, how do we modify these things? Right? How do we make it applicable? The other thing I call it’s called clamps again, Morrow is a centering. It’s a core reflex.

So I use, um, hold on. If you’re out there. Okay. I’m going to show you actually with little babies to how to do this. Okay. We’re going to modify it for the little, little, little, little ones. Okay. But clams are, um, I use either, you’re going to see two different versions here. You’re going to see me using a deflated plated physio ball. And you’re going to see me using a beanbag chair B back because we want to mimic, we want to get an action that they can carry out that gets them into that center. All right. So this is kind of fun. The boys, especially like it. Um, so I’m going to show you. Okay. Ready, buddy. Okay. Everything comes up and squeezes it. Here we go.

Beautiful. Beautiful. Ready to go again? I think I have it ready. Okay. So you want their arms and their legs to kind of come up, see how the end phases here has legs. There’s those bits spread apart. You want them that kind of squeezing that whole, the upper and lower extremities. And then you’ll see this guy. Awesome job three, because especially this, the second one that I showed you, that little guy would, can not figure out right. Left more reflex. It’s going to be, uh, uh, uh, right left body, right. Left brain, upper lower body, upper lower brain brainstem to frontal lobe. Okay. So they can’t figure a lot of this. These kids can’t figure this stuff out, so we’re helping them and we’re playing a game at the same time and they love it. Um, so how do we modify this with the baby? Okay.

Okay. So with the infant, with a positive Mara, we can do the same type of things that we did with the older child. We’ll just modify it. So we saw that video clip where we had the little toddler and we had mom had him sitting in at her lap and we put the ball and we call it the clam. So what we can do with the little ones is get the small step in and we’ll okay. We have our quality

And we just use that boom. And we just modify ends up squeeze. Okay. And then maybe get her attention and then, and roll up and squeeze. Okay. So we’ll do that three to five times, and then we can do a model

Venus flytrap as well, where just like you saw in the video with the older child where we’ll just

Do the, um, maneuvers for them

And then roll them up and roll and I’m cross. And you can have the parents do at home again, three to five times on each side with the little ones it’s really easy to do for just one person, because they are so small, so modifications depending on functional capacity, age and size. So there’s some tips for the Morrow, with the iPad.

Jeez, gotta love that hair in that video. Hi, wild hair day there. Um, now what I want to say is, um, you saw me do the clams with that older child. The other way I’ve had them like, like a three-year-old where I’ve had them, where sit in mom’s lap and they’re facing out. And we just use a big step down, a big Teddy bear when they’re step animals or a big physio ball or whatever. Okay. And you just kinda put it into their core. And mom, um, mom would help them maybe squeeze with the arms and dad or me depending where they’re at would help him curl up with their legs. So they’re the comfort of mom’s lap. The object is coming out to their core and they help them squeeze. And what I found, especially with my autistic kiddos is they end up really liking this.

And sometimes they’ll end up dragging that step down and what’s mom or dad, or the physio ball. And, and they want this done because with some of them, it’s very calming actually. Um, I’ll give you one more thing. The other thing you can do with the older individual is you can have them in this position. So again, they, the unused arm is out the side, Palm up, you have the arm and the leg at a 90 90 position. You want them in a 90, 90 position. And you’re simply again, in, in the picture here on the left, I’m pushing into their core and they need to resist me. You’re not using more than 20, 25% of your body strength. Okay? You don’t want them overpowering you. And a lot of the kiddos will try to overpower you because it’s harder for them to do more of an isometric push.

So you’re pushing, you’re, you’re re having them resist as you’re pushing in. And then on the other picture, you see I’m Abby, I’m pushing out a wave from their core, and they’re supposed to try to maintain that position. So not easy to do. Um, and so what I do is I’ve done some cheat sheets for y’all. I, what they like to do is like this little dude, how he likes to rest his he’s resting his hand on his head. They like to cheat. Okay. When we’re in the sympathetic dominant shift, it really shuts up our prefrontal cortex and motor control and motor strength is off. So I I’ve used these little plates where they have to try to entice them to keep that position. I’ll show you this real quick. Right.

Keep that one bent. So we bounce a little bit like this there and bounce that place. Okay. That goes, this goes

Up. Okay. Bounce that plate. Okay. Right. Push in. Where do you push outward? So don’t let those plates drop. Oh, you’ve got to keep up. Awesome. Okay. So that gives the older kiddo a challenge. I’ve also used slink from, for the little kids slink from toy story. It was a perfect stuffed animal to, to rest on their leg. And then I said, don’t let slink flaw fall. Okay. So these are just ways again, to have some fun modify things, to get where you want to get with the little kiddos. And so again, you start with the easy stages and work your way up to harder, do harder maneuvers. So I think we had a pretty good fun time for you enjoyed this. Um, please reach out to me if you have any questions, this is going to be a big one right now because people are in, um, again, second a spider flight mode.

And, um, we want to help to be able to, uh, pull out all the red stops in addition to adjusting them, getting lifestyle management, diet regulation, blood sugar regulation. Um, look at that more reflects in a little bit can go a long way. So again, thank you again, ChiroSecure. You’ve been amazing for the chiropractic profession. Um, what would we do without you? Thank you for letting me share this information and be sure to check in on the first Tuesday in February with the amazing Erik Kowalke and his amazing information. And I’ll be back the third Thursday of February until then keep changing lives, keep changing the future.

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Empowering Women in Chiropractic – Playing the Compliant Discounting Game

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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.

As we jump into those slides together, uh, we’re going to be able to see what we’re going to be working on. It’s your vet from games, university. So glad to see you. And as I stated, we’re going to be playing around with the complaint discounting game today. Sometimes it’s a little bit difficult to know exactly what you’re going to do, and we’re going to get started with those slides so that we can get moving quickly. As you know, I try to keep it power packed and moving fast as we go. So as we start the slides now, uh, we’re going to be able to move along and get those things underway. Are you ready? Welcome to 2021. So today, while we’re talking, we’re going to discover how we can do legal discounting options. So many times here at KMC university is I’m bringing in clients who are coaching my own clients or just doing consultations.

Overall. We noticed a lot of issues in the way that people are discounting, even with some of their compliant coupon offers that they think they have, just because someone told you to do it and they’re getting by with it down the street doesn’t necessarily make it okay. We always need to verify those things, make sure that they dot all the I’s cross all the T’s as far as any federal regulations, any type of other things may be going. So always want to make sure we have that in place. We’re going to also recognize where you may have some inconsistencies in your patient fee schedules learn how to properly implement some hardship agreements in your office and men. It may be appropriate to use something more like a professional courtesy policy. So again, these are the things that we’ll be covering today. Um, as we move into the rest of our slides and I do walk them, you, I do appreciate Carver secure giving me these opportunities to speak to you and coming to you again from KMC university.

So as we talk about this one person said, very famous person said, your fee is your fee is your fee. And you know, with real estate it’s location, location, location, but when it comes to having compliant fee systems in your office, it is your fee is your fee is your fee. And we want to always make sure that we’re abiding by those rules dotting our I’s again, crossing those T’s just so we can be compliant rest at night. Don’t worry about the fee police to come get you and say, Oh, that’s wrong. And we’ll figure out who some of those players may be. And then we need to figure out where are the discounts coming from? So we’ll have some that are imposed that are like some of our regulated contracted. And then we may have some of those that are a little bit more elective in nature.

And we’ll talk about those. So we’ll get a clear understanding about that as we go along today. So as we continue to move forward, I’ve kind of wanted to start with some of the dangers and pitfalls that you could fall into. If your fees are not compliant in your clinic. So oftentimes we’ll see inducement violations. We’re not necessarily doing it to induce some may be, but we’re not necessarily doing some of our practices to induce, but it’s what necessarily our intention was. It’s what the perception is by those governing entities. Many times, anytime we have an issue in our fees or any other area with our billing, it’s no balls into the next area of false claims act. Nobody can afford these things. Number one, you don’t want to have recoupments number two, you don’t want to have any issues with, um, what you’re going to be noticing.

Um, when you’re sending over to a pair and they’re saying that’s inappropriate, or we’re going to find out somebody else who’s playing some really dirty tricks lately. Um, as we go along and then the anti-kickback violations, we need to make sure these are not being identified with our office. And we’re going to learn how to safeguard that as we go along. So Medicare vocabulary goes inducement and remuneration. So when we’re talking about that inducement, that’s influencing someone to come in and, uh, maybe giving away something for free. That’s, uh, maybe higher than the value that’s allowed or we’re giving away discounts through our waiving of copays deductibles and things like that. You may not give any item or service away that exceeds $15 or $75 aggregate, um, to a Medicare patient. This really falls over into federally funded patients. And what happens is when it falls over here, generally, you’re finding a lot of the payers piggybacking on this and saying, Hey, you know, we can’t do this for, uh, for our patients either, or our patients.

You need to have fraud, waste and abuse in place because you’re dealing with us. Everybody’s moving to this model. But right now we know that there are penalties imposed from federal entities when we do inducements and the remunerations waiving copays and things like that. So it’s in the regulation. We have the, the patient solicitation, anti inducement provisions. You can see it here on the screen, someone who’s offering or transferring to a Medicare and Medicaid beneficiary, any remuneration that the person knows should or would likely influence their decision to come in. This is applicable to Medicare and Medicaid. We know that VA, uh, moves over into that and we have some other programs and you’re talking about the affordable care act. And some of those things, you gotta be very, very careful. And why said you can’t afford it? Look at the bottom sentence. It says up to a $10,000 penalty for each wrong for act.

Oh, all right, well, let’s get it stopped. Now. We can’t afford to be over here in playing in the non-compliant game. You know, where it’s like playing Stratego, we’re playing chess. We got to move our pieces just right. We can still get to the other side and win what we want to win, but we avoid being captured and avoid the bomb when you’re playing Stratego. And we just want to make sure that we’re matching the right places together. And we’re still moving towards our goal of being profitable, getting our patients in the door and not scaring them off. So as we go ahead and move to our next slide, we’re going to talk about again a little bit more about that remuneration. We’re going to waive your copay. I had a local dentist, um, asked me several years ago when I was working in the local clinic.

He said, what my office thought we’ll do is we’ll have a doctor or even our staff members get treated. We’ll submit it to their insurance, just to help them meet the deductible. And I’m asking you to do that for me. I know you do a write off for doctors and, but I want you to submit it because I know you’re going to write it off. And, um, I want that way. It’ll help me meet my deductible. It’s not going to hurt you guys. I’ll still pay the bill. Uh, he did not like my fight back. I said, I can’t do that. I can not waive your deductible or copay. I don’t have any financial, uh, hardship in place or anything saying that this is okay for you. And he got a little Tifft. He said, I do it at my office. I can’t help what you do at your office.

We can see it’s usually way well laid out, especially in our federal programs, but we can also find it in our commercial programs. So always be sure that you’re just, again, dotting I’s and crossing T’s that we’re playing our chess pieces or our Stratego pieces. Right? And we’re being a little bit more intuitive where those bombs may be laying there waiting to capture us. So we’ve got to be so careful. We had a poor guy, all the one chiropractic. He was in Iowa. And this is out. We’re not, this is not something we’re displaying of one of our clients. This was something published. You can go find it on the department of justice website. Yourself probably could do it through the Google search of any type of search engine would bring this up. But while he was doing, he’s like, Oh, my poor Medicare patients.

They can’t afford a STEM. I hear this all the time. I’m not joking. I am not kidding you one bit. I hear it constantly. Well, they can’t afford it. Medicare doesn’t cover it anyways. Why does it matter? All I have to do is pull this up on the screen and say, this is why it matters. They feel, even though your intent was to help them out, they feel your intent was to influence them to come to your office because maybe Dr. So-and-so down the street is an offering that, but you’re sitting here going, yeah, Yvette, the doctor so-and-so down the street is offering that. I’ve never talked to them. I don’t know what’s going on there. And we can’t help if they’re doing it wrong, it doesn’t make their wrong BR right. So we’ve always got to be careful, but this poor guy in his innocence and just trying to be nice, ended up with the $79,919, uh, payback that he had to do.

And you can see there after the highlighting, it hit the anti-kickback statute. And the false claims act happened between. And look at that span of time, they looked at, they looked at a long span of time. You can pull it up and read a little bit more. But, uh, the thing is, is that you’ve just got to be so careful. And as you know, the old saying goes, don’t let your good be evil spoken of always make sure that if you’re going to do good, you can do the good or you find the legal way to do the good. And we’ll talk about that. So the biggest thing that this member rev represents is that we want to avoid dual fee schedules altogether. This is not something that you want to have in your clinic. And I’m going to just kind of hit the nail on the head here in a minute.

When I tell you why a with somebody you’re not expecting it to be somebody playing tricks, I told you earlier, they’re playing these crazy tricks on everybody, but we want to figure out what is the dual fee schedule, because it can misrepresent charges to a carrier. I had the pleasure to do an onsite back in October, we talked about it a couple of times, since I was here, they were just having the patients pay $55 here. I’ll take your credit card right here, $55. And they were billing the insurance company 150 I’m like, how did you know that was their co-insurance their copay? Oh, well, we just do it. Uh, we’re out of network. I just sat back. And I said, well, that will stop. It has to stop. Now we have to clean this up. And, uh, needless to say, they’re probably one of the top producers with one of the medical discount plans.

I’m going to talk about here in a little bit, because we got that straightened out for them. Again, false claim act violations. And then it may very well violate your provider agreements. Think about it. You know, we’ve got blue cross patient Lang here and blue cross representative behind him, PI patient here, PI representative behind them, cash, patient, ear cash, patient behind them. Everybody has the same thing. Everybody goes to the front desk together. You will bill your insurance. Two 50 we’ll bill you two 50 and that’ll just be 50 today. Same service don’t work it. And very well may violate your provider agreements, but keep watching here. It is the PAI complex. I cannot stress with you how much this is happening. We had one of our members call him the other day. What do we do? Oh Lord, what do we do? Well, we’re like, well, first may we do a consultation with you to see if we can get this worked out together, figure out what you did, figure out what needs to be cleaned up and what we need to stop.

And we looked at it and what had happened is they had Geico, give them a call and say, I don’t have insurance. I was just calling to figure out if you have a cash break for your patients. Oh yes. If you don’t have insurance, your visit will only be blocked. Next check. That’s what they send. And guess what? They reported them. They reported them for having a fee schedule that they were giving to cash patients that they weren’t giving to them. There was no legal reason. So everybody starts with the same fee. There was no justifiable legal reason on that next line for a deduction that said they should get something. There was nothing regulating it, nothing contracting it. They were just giving it because that’s the way they do their cash patients. Well, state, farm, and Geico doesn’t understand why that doesn’t pass along.

So we ended up having some pretty major issues. There got to clean it up, got to write some policy. Luckily we were able to work on it a little bit creatively with them. Uh, obviously some reeducation of the staff up front at the front desk and how they’ll answer the phone needs to take place. But overall, their feast systems need space systems needed to become compliant. So we talked a little bit about those impose discounts, the ones you can’t do anything about. You signed the dotted line, you get the dog and pony show that comes along with it. So those are the regulated, which is more like your Medicare, your worker’s comp, some personal injury, no fall and Medicaid. Can’t do anything about it. It is what it is now. Your workers’ comp and personal injury. Mainly your personal injury can differ from state to state.

Sometimes you can expect your full, uh, reimbursement of whatever your charge is. Other times you’re going to be part of some type of regulated or some type of contracted because you’ve got a silent PPO or maybe they’re pigging backing on some other type of pair. Then we have those contracted discounts, which are, I signed the dotted line because I want to be a provider with blue cross. I signed the dotted line because I want to be a provider with Aetna. This payer, that payer, these are those you can avoid. These are the conundrums you can get into, especially when you have those per diem payers that say I’ll pay you $65 a visit, no matter what you do. We have people all the time trying to circumvent that we’re like, Hmm, go back first, read your EOB. Did it tell you it can go to patient responsibility.

Now, go back and read your contract. Look at your medical review policies. Make sure that you know, what you’re doing is appropriate. This is why you can’t take your fees lightly in your clinic. They have to be every I dotted and every T crossed in order to be compliant and be most profitable. I think when you’re looking at impose discounts, one of the most profitable things you can do for your office is one take the services that you do and find out does that payer exclude them. Aetna has a very long list of CMT services. They consider experimental and investigational. Are you on that list? Does it even make sense to go in is everything you do on that list of experimental and investigational that’s one step. The next is if they won’t give you your fee schedule or a fee schedule prior to enrolling with them, ask a peer down the street, Hey, what does it look like for the fee schedule for this insurance company?

Know what it costs for you to be profitable in your clinic, and then gauge if you can go in before you sign the dotted line. Because remember once we signed the dotted line, we are now either regulated, contracted with an imposed discount. Can’t do anything about it. So you get out and with Medicare, we know you can’t get out how to give that commercial one more time. So that relationship with the payer and network, it really starts here. The doctor joins the payer, the patient pays the premium. They have an insurance card, you have this type of agreement. Everything comes back to the central hub of that payer and that network telling you what you can charge. That relationship is between the provider in the patient. But again, a lot of times we’re relying upon that and that requires the enrollment of the doctor and, and the enrollment of the patient into that plan.

So again, this is going to be part of your imposed, contracted, regulated, uh, type of discounting. That’ll go on. So we’ll skip over to the next part, which everybody’s probably wondering why are you taking so stinking long to get to this part about it? I need to know how I can do discounts. You told me what I can avoid. Now tell me what I can do, because now that you scare me to death, I need a way to deal with these patients that are cash, or maybe don’t have a great insurance plan. Maybe don’t want to use their insurance plan. Maybe have limited benefits. So let’s go there together. There really are. There really is one fee in your office that is if your spinal CMT for a nine, eight, nine, four, one is 55, then it’s 55. Then it’s 55 and it’s 55 next payer.

It’s 55. Everybody starts at the same level. Now the next line down. Why? Why is it not 55? Tell me why it’s not well, because it’s regulated. Okay, great. Well, because it’s contracted great. Well, because they’re a cash, they’re a cash patient. Okay. Can we talk about that cash patient for a moment? How large is that discount with discount by half, sometimes 75% wrong answer. We’ve got to make sure that’s within spec. Although the federal government has some rules that we believe are five to 15% on a time of service discount. Do you know that your state or your payers may have something to say, but again, we’ve got the actual fee next line down. Why shouldn’t they pay that fee? And we’ve always got to make sure we have checked with every entity that we’re doing that appropriately. So again, the discounts go imposed an elective.

We’re on the elective side. Now these are the ones that are at your discretion that you decide to implement in your clinic. As we move down, we’ll go the other direction. We can see that those are elective fees could be your five to 15% time of service savings, financial hardship, professional courtesy, or maybe your discount, medical plan participation, something like Cairo health USA to where they are set up in most States, I believe the only state is Washington, where they’re not in where you can offer your patients a compliant discount, go to bed at night and know you did it right? Setting up your own fees in your office. So even though it may fall in kind of that contract land, it’s your fees that you picked. We already know insurance. Isn’t going to pay you your full fee. You’re not going to chase your tail with this cash patient.

Why not give them a little bit of a discount? Uh, so they don’t have to pay you 565. Maybe they pay you 200. Plus the joining fee to Cairo health, which covers them and all their dependents for an entire year. It’s crazy. It’s like Costco or Sam’s, but these are the elective discounts that you can do, but you have to do them right again, dot the I’s and cross the T’s. So again, actual fees, discounted fees, or where are we going to focus our attention? And here are four possible fee structures that will help you pass the muster. When it comes to doing this compliantly one charge your actual fee. My fee is my fee is my fee. And if you’re cash, that’s my fee. That’s my fee. Absolutely. You charge it to the insurance company. They come back and say, write it off. You write it off.

Everybody going out the door gets charged the same. That is super compliant, no issues. Everybody pays your actual fee. You’re not discounting. You could charge a reasonable time of service of five to 15% for your federally funded patients. Always make sure to see if your state has a more strict role. Whichever is most strict rule, real rule and be the one that you’ll have to implement for your office. But when you find the state may be more lenient that may apply towards those outside those federal programs. So charge a reasonable time of service discount. Five, 15%. For me personally, I would not want to think about this as federal. You get 15, this is you. You get there. I would pull out my hair. I would either do five to 15 based on my bookkeeping savings and or do something like Kira health. Make it simple.

Don’t complicate it for your patients. We’re already in uncertain times with money and they don’t want somebody feeling like they’re jacking around with their money. They want to know this is what it is or this is what it is. You can pay our full fee. You can join this discount medical plan, and this is what your fee will be. Which one would you like? Let them make the choice, give them a choice. You could use a network-based legally discounted fee of choice ups, Kira health. And then you have those legal options with the hardship indigents policies for those patients who qualify. And I did say qualified. So these are the ones we’ll look at Cairo health, a little bit hardship, professional, and then billing for family members. I’m not going to cover a slide specifically on billing for family members. I just want to cover it verbally with you today.

Please know that with Medicare and many payers, they restrict you from billing, your immediate family members, and they do give you a list of what that is defined as they saved your mother, your father, brother, sister. And they go on. It’s a list probably if you’re looking at the page about that long, that tells you who you should not be billing to the payer. A lot of times we find family that I’m kind of tempted to help exhaust a deductible for their family members, or I’ll just send it in. I need a little extra cash family’s demanding to pay. Please look at these rules, please make sure you’re dotting your I’s and crossing your T’s. So the compliant time of service discount, it is based on viable bookkeeping savings. Pick one of them. What does it truly look at your overhead? What does it truly saving you to not have to send the claim, chase the claim, get authorization for the claim.

Go back and get authorization again, to see them for five more visits, chase your tail, wait, uh, appeal. Do all that. Send a statement. What are you really saving? Are you saving 5% great? Are you saving 15% great. Write a policy. There’s your time of service discount? It’s often, um, found that a lot of people are using something that’s not within those guardrails. And it’s unreasonable when we get up into 50% or, Oh, I just have a flat rate for cash patients. Can I ask you what you’re billing the insurance? Well, typically about $180. Okay. What is your flat rate for your cash patients? Oh, it’s 50. They just come in whenever. And the other one I hear that makes me want to scream is, Oh, well when they’re with their insurance, we just always use the nine, eight, nine four one. And when they’re cash, we just use the nine, eight, nine, four.

Oh, I’m like, Oh Lord, you can’t play with your codes. You can’t play with your fees to make it fit what you need. So you gotta find what you need and get it to fit what you have to have. So understanding again, that when we’re using these time of service discounts, there are guard rails, and they really should be because it’s a time of service be paid in full at the time of service, maybe lingering just a day or two after, but it’s got to have some parameters on it, not loosened it. So that relationship, when we talked about Cairo, health USA kind of works like this. I love them. By the way. Uh, before I came to KMC university, I said there were a couple of things I wouldn’t live without and practice. And that was Tusa Cairo health and KMC because they helped me to get to, you know, to the knowledge I have today.

They a part of how I got here. And when I joined Caro health, what I could do was now legally offered discounts. So at the office I served last, we were a specialty clinic. Uh, I know a lot of you say, Hey, all of us are specialty clinics and we truly are, but we did something that no one in a very large geographical region did here. We have pizza. People travel in from thousands of miles away. We have people that traveled in from States. We had about a five state surrounding area that came to this practice. And, uh, so we needed to make sure that we had some way to compliantly offer them a discount. So we looked at Kira health USA, and here’s in that specialty niche. Our typical first visit was $565. It’s just what it was. We knew when we bill blue cross and blue shield for those services, that would qualify that generally we could get back somewhere around three 70 when we build Aetna and we’re coming down closer on two 25 and we’re like, number one, we’re not chasing it.

We’re not having to get authorization. Um, that’s we want to just count more than 15%. What can we do? We went with Cairo health and how it ended up being that $565 visit came down to $200. All the patients had to pay that day was $249. They’d paid 49 to Cairo health. They paid 200 to us and they didn’t pay five 65. And they kept getting all the discounts that we made available through Cairo health. From that point forward through the rest of that year. So doctor joins, he sets his own fees of what he wants it to be. You can do discounting for multiple family members. You can set it up that, Hey, I want to cap these visits here. Or, Oh, I want them just to be this percentage off, or I want this service to be that don’t include that in my cap.

As you see, I’m telling you all kinds of things you can do. You can’t do that with Medicare. You can’t do it that with a payer where you can order it and have it your way. But with Kaiser health, in many ways, you can have it your way compliantly and your patient has an option. If they don’t want to pay 55 and they want to pay 35, then they join Cairo health. If they say no, then they really said, I’ll pay 55, no problem cash check or credit card, but the patient joins. And again, they, and all their dependents are covered. This relationship is about between that doctor and the patient. And we have compliant discounting. I cannot tell you and stress to you enough. This is a huge Savile. When you’re looking at discounting in your practice, the other one may be that professional courtesy.

Did you know that you actually need a policy when you are treating your staff members for free? Please don’t play that game. If I’m going to help them meet their deductible, please don’t do it please. You can’t waive the deductible. Their insurance is banking on you to collect that this is part of the plan they chose. But if you’re going to treat them in your immediate family members for free habit in your professional courtesy, um, what about others in the community? Maybe it’s all the first responders. Maybe it’s ministers. Maybe it’s all other doctors define that, put it into policy. But for the love of the Lord, don’t be like what that doctor asked me to do. He didn’t get me to budge, which was no. We offer this service for free. I cannot charge your insurance for something we offer for free to you, nor will I help you meet your deductible.

The only way I could have done this was told him you are going to forgo our professional courtesy. And when that bill comes in and it tells us what your deductible is, we will have to assess that charge to you. So keep in mind, this is one legal way. You just gotta make sure you’re dotting your I’s and crossing your T’s and no isn’t for all your friends. And the quick way, we’ll just do a bunch of professional courtesy. No, they’re still dotting of I’s and crossing of T’s that need to take place. What about hardship first visit, take their word. I can’t afford it. Okay. Well, we offer hardship for people who can’t afford service, and we kind of can get by with taking their word the first time, but not after that, we actually have to verify don’t just take the word and my office.

I had one way you could qualify if you were on government assistance and you could show me proof of government assistance and I checked it on a consistent basis, then I would qualify you. I did not think about some of these other things to implement. Ours was just pretty short and sweet. We had Cairo health and we knew we could fix most problems and we have payment plans. So we knew we could fix most financial considerations for patients, but that was one consideration. And when I did it, it’s like, you can come for $25 a visit. If you’re having an exam, it’s another 25. If you’re having x-rays that’s another 25. So the most they ever paid was 75, but that’s the way my hardship was set up, but I couldn’t just offer it because they said they did, especially if they’re coming in with their Prada shoes and their Gucci purse or their nails are always done.

I’m not disqualifying those people. I’m not saying they’re in a financial hardship, but I’m saying we have to use a systems of measure to verify this. Or then this is not having an I dotted and T crossed. We do know that those federal poverty guidelines are about to come out. They’re just right out of. They’re always a little slow for some reason, but once they come out, we’ll be able to see what those federal poverty guidelines are and what percentage that particular patient falls under. You have the ability to set that up down. You can see this as one of our forms, by the way, that’s in the library. If you’re a library member, you can find this in the office management section one, and that’s going to be in less than three. And you’ll be able to go in there and tweak. You can see any of that great out areas, something they can do, but you can set what your fees will be.

Put your exclusions in there and make sure that you’re able to just do this appropriately, going by those guidelines. Again, a little bit of leeway with you on what you want to set up. There’s any questions on this? This is a bigger topic than what I’m able to cover here. Definitely let us know. And just a little bit of role playing. So let’s say you treat Medicare part a and part B patients. So are you enrolled? No, we already talked about it many sessions ago. We can’t see the Medicare part B patient. If you are, you’ve got to charge the appropriate fee for the excluded services. Even if they’re a, QMB a duly eligible, you still on the excluded services have to, you’ve got to bill on behalf of them. Your collections will be based on their co-pay, their co-insurance deductible, figuring all that out.

There’s one of your regulated then what about the part C if you’re not enrolled, we fill, these are cash patients to your office. You can see down at the bottom that we have cash paying patient, not insured. We have actual fee, um, or that discount medical plan. They get a super bill. Make sure if you’re giving a super bill and you’re doing discounts that there’s a line item that shows what that discount is. Don’t send that patient out the door with, Oh, it was a hundred dollars and you only charged them 50 because they’re going to get paid to come in your office. If their insurance, as an allowable higher than your 50, they will actually make money coming to you. So it needs to have everything listed there that shows that actual financial transaction that you have. What if you’re not enrolled with the insurance plan, then you have that cash play game that you can do again.

But over here on the other side, you’re going to be abiding by those contracts, looking for deductibles, obeying those rules of medically necessary and active maintenance and all that type of stuff. But you’ve got to bill, according to them, you sign the line. You’re there. You can see a little bit with the non par and the par there at the bottom. What about worker’s comp? Well, with some worker’s comp, you have to be enrolled in order to treat them. So please make sure there’s a lot of rules in my state alone that you got to jump through hoops. If you weren’t the first person who saw that patient a little bit of here that you can look at, but if you’re one option with PI patients, if you feel like you’re always getting stung by it, make them cash patients. When they get paid in their settlement, have the lawyer incorporate what they already paid to you.

That’s probably one of the most simple ways to get rid of the problem of lingering bills. So this is what it looks like when you’re done setting up your fees. We’ve got the doctor’s actual fees up here. Next rainbow down is our contract and fees are regulated fees in our hardship fees. And when it all starts coming together, we can see that Cairo health USA, that legal way to do a discount gets the fall in the green it’s right there. It’s part of our contract. And we got to pick what it looked like. Imagine that it wasn’t $9 for a therapy, unless you want $9 for a therapy. I have seen reimbursements be that low or say, Oh no, that’s bundled. Oh no, we don’t pay for that. On the same day, Kyra health USA is a great work around, especially with, for high deductible patients.

You can see that you’ve start piling in those other things with Cairo health, you’ll have those cap fees or your discount and name it. What you want it to be, make it that way. It includes everything. Oh, no includes everything. But this, this is you. It’s an elective discount. You get a set, a lot of it up. Then you’ve got some of the other things that come down in there where you’ve got this hybrid of Medicare and Cairo health. What the same service cannot have medic cannot have Cairo health, but we know Medicare only covers spinal CMT. So there’s a bunch more, we could apply that to. So it makes a very beautiful product for those patients. And then down at the bottom, we have our hardship fee schedule. This makes it all look beautiful. One pretty rainbow everything’s in there. Everything’s compliant. Nothing’s out here on the perimeter.

That’s kind of not okay. We fit all of our discounts nicely into this beautiful rainbow to where we can rest at night and be compliant. So you’re free to choose, but you’re not a free free from the consequences of your choice. So be careful when you’re doing fee changes in your office, making sure that you’re doing it by dotting I’s and crossing T’s. If you’re a member, if by chance you didn’t have this in your, a member, we do free schedule a fee schedule consultations, either help you, uh, get Kira health USA put in place at which we will. We’ll take you all the way up to it. Almost being implemented, just what they have to do at the very end, or if you’re not interested in that we still do. If you’re a member, that’s something we did. So it’s free for you as a member.

Um, the very next thing I want to show you are hot topics. And then we got to go hot topics. One, one that ABM form had to be implemented. Look at the bottom of your form. If you’re an Anon version, six 2023, starting January 1st. If you’ve got more questions about what you do about the one signed in December or November, you’re glad to give us a call. But as far as the new ones being signed, ABM must be implemented. When you’re looking at box D your mandatory is spinal CMT only don’t have anything else on it. And know when to issue it, big issues going on misconceptions, going on in this industry regarding how to use an ABN appropriately. And it can get you in big trouble because when they pull your records, they pull the ABNs in M coding went into effect. January 1st one code is gone for the new patient.

Do you know which one it is? You should never be using the nine nine two one one. That’s an established patient, but there’s one of them went away. The change in the coding methodology, how you’ll get to it is all lining up over on the medical decision-making. And although the AMA and all those rules have come out and said, Hey, history and exam, you can do it. If it’s warranted for us as a profession, it is warranted because that’s how we establish the medical necessity. Everything is built off the history and the exam next down Medicare fee schedule update. We had a big 10% drop this year. It was a huge disappointment and the middle of COVID and everything’s shutting down practices. It shocked everyone. However, we saw about as quickly as those one up on the website, they got pulled back down because the COVID relief came a bias about sort of bipartisan act that removed the full 10% gave us back 3.7, 5%.

The reduction is still sitting at six two five. And I’m just telling you if you want to be a part of the solution and not have to sit back and accept the problem, contact your state representatives. Remember it’s time to verify benefits again. And if you don’t remember why I go back and listen to a couple of my sessions a little bit ago, one more thing. If you are a KMC university member, please keep in mind. You’re going to be seeing a lot of stuff coming from us. Go in this spring, don’t put your head in the sand or not look at an email cause there’s a new website launch. You’re going to go to the, our website. You’re going to, uh, what happened, make sure you’re paying attention. And if you have any questions with what we’ve discussed today, feel free to give us a call. Uh, we’re always here to help. We’ll be more than happy. That’s (855) 832-6562 or info@kmcuniversity.com next week. Make sure you’re here because Janice Hughes will be presenting again. It seems like she follows me up a lot, but I think that’s really great. And I’ve watched these people and they’re wonderful if you miss these, just let us know we’re here for you. Good to see you. Thank you for spending some time with me again today. Bye-bye

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Empowering Women Chiropractic – Tips for Tiptoers – 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.

Now here’s today’s host Dr. Monica Buerger. Hello,

Welcome to our December. Um, ChiroSecure Look to the Children’s show. We are going to have some fun today. We’re going to keep you on your toes as we talk about Tiptoes. So why did I choose this subject? Um, first of all, let me backtrack. Thank you, ChiroSecure once again for giving us this amazing platform and opportunity to share with the world, um, the importance of chiropractic pediatric, uh, for kids and, um, to help other docs out there, um, gain some extra pearls of wisdom during this time. So tiptoes, why did I choose this subject? Because I get a lot of questions on, what does it mean? Why are they still tiptoeing? What do I do? Um, all that and more so let’s dive in and let’s have some fun and talk about it. So again, I want to thank ChiroSecure for, um, always being there for the chiropractic profession, excuse me, my froggy throat.

So tip toes, we tend to see this in little kiddos. Um, and if I slip into my endearing little, um, version of my little fiddle farts, I, I use that as an endearing expression for these kiddos that we work with. So, um, my apologies, if I slip into that, um, we tend to see tiptoes common up until about the age of two, and that is considered, um, fairly normal. But if we see this consistently and beyond that age, what might we need to want to look at what possible differential diagnosis is? What associations? So let’s dig into that a little bit. First. Certainly we want to look at muscle tone, either low tone or hyper tone, and we want to, um, rule out cerebral palsy or multiple dystrophy. So those are two top things you may want to consult. Um, outside of the chiropractic profession, have the pediatrician take a look, et cetera.

So those are two things on the top of the list that you want to make sure that isn’t involved. But what we didn’t know about neuro-development is when we have a hijacked trajectory of development, so to speak that this is one of the possible competence Atari gate mechanisms that we might see with little fiddle parts is a tip toe or altered gait pattern. So autism and ADHD happened to be on the top of that list and alter gait patterns of which one is tiptoeing can be associated with both of those labels. Um, sensory, definitely sensory processing disorder. So that’s SPD sensory processing disorder or processing dysregulation. And we’re going to see how all these kind of tend to tie together actually. So within the sensory processing world, three particular sensory systems have been associated with altered gait patterns. Tiptoe is one of them. The other gait patterns are, would be like a wide based waddle or wide based stance.

And the reason that we might see these altered gait patterns in those with processing disorders is because they’re trying to upregulate sensory input into their world so that they know where they are in space and they can modulator move about safely through space. So the three big systems within that sensory processing realm are vestibular. Um, the, the ability to maintain ourselves upright against gravity and know where we are in space proprioceptive, which we’re going to get that input from our joints and muscle spindles. Um, and actually you get some proprioceptive input from the vestibular labyrinth time and visual. So those are three big sensory systems that three big kahunas that all work together. Um, and they, they are really responsible for us being able to modulator ourselves upright against gravity and have good postural control, postural stability. So if we don’t have that, we will innately, or that the child person, child little foot apart, we’ll try to upregulate that to their CNS.

And by being on their toes, they get more bounce of the world and, and, um, more input coming up, particularly vestibular and proprioceptive. Um, so you’ll see them have that little bit more bounce in their step. Kind of like trying to be Tigger. If we look at our Winnie the Pooh characters. So, um, sensory modulation can be a reason that they are on their toes. Now, likewise, they might be, um, hyper tactile. They don’t like a lot of tactile input, so they might be up on their toes in certain environmental situations. And we’re going to talk about some history and some questions we want to ask parents, um, on the timing and the consistency of this altered gait pattern, but we’ll get there.

Um, neurogenic bladder bowel, and the world of neurology have been tied with altered gait patterns like tiptoe tiptoe in particular. So we want to look at their, um, bladder and bowel control. And in the autism world, gut dysbiosis has been associated with many neuro expressive patterns. One of them is tiptoe. So we want to look at gut dysbiosis. So if we start with, we start other than CP and MD, if we start looking at these next, um, considerations, they all kind of tie together. Okay. Because we know in the world of autism ADHD, um, we can throw in here developmental coordination disorder, a lot of labels, actually, they are often associated with processing disorders. They’re going to have, they are going to have some form, some extent of processing disorders. Those three systems are big key systems, the vestibular visual proprioceptive in regulation that we see dysregulated in this population groups.

Then we often see bladder bowel and dysbiosis issues with these population groups. So you see how I’m just kind of taking you through a journey of looking at the big picture, all those things that might be involved. It’s really not as simple as saying they tip toe because of one thing, it’s usually a systems wide approach. And that’s what I’m trying to walk you through. So in the world of autism, um, tiptoe walking is often associated with gut dysbiosis. Um, and it can lean a little bit more towards reflux because they’re trying to, um, in fact, there is a maneuver that many talk teach to adults about reflux and in the morning, first thing in the morning is drink some water and then kind of bounce on your toes, kind of jump up and down and bounce on your toes to try to pull that. Um, if you especially like have like a hiatal hernia or something, so think gut dysbiosis, but lean towards the side of maybe reflux and GERD issues. So now if we take that next thing in line, when we talk about primitive reflexes, a couple of primitive reflexes in particular have been associated with tiptoe.

And if we look again, if we take you through the journey, say, okay, with developmental considerations, they, these individuals, these little fiddle farts in the autism or ADHD or development or coordination, any label we want to get them oftentimes have processing issues about issues and retain primitive reflexes. A couple in particular, you want to look at, um, tonic. Labyrinthine is one of them that is associated with tiptoe walking. Now, the tonic labyrinthine is kind of considered a, um, a, a dural tube or cranial sacral rhythm associated with cranial sacral rhythm abnormalities. So for us in the chiropractic world, we definitely want to look at, um, the upper cervical, especially the occiput and the sacral areas and looking at neural tube tension and, and addressing, um, not just with adjustments, but maybe some cranial sacral therapy as well, trying to get that dural tube, the tension off the dural tube, the tonic labyrinthine reflex is one of those associated with the craniosacral rhythm as is the symmetrical tonic neck reflex or the STNR.

Um, so I just want you to keep a couple of those things in mind. You also might find it ASA occiput with these kiddos. Um, and when they’re have the ASA occiput and their eyes are looking above the horizon for brain compatibility, for us to be able to process our world and be in sync with our world, all these sensory systems are imperative. Um, and that visual system is, is key. And we want to have our eyes on the horizon. Our eyes want to be parallel to the horizon if we have an occiput, or if we have dural trench in causing that ASR occiput, our eyes are going to be, um, we might have what we call midline shift superior midline shift. Our vision is our eyes are paid attention to above the horizon. And so we want to, we’re not sure where we are in space.

They might not be sure where they are in space or having to navigate through space because of that visual security. And so you might see the tip toe from a biomechanical reason, as well as a visual compensatory reason or processing compensatory reason. So keep that in mind as well. So look at the occiput in particular, the moral reflex can play a role in tip towers because Mara reflex it. Um, Maura is associated with a hyper defensive sensory mode, and when we’re on sensory defensive mode, that is going to shift us to a sympathetic dominant state and, um, keep our cortisol kicking, keep those adrenals pork butt cranking. And when that happens, we might not, we might have trouble with, um, the onboarding, the development, um, of pastoral reflexes and one called the tendon guard reflex. Essentially what happens is the postage courier muscles, especially the posterior leg muscles, um, contract because of all this cortisol kick.

And so that’s, we’re getting shortening of the posterior calf muscles and Achilles tendon. And so they really can’t elongate those ones. This is where this is one thing we have to be mindful of this whole picture, because so many of these kiddos can get scheduled for an Achilles tendon release, which is a huge major sure. Or ordeal, and that may or may not mitigate the problem, but the core, the roots of the problem it’d be a systemic wide approach. So, um, that’s another reason why I wanted to bring you this information. And then the Ben scheme, you do want to look at a retain Babinski, but Bensky, it can be, can be active, um, through the first couple of years of life. And that’s, that’s why maybe toe walking can be seen for the first couple of years of life. The bisky gets integrated by, um, it’s helped to get integrated by a, um, the belly crawling by belly crawling.

And I call it the toe dig when we’re learning to belly crawl, you take, as you’re pushing off on that, back on the, on the leg, that’s propelling you forward that toe digs into the ground. That’s I call it a toe dig and that helps to integrate that, but Minsky reflex. So if they skip belly crawling, um, that can be a factor as well. So keep that in mind. So if you see a little fiddle fart, that’s not going through their motor milestones, um, they’re not rolling. They’re not tummy time rolling. And then belly crawling and doing that toe, dig propelling off their toe, pushing forward. You know, that’s the thing that you want to try to help, um, navigate and employ that they’re doing that. But later on, they may present with this, um, compensatory gait mechanism of toe walking tots, tethered oral tissues, tongue tie.

Again, this is such a complex issue. It’s much more than breastfeeding and speech. So way beyond that, the tongue is considered the, um, Rutter of the city. Okay. It says it’s a tethered restriction, it’s a fascia restriction. And if we have this restriction, it can, it can go from cranium to toes and it can constantly be this anchor pulling us down and it can cause neural tube tension. So we’re right back down to dural tube tension. Um, so you might see a compensatory mechanism and, and by the way, with tots, it’s very much associated with various learning and neurodevelopmental struggles. Um, and with that dysbiosis, neurogenic bladder and bowel and retained primitive reflexes. So once again, you kind of see the whole global picture that we’re talking about here. And definitely we want to look at subluxations again, look at those, look at the cranial sacral regions in particular and that creating neural tube and, um, that ASMR occiput. Okay. Hang on a second. I just have a question here.

Yeah.

And absolutely they can be locked in a flection type pattern because the brain, because of dysregulation of, uh, circuitry due to poor processing problems, they can’t, the brain might not be able to inhibit those Fletcher, the flexor muscles. And so they’re locked down. Um, the vestibular systems big in this whole role-play and the vestibular system is going to activate your extensor muscles. So this is a great question because they can be locked down in a flexor based position because, um, of distortion of sensory input, especially the stipular sensory input that they can’t get there, that they don’t go to the extensive patterns. So it is a very systems wide approach. So thank you for that question. Hopefully I answered that question, um, to your liking. Okay. So we want to look at history because we want to look at the whole picture here. So we’ll go back to that question on step into flux, into flexor pattern.

Tommy, time’s a big issue here. Not only do we want to see Bailey climb, but oftentimes the precursor to that is going to be our tummy time. And if they don’t like tummy time, they might not go to these progressive milestone patterns and thus belly crawling, tell me, time is going to help us, um, activate those extensor muscles and that mystical division. And oftentimes we see kiddos that have labels autism, ADHD in particular. They didn’t like tummy time kiddos with tots, with tether or restrictions. Um, oftentimes don’t like tummy time. Lack of getting through these milestones will pro um, prevent these primitive reflexes from integrating. So again, look at the systems wide approach. Oftentimes those little fiddle parts that don’t like tummy time also have gut dysbiosis reflex is a big one. Okay. So hopefully this shows you that systems wide approach.

So we want to dig into deep history, lots of times with these little kiddo kiddos, our observation and our detailed history is going to give us a lot of the red flags and give us a pathway in which to dive into first. So we do want to look at, um, gestation, what was mom’s stress, stress level right now, this is a big one. Um, and we’ve talked about, we’ve talked, um, I can’t remember which month we did it, but we did talk about prenatal stress. So you can go back and scroll through either, um, our intersect for like educational seminars, Facebook page, or Cairo Securus, Facebook page, and look back a few months when we talked about prenatal stress. Cause this is a huge one. So we want to look at gestation. We want to look at mom’s stress level. Did she have trouble conceiving? Did she need help conceiving, um, what was that birth experience? What was the mechanism of birth? Was it C-section, were there assisted devices such as forceps or section cup assisted devices are associated with things like plagiocephaly and torticollis, which if we add that into the mix and the history, we can see, we can see why there might be a number of these previous associated, um, issues, because we know that with those types of birth experiences and with those assistive devices, there’s a predisposition to pleasure separately and toward a call us and thus developmental considerations.

Um, we know that prenatal stress is associated with dysmaturation of the autonomic nervous system, which is going to go play right into the role of that question of, is there maybe dysregulation in the brain? Can the brain not turn off those flexors because of poor processing and poor neural circuitry? So we know that prenatal stress is, is definitely an issue here. So we want that good history. What is mom’s current stress level? That’s a big one as well, where they, um, preterm. We know that preterm, we know that prenatal stress is also not just associated with dysmaturation of the nervous system, but, um, um, neuromuscular development. So there might be competence, compensatory mechanisms there. What were there, depending on the age of the little fiddle fart. I mean, if they’re coming into you at age five, eight, whatever, and they’re still having this tip toe pattern, what were their early developmental years like?

Did they like tummy time? Did they roll in a corkscrew fashion at the appropriate times? Did they, um, did they belly crawl? Did they creep on all fours? Did they have an injury? Did they fall off a change, a table down the stairs, all those things we need to look at early development and then a past medical history and family history in the ADH literature, they look at idiopathic toe walking. They don’t, there’s no known reason for this toe walking pattern, but they do see it with ADHD that if a family, a family member, um, especially the dad, excuse me, had a history of idiopathic toe walking, excuse me. Um, the little, the little foot apart, the offspring may also have a history of idiopathic idiopathic toe walking. But what we have to take into consideration is oftentimes our ancestors, the way they process their world and respond to the stress in their world gets hammy, doubted it, it goes, it actually kind of, it follows the DNA pattern.

So those stress responses follow, uh, we call it inter intergenerational inheritance. So it would stand to reason that if we have a family history of ADHD and toe walking, that the offspring is inheriting their parents load and the response to their processing, the way they process their environment and their stress mechanisms. So that would could potentially to this altered gait pattern as well. So we want to dive in and get a good history. Um, at what age of the toe walking begin, has it been there from when they started to learn how to walk it, did it, um, all of a sudden become an issue? Is it both feet want to get into that, into that gait pattern? Was there an injury? Was there a tipping point? No pun intended. I didn’t, I just did that one in there. Was there a tipping point of Tictail? Um, do they get an infectious load? Did they, um, have an accident? Was there a time point that, that, that, that pattern started? Is it variability of toe walking on certain surfaces only under stressful conditions, only when they’re more tired when they, um, are sick. Is there a pattern to this? Again, if they’re on different surfaces, like grass or sand, they may have a hypersensitivity to tactile input. And so it’s just, it’s not a biomechanical issue. It’s a compensatory issue to that particular environment. So they may be hyper sensory in that tactile system.

Is it going on uneven surfaces up and down stairs where they might have a display of what we call gravitational insecurity, not being self-aware and comfortable in those environmental conditions that may tip you off. I’ve got another, I’m just, I’m just full of them today. Um, that may tip you off that this tip toeing is compensatory to particularly gravitational measurements because of lack of distibular integration processing. So we want to, you know, we want to dig in a little bit, um, how much time are they spending on the tiptoeing? Uh, are they able to get into a flat position? And sometimes that may be when they’re more comfortable, calm environment. Okay. So again, look at these patterns. Are there any associations of, uh, pain? Okay. Is it maybe a biomechanical issue, um, that is resulting in this walking pattern?

So on your examination, we definitely look at muscle tone, hyper or hypo. You want to not only asking your history, but the observe this little fiddle fart, or depending what age are coming in. Do they have language delays? Do they have speech delays? So this is, this is important for a couple of reasons. Are, are, if you have the, uh, are, are they, um, have they been in speech therapy a lot, are kids with tongue ties, oftentimes have ongoing language delays and speech delays. We also know that speech delays are very much associated with, um, poor, fine motor development.

So is this altered gait pattern dune due to number three on here, fine and gross motor delays, which is also associated with poor link with language delays. So you want to look at tethered oral tissue. You want to look at muscle tone. You want to look, what is their fine and gross motor skills, observe them in your office, have them do various finding most finding gross motor tasks. Can they do sequential finger touching? Do they have the pencil grip that should be there by one year of age? Um, what is their gross core control? Can they balance on one leg? And they tandem walk some very simple screening procedures. Can they hold their core stability on a unstable surface? Um, like a, um, a balance pad or something, get a sense of what their finding gross motor skills are. Visual tracking is going to be give you a sense of their fine motor control.

Um, so these are some things we can tie together into the whole picture. Again, again, we want to look at processing dysregulation. You may want to screen for your primitive and postural reflexes. Again, those reflexes in particular that we want to look at, if they’re integrated would be more on tannic labyrinth by and the Bensky depending on the age of the child coming into, have they developed their postural reflexes, posture, reflexes don’t fully develop, um, until that age three or three and a half, but those would be the Oculus head writing when you lean them in one direction, do they does their head right to the midline? Because again, our eyes want to be on the horizontal on horizon. So when we put them in these positions, do their eyes, do their, their eyes compensate right to the midline. Um, do they not, do they have good postural control?

Do they have a tongue tie? Here’s a little caveat. Sometimes it’s hard to, if you’re not, especially if you’re not well versed or are used to that, please be mindful that if you’re in a state where you cannot enter the oral surface or a cavity, keep that in mind. Um, but here’s a general rule of thumb. It’s easy to find a lip tie, just having them lift their lip up and see if they have a lip tie. They’ll have a tongue tie. And so often if you’re not seeing that tongue type, um, visually it’s because it’s a posterior tie and it’s hard to distinguish. So look at the lip tie. Do they have a lip tie that’ll kind of tip you off that, um, look at the range of motion, of course, spine and pelvis. One thing I want you to also think about in your cranial work is look at the speed annoyed as well because the speed annoyed, um, represents, uh, it’s counterpart is the pelvis. So addressing, um, the Spino and can be huge in this cranial sacral rhythm and this dural tube tension. It’s also going to very much help you with, um, the visual system. You’ll find that kiddos with visual processing and especially fine motor visual scanning. If you work that sphenoid, you can get a lot of bang for your buck out of that. So you want to look at the range of motion and hips, knees, ankles the spine.

Um,

I’ll get this question just in a minute here. Um, and spine and pelvis leg, leg, discrepancies, foot deformities, et cetera. So I have a question here. Um,

Okay.

Are there any challenges you can do to better, um, insight into treatments?

Um, let me try to, I don’t have my glasses on here. So, um,

I would say I’m thinking the question is any challenges, any tests

We can look at? Um, okay.

So, um, with regard to Babinski in particular or anything in particular,

Anything

In particular. Okay. So let’s look at, um, let’s look at tonic labyrinthine reflex, tonic, labyrinthine reflex. We’ll go through a few of the reflexes. Tonic labyrinthine reflex is a flection extension reflex of the head. So with you can either have them stand with their feet together and have them close their eyes,

Look down,

Have them hold for 10 seconds and then keep their eyes closed and look up. So you go into flection extension, you can see how well they can hold their core postural control. You can, um, see whether they dig their toes into the, they do this barefoot idealistically. If they dig their toes into the ground to try to maintain their core stability, do they sway? Do they sweat ADP? Do they sway laterally? This gives you an idea of how the integrity, if that tonic labyrinthine reflex is still too active, the other way, if they can’t do that, um, one of the exercises we will do for the little kiddos, the younger population is I call them, um, the, the bird nest and the flying bird. So the bird nest would have be have them supine rolling up and grabbing their knees and wholly with their head flexed and holding that position, rolling up into a ball.

Essentially, I call that the bird nest, um, and hold for 10 to 20 seconds. See if they can hold that position, then flip them over, um, prone and kind of do a modified Superman. I have them put their hands on their shoulders. So these are the bird wings, their feet, their legs are zipped together, they’re together. Um, and so they hold their legs together. There’s zipped together, arms are appear, and they come up into an extension position Superman. So you can use that as another test to test the integrity of the tonic lab and find can they do those? So flying like a bird arms on shoulders, feet zipped together, come up into extension. Can they hold that for 10 to 20 seconds? And then supine, they roll into the ball into the bird’s nest. Now I also do that as an exercise. Okay. So if they have a, I might do the tonic labyrinthine test standing, okay.

Eyes closed. Like we talked about flection extension. They don’t do that. Well, then I have them do the flying bird and the bird nest as an exercise to help integrate that tonic lab with line. The other thing you want to check is you want to check, um, the integrity that the, the, um, other gas drops and the soil is how tight they are. So do a straight leg raise and Dorsey, flex their foot to see if they can, if, how tight they are. Um, so you might also have them doing stretching, have parents do stretching or the kiddo do stretching themselves and try to elongate, um, the gastroc and soleus and stretch those out a little bit. Um, for Morrow, again, we want to look at moral reflex. You can do that standing and do that trust fall gate and see if they have a retain Morrow.

The closer a primitive reflex mimics the infant tile reflux. So the closer that they have that display of impetus more reflects the more engaged it is, the more active it’s staying more cortisol’s kicking out. So if that’s positive, I’m going to look at a couple, again, depending on the age, I am going to look a couple, maybe nutritional Def deficiencies that keep us hypertonic iron zinc, magnesium big ones. And because when they had, when you were on this Morrow kick and in sympathetic shift, we burned through these nutrients faster. So check those out as well. And if they have a positive Morrow, I may have them be, um, doing the, um, I call them and Venus fly traps. I think I’ve heard them also called starfish exercises where they cross the same arm and same foot. So if my right arm’s on top, my right foot would be on top and roll up into a ball and then unroll and uncross.

So that can be good for the Morrow. Um, uh, definitely you can strike the Hill, look at Babinski if they’re older than two, two and a half, um, and to mitigate Babinski, you can do that same kind of brushing. The other thing you can do, I’m going to do this using my hand, cause I can not, I’m not flexible to tip my toes up to the screens to show you what my toes, but if these are my toes, you can put one foot, one finger underneath and have the toes curled over kind of toes latched on here and try to have them keep their toes flexed while you put resistance against them. So that’s another way you can help mitigate Babinski. Okay. Um, does that help with that question? Let me know. So those are some things we can check. Those are things we can do to help mitigate.

If they’re, if they’re there again, you’re going to check your spine, your pelvis, check your speed annoyed, cause that spheroid will mimic the pelvic, um, the, the pelvic alignment. So that’s why craniosacral work is, can be so important. I would check also, um, look at doing, because of that mustard division’s off. I would also look at doing maybe ear poles and seeing if, um, add that with the speed annoyed. And then of course the palate, the hard and soft palate, especially heads, they have tethered oral tissues. Those are going to be really, really important there. Okay. So those are some things I’d like you to look at on examination. And I think we’ve covered any more questions that I’ve got out there. Please bring them on a, wait a second or two. Nope, no more questions. Okay. Well hopefully you enjoy this information. Hopefully it helps you again, looking at the big picture from a neurological standpoint, from a neuro developmental standpoint and from a neuro nutritional standpoint, big things that are deficient in the prenatal period, um, are going to also affect neuro development.

And again, magnesium zinc iron are really, and, uh, chronic muscle contracture, um, and Coleen Coleen is a fun one. Coleen deficiency in a prenatal period is said to, um, is known to disrupt sensory processing development processing, especially processing speed. About 70% of mamas are said to be low on Choline, and this will translate into the neuro-development of the offspring. And, um, so that’s a big one to look at, look at as well as calling you get Coleen from egg yolks and it is essential for a cell wall, membrane, integrity and synthesis. So that’s another big one. That’s a hand-me down during the prenatal period that I would look at, um, possibly as an issue as well. So I’m going to wrap it up and leave it there. And I want to wish all of you an incredible holiday season and thank you again, Kyra secure for, um, always being there and having our backs and those of you out there enjoy may you have a lot of peace and some downtime, some time to regenerate and rejuvenate and, um, take on 2021, like, uh, in a totally different way than we’ve taken on 2020, hopefully.

So until next year I will see you in the new year. So Merry Christmas, happy Hanukkah, happy Kwanza, happy new year, um, and may peace and many blessings be your way. I’ll see you in January the third, Thursday in January and Dr. Erik Kowalke will see the first, the first Thursday in January and, um, blessings to all of you, we’ll see you then

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