Chiropractic Forward Podcast

Joint Replacement Expectations, Spinal Infections, & Vitamin D with Calcium

CF 106: Joint Replacement Expectations, Spinal Infections, & Vitamin  D with Calcium

Today we’re going to talk about Joint Replacement Expectations how long can you expect a joint replacement to actually last, we’ll talk about Spinal Infections – what are some of the signs and symptoms according to research, and they we’ll cover a paper in JAMA on supplementation with Vit D alone vs. Vitamin D with Calcium. Stick around for a great show. 

But first, here’s that sweet like a Christmas candy cane bumper music

Chiropractic evidence-based products
Integrating Chiropractors
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OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around. 

We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. So go get one and crack it open because we’re off and running. 

Welcome, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

If you haven’t yet I have a few things you should do. 

  • Like our facebook page, 
  • Join our private facebook group and interact, and then 
  • go review our podcast on iTunes and other podcast platforms. 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com
  • While you’re there, join our weekly email newsletter. No spam, just a reminder when the newest episodes go live. Nothing special so don’t worry about signing up. Just one a week friends. 

Do it do it do it. 

You have ping ponged into Episode #106. And my Parker alums will remember all of the ping pong that went on there at the student rec room. Pretty heated matches right there!

Now if you missed last week’s episode on Groupon deals, Gabapentin, and on Weight Loss…. make sure you don’t miss that info. As I tend to do, I got a little red in the face and probably got a bit dramatic and opinionated but I felt better by the time it was over with. 

Did you know that if you have an Alexa product, you can now just say something like, “Alexa, play The Chiropractic Forward Podcast on Apple Podcasts” and kablooey! You here the golden throated stylings of yours truly! Lol. You can say skip ahead 30 seconds, play previous episode, and on and on so pretty cool right there. 

On the personal end of things the Holidays are always stressful and this season has been a bit extra with my Dad having the stroke and being in the rehab hospital. That and whatever other daily trials and tribulations that come along with raising teenagers. 

It’s been journey but isn’t life just like that? Whack a mole every day. Whackin whacking whacking. Sometimes it’s exhausting. Obviously, I have a little turmoil poking it’s head up here and there lately but I’m a good swimmer. 

What I mean is, this world is full of sinkers and swimmers. Very rarely do you find simple water treaders. We’re sinking or we’re swimming. The sinkers let life happen to them rather than happening to life. 

They either make things happen, let things happen, or wonder what the hell just happen. 

On the other hand, swimmers are making things happen every day. Things keep coming at them and they keep batting them away and they stay above water. Hell, some of them make a game out of it and adapt to have the best breaststroke or back stroke you’ve ever seen. 

Those are the ones that just act like they’re indestructible. Well, I’m not indestructible. At all. I’ve been going through a season lately for sure. Nothing about business. All about my dad and other family stuff here and there. Luckily, I have an amazing wife and support structure. Good support allows swimmers to swim. She allows me to be a swimmer. No doubt. 

Enough about all that. Again, I share personal aspects because I know many of you will either relate on some level and ideally maybe even draw some inspiration. Others can learn from it I think. At least that’s my hope. 

By the time this airs, Christmas will have come and gone. I hope you had the merriest of Christmases. Being a Christian myself, I can’t tell you how much I love the season, the music, the magic of giving. Even with all of the hustle and bustle and pain in the butt it brings, it’s a special time of year and I try to keep it special for me and the family. 

Before we dive into the reason we’re here, it’s good to support the people that support you don’t you think? Well, ChiroUp certainly supports evidence-based practices. 

If you don’t take advantage of this deal, I just think you might be crazy.

If you’re a regular listener of our podcast, you know I’ve used ChiroUp since about June of 2018. Let me tell you about it because I’m about to give you a way to do a FREE TRIAL and, if you sign up, only pay $99/month for the first six months which is pennies compared to what it’s worth. So listen up!

ChiroUp is changing the way we practice by simplifying patient education and here’s what I mean: 

In a matter of seconds, you can send condition-specific reports to your patients with recommendations for treatment, for their activities of daily living, & for their exercises. 

You can see how this saves you time – no more explaining & re-explaining your patient’s care, because they have access to it at their fingertips. 

You can be confident that your patients are getting the best possible care, because the reports are populated based on what the literature recommends and isn’t that re-assuring? All of that work has been done FOR you. 

There are more than 1000 providers worldwide using ChiroUp to empower their treatments, patients, & practice – Including myself! **Short testimony**

If you don’t know what it’s all about or you’d like to check it out, do yourself a favor and go to Chiroup.com today to get started with your FREE TRIAL – Use code Williams99 to pay only $99/month for your first 6 months

That’s ChiroUp.com and super double secret code Williams99.

Item #1

This one is called “Vitamin D and Calcium for the Prevention of Fracture. A Systematic Review and Meta-Analysis” it was authored by Yao, et. al. and published in JAMA Open on December 20, 2019(Yao P 2019). 

Hot hot hot like Texas in the Summer.

Why They Did It

Considering that vitamin D and calcium are recommended for prevention of fracture but prior RCTs have reported conflicting results, the authors wanted to assess the risks of fracture associated with differences in concentrations of 25-hydroxyvitamin D in observational studies and the risks of fracture associated with supplementation with Vitamin D alone or in combination with calcium in RCTs

How They Did It

  • Systematic review and meta-analyses. 
  • 34,243 participants. 
  • They mined data from PubMed, EMBASE, Cochrane Library and other RCT databases
  • Observational studies involving at least 200 fracture cases and RCTs enrolling at least 500 participants and reporting at least 10 incident fractures were included
  • RCTs compared Vit D or Vit D with calcium with control
  • Two researchers independently extracted the data and assessed possible bias

Wrap It Up

The authors concluded “In this systematic review and meta-analysis, neither intermittent nor daily dosing with standard doses of vitamin D ALONE was associated with reduced risk of fracture, BUT daily supplementation with both vitamin D and calcium was a more promising strategy.” To the tune of a 16% reduced risk of hip fracture. I’d sure as hell take that reduced risk if it’s my mom, wife, sister, or if it’s a patient. 

So, if you have a patient with osteoporosis and I know that you absolutely do…..it looks evidence-based to tell them to supplement with Vitamin D but only if they add Calcium to the mix. 

I love getting smarter and better. This is a nugget that does just that for us. 

Item #2

Joints!! 

How many knee replacements do you check reflexes on during the month? We average around 70-80 new patients per month so the answer in my office is, ‘several’. 

You probably already know that surgeons don’t like to do knee or hip replacements on younger folks because they don’t want the replacement to wear out before the patient dies. They don’t want the patient to have to go through the damn thing twice basically. 

The Lancet medical journal recently published two papers on the topic. One on the hip and one on the knee. One was called “How long does a hip replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up” and the other was called oddly enough “How long does a knee replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up.” They were both authored by the same group led by Jonathan Evans and were published in The Lancet on February 16, 2019. Not hot off the press but not room temperature either. Very luke warm, folks. (Evans J 2019, Evans J 2019)

Why They Did It

For both papers, it’s pretty obvious why they did it. They want to know how long hips and knees last when replaced. Easy peesy. 

How They Did It

  • The papers were systematic reviews and meta-analyses 
  • Medline and Embase were used from Sept 12, 2017 to current
  • They used 140 eligible articles
  • They also reviewed reports of national joint replacement registries

Wrap It Up

On the hip paper, they concluded “Assuming that estimates from national registries are less likely to be biased, patients and surgeons can expect a hip replacement to last 25 years in around 58% of patients.”

On the knee paper, they concluded “Approximately 82% of total knee replacements last 25 years and 70% of unicondylar knee replacements last 25 years.”

Isn’t good to have a solid number you can confidently tell your patients when they’re thinking about making that appointment with the orthopedic surgeon?

Item #3

Our last paper this week is on spinal infection. It’s called “Red flags for the early detection of spinal infection in back pain patients” authored by Yusuf et. al. and published in BMC Musculoskeletal Disorders in December of 2019. (Yusuf M 2019)

Sizzlin’ hot like a Summer sidewalk come on.

Why They Did It

The aim was to conduct a systematic review specifically reporting on studies that evaluated the diagnostic accuracy of red flags for Spinal Infection in patients with low back pain.

How They Did It

  • Again they mined the biggies like Medline, Cochrane, and EMBASE,  but also Pedro, Web of Science, OpenGrey, and Grey Literature Report
  • 40 papers were accepted
  • A total of 2224 cases of spinal infection were identified

What They Found

  • Spinal pain and fever were the most common clinical features
  • Diabetes and IV drug use were the most occurring determinants
  • MRI was the most used imaging and 
  • Staphylococcus aureus and mycobacterium tuberculosis were the most common microorganisms detected. 

Wrap It Up

The authors wrapped it up saying, “The current evidence surrounding red flags for spinal infection remains small, it was not possible to assess the diagnostic accuracy of red flags for spinal infection…..the most frequently reported clinical feature was the classic triad of spinal pain, fever and neurological dysfunction.”

Key Takeaways

Store

Part of making your life easier is having the right patient education tools in your office. Tools that educate based on solid, researched information. We offer you that. It’s done for you. We are taking pre-orders right now for our brand new, evidence-based office brochures available at chiropracticforward.com. Just click the STORE link at the top right of the home page and you’ll be off and running. Just shoot me an email at dr.williams@chiropracticforward.com if something is out of sorts or isn’t working correctly. 

If you’re like me, you get tired of answering the same old questions. Well, these brochures make great ways of educating while saving yourself time and breath. They’re also great for putting in take-home folders. 

Go check them out at chiropracticforward.com under the store link. While you’re there, sign up for the newsletter won’t you? We won’t spam you. Just one email per week to remind you when the new episode comes out. That’s it. 

Chiropractic evidence-based products
Integrating Chiropractors
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The Message

I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment instead of chemical treatments like pills and shots.

When compared to the traditional medical model, research and clinical experience show us that patients can get good to excellent results for headaches, neck pain, back pain, and joint pain just to name just a few.

It’s safe and cost-effective. It can decrease surgeries & disability and we normally do it through conservative, non-surgical means with minimal hassle to the patient. 

And, if the patient develops a “preventative” mindset going forward from initial recovery, we can likely keep it that way while raising the general, overall level of health of the patient!

Key Point:

Patients should have the guarantee of having the best treatment offering the least harm. When it comes to non-complicated musculoskeletal complaints….

That’s Chiropractic!

Contact

Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.

Help us get to the top of podcasts in our industry. That’s how we get the message out. 

Connect

We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. 

Website

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Chiropractic Forward Podcast Facebook GROUP

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Twitter

YouTube

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https://player.fm/series/2291021

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https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through

TuneIn

https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/

About the Author & Host

Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger

Bibliography

  • Evans J, E. J., Walker R, Blom A, Whitehouse M, Sayers A, (2019). “How long does a hip replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up.” The Lancet 393(10172): 647-654.
  • Evans J, W. R., Evans J, Blom A, Sayers A, Whitehouse M, (2019). “How long does a knee replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up.” The Lancet 393(10172): 655-663.
  • Yao P, B. D., Mafham M, (2019). “Vitamin D and Calcium for the Prevention of Fracture. A Systematic Review and Meta-analysis.” JAMA Open 2(12).
  • Yusuf M, F. L., Selfe J, (2019). “Red flags for the early detection of spinal infection in back pain patients.” BMC Musculoskelet Disord 20.

Thoughts on Chiropractic Groupon, Gabapentin, & Weight Loss Research

CF 105: Thoughts on Chiropractic Groupon, Gabapentin, & Weight Loss Research

Today we’re going to talk about some thoughts on Groupon and Chiropractic, if you know me, you probably know where this is going and it’ll probably be fun. We’ll find out. We’ll talk about Gabapentin and we will talk about a couple of papers I encountered recently having to do with metabolism, intermittent fasting, and things of that nature. 

But first, here’s that sweet sweet bumper music

Chiropractic evidence-based products
Integrating Chiropractors
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OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around. 

We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. So feel free to crack one wide open would you?

Welcome, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

If you haven’t yet I have a few things you should do. 

  • Like our facebook page, 
  • Join our private facebook group and interact, and then 
  • go review our podcast on iTunes and other podcast platforms. 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com
  • While you’re there, join our weekly email newsletter. No spam, just a reminder when the newest episodes go live. Nothing special so don’t worry about signing up. Just one a week friends. 

Do it do it do it. 

You have plopped down into Episode #105 just like a comfy easy chair. 

Now if you missed last week’s episode talking about our TWO YEAR wrap up, make sure you don’t miss that episode. It was a lot of fun to put together and to reminisce on some of the amazing episodes we’ve had over the past two years. Good good stuff. 

Something new I found out here…..Did you know that if you have an Alexa product, you can now just say something like, “Alexa, play The Chiropractic Forward Podcast on Apple Podcasts” and kablooey! 

You automatically start to hear the golden throated stylings of yours truly! Lol. You can say skip ahead 30 seconds, play previous episode, and on and on so pretty cool right there. 

On the personal end of things, we just found out that Dad started moving his left leg today for the first time and that’s exciting. It’s the first REAL solid sign of big progress since his first stroke on November 9th. As you can imagine, we are ecstatic about this. Good stuff. Keep on keeping on Pops. Strong like bull!

Before we dive into the reason we’re here, it’s good to support the people that support you don’t you think? Well, ChiroUp certainly supports evidence-based practices. 

If you don’t take advantage of this deal, I just think you might be crazy.

If you’re a regular listener of our podcast, you know I’ve used ChiroUp since about June of 2018. Let me tell you about it because I’m about to give you a way to do a FREE TRIAL and, if you sign up, only pay $99/month for the first six months which is pennies compared to what it’s worth. So listen up!

ChiroUp is changing the way we practice by simplifying patient education and here’s what I mean: 

In a matter of seconds, you can send condition-specific reports to your patients with recommendations for treatment, for their activities of daily living, & for their exercises. 

You can see how this saves you time – no more explaining & re-explaining your patient’s care, because they have access to it at their fingertips. 

You can be confident that your patients are getting the best possible care, because the reports are populated based on what the literature recommends and isn’t that re-assuring? All of that work has been done FOR you. 

There are more than 1000 providers worldwide using ChiroUp to empower their treatments, patients, & practice – Including myself! **Short testimony**

If you don’t know what it’s all about or you’d like to check it out, do yourself a favor and go to Chiroup.com today to get started with your FREE TRIAL – Use code Williams99 to pay only $99/month for your first 6 months

That’s ChiroUp.com and super double secret code Williams99.

Item #1

Alright let’s dive in. We’ll save Groupon until the last because if I know me, it’ll be what I have the most to say out of all of these. 

Let’s start with Gabapentin shall we? The most recent article I’ve come across was in The Atlantic. It was authored by Olga Khazan and called ‘Chronic Pain Is An Impossible Problem’. It was posted December 9, 2019(Khazan O 2019). 

That’s got some sizzle on it!!

Some key points in the article are that 

  • Chronic pain affects about 1/5 of American adults
  • For years those in the medical field thought it could be treated with painkillers like Oxy but that was proven wrong when basically three planeloads of Americans started dying of opioid-related causes each week
  • Now, they’ve turned to Gabapentin, an anticonvulsant, to help treat it. 
  • From 2012-2016 prescriptions of the medication went up 64%
  • There is emerging information that Gabapentin may not be as safe as previously believed. Certainly when combined with other sedating meds. 
  • When taking it long-term, patients can develop tolerance so more and more is required to reach the desired effect. 
  • There is also a withdrawl effect when trying to get off of gabapentin. 
  • People are now starting to use Gabapentin in combination with Baclofen and benzos like Xanax to increase the intoxicating effect. We can see where that is going can’t we?
  • The article goes on to say, “not only does gabapentin appear to exacerbate or create overdose risk, it also doesn’t work well for chronic pain.” They site a study that we’ll cover in a second. 
  • The paper wraps up by saying they’re essentially out of option when it comes to chronic pain. Which to me says they’ve run out of pills basically. That doesn’t mean they’re out of options though. 
  • Arthur Robin Williams, an assistant professor at Columbia University says “The medical community should take a closer look at non-pill remedies such as physical therapy and psychotherapy…I would add evidence-informed chiropractic… These treatments are often not covered by insurance, take longer to work, and take more of providers’ time. But for many, they might be a better option than yet another pill that has yet another pathway to abuse. “The reality is, a lot of the pills that change how you feel in the next 10 to 30 minutes,” Williams says, “carry addictive liability.”

Well…..no kidding? Who would have ever thought that? Hmmm….let’s see. Oh yeah, every chiropractor and PT that ever lived. 

Let’s combine that with a systematic review and meta-analysis from just last year that was in the Canadian Medical Association Journal called “Anticonvulsants in the treatment of low back pain and lumbar radicular pain: a systematic review and meta-analysis”(Enke O 2018)

  • Nine trials compared topiramate, gabapentin or pregabalin to placebo in 859 unique participants. Fourteen of 15 comparisons found anticonvulsants were not effective to reduce pain or disability in low back pain or lumbar radicular pain. 
  • There was high-quality evidence of no effect of gabapentinoids vs. placebo on chronic low back pain. 
  • The lack of efficacy is accompanied by increased risk of adverse events from use of gabapentinoids, for which the level of evidence is high.

It is painfully obvious (no pun intended) that pills aren’t cure-alls and aren’t curing the pain problem. And they won’t sure the pain problem so isn’t it time to look elsewhere? In the year 2020?

All of this is cited in the show notes at chiropracticforward.com. Go get the article and the paper. Use it to educate your community on gabapentin. Set yourself as the reasonable alternative to it. 

Item #2

Fasting and weight loss. I want to be right up front on this, I’ve always wanted to make nutrition and weight loss a part of my practice in some shape form or fashion but, if I’m being honest, I’m just straight up a big big dude. Like I’m 6’4” and, depending on the time of year, 280+. I was a college offensive lineman. I played center and i anchored that line pretty well with my overall biggness. Lol. 

Cat-like reflexes people but big as a damn house. So, I’m not going to teach you how to implement weight-loss into your practice here but I am going to give you some interesting research I cam across recently that might make you think a bit. 

The first paper on this is called “Effects of time-restricted feeding on body weight and metabolism. A systematic review and meta-analysis”. It was published in Reviews in Endocrine and Metabolic Disorders, authored by P Marianna, C Iolanda, et. al. and published December 2019. (Marianna P 2019)

Hot to the touch. It’ll burn your  damn finger prints off. 

Why They Did It

Restriction in meal timing has emerged as a promising dietary approach for the management of obesity and dysmetabolic diseases. The present systematic review and meta-analysis summarized the most recent evidence on the effect of time-restricted feeding (TRF) on weight-loss and cardiometabolic variables in comparison with unrestricted-time regimens.

How They Did It

  • A total of 11 studies, 5 randomized controlled trials and 6 observational, were included
  • All selected studies had a control group without time restriction
  • Most studies involved the Ramadan fasting

Wrap It Up

Time restricted feeding regimens achieved a superior effect in promoting weight-loss and reducing fasting glucose compared to approaches with unrestricted time in meal consumption. 

As we’ve covered, systematic reviews and meta-analysis are, ideally, high-level research and, considering the majority of the included studies involved the Ramadan fasting regimen, I went to search it up to see what the what. 

So, what exactly is a Ramadan Fasting Regimen? Well let me tell you. And I’m not going for the fancy stuff because I’m tapped for time here so we’re just going to hit up Wikipedia real quick and Wiki says that the basics are:

  • Fasting from sun up to sun down
  • Abstinence from sex, food, and drink
  • It also means one should refrain from things like
  • violence
  • anger
  • envy
  • greed
  • lust
  • angry/sarcastic retort
  • gossip
  • and you’re supposed to get along with others better than you normally do

In America at least, I’m certain we’ll all just do the food part because everyone’s so busy looking for a reason to be offended that I’m certain being nice and getting along is off the table for now. 

So, if you have any personal experience with intermittent fasting, if you’re an expert on the topic, shoot me an email at dr.williams@chiropracticforward.com Let’s talk about it. Maybe we can set up some guests and do a full episode or two on the topic to educate our community of docs on the matter. Sounds like a great topic so hit me up. 

Now, the last thing I have here I want to talk about is Groupon. 

This one is a bit of a trigger for me honestly. Looky here. I am well aware that people are struggling. I’m well aware that I am fortunate and to sit and judge can seem disconnected and unfair at minimum to some. I definitely get that. 

What I also understand is that a whole bunch of those that are struggling are in a profession they really shouldn’t be in because they’re lazy and want to sit behind their desks and hit a few buttons and be magically transformed into a master chiro with an office stocked full of patients and never ending new patients. 

That’s magic time dreamland stuff. 

There will always be supposed shortcuts. There will always be business hacks or whatever you want to call them. But at the end of the day, shouldn’t you make decisions while keeping several things in mind? Meaning, you have to do what is best for your family. You have to do what is best for your office and your employees. But don’t you feel like you should make decisions based on what is best for your profession and for your colleagues?

I would hate to think that I’ve done something that damages my profession . Obviously I don’t mind calling out BS business practices and unethical chiropractors. If that’s damaging my profession well then, I’m guilty as hell. 

But when you are making the deals some of these guys and gals are making on Groupon, you are demeaning, lessening, and trashing what the rest of us take a great deal of pride in. 

Imagine, you go through chiropractic school, you survive 21+ years in practice while steadily getting more and more education, you take on a Diplomate program and finally complete that, and you are fighting on the state level for your profession and your profession’s image…..and then you open your email. 

Yes, I get emails from Groupon with their best and newest deals. I open it up and BAM….It almost seems like all of that work can just be flushed down the toilet. It’s depressing and it makes me want to club baby seals. 

Before we start talking about the article, I did a quick search for Groupon deals in my area and, right there next to Reflexology deals popped up this:

  • 10% cash back – Sounds like a damn car deal
  • Consultation, exam, x-rays, adjustment, and one full-body vibration plate session for $70. Way to value your services. Great. Way to look awesome. Assuming they actually need vibration plate. Assuming they actually need x-rays, assuming they even need and adjustment. Blah
  • Then this one, it’ll make you tickle – One laser lipo session w/ two vibe plate sessions for $45. See…..in Texas, you can only have laser lipo if you’re trying to increase function. Not just look better. So, that’s not necessarily legal as this implies to me it’s for looks. Unless they have a medical director and I’m here to tell you they do not. 
  • When you go to the bigger cities, it only gets worse. I found a $564 value for only $43.70!!! What a damn deal!!!

It’s all just shady and sketchy. Luckily, there are only two in my area doing this stuff. And if they keep it up, we may have two less competitors here as well. 

Besides the shady, street corner huckster look it so convincingly creates, it’s potentially illegal based on the idea of fee splitting, Medicare inducement, and dual fee schedules and, if the state boards start getting their acts together and going after this stuff, they will be the ones to go down. 

What started me down this path today was an article I came across called “Legal Implications of Chiropractic Groupons.” It was written and posted on the website for Carlson and Jayakumar – attorneys at law. I’ll have the link in the show notes. https://cjattorneys.com/legal-implications-of-chiropractic-groupons/

Highlight of the article include:

  • Each day, numerous chiropractors contract with Groupon and its competitors to sell certificates for adjustments, examinations, x-rays and massages. 
  • Despite the variety of services offered, these programs all have two things in common: (1) the chiropractor is offering a significant discount –92% in some examples, and (2) the chiropractor is sharing the income from each certificate sale – usually around 50% – with the website. While we are unaware of any state board taking action against a licensee for a Groupon-style offering, we believe these programs could create significant civil and criminal liability for chiropractors.
  • most states have rules prohibiting the offer or acceptance by a chiropractor of any commission, discount, or other consideration as compensation or inducement for referring patients, clients, or customers to any person, irrespective of the practitioner’s membership, proprietary interest or co-ownership in or with that person. I was once offered the opportunity to buy in to an imaging center here in town. As badly as I wanted to do it, I made the mistake of hiring two different attorneys for their opinions. BOTH advised against and this is exactly why. 
  • With Groupon, money is paid by the chiropractor to the website in connection with a patient’s referral. The chiropractor essentially, albeit indirectly pays the website per patient that purchases the certificate. At their base, these agreements require the chiropractor to pay the website for soliciting, referring and/or procuring clients not he chiropractor’s behalf. Stuff you’re not supposed to do and can get in a lot of trouble for. 
  • Medicare’s Anti-Kickback Statute criminalized the payment of kickbacks for patient referrals. Subsequent laws expanded it to all federalpay programs. Kickbacks include “any remuneration,” a very broad definition, which includes coupons. The Office of the Inspector General issued a “Special Fraud Alert” regarding advertisements offering “discounts” given to Medicare beneficiaries. Then a “Special Advisory Bulletin” appeared on offering inducements to Medicare beneficiaries. Essentially, it said a provider could not offer a patient anything worth more than $10, and combined $50 in a year for multiple gifts.
  • Groupon-style deals are unadvisable as they may pose problems with insurance companies. Most insurance policies will not pay for any charges that would not have been made in the absence of insurance. Groupon offerings, which almost always charge a lower fee to the purchaser versus insured patients, could be viewed as creating a “dual fee schedule.”  Insurers believe dual fee schedules constitute fraud and over billing. Some argue that Groupons are merely a version of a prompt-payment discount. While California law expressly permits prompt-payment discounts, such discounts must be reasonable. Given the extreme nature of the discounts typically offered by Groupon and its competitors, such certificates likely would not fall under the prompt-pay exception.

They conclude that “Given their widespread use, it seems unlikely that the Board of Chiropractic Examiners would discipline each and every licensee who engages or has engaged in Groupon-style offerings. That said, there may be a rash of “test case” or “example” disciplinary actions that follow. Eventually, we would expect the Board to adopt a regulation, or the Legislature to pass legislation, that explicitly either proscribes or prohibits the use of these deals. In the meantime, we recommend that chiropractors abstain from these types of marketing campaigns….”

I couldn’t agree more with them. 

When I opened up a new place h ere in Amarillo, I printed flyers at Kinko’s and I walked from one business to another knocking on doors and meeting people and telling them about me and my new place. I marketed anyone that could send me business. For more on that, go back about 5 episodes and listen to our episodes called Big Ideas On Marketing Evidence-Based Practices. Link is in the show notes. 

You must know this just isn’t the way to go. Join BNI, join civic clubs, start working out at a gym and get tight with the managers and personal trainers, spend time volunteering, joint a running club if that’s your gig, combine those things with social media and a solid email list that you continue to build and work on. There are so many things you can do that are above the cuff. That are respectable and raise up you and your profession. 

Groupon isn’t one of them. It does exactly the opposite. It identifies those of us who are racing to the bottom of the barrel and dragging the rest of us down with them. 

If you’re doing Groupon, it’s my opinion that it’s time to stand up, stop doing it. Yesterday..if you catch my drift

Store

Part of making your life easier is having the right patient education tools in your office. Tools that educate based on solid, researched information. We offer you that. It’s done for you. We are taking pre-orders right now for our brand new, evidence-based office brochures available at chiropracticforward.com. Just click the STORE link at the top right of the home page and you’ll be off and running. Just shoot me an email at dr.williams@chiropracticforward.com if something is out of sorts or isn’t working correctly. 

If you’re like me, you get tired of answering the same old questions. Well, these brochures make great ways of educating while saving yourself time and breath. They’re also great for putting in take-home folders. 

Go check them out at chiropracticforward.com under the store link. While you’re there, sign up for the newsletter won’t you? We won’t spam you. Just one email per week to remind you when the new episode comes out. That’s it. 

Chiropractic evidence-based products
Integrating Chiropractors
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The Message

I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment instead of chemical treatments like pills and shots.

When compared to the traditional medical model, research and clinical experience show us that patients can get good to excellent results for headaches, neck pain, back pain, and joint pain just to name just a few.

It’s safe and cost-effective. It can decrease surgeries & disability and we normally do it through conservative, non-surgical means with minimal hassle to the patient. 

And, if the patient develops a “preventative” mindset going forward from initial recovery, we can likely keep it that way while raising the general, overall level of health of the patient!

Key Point:

Patients should have the guarantee of having the best treatment offering the least harm. When it comes to non-complicated musculoskeletal complaints….

That’s Chiropractic!

Contact

Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.

Help us get to the top of podcasts in our industry. That’s how we get the message out. 

Connect

We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. 

Website

Social Media Links

https://www.facebook.com/chiropracticforward/

Chiropractic Forward Podcast Facebook GROUP

https://www.facebook.com/groups/1938461399501889/

Twitter

YouTube

https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q

iTunes

https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2

Player FM Link

https://player.fm/series/2291021

Stitcher:

https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through

TuneIn

https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/

About the Author & Host

Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger

Bibliography

Enke O (2018). “Anticonvulsants in the treatment of low back pain and lumbar radicular pain: a systematic review and meta-analysis.” CMAJ(190): E786-793.

Khazan O (2019) “Chronic Pain Is an Impossible Problem A “safe” alternative to opioid painkillers turns out to be not so safe.” The Atlantic.

Marianna P, I. C., Andrea E, Valentina P, Ilaria G, Giovannino C, Ezio G, Simona B, (2019). “Effects of time-restricted feeding on body weight and metabolism. A systematic review and meta-analysis.” Rev Endocr Metab Disord.

Year Two ‘Big Hits’ Wrap Up

CF 104: Year Two Big Hits Wrap Up For The Chiropractic Forward Podcast

This is chiropractic forward podcast episode #104. Fifty two times two = 104. That means two solid years of pumping out the Chiropractic Forward Podcast religiously. Pumping it out like a damn piston people. Dependable and powerful. 

BAM, kowapow!!! We’re going to talk about the most listened to episodes from the previous two years and we’ll talk about why they continue to be so darn popular. 

But first, here’s that sweet sweet bumper music

Chiropractic evidence-based products
Integrating Chiropractors
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OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around. 

We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers.

Welcome, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

If you haven’t yet I have a few things you should do. 

  • Like our facebook page, 
  • join our private facebook group and interact, and then 
  • go review our podcast on iTunes and other podcast platforms. 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com

Do it do it do it. 

You have done the electric slide into Episode #104. The two-year anniversary party is engaged. Yaya!! If you know me, doing really anything at all dependably for two straight years every single week is pretty good. 

I’m high maintenance people. In some ways anyway. I can’t be bothered with this and sometime that. I don’t seem to have time for some of the simplest tasks. You know how it is. 

I don’t go camping either. Nope. I need plumbing. I need central heat and air. And I need a decent bed. None of that camping foolishness unless it’s in a bus of some sort. Then……prolly. Otherwise, I’m too high maintenance and I’m not ashamed. I’m good with hanging out by a rocky mountain river for a bit. Maybe even hiking in the forest a bit. But then, back to the hotel. Come on now. 

Also, the beach. Am I the only one that can’t lay around on a damn beach all freaking day long? It’s not even remotely possible. It’s insane actually. I’m the kind, I hate sand all up on me everywhere. That’s the worst feeling. 

And then, after sitting around and soaking up the beauty for about 30 mintues…..maybe an hour…..it’s time to look around for something else to do. I can’t sit around and drink all day. Not unless I want to be out of commission the next day. Maybe two days. See…..I’m a little high maintenance. But don’t tell anyone. It’s our little secret. 

Now if you missed last week’s episode on spinal manipulation’s effect on the brain, on forward head posture and if it’s really related to neck pain, and we talked about how smoking is related to pain throughout the body,  make sure you don’t miss that info. It was good stuff and very well-listened to!

On the personal end of things, my Pops is back in the hospital. He had a mini stroke, TIA sort of thing that spooked the folks at the rehab hospital that they sent him over to the big hospital to be sure everything is A-OK. 

He’s looking and talking roughly the same as before he spooked everyone so I’m hoping we are back on track. Maybe he was just feeling a little extra on that day. He called his wife and his neighbor at around 2am last night so his brain still has some confusion but he’s doing OK overall. A lot of folks have been in a lot worse shape from strokes. Still not sensory or motor in the left upper and lower extremities. Unfortunately. 

Before we dive into the biggest episodes in Chiropractic Forward Podcast History, it’s good to support the people that support you don’t you think? Well, ChiroUp certainly supports evidence-based practices. 

If you don’t take advantage of this deal, I just think you might be crazy.

If you’re a regular listener of our podcast, you know I’ve used ChiroUp since about June of 2018. Let me tell you about it because I’m about to give you a way to do a FREE TRIAL and, if you sign up, only pay $99/month for the first six months which is pennies compared to what it’s worth. So listen up!

ChiroUp is changing the way we practice by simplifying patient education and here’s what I mean: 

In a matter of seconds, you can send condition-specific reports to your patients with recommendations for treatment, for their activities of daily living, & for their exercises. 

You can see how this saves you time – no more explaining & re-explaining your patient’s care, because they have access to it at their fingertips. 

You can be confident that your patients are getting the best possible care, because the reports are populated based on what the literature recommends and isn’t that re-assuring? All of that work has been done FOR you. 

There are more than 1000 providers worldwide using ChiroUp to empower their treatments, patients, & practice – Including myself! **Short testimony**

If you don’t know what it’s all about or you’d like to check it out, do yourself a favor and go to Chiroup.com today to get started with your FREE TRIAL – Use code Williams99 to pay only $99/month for your first 6 months

That’s ChiroUp.com and super double secret code Williams99.

First thing you gotta know is that as I list these off, the link to the specific show will be in the show notes so that you can have quick access to the episodes that sound the most interesting to you. 

OK, let’s start with #10 – 

#10

Our tenth ranked episode was Episode #68 and was called “British Medical Journal Research, Surgeons Against Back Surgery, and Pediatric Chiropractic Under Attack”

Any time the British Medical Journal is going to come out and say that moderate quality evidence suggests that SMT has effect on short term pain relief and increased function, we’re going to talk about it and we did. 

We also talked about Dr. David Hanscom, MD who wrote a book called Back In Control and who is also on the war path against chronic pain and surgery for the wrong candidate. Sounds like a guy I can get on board with right there. He’s well-versed in upregulated, sensitized CNS and I highly recommend his book to any practitioner or chronic pain sufferer. 

#9

Number nine all time is actually Episode #9 oddly enough and that was when I had my good friend and colleague, Dr. Tom Hollingsworth of Corpus Christi, TX join me to discuss the Case Against Chiropractic in Texas. Evidently that episode is still riging true for chiropractors because it’s still getting downloaded. The thing is, the Texas Medical Association is still suing us here. This case is still going. The episode aired on February 15 of 2018 so moving in on two years ago and the case is to the point where the TMA has won and we are waiting to see if the TX Supremes will hear the case. 

Keep your fingers crossed and go listen if you don’t know what it’s about because whatever happens here in TX can, and probably will, happen anywhere. 

#8

It was very recent. Episode #98 and it was called “Big Ideas On Marketing Evidence-Informed Practices.” This episode and it’s part II episode were listened to in big numbers and well-received. Which is exciting. I’ve always seen myself as a marketerpersonally but, primarily for the podcast, a voice of reason, responsibility, honesty, ethics, and yes….of course, research. 

But, I’m a marketer as well and how the heck do you market an Evidence-based practice? Well, there’s Jeff Langmaid with the Evidence-based Chiropractor material. There’s Dr. Kevin Christie with The Modern Chiropractic Marketer material. There’s Dr. Christie teaming up with Dr. Bobby Maybee and the Chiropractic Success Academy. And then there’s myself and the Chiropractic Forward Podcast. 

That’s it as far as I know. We are the outlets to help you market responsibly and ethically. There are a million other programs but A LOT of them are questionable at minimum. So, I have to say that I was pleased to see that so many found those marketing episodes to have value. 

#7

“How To Not Miss A Dissection & De-legitizing Complementary Medicine” This was episode #69. Well this one hit it big because people don’t want to get in trouble!! We are here to help people. Certainly not hurt people. That’s not what we’re built for. I went over a lot of policies I have here in my office that have so far helped me avoid and crazy situtations. 

I think every practitioner that is in practice for 21 plus years will have a couple little adverse things here and there like a patient actually getting a little worse in the short term and things like that but, I’ve been fortunate enough to avoid anything scary or serious. I think mostly because I’m very cognizent and aware of the research and do eveyrthing I can to avoid anything scary. Now I’m going to knock on wood and you should go get this episode because there was some real solid, immediate useful information in it. 

#6

“National Scope, Chronic vs. High Impact Chronic Pain, Coordinated Care/Medicaid, and DACO to DIANM”

Episode #96 – For this episode, which again was very recent, we were fortunate enough to be joined again….for the second time…by Dr. James Lehman of the University of Bridgeport and a key driver of the DACO/DIANM program and a frequent author of articles in Dynamic Chiropractic. 

This one shot right up to the top of our most listened to episodes because Dr. Lehman is a legend first of all and second it’s because he gives some amazing, profitable, and entrepreneurial ideas about the future of coordinated care. He also taught us about the difference between chronic pain and high impact chronic pain. 

I’d say the main thing though was his push for a modernized, national scope rather than 50 different scopes of practice in the US. Fascinating stuff from Dr. Lehman in this one. Don’t miss it. 

#5

Our fifth most listened to episode was episode #80 with Dr. Anthony Nicholson called “Decoding Chronic Pain” and I’m here to tell you that if anyone can help you decode chronic pain, it’s Anthony Nicholson. 

This episode, you get to hear it for free but I’m telling you, it’s a master class in chronic pain. Have you ever wondered about central nervous system sensitization or upregulation? Have you wondered what centralized pain vs. peripheral pain is? And no….I’m not talking about McKenzie protocols. 

I have covered a lot of material on chronic pain over the last two years but THIS is typically the source of my information. Dr. Anthony Nicholson si a neuro diplomate as well as an ortho diplomate. He is a genius and when he speaks, you need to be listening. So go listen. Don’t you dare miss that one. 

#4

This one was episode #55 and I told you all Dr. James Lehman was a legen y’all. Well here he is for the second time in our top ten most listened to episodes. 

This one was called “The Future of Chiropractic, Chirorpactic Specialization, & Chiropractic Integration.” Again, Dr. Lehman shared information that can make the entrepreneurial mind start swooning and swimming. Seriously. Knowledge nuggets raining down like manna from heaven people. 

#3

Our third most listened to is Episode #6 done with Dr. Tyce Hergert of Southlake Texas as our guest. The episode was called “Expert Information on Immediate Headache Relief”. Dr. Hergert and I covered several papers on how chiropractic helps knock those dudes out. Tyce is a pretty entertaining individual typically and is most certainly one of the smartest your going to find. 

#2

Our second most listened to episode is still probably my favorite personally. It was episode #13 and is called “DEBUNKED: The Odd Myth That Chiropractors Cause Strokes.” 

This was a lot of fun for me because it was part brain dump, part entertainment, and part educational. 

I said in a recent episode that there are few things in the world more satisfying than being able to slap someone straight across the face metaphorically by saying, “I can get that research paper for you if you like.” Well, this is THAT episode. 

I cover literally everything I could think of. From the risks vs. benefits, the research behind SMT for the neck. The research behind SMT for headache. The research AGAINST SMT causing strokes. The issues the medical field should REALLY be worried about when it comes to adverse effects. Man, I covered it all and while I’m aware it’s not very humble of me to say, I just don’t understand how a hater can really go through it and still be convinced chiropractors cause strokes. 

I just don’t. I feel like the information is just that thorough. Go listen to episodes #13, #14, and #15 and see what you think by the time you hear it all. 

#1

Well looky there, Dr. Tyce Hergert makes two appearances in our top five….not even the top ten….no, the top five. Only the best for Dr. Hergert. Which that’s fine. All those folks down in Southlake Texas think they should only get the best anyway. Lol. It’s jokes I make jokes. 

We go way back. Like….to 3rd or 4th grade basically. For real. Grew up in the same neighborhood in Perryton, TX – look it up – we were in Parker Chiropractic College at the same time and we’ve been serving in the Texas Chiropractic Association together for years. He’s actually an ex-President of the TCA so definitely worth listening to. 

This particular episode was called New Guides For Low Back Pain That Medical Doctors Are Ignoring. 

Surprise surprise, they’re STILL ignoring guides set forth by their own damn organizations and associations. 

We talked about Section 2706 of Obamacare. We covered a lot of ground and people have responded by making Episode 11 our #1 listened to episode of the first 2 years of the Chiropractic Forward Podcast. 

It’s been fun and we’re still rocking and rolling and whatnot. Don’t you go anywhere. You keep coming back every Thursday for the new episodes. 

Keep sharing us on Facebook and Twitter. Keep writing reviews on podcast platforms. Keep stoppign by the shop at chiropracticforward.com and let’s keep seeing where this here train will lead. 

I’m hoping it leads to more evidence-informed practitioners comign out of college each and every semester. More and more and more until some of the garbage we see right now becomes the exception rather than the rule. 

Together, with your involvement here and with your help, we can make it happen. 

Store

Part of making your life easier is having the right patient education tools in your office. Tools that educate based on solid, researched information. We offer you that. It’s done for you. We are taking pre-orders right now for our brand new, evidence-based office brochures available at chiropracticforward.com. Just click the STORE link at the top right of the home page and you’ll be off and running. Just shoot me an email at dr.williams@chiropracticforward.com if something is out of sorts or isn’t working correctly. 

If you’re like me, you get tired of answering the same old questions. Well, these brochures make great ways of educating while saving yourself time and breath. They’re also great for putting in take-home folders. 

Go check them out at chiropracticforward.com under the store link. While you’re there, sign up for the newsletter won’t you? We won’t spam you. Just one email per week to remind you when the new episode comes out. That’s it. 

Chiropractic evidence-based products
Integrating Chiropractors
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The Message

I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment instead of chemical treatments like pills and shots.

When compared to the traditional medical model, research and clinical experience show us that patients can get good to excellent results for headaches, neck pain, back pain, and joint pain just to name just a few.

It’s safe and cost-effective. It can decrease surgeries & disability and we normally do it through conservative, non-surgical means with minimal hassle to the patient. 

And, if the patient develops a “preventative” mindset going forward from initial recovery, we can likely keep it that way while raising the general, overall level of health of the patient!

Key Point:

Patients should have the guarantee of having the best treatment offering the least harm. When it comes to non-complicated musculoskeletal complaints….

That’s Chiropractic!

Contact

Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.

Help us get to the top of podcasts in our industry. That’s how we get the message out. 

Connect

We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. 

Website

Social Media Links

https://www.facebook.com/chiropracticforward/

Chiropractic Forward Podcast Facebook GROUP

https://www.facebook.com/groups/1938461399501889/

Twitter

YouTube

https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q

iTunes

https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2

Player FM Link

https://player.fm/series/2291021

Stitcher:

https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through

TuneIn

https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/

About the Author & Host

Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger