In October 2005, I started the Life Enhancement Clinic with a goal of serving those in my community and helping them to restore health and wellness. My interests have always been in the patient’s best interests. I thought that all the parties involved in patient care would think the same thing. Unfortunately, I found out that insurance third-party payors do not have the patient’s best interest in mind. Their focus is solely on the bottom dollar. Critical statement? Yes, perhaps. True statement? Yes, definitely.
A couple of years ago we experienced something that shocked us. We received a report and reprimand from Blue Cross / Blue Shield of North Dakota (of which we are providers) for care provided in our office. Now this was not negligent care, care that was not medically necessary, it wasn’t fraudulent and it wasn’t even questionable. We were reprimanded because we ordered lab tests. We were notified that within a year period we ordered about 1000 individual tests for our patients. Now, you have to understand, this was for a few hundred patients so we are talking of anywhere from 2-10 simple blood tests for each patient. Not MRI’s, not x-rays, not CT scans, not unnecessary surgeries…standard blood chemistry panels.
So why did we get reprimanded for ordering blood tests? Because I am a chiropractor. I was informed that the other chiropractors in the state don’t order lab tests, so if they didn’t order lab tests then it wasn’t necessary for me to order lab tests and I should stop submitting these services through for reimbursement. My question of why more chiropractors aren’t ordering lab tests and why we establish such a low standard for patient health fell on deaf ears. So because Chiropractor XYZ doesn’t order labs, I shouldn’t either.
Please don’t misunderstand me. I practice with a group of great chiropractic colleagues that place their patient’s health as their primary concern. I work with a group of medical doctors and nurse practitioners that are equally concerned in the health and well-being of their patients. They too are frustrated by the crazy demands placed on them from the current insurance reimbursement system.
So I was faced with an obstacle. Practice solely the way the insurance company was requesting without the guidance of blood chemistry analysis and labs, or stick with my educational background, medical training and clinical expertise and do what was best for the patient. We went with the latter. We were able to join with a large laboratory cooperative that is able to negotiate much lower lab fees for standard blood chemistry analysis. Then, even though we directly bill the patient and the labs aren’t submitted to insurance, they are able to appreciate a very substantial savings in their lab fees. For example, in 2010 the BCBS fee for a serum ferritin was around $40 fee. With our discounted lab fees I am able to charge a patient a cash-discount fee of $9. Quite the savings.
We incorporated these changes and repositioned our clinic to offer these savings with a great deal of effort, hard work, determination and increased expense to us. So why would I go through all that trouble for some lab testing? The reason is because I feel it makes all the difference in the world. I use blood chemistry analysis in my clinical nutrition practice, but I have developed a 10-test blood panel that I think is valuable for all patients presenting into a chiropractic office with musculoskeletal pain that is chronic in nature. So why do I use labs? Find out the ten reasons below the picture.
(1) Rule Out Inflammation
Inflammation is a component to almost every disease and degenerative process we know of. If you are inflamed, you are going to be in pain. If you are inflamed your soft tissues will not heal appropriately. Now obviously in an acute trauma or injury, say a sprained ankle, there is going to be some initial inflammation which is quite necessary and healthy for the body. When this inflammatory cascade process gets out of control is when you have big problems. That is why the first few days of supporting inflammation after an injury is so vital to the long term health and stability of your joints, spine, muscles, ligaments and tendons. With our panel we are able to look at markers of inflammation and if you are inflamed there are safe, natural, effective ways to manage this.
(2) Rule Out Anemia
Anemia, most notably iron-deficiency anemia, will disrupt the amount of oxygen delivered to your tissues and your brain. Guess what? You need oxygen to heal and survive. So anemia is one of two “deal-breakers”. As long as you are anemic you cannot improve your health status and that includes dealing with things like headaches, muscle soreness. back pain, etc. One of the most important markers to check for iron deficiency is a serum ferritin level. I have seen many patients with “normal” markers on their complete blood cell count (CBC) yet have ferritin levels that are extremely low between 4-10.
(3) Rule Out Insulin Resistance
As mentioned with anemia, insulin resistance is a deal-breaker. You cannot properly mend tissues if you can’t deliver proper fuel to the cells. Insulin resistance causes cells to “starve” by not allowing the proper levels of glucose into the cells for energy production and life-critical processes. Proper interpretation of a chemistry panel and lipid panel along with a glycosylated hemoglobin can give you information as to whether you are insulin resistant or not.
(4) Rule Out Vitamin D Deficiency
Vitamin D deficiency is a very common cause of chronic musculoskeletal pain, headaches, arthritis, and autoimmune diseases. I have had patients see a number of chiropractors, physical therapists and massage therapists for chronic muscle pain only to find that they were severely deficient in vitamin D. When the vitamin D levels were corrected their chronic musculoskeletal pain disappeared.
(5) Rule Out Chronic Infection
Chronic viral infections, or chronic low-grade bacterial and/or fungal infections, can wreak havoc on your general health and the health of your musculoskeletal system. Consider “shingles” a viral-induced disease that often manifests as midback pain, and in some cases this is before any distinguishing rash or other clinical sign.
(6) Rule Out Toxicity Challenges
Toxins affect us…period. There is no longer any debate as to whether toxin exposures can precipitate cancer, heart disease, diabetes, fibromyalgia, joint pain, headaches and obesity. The facts have clearly established a causal relationship. We quantify toxic burden with a chemistry panel, a bioelectrical impedance analysis and history to see if toxin exposure may be contributing to your poor musculoskeletal health. You can be adjusted by the greatest chiropractors in the world, but if your body is toxic your muscles can’t heal, the joints can’t stay aligned, and fascial restrictions can’t be alleviated. A clinically-proven detoxification strategy should be a part of every case of chronic musculoskeletal pain.
(7) Rule Out Trace Mineral Deficiency
From a standard blood chemistry analysis that we use in our office we can assess antioxidant status, consider selenium status, and identify probable zinc deficiency. Trace minerals are depleted in our Standard American Diet (SAD) and are absolutely critical to key enzyme processes in our body that promote healing and restoration of our tissues. Proper levels of micronutrients such as vitamins and minerals is literally what drives our mechanisms of life.
(8) Rule Out Magnesium Deficiency
Stress depletes magnesium levels. The Standard American Diet depletes magnesium levels. The high sugar, low fiber, low fruit/vegetable intake each day depletes magnesium levels. Over 1/2 the population is affected by magnesium deficiency. This condition has been linked to migraine headaches, chronic musculoskeletal pain, constipation and a whole host of other problems. Sometimes the answer to your chronic muscle aches and pains is simply getting increased levels of magnesium to your tissues.
(9) Rule Out Abnormal Stress Response
Let’s face it…we all experience stress and it is impossible to completely avoid stress. However, healthy bodies are designed to deal with stress with healthy stress responses. When this normal stress response is compromised you start a downward spiral of ill-health. The fact that the majority of all visits to a doctor have a stress component let’s us know how important this is. However, in most cases no support is given, no stress management tips are provided and you, as the patient, are left to suffer.
(10) Rule Out Malnutrition
There are really three primary things that cause us to not be healthy and in pain. They are stress, toxins and malnutrition. Yes, malnutrition is a very common problem. I see a lot of obesity in my practice. These are individuals that are feeding themselves full of non-nutritive calories and are literally “starving” themselves. I see a lot of sarcopenic obesity where poor diet and lifestyle choices have left individuals with low lean body mass and increases their risk of joint pain, osteoporosis, and muscle pain. I also see a lot of people with insufficient stomach acid that are told they have “too much” acid and are placed on acid-blocking medications which compromise nutrient absorption, they are placed on statin drugs for cholesterol that deplete CoQ10 levels, they are treated with anti-depressants that lower their levels of B-vitamins and they have chronic ingestion of over-the-counter pain pills (NSAID’s or non-steroidal anti-inflammatory drugs) that cause a variety of nutrient deficiencies. Summed all up this leads to a chronic state of malnutrition.
By looking at a complete panel I am able to save patients a lot of time, money and effort by identifying key underlying processes that are not working. Thankfully, in most cases, we are able to provide recommendations with clinical nutrition, diet, stress management and exercise that can remove these obstacles and re-establish a solid foundation on which a healthy life can be built.
You are the reason I am a chiropractor that uses labs. You are the reason my history is comprehensive. You are the reason my examination is the “most thorough you’ve ever had”. You are the reason we strive for excellence.
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