There are some great hands-on shots and video demonstration of Microsoft’s Courier. As you can see, it is pen-based. 

If the pen-based inputs on the courier is as sensitive, responsive and precise as they are on a Tablet PC, then I can see this device being a great tool for EMR (electronic medical records). 

I’m loving the pen inputs on this device, and I like how there are two screens to sequester two different applications.  In my practice, I rely on typing in letters and numbers that aren’t real words, and drawings.  I see this as a great interface for this.  If this interacts with Microsoft’s OneNote, and it probably will, it will be a note-taking winner. Sometimes you need to have your stuff on a desktop to work with, and sometimes you need to have your stuff in your hand, on the go.

Caution, though.   Sometimes the romantic notion of having a slate in your hand, taking notes while talking to patients doesn’t always pan out.  I’ve tried this with a slate style Tablet PC in my chiropractic office, and I rarely picked it up. That’s one of my arguments against using an Apple iPad, and that same argument goes for this too.  However, this fold up to the size of a 5X7 photo, and is just under an inch thick.  I’m no engineer, but that sounds like it would fit in a large pocket.

I’m getting one.  I don’t know how much it will cost, but they’re probably going to shoot for the iPad’s excellent price.  It’s due out at the end of this year.

Todd Lloyd, DC
Chiropractor in Sonoma

Thanks Engadget

Balance Benefits at a Glance:

Reduced joint pain

Better posture

Reduced back pain

Higher confidence for sports or daily activities

Faster balance reaction time

Reduced risk of sudden trauma due to improved body awareness

Reduced risk of future injuries

With Better Balance You Can:

1. Develop a killer golf swing
2. Avoid a broken hip
3. Look taller and slimmer
4. Reduce incontinence
5. Walk straighter and more gracefully
6. Ski the blue and black diamonds instead of the green
7. Improve your sex life
8. Have the guts to try something new
9. Greatly improve performance in ALL sports
10. Prevent sports injuries, especially sprains and strains
11. Hold that yoga pose as long as you need to
12. Stay on the mountain when you’re hiking
13. Avoid accidents because you’ll react faster
14. Stop wobbling
15. Pick up your kids without straining your back
16. Look cool when you’re carving on your skateboard, snowboard, long board, surfboard
17. Increase the benefit of and response to your chiropractic visits.

18. Be agile
19. Enhance your quality of life
20. Increase your independence
21. Raise your overall level of health

Read more about how to improve your balance here.

From allegromedical.com

Todd Lloyd, DC
Chiropractor in Sonoma

They are seeing these problems in war too.  It’s known that injured soldiers at Army medical bases get discharged often because of psychological problems from being exposed to the stresses of war.  Now studies show that back pain is one of the great problems holding soldiers away from duty.

Fortunately, they have placed chiropractors in the Army Landstuhl Regional Medical Center in Germany.  While most of the soldiers with back pain are treated conservatively, it will be interesting to see how the chiropractors there can change things for the patients there.

For the veterans here in Sonoma, the Veteran’s Administration pays for chiropractic care if approved by the VA.  Usually, they will give you a handful of starter visits.  If the care in our office shows continual benefit, they will approve more. If you are in the VA system, and you have back pain, you give our office a call to set up an appointment. We’ll help you out.

Todd Lloyd, DC
Chiropractor in Sonoma

They use to say that you can’t tell from an x-ray if a person has back pain or not.  While it’s true that you can’t tell with certainty that a person’s X-ray findings will tell you if a person has back pain, you can make a good guess about it.  If a person has thin disc spaces because they have abused their spine through their lifetime, then that extra compression on the joints of the spine will cause more back pain.  It makes perfect sense.

Below is the abstract to the study (after the break.)

Todd Lloyd, DC
Chiropractor in Sonoma

Spine:
1 March 2010 – Volume 35 – Issue 5 – pp 531-536
doi: 10.1097/BRS.0b013e3181aa5b33
Clinical Case Series
The Association Between Lumbar Disc Degeneration and Low Back Pain: The Influence of Age, Gender, and Individual Radiographic Features
de Schepper, Evelien I. T. MD; Damen, Jurgen MD; van Meurs, Joyce B. J. PhD; Ginai, Abida Z. MD; Popham, Maria MSc; Hofman, Albert PhD; Koes, Bart W. PhD; Bierma-Zeinstra, Sita M. PhD
Abstract
Study Design. Cross-sectional open population based study (nested in a prospective cohort study).
Objective. To explore the association of the different individual radiographic features, including osteophytes and disc space narrowing, with self-reported low back pain (LBP). Different definitions of lumbar disc degeneration with self-reported LBP and disability were considered in a large open population sample. Furthermore, in order to disentangle the discrepancies in reported strength of the associations, we characterized the frequency of the different individual radiographic features of lumbar disc degeneration and definitions of lumbar disc degeneration, as well as their association with LBP status, by age, gender, and vertebral level.
Summary of Background Data. Currently within the literature, there have been no studies that have explored different definitions of lumbar disc degeneration and their association with LBP within one study sample.
Methods. The intervertebral disc spaces (L1/2 to L5–S1) were evaluated for the presence and severity of anterior osteophytes and disc space narrowing using a semiquantitative score (grade 0–3). Logistic regression was used to determine the association between these individual radiographic features of lumbar disc degeneration and different definitions of lumbar disc degeneration for LBP.
Results. Lumbar radiographs were scored for 1204 men, and 1615 women. Osteophytes were the most frequent radiographic feature observed, with men having the greatest frequency. Disc space narrowing was more frequent in women than men. Both radiographic features increased in frequency with age.
Disc space narrowing appeared more strongly associated with LBP than osteophytes, especially in men (odds ratio [OR] = 1.9; 95% confidence interval [CI]: 1.4–2.8). Disc space narrowing at 2 or more levels appeared more strongly associated with LBP than disc space narrowing at only 1 level (OR = 2.4; 95% CI: 1.6–3.4). After excluding level L5–S1, the strength of almost all associations increased.
Conclusion. We are the first to report different possible lumbar disc degeneration definitions and their associations with LBP. Disc space narrowing at 2 or more levels appeared more strongly associated with LBP than other radiographic features, especially after excluding level L5–S1.

There are fewer and fewer primary care doctors in practice.  I remember there being a big story a few years ago form the Press Democrat talking about the crisis in Petaluma of the shrinking numbers of primary care, general physicians. 

Now, there is a lot of talk that more doctors are starting to retire prematurely because it just doesn’t make business sense to stay in practice. There is too much overhead in a doctor’s office.   Costs are rising, while income is shrinking.  Doctors in private practice wear two hats; they are business people at the same time that they are healers.  Without one, you can’t have the other.  The only choices that they have now are to retire or to go work for a hospital.  This all depends on their age and financial standing.

We are still accepting Medicare patients for chiropractic care. Even though Medicare only pays for the adjustment, and does not pay for examinations or other adjunctive procedures, we still accept it. There are some things that you have to pay out of pocket for, including the examination and extremity manipulation.  Fortunately, both of these remain affordable in my office. 

Check out the links to the articles after the break

Todd Lloyd, DC
Sonoma doctor of chiropractic

http://www.tennessean.com/article/20100301/BUSINESS01/3010332/2047/business

Uncertainty about reimbursements from payers, including Medicare and private insurers, is a lingering issue for many doctors. They face a 21 percent overall cut in Medicare reimbursements that becomes effective today. It could still be averted by a monthlong stay that the U.S. House passed on Thursday; action is pending in the Senate. Many doctors, meanwhile, are holding out hope for a "permanent fix" to how physicians are paid.

In the interim, more doctor practices are considering not accepting new Medicare patients. Many other doctors are seeking employment at hospitals. And others are focusing more on patients who pay out of pocket and ending ties with insurers that cut rates.

http://www.ama-assn.org/ama/pub/health-system-reform/physicians-sgr-medicare-cut.shtml

“The Senate had over a year to repeal the flawed formula that causes the annual payment cut and instead they abandoned America’s seniors, making them collateral damage to their procedural games,” said AMA President J. James Rohack, M.D.  “Physicians are outraged because the cut, combined with the continued instability in the system, will force them to make difficult practice changes including limiting the number of Medicare patients they can treat.”

Physicians from across the nation are in Washington, D.C. this week for the AMA’s National Advocacy Conference and will meet directly with their senators to tell them it is urgent that they permanently repeal the flawed Medicare physician payment formula and replace it with one that reflects the increased cost of caring for patients. 

“The AMA is hearing directly from physicians, and seniors should be very concerned about how the Senate’s inaction will impact their ability to see a doctor,” said Dr. Rohack. “Military families are also hurt as TRICARE ties its payment rates to Medicare.”

Messages to AMA from practicing physicians about today’s 21 percent cut include the following letters in their own words:

“As a practicing psychiatrist in D.C. for over 35 years I have always treated Medicare patients for the Medicare fee, which is already way below the standard fee for my services. I felt this was an obligation to take care of senior citizens.  At this point unless this 21 percent reduction in fee is repealed I will have to abandon seeing Medicare patients. I will have to do this with a heavy heart as I will not be able to maintain my practice at these rates.  Given the expenses of maintaining a practice where all costs escalate every year — malpractice, licensure, CME credits, rents, administrative fees, etc — it no longer becomes feasible to sustain the practice.” —Psychiatrist, Washington, D.C.

“The sad truth is that we will no longer be able to see Medicare patients who come to establish care with our group.  We won’t fire our existing patients I hope.  The alternative is to close the doors.  To say that this is discouraging is an understatement.  I went into medicine with the ideals of serving my patients with a covenant to provide the highest quality care.  I can’t do this with the cruel cynical actions of our Congress.  I am ashamed of our system.  I most likely will quit the practice of medicine.” —Primary Care, Duluth, Minn.

“We are now forced to cease seeing new Medicare patients and may have to opt out altogether. This will be a devastating turn of events for us and our community.” —Urologist, Chatanooga, Tenn.

“I plan to retire as soon as possible if the Medicare cuts go through.  Most of my patients will be unable to find another competent psychiatrist who takes Medicare.  I am the only one of my colleagues who takes Medicare now.” —Psychiatrist, New York and Pennsylvania

“These cuts are forcing me to limit the number of Medicare patients I will see. As a private practitioner, all of my expenses are going up including the rent, utilities, malpractice, employee salaries, etc. I want to continue to provide good care to my patients, but if I have to increase the number of patients I see, work longer hours, get less sleep, reduce time with my family, reduce my required medical supplies, etc., continuing to take Medicare will only make it impossible for me to do so in these tough economic times. I will not be the only physician making this tough decision. In reality these cuts will reduce the quality of care to the elderly and increase healthcare costs as the access to preventive care decreases, thus increasing the emergency room visits, intensive care visits, emergency surgical operations and poor medical outcomes. These cuts are a slap in the face to the elderly whom have worked hard and paid into the system that is now turning its back on them when they need it most." —Ob-Gyn, Baton Rouge, La.

“I am not sure which is more disruptive; the constant uncertainty each year regarding the SGR, the actual 21 percent cut, or the payment freezes that are now seemingly routine.  One thing is for sure.  My office will attempt to minimize our exposure to the now-politicized Medicare program.  Starting now, we will limit the number of new Medicare patients to 3 per week per provider (down from about 7), and limit surgeries to emergent cases on our existing Medicare patients.” —Urology, Cadillac, Mich.

“The government continues to encourage the use of EMR’s. However, these systems are extremely costly to maintain. These cuts are making it impossible to pay for expensive EMR systems, and we are considering going back to paper charts.” —Family Physician, Muncie, Ind.

The “Doc Fix” for Medicare Fees: Déjà vu All Over Again…but Worse?

As you can imagine, a 21% cut in Medicare physician fees would likely result in limited access for seniors and veterans.  Reports already highlight that doctors will be forced to drop or delay seeing their Medicare patients until they know what will happen.  Although many physicians ‘participate’ in Medicare, it is unknown how many may be limiting the number of Medicare patients they would see.  Since Medicare is the largest payer, it is likely that other insurers will follow suit and cut physician fees.  Lastly, all the money and time that goes into the short term patches have left physicians tired, uncertain of the future and with little faith in the legislative process.  We need to fix this so we can move onto other pressing issues in healthcare.

Medicare Pay Cuts to Doctors: The Latest Patch

I can’t believe it’s actually going to happen. Well I guess that it is time for us all to stop accepting medicare and charge cash for our services. We should also have a 21% cut is social security payments so that all of those medicare recipients who support the cuts can feel our pain. Then we’ll really be in this together. Let’s give it all to big pharma!!! They’re the only people who get paid for anything. Call Merk when you have chest pain.

Medicare Doctors May Limit Patients as Fee Cuts Loom

The Mayo Clinic, praised by Obama as a national model for efficient health care, said it would stop taking Medicare patients at its primary-care clinic in Glendale, Arizona, starting Jan. 1, saying the U.S. government pays too little.

Talk Therapy May Reduce Back Pain

Group cognitive behavioral therapy may help patients with chronic or acute low-back pain, British researchers say.
full story http://www.medpagetoday.com

The treatment consisted of an initial individual assessment, followed by six sessions of group therapy lasting 1.5 hours each. Therapy targeted behaviors and beliefs about physical activity and avoidance of activity.

While there isn’t a lot of research to back this up, it looks like some group therapy can help you out with your back pain.  If I had back pain, I would take a multi-professional approach at handling the pain.  I would get myself on an anti-inflammatory diet, a spinal stabilizing core exercise routine, I would join a support group, and I would make regular visits to a chiropractor. 

I’m thinking about making the benches in our courtyard into a meeting place for a support group.  What do you think?

Perhaps we’ll lay out some exercise mats to demonstrate some core stability techniques, and talk about our back pain. 

Todd Lloyd, DC
Sonoma Chiropractor

They found that chiropractic care and Manual therapy in general does a very good job with those disorders that have a biologically plausible explanation for their relief. This means that any condition in the body that can be relieved with physiological movement and sound soft tissue healing techniques will get a good result with care received in the chiropractic office.  What the researchers don’t know now for sure is how other conditions will respond to chiropractic care.  There just simply is not enough evidence out there for the research is to know for sure if chiropractic care helps with other conditions not related to the spine or the musculoskeletal system.  These are conditions that chiropractors see clear up in their offices, and are still confident in treating, but do not have evidence from scientific reviews to support what they’re doing.  This is not a bad thing to try to treat a condition as long as it it is relatively safe to do so.  It is safe for a properly trained and skilled chiropractor to deliver care in any part of the spine as long as the chiropractor has decided that it is safe to proceed.

This reminds me of a time when I was going for school and I started getting really bad stomach aches.  I tried to be stoic during that time by not taking any medications to relieve the pain.  But, the pain from the stomach aches got pretty severe.  This was happening when I was in chiropractic college and we had a lot of stressful course work to complete.  I told this to my intern who was treating me about this, and he proceeded to adjust me in my mid back three times a week for several weeks.  What we saw was a gradual improvement in the symptoms that were coming from my stomach.  This kind of cure has no biological plausible explanation except for the fact that the nerves that go to the stomach come from the spine in the mid back.  Other than that, the stomach is pretty well detached from the rest of the spine.  This is an example of where chiropractic treatment to the spine resulted in the cure for an organic condition.  We wouldn’t have done this if the treatments are rendered was dangerous, but because chiropractic care is so safe we went ahead with a treatment to see if it would affect of a cure.

In my office we put a particular emphasis on the relief of back pain.  Many chiropractors who I talk to do not like to treat back pain, but this is something I see good results in, and I enjoy seeing people get relief in a short period of time.  Low back pain is the number one condition for which people refer other people to me.  People know that I am the guy to see when the low back starts feeling stuck.  My patients also know that when somebody they know has something in there and neck that is causing them pain or shoulder pain that I am the guy to see.  I see good results in my office for this, and now the scientific literature continues to back me up.

Todd Lloyd DC
The chiropractor in Sonoma

Dr. Perry shows you how to tone the core, stretch the hip flexors and tighten your butt all in one move. It’s all in how you move.

Using the neurological principle of “reciprocal inhibition”, Dr. Nickelston shows us how to relax the hip flexors to prepare for core exercise.

Believe me, I know what this feels like too.  I remember being a college student, before receiving regular chiropractic care.  I use to sit at my desk studying and using an antique computer to type papers. My muscles use to ball up too.  I use to rub them.  No help.  I use to stretch.  No help.  I had to let them calm down on their own.  I was 20 years old, and this was happening!

It wasn’t until I got into chiropractic college and I started getting regular chiropractic adjustments that these finally went away.  I got my neck adjusted, and I got my ribs adjusted.  I got them adjusted once a week.  And, I hit the books hard.  In my first two years of chiropractic college I got nothing less than A’s and B’s.  You would find me in the library in the evenings and at seminars on the weekends.

And I never had a problem with trigger points in my neck muscles ever again.

Among different manual therapies aimed at inactivating muscle TrPs, ischemic compression and spinal manipulation have shown moderately strong evidence for immediate pain relief.

New research shows that when you have parts of the spine not moving well, then you’ll have more knots in your muscles.  They go hand in hand.  Because my neck and ribs weren’t moving well, my muscles got trigger points.  This is the body’s innate way of telling you that things need to move better. 

Reduction of joint mobility appears related to local muscles innervated from the segment, which suggests that muscle and joint impairments may be indivisible and related disorders in pain patients.

When there’s poor movement in the neck, there’s a reflex that goes from the joints in the spine, to the spinal cord, and back out to the muscles that support the spine.  This reflex has the muscles tightening down and guarding the area so it can heal and stabilize itself against further injury.  the body perceives poor posture, locked up joints, and achy muscles as injury.

Two clinical studies have investigated the relationship between the presence of muscle TrPs and joint hypomobility in patients with neck pain. Both studies reported that all patients exhibited segmental hypo-mobility at C3-C4 zygapophyseal joint and TrPs in the upper trapezius, sternocleidomastoid, or levator scapulae muscles.

Because chiropractic care restores normal motion that flushes out inflammatory chemicals, and provides a reflex relaxation of the muscles and pain gate, it also helps to break the reflex causing trigger point knots in the shoulders.

There is scientific evidence showing change in muscle sensitivity in muscle TrP after spinal manipulation, which suggests that clinicians should include treatment of joint hypomobility in the management of TrPs.

Quotes taken from Interaction between Trigger Points and Joint Hypomobility: A Clinical Perspective.

Todd Lloyd, DC
Trigger point doctor in Sonoma, CA

J Manipulative Physiol Ther. 2009 Nov-Dec;32(9):765-71.

People feel better with chiropractic care, and they function better.  Those with newer injuries do a lot better, and recover more quickly from their injuries with chiropractic care than do those people with long-term low back pain. But, they both tend to do pretty well with chiropractic care.

In Sonoma, we’re always looking for your referrals for low back pain. You don’t even need to be a doctor to refer to us.  You don’t even need a referral to enjoy the benefits of autonomous chiropractic care.

Todd Lloyd, DC
http://lloydchiro.comChiropractic care for back pain in Sonoma, CA