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Subluxations and Blockages and Interferences, Oh My!
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Written by Tedd Koren, DC   
Thursday, 25 April 2013 22:05
"Lions and tigers and bears, oh my!" Dorothy in The Wizard of Oz reminds us that the world is full of many dangers. It’s the same with the body. There are many things that can disconnect us from our inborn perfection and prevent us from functioning at our optimum, thus creating dis-ease.

bookstackD.D. Had It Right
D.D. Palmer had it right; three things that ruin our health are toxins, trauma, and thoughts (autosuggestion). 
 
D.D. and B.J. Palmer’s understanding of the subluxation is more profound than most chiropractors originally realized.
 
Let’s Begin at the Very Beginning (a very nice place to start)
D.D. Palmer acknowledged that spinal adjusting was used in ancient healing systems. For example, in The Chiropractors Adjustor (p. 12):
 
These axioms, rediscovered and known as Chiropractic, were also known and practiced by Aesculapius and his followers . . . [I took] two Greek words, cheir (hand) and praxis (done by) . . . from which I coined the word Chiropractic.
 
However, before ancient Greece, there was a land that was ancient to the Greeks, and that land was Egypt. Palmer writes (ibid):
 
Dr. Atkinson has frequently informed me that the replacing of displaced vertebrae for the relief of human ills had been known and practiced by the ancient Egyptians for at least 3,000 years.
 
The Cause of Illness
Chiropractic’s connection to ancient Greek and Egyptian healing practices was highlighted in Blessed by Illness by L.F.C. Mees, MD (Anthroposophic Press, 1983, p. 50). Mees reports that the Greeks believed “deformation” caused illness and was treated by “temple sleep, prayers, herbs, laying on of hands, baths, diet, lifestyle.”
 
The Egyptians (thousands of years earlier) also said “deformation” caused illness and was treated by “temple sleep, prayers, and herbs.”
 
Deformation
We do not know precisely what these ancient people meant by deformation. However, we do know that a deformed object does not work as well as a properly formed object. This coincides nicely with chiropractic’s relationship between structure and function.
 
What Does This Have to Do with Subluxations?
Dis-ease is a communication disorder and subluxations result from that dis-ease or communication disorder.
 
The subluxation is a metaphor for interference, blockage, deformation, distortion, or stagnation (of energies, too much or too little).  
 
Chiropractors Treat the Symptom
B.J. Palmer reinforced this understanding when he said:
 
Vertebral Subluxation is a symptom of interference of Innate and not a cause. (Palmer BJ. The hour has arrived – lecture. Lyceum, Palmer College, 1931.)
[Thank you to Richard Barwell, DC of Neuroinfiniti for this quote.]
 
The subluxation is secondary, not primary. The primary problem is lack of or altered communication.

How do We Remove the Subluxation?
Different healing systems use different methods to remove blockages, interferences, and subluxations to reestablish communication:
  • Chiropractic
  • Homeopathy
  • Acupuncture
  • Classical osteopathy
  • Shiatsu
  • Qigong
  • Yoga
  • Tai chi
Many other systems, both ancient and modern may also reestablish communication.

How else could an acupuncturist putting a single needle in the body relieve sciatica? How could a homeopath using a little sugar pellet in water do the same? How else could a qigong master release sciatica without touching the patient?

Let’s expand our understanding of chiropractic philosophy, build bridges with other vitalist healing systems, and resist merging with those that do not share our philosophy. Let us not emulate the narrow-mindedness of modern medicine holding fast to discredited mechanistic models of life.

Chiropractic is information healing. B.J. Palmer said it well:

Adjusting a vertebra is what happens when my hands leave the back … My work is an enticement to get innate to make the adjustment. (Palmer BJ. The hour has arrived – lecture. Lyceum, Palmer College, 1931.)
[Thanks again to Dr. Barwell.]

The adjustment is energy/information the body uses to create:
  • Connection
  • Wholeness
  • Healing
  • Release
  • Integration
  • Restoration
  • Renewal
Flexibility is a sign of health. Remember, when things don’t fit our theory, we change our theory. Let us heed the words of John Wilmot, Earl of Rochester: “Before I got married I had six theories about bringing up children; now I have six children and no theories.”

Tedd Koren, DC’s years of suffering were a blessing in disguise because they led to the discovery of the Koren Specific Technique (KST), which now helps millions of people achieve greater health and well-being. KST’s protocol of challenge, check, and correct can be easily applied to physical and emotional issues. Practitioners and patients alike say KST gives them “the best adjustment of my life.” To learn more about this healthcare breakthrough visit www.korenspecifictechnique.com or call 800-537-3001 or 267-498-0071.
 
 
Extension Exercise For Thoracic Kyphosis
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Written by Mark R. Payne, DC   
Thursday, 25 April 2013 21:31
G
reetings and welcome to Science In Brief. This column is an extension of ScienceInBrief.com, our chiropractic literature review service. The Science In Brief project scans the scientific literature base, both past and current, for articles of interest to practicing chiropractors, and then distills each paper’s pertinent points into “plain English” format for busy practitioners. Reviews are delivered weekly to your in-box and there is absolutely no charge to subscribe. The American Chiropractor has graciously allowed us to publish a monthly column to help in our efforts to keep the profession abreast of the latest relevant research. The following is a review of a 2008 article that didn’t get a lot of attention at the time. Thanks to our chiropractic sciences contributor Roger Coleman, DC (Othello, Washington) for this interesting article. I hope you find it and future articles to be helpful.
 
backextentionexerciseTitle
Spinal extension exercises prevent natural progression of kyphosis
 
The Facts:
  1. The authors sought to determine if spinal extension exercises could prevent the natural progression of thoracic kyphosis in women.
  2. Kyphosis tends to progress with age and increases are greatest in the 50 to 59 age group.
  3. The study involved 250 women who did not exhibit either scoliosis or compression fracture of the thoracic spine. 
  4. Participants were prescribed a series of nine extension exercises directed at the middle back, shoulder girdle, neck, and lower back. Participants were to perform the exercises three times weekly and were followed up at one year. 
  5. Participants exhibited less progression of kyphosis than the controls who did not do the exercises.
  6. The difference in the two groups was “highly significant.”
  7. Compliance was a problem as they were only able to get 18% of the subjects to perform the exercises regularly.
Take Home:
Although this was only a pilot study, extension exercises appear to be helpful in the prevention of kyphosis progression. More study is needed.
 
Reviewer's Comments
Most doctors of chiropractic utilize exercise in their treatment programs, although it is probable that many do not recommend exercises specifically for thoracic kyphosis. This paper should encourage doctors to look more closely at implementing appropriate programs of extension exercises for their patients with thoracic kyphosis.
 
Reviewer:  
Roger Coleman, DC
 
Reference:
Ball JM, Cagle P, Johnson BE, Lucasey C, Lukert BP. Spinal extension exercises prevent natural progression of kyphosis. Osteoporos Int. 2009;20:481-9. Epub 2008 Jul 26.
 
Link to Abstract
 
The authors point out that more study is needed. Nevertheless, I think the paper has practical application. Patients with kyphosis present in chiropractic offices with great regularity, so the subject is relevant. Also, by chiropractic standards, this wasn’t a particularly small study. Furthermore, the design and conclusions seem fairly straightforward. Best of all, there’s minimal risk and cost associated with the treatment involved. Taken together, I’m very comfortable recommending extension exercise for my patients with kyphotic deformity. 
 
Finally, it’s noteworthy that the authors, who are all faculty members of the Department of Physical Therapy Education, University of Kansas, experienced the same problems with patient compliance that many of us see in practice. This study tells us that, although it can be frustratingly difficult to actually get patients to do their self-care programs, the results for those who do participate are definitely worthwhile.
 
This column extends out of ScienceInBrief.com, our chiropractic literature review service.
 
Dr. Mark R Payne, Phenix City, AL is Editor of ScienceInBrief.com, a scientific literature review for busy chiropractors. He is also President of Matlin Mfg Inc. a manufacturer of postural rehabilitation products since 1988. Subscription to ScienceInBrief.com is FREE to doctors of chiropractic and chiropractic students. Reviews of relevant scientific articles are emailed weekly to subscribers.

 
Adrenal Fatigue and Chiropractic Care
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Written by James L. Wilson, DC, PhD   
Thursday, 25 April 2013 21:14
S
tress is one of the largest understated health problems in our country.1 Every chiropractor understands the important role the autonomic nervous system (ANS) plays in stress, and which adjustments enhance sympathetic/parasympathetic balance, decrease nervous tension, and produce relaxation and calm. 
 
However, many may not be as familiar with the function of the hypothalamic-pituitary-adrenal (HPA) axis, which is intimately related to the ANS and influences production of adrenal hormones that regulate stress adaptation. Chronic or excessive stress can overtax the ability of the HPA axis to respond adequately, which results in suboptimal adrenal function (adrenal fatigue). Unlike the relatively rare Addison disease,2 adrenal fatigue is a widespread problem that manifests as a unique circadian energy/fatigue pattern.3 By addressing adrenal fatigue in stressed patients, chiropractic can achieve deeper changes that increase patient well-being, vitality, and the ability to handle stress. In addition, adjustments hold better once the HPA axis and adrenal hormones are balanced. 
 
Begin by listening for the common signs and symptoms of adrenal fatigue:
  • adrenalsDifficulty getting up and being fully awake in the morning, even after a full night’s sleep
  • Caffeine is often necessary to get going and stay going
  • Energy lows occur midmorning and/or midafternoon 
  • Increased energy from 6 p.m. (dinner) to around 9 p.m. — often feeling the best of the day 
  • Experience a second wind from 11 p.m. to 2 a.m.
  • Most refreshing sleep is from 7 to 9 a.m., given the opportunity to sleep in 
  • Crave salt or salty foods 
  • Often also exhibit many signs and symptoms of hypoglycemia due to cortisol’s role in gluconeogenesis
  • Difficulty bouncing back from stress or illness
  • Decreased sex drive
If  these are present, there are three quick clinical tests to confirm suboptimal adrenal function: iris contraction, postural low blood pressure, and Sergent’s white line.4 
 
A positive test result can be followed with lab tests to establish baseline cortisol levels. My preference is the salivary hormone test, which patients can do during their regular daily routines. It measures salivary cortisol levels (more indicative of tissue levels than serum levels5) at four times during the day, usually at 8 a.m., noon, 4 p.m., and bedtime. Many labs can also measure salivary estrogen, progesterone, testosterone, and DHEAS. 
 
Much can be done to help chiropractic patients with adrenal fatigue, even when the severity is so great that they cannot hold down jobs or function well in daily life. The core of effective treatment is a combination of lifestyle and dietary modifications plus specific dietary supplements designed for adrenal fatigue. Spinal adjustments that release tension are helpful and about 25% of patients with adrenal fatigue have fixations at T-11 through L-2 motor units. Diathermy with the heads placed over the adrenals can also aid adrenal function.
 
Lifestyle recommendations include minimizing sources of stress, one or two brief rests during low-energy times of day (preferably lying down), sleeping in until 9 a.m. whenever possible, eating at regular intervals, and engaging in enjoyable, revitalizing activities. Dietary choices are important with emphasis on easily digestible protein, unrefined carbohydrates, and good quality fats or oils in every meal and snack, plus five to six servings of fresh vegetables daily. Frequent small meals help avoid getting too hungry and help keep blood sugar levels more normal. It is also important to eat by 10 a.m. and again before noon. Patients should avoid caffeine, alcohol, sugar and white flour. Ask your patients to read Adrenal Fatigue: The 21st Century Stress Syndrome and it will save you time by answering their questions and providing detailed lifestyle and dietary information to aid recovery.
 
The right dietary supplements are integral to full recovery in all but the mildest cases of adrenal fatigue. Chief among these are glandular extracts. In more than thirty years of professional experience, I have found that a combination of hormone-free, porcine extracts from the adrenals, hypothalamus, pituitary, and gonads works best. This provides the essential building blocks for repair and maintenance of the HPA axis, especially the adrenal glands. Herbs that balance the HPA axis function include ashwagandha,6 maca,7 Eleutherococcus senticosus,8 and licorice.9 They are especially beneficial when taken together, promoting a sense of balance and well-being during the day, and then calm and restful sleep when taken at bedtime. Specific nutrients are essential for normalizing and maintaining adrenal hormone cascade function, including relatively large quantities of niacin, vitamin B6, pantothenic acid, vitamin C, and magnesium, among others.10, 11, 12, 13 Vitamin C should be pH-balanced, to avoid aggravating the physiological acidity that occurs during adrenal fatigue, and sustained release for optimal clinical effect.
 
During a regular or briefly extended office visit, you can use this protocol to listen for signs and symptoms of adrenal fatigue, assess adrenal function, and start your patient down the road to recovery.
 
References
  1. Tangri R. What Stress Costs. http://www.clarityseminars.com/stress_clinical_research.html
  2. Liotta EA. Addison Disease Jun 7, 2010; http://emedicine.medscape.com/article/1096911-overview 
  3. Wilson JA. Adrenal fatigue: the 21st century stress syndrome. Petaluma: Smart Publications.; 2001. 43p.
  4. Wilson JA. Adrenal fatigue. the 21st century stress syndrome. Petaluma: Smart Publications; 2001. 82p.
  5. Riad-Fahmy D, Read GF, Walker RF. Salivary steroid assay for assessing variation in endocrine activity. J Steroid Biochem. 1983;19(1A):265-72.
  6. Archana R, et al. Antistressor effect of Withania somnifera. J Ethnopharmacol. 1999;64:91-3.
  7. López-Fando A, Gómez-Serranillos MP, Iglesias I, et al. Lepidium peruvianum chacon restores homeostasis impaired by restraint stress. Phytother Res. 2004 Jun;18(6):471-4.
  8. Panossian A, Wikman G. Evidence-based efficacy of adaptogens in fatigue, and molecular mechanisms related to their stress-protective activity. Curr Clin Pharmacol. 2009 Sep;4(3):198-219.
  9. Al-Dujaili EA, Kenyon CJ, Nicol MR, Mason JI. Liquorice and glycyrrhetinic acid increase DHEA and deoxycorticosterone levels in vivo and in vitro by inhibiting adrenal SULT2A1 activity. Mol Cell Endocrinol. 2010 Dec; 22.
  10. Patak, P, Willenberg HS, Bornstein SR. Vitamin C is an important cofactor for both adrenal cortex and adrenal medulla. Endocrine Res. 2004 Nov;30(4):871-5. 
  11. Groff JL, Gropper SS, Hunt SM. The water soluble vitamins: Advanced nutrition and human metabolism. Minneapolis: West Publishing Company; 1995. 221-37p.
  12. Murck H, Steiger A. Mg2+ reduces ACTH secretion and enhances spindle power without changing delta power during sleep in men—possible therapeutic implications. Psychopharmacology (Berl). 1998 Jun;137(3):247-52.
  13. Yoshida E, Fukuwatari T, Ohtsubo M, Shibata K. High-fat diet lowers the nutritional status indicators of pantothenic acid in weaning rats. Biosci Biotechnol Biochem. 2010;74(8):1691-3. Epub 2010 Aug 7.
 
For more than thirty-five years, Dr. Wilson has dedicated himself to helping people regain their health and vitality, and to promoting a deeper understanding of the physiology underlying stress. His book, Adrenal Fatigue: The 21st Century Stress Syndrome, is used as a university textbook, and many of the clinical tools he developed to help stressed patients are available at icahealth.com, including his original Adrenal Fatigue Questionnaire.
 
Dealing with Subluxations Effectively
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Written by Ogi Ressel, DC   
Thursday, 25 April 2013 20:55
M
ost doctors I speak with have a difficult time determining how often a patient should be adjusted. It all seems to stem from our understanding, application, and patient explanation of “maintenance care” and “corrective care”—terminology we often use interchangeably.
 
subluxationsWhat do these terms mean exactly? The vast majority of chiropractors across the globe schedule their patients (adults and children) for their monthly maintenance adjustment visit. We tell our patients that their monthly visit will help prevent and alleviate many problems that they will experience if they do not heed our warnings and accept our preventative-measure philosophy. 
 
Patients look forward to the end of their corrective care and the start of their maintenance care because it means to them that they have graduated; they have paid their dues. Their subluxations are corrected and are no more. Now life begins!
 
Patients are then seen on a monthly basis because it is good for them—that is our mantra. Most doctors are adamant about their patients following this protocol. And our CAs urge patients to follow their doctor’s advice on this matter. It makes total sense not only for the benefit of the patient, but also for the benefit of the doctor.
 
We all like to see our patients return and be happy to see us. There are also other benefits: Doctors can be certain of a steady income stream from “maintenance patients.” 
 
What about the benefit to the patient? A likely response is that your patients are getting great care, and you are preventing any future problems from presenting. But how certain are you that this is the case? Your monthly maintenance program may not be preventing or alleviating your patients’ future health problems.
 
Rather than solving or preventing the problem, most DCs place their patients on maintenance care that is simply maintaining the problem. Most of us tell our patients that our monthly maintenance program is of great benefit to them and that it will prevent specific issues from happening to them in the future. However, while the patients’ symptoms are gone, the problem is still very much present. Patients think their problem is resolved because they feel so much better, and as far as they are concerned, you have done a wonderful job. 
 
However, research by Tapio Vidman tells us that a subluxation, once formed, will initiate a degenerative pathological progression if it is allowed to remain for any longer than two weeks. This means that a monthly maintenance patient visit to our offices will ensure the patient will get worse over time. Their condition will slowly deteriorate and accelerate. 
 
Picture for a moment explaining the results of a patient’s progress exam to them and the fact that their films now seem to be much worse. The patient may confront you and ask why you have allowed their condition to worsen when they have paid you to keep them healthy. They may even ask for their money back as you have failed to provide them with a level of care that you promised. This can escalate into a huge problem, including State Board complaints and a possible lawsuit, not to mention the erosion of your reputation in the community. 
 

Money will not be an issue as long as they trust you and what you are saying makes sense.

 
In addition, most doctors do not see their patients on an appropriate schedule of care in order to be able to really correct their patients’ subluxations. Once formed, a subluxation becomes a habit; it is a neurological pattern that the body learns, adapts to, and copes with. Most often, subluxations start in children. 

The following excerpt is from a research paper I wrote on this subject:
 
"In the child, neuromuscular and functional adaptive reflex development represents a critical period of time when the young developing nervous system assimilates, differentiates, and adapts to external and internal stimuli. By means of these processes,the nervous system learns proprioceptive patterns and acquires future habits and reactions by responding to repetitive stimuli.
 
However, such a developing nervous system is not always able to distinguish between proper and improper stimuli; therefore, it responds to both. This is the conundrum - the response is neither "good" nor "bad," but rather adaptive to the presenting stimulus. These adaptive responses are remembered and patterned, and thus the young nervous system is conditioned for future response.
 
This process of neurological "learning" or "programming" of the central nervous system with respect to locomotion, posture,proprioception, and body kinetics begins within a few short months after birth."1
 
Unfortunately, many doctors see their patients on a schedule that they feel their patients will accept and can afford. This often translates into a patient being placed on monthly maintenance—and nothing more—once their symptoms are relieved. 
 
Rather than putting your patients on some nebulous and poorly understood maintenance program, I recommend you see your patients on "wellness" care: a maximum of every two weeks, especially for children. The correction of your patients’ subluxation patterning and habit is the most important thing. To me, there is no such thing as "maintenance."
 
I suggest you tell your patients the truth. Tell them what you are doing and why. Money will not be an issue as long as they trust you and what you are saying makes sense. Now, get out there and be the doctor you were meant to be.
 
References:
  1. Ressel, O, Rudy R, Vertebral Subluxation Correlated with Somatic, Visceral and Immune Complaints: An Analysis of 650 Children Under Chiropractic Care, J. Vertebral Subluxation Res. October 18, 2004
Dr. Ogi is a Practice Coach and teaches the Practice Evolution Program. He is an international lecturer, a pediatric and x-ray specialist, researcher and clinician. It was Dr. Ogi and Dr. Larry Webster who started the whole pediatric awareness and movement on the planet - when it comes to kids, he has no equal. He can be reached at This e-mail address is being protected from spambots. You need JavaScript enabled to view it or www.practiceevolution.com
 
The Post-Chemotherapy Neuropathy Patient - Can YOU Help Them?
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Written by John Hayes, D.C.   
Thursday, 25 April 2013 19:46
chemotherapyA cancer diagnosis is terrifying. 
 
The questions, the fear, and the concept of facing mortality are enough to paralyze even the strongest individual.
 
In the not so distant past, the standard was surgery, chemotherapy, or radiation, or some combination of the three, and that was it.
 
Then the patient played the waiting game to see what, if anything, worked.
 
People didn’t realize that the end of a course of chemotherapy was not the end of the healing process. They would deal with the lasting effects of chemotherapy long after their hair returned and the nausea ended.
 
One lasting effect for some patients is post-chemotherapy peripheral neuropathy.
 
Fortunately for the community, cancer patients are quickly learning that the right combination of physical therapy, nutrition, and often the correct forms of nerve stimulation in the hands of a skilled therapist can help alleviate the symptoms of post-chemotherapy peripheral neuropathy.   
 
The post-chemotherapy peripheral neuropathy patient is becoming an enlightened consumer of this specialty practice that goes beyond traditional medications and standard medical treatments.
 
A new, progressive approach to treating peripheral neuropathy symptoms gives specialty-trained DCs an ever-expanding patient population to serve. Treating patients who have already been through an experience that most people fear can be incredibly rewarding. 
 
To get these patients in your office though, you need to show them exactly how your training, expertise, and specialty care can improve quality of life. It’s not just about marketing traditional care that people associate with post-op issues or sports injuries. It’s about educating potential post-chemotherapy peripheral neuropathy patients on a multi-pronged approach to their medical issues:
 
It’s Not Just About Weight Loss or Some Device!
Chances are that a therapist specializing in neuropathy has never treated your potential post-chemotherapy peripheral neuropathy patients. They may think they know what a specialty DC does, but they may not understand everything that your unique services can do to manage their condition. 
 
Traditionally, your therapy is associated with the treatment of injuries and illnesses affecting the bones, muscles, ligaments, tendons, and joints. In educating post-chemotherapy peripheral neuropathy patients, recognize that they may deal with gait problems, muscular weakness, or even issues caused by radiation. Your usual techniques cannot always address the stress of dealing with any of these conditions.
 
Great therapy can help the post-chemotherapy neuropathy patient deal with the symptoms and pain associated with both their cancer and their course of treatment. Often, by carefully addressing pain in the correct way, as well as related tissues, we may actually stimulate a healthier nervous system, which is a basic building block for regaining pre-cancer health and alleviating nerve pain.
 
Nutrition
Chemotherapy and other cancer medications can wreck a patient’s digestive system. In the process of killing cancer cells, it can also damage healthy cells, which brings on the side effects of chemotherapy. This not only affects the ability to eat, but also prevents the body from getting the nutrients it needs.
 
Learn enough about good nutrition, but beyond that, knowing the basics of the biochemistry of nerve metabolism allows you to talk professionally to your post-chemotherapy peripheral neuropathy patients and their physicians about their nutrition issues. They may be dealing with any number of symptoms ranging from nausea and loss of appetite to dry mouth and changes in their senses of taste and smell. Offering nutrition information and dietary planning in your practice’s services is another way to serve this patient population. Good nutrition will boost the immune system and let it do its job fighting off illnesses brought on by chemotherapy.
 
Potential post-chemotherapy peripheral neuropathy patients may not realize that you can help with this is an area of their recovery. So if you trained in this specialty, make sure to include nutrition information in your patient education materials. Post-chemotherapy peripheral neuropathy patients need to make sure they’re getting nutrients to prevent or reverse nutritional deficiencies, lessen the side effects of treatment, and improve quality of life. Without appropriate, simultaneous nutrition, other treatment protocols have no chance to succeed. Just be sure you are trained and working within the scope of your license.
 
Appropriate Neuropathy Treatment
Once a course of treatment has been designed and a nutrition plan established, the final piece in the overall treatment of the post-chemotherapy peripheral neuropathy patient treatment plan is modality selection and combination.
 
There are several neuropathy treatment devices and therapies being advocated to help peripheral neuropathy patients. Misapplication is dangerous. Learning the correct applications for both clinic and home care for each unique patient is the best course of action.
 

When specialty trained and properly equipped can offer them hope for a more normal life without debilitating pain.

 
Some patients may have adopted an attitude of “I went through chemotherapy and my cancer is gone. I shouldn’t complain about nerve pain, tingling, and numbness. I should just be thankful to be alive.”
 
What they need to know is that they don’t always have to live with sleeplessness, pain, and balance and walking issues secondary to their treatment. Those who are specialty trained and properly equipped can offer them hope for a more normal life without debilitating pain. 
 
Yes, they survived cancer, but many can beat post-chemotherapy peripheral neuropathy too. 
 
Precise combinations of therapy, nutrition, and often forms of LLLT and LED with combined neurostimulation are showing great promise in helping post-chemotherapy peripheral neuropathy patients return to a pain-free life without the debilitating effects of neuropathy.
 
Serving this courageous patient population can be incredibly rewarding. However, this subspecialty takes some study and time to learn—you can’t learn it in a weekend.
 
When you are ready, let them know you’re there to help them. Just be sure you are the real deal. If not, let them seek appropriate care elsewhere.
 
 
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