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Surviving the Squeeze of the Sandwich Generation
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Written by Rich Van Loan, CRPC   
Saturday, 25 June 2011 02:12

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A
s if saving for retirement isn’t challenging enough, add to it the financial and emotional responsibility of helping your kids and attending to the needs of elderly parents, and you’re officially a member of the Sandwich Generation.

Buzz about the Sandwich Generation emerged several years back as the bulk of Baby Boomers reached age 50. While at the peak of their careers, many Boomers met this milestone with big financial obligations looming – funding their retirement, paying for their kids’ college, and caring for aging parents. Now, as more settle into their 60s, members of this demographic set face a new array of challenges.

Changing needs of aging parents

Watching your parents’ health deteriorate with age is something most of us anticipate having to cope with as we approach middle age. Adding to the pain for many Baby Boomers is the bad economy’s impact on their parents’ finances. In many families, the nest egg Mom and Dad relied on to fund their late-in-life needs has been eroded by declining investments and a sunken housing market.

Depending on the extent of their losses, the situation may require that their adult children step in and help. While their parents may have once thought they would live independently for their remaining years, that may no longer be a reality. What’s more, medical advancements have allowed people to live longer than ever before, putting extra strain on their retirement savings and their Sandwich Generation children.

Boomerang kids stay dependent longer

On the other side of the sandwich are young adult children who aren’t able to reach financial independence.  Graduating from college once meant getting a ‘real’ job and living on your own.  With today’s soft job market, many recent graduates are realizing they can’t live independently and are finding shelter under mom and dad’s roof once again – thus being dubbed boomerang kids.

Finding a solution

While the Sandwich Generation faces some issues foreign to past generations, there are ways to help lower your stress level and ease your financial burden if you are feeling the squeeze.  Consider these suggestions:

Update your financial goals regularly.  As your family situation evolves, you may need to reassess your target retirement date and the amount of savings you are planning to amass for retirement.  Dependent parents and children may translate into financial obligations for you, and the sooner you plan for them, the better.

As your family situation evolves, you may need to reassess your target retirement date

Maintain control of debt.  Saying that you’ll eliminate debt from your life may not be a realistic goal.  A more achievable bogie may be to steer clear of new debt.  With uncertainty approaching, you may want to avoid the lure of your dream home in lieu of a more secure future for your family.  Consider what you really need rather than what you want when making major buying decisions requiring long-term financial commitments.

Discuss care options with your parents.  It may be difficult to approach your parents with this topic, but planning early can pay off both financially and emotionally.  If you explore possibilities while your parents are still healthy, more options may be available – plus, your parents can help you work toward mutually desired goals.

Protect your assets with insurance.  Revisit your disability and life insurance coverage to make sure your family is protected in case you are no longer able to work or suffer an untimely death.  Long-term care insurance for you or your parents may also be an option to help offset the asset-draining cost of nursing home or home health care.

Put yourself first.  As you count down to the end of your career, make sure your retirement plan remains a high priority among your financial obligations.  While you can finance many things in life, it’s hard to put retirement on a credit card.  Don’t be a Sandwich Generation martyr by putting your own needs after those of your adult children or aging parents.  You’ll be a much more valuable parent and child with your own financial house in order.

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Be sure to ask your sales representative about the insurance policy’s features, benefits and fees, and whether the insurance is appropriate for you, based upon your financial situation and objectives.

Brokerage, investment and financial advisory services are made available through Ameriprise Financial Services, Inc. Member FINRA and SIPC. Some products and services may not be available in all jurisdictions or to all clients.

 

Rich Van Loan is a specialist in retirement, as well as a Senior Financial Advisor at Ameriprise Financial Services, Inc., in Boston MA.  He may be contacted at This e-mail address is being protected from spambots. You need JavaScript enabled to view it

 
Commercial Motor Vehicle Physicals—Your Unique Practice Option
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Written by Clinton M. Smith, D.C.   
Saturday, 12 March 2011 21:05

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F
or the first time in our profession’s history, we are soon to be placed on a level playing field with our M.D., D.O., Nurse Practitioner and Physician Assistant peers.  Soon, the National Registry of Certified Medical Examiners will become final rule for the Federal Motor Carrier Safety Administration. What this means is that Chiropractic Physicians will be on the front lines, keeping our roads safe for truck and school bus drivers. But what does all this really mean for each of us?

FMCSA estimates there are 200,000 examiners in the United States performing CMV exams. When the NRCME is implemented, each examiner will be required to complete certification training and successfully pass a Federal written examination. FMCSA estimates the numbers of examiners will drop to 40,000 examiners. This is for nearly 12 million drivers in the United States. These numbers reveal that opportunity abounds for examiners obtaining the training and certification.

FMCSA is concerned that the numbers of examiners will be too low. So what can you do now? Get trained. Though there is no certification training out there yet, there are companies developing these programs in anticipation of the final rule.  These drivers are forced to come to your office for these exams. No other program in your practice mandates anyone to come to your office. When these drivers see your pleasant surroundings, meet your staff and see you are very professional, the possibilities are limitless.

All of this requires minimal investment on the D.C.’s part. Basic exam equipment to include would be a stethescope, otoscope, opthalmoscope, urine dip sticks, a Snellen chart and a broad base of knowledge of DOT rules, regulations and recommendations, along with some core pharmacology knowledge requirements—this will put you in the forefront of performing these examinations.

Once you have the basics and are able to apply DOT rules and regulations to your clinical findings, you will be in the top tier of CMV driver examiners in the country.

Typical reimbursement is not insurance driven. No doctor-patient relationship is created and does not require managed care inclusion or intervention. These are cash exams either paid for by the drivers themselves or the company for which they work. Most exams are between $50 and $75 per evaluation. However, once NRCME is implemented, most exams will increase to around $100 until the service pool of NRCME examiners increases to force competition, and this will take some time.  An average exam takes around 20 minutes, but staff handling paperwork, blood pressure, and urine sampling can reduce the doctor’s contact to around 8 minutes for a normal, healthy driver. Of course, complicating factors such as co-morbiditities (diabetes, hypertension, smoking, seizures, etc.) will require more investigation, thus taking more time. However, the majority of CMV driver exams are straightforward and drivers are usually easily certifiable for the two year DOT maximum certification period.

So how do you begin performing these exams? Again, get trained. Once you have the basics and are able to apply DOT rules and regulations to your clinical findings, and do it consistently without wavering, you will be in the top tier of CMV driver examiners in the country. When the official training comes out, take that in a didactic lecture format or online (both will be allowed by the FMCSA) and then take the examination. There are pre-release training programs active at this time. Proposed rules state that a potential examiner should not have to drive a long distance to take the examination.  Beta testing that was administered in July of 2009 was proctored at H&R Block businesses around the country. We estimate this will be the contractor of choice for examiner candidates in this program.

Many have asked about the other required testing for CMV drivers, which include breath alcohol and urine drug testing. These two will enhance your practice and make it attractive to local companies that would like it all in one place.  Now, many companies have to go to three different clinics to get physicals, drug screens and breath alcohol testing performed.

Training consists of numerous modules presented in a slide show format. You will need to take notes and study for this exam.  No examiners will be grandfathered into the program. All examiner types will be on the same playing field and equal. Now is the time to begin your training and get proficient in these examinations.

As insurance companies erode your bottom line, DOT work can increase it. With a little elbow grease, equipment you already have and the desire to be investigative, your office can become a highly respected DOT clinic in your area.

Plan, in the next four months, your training path. Get going and, when the NRCME switch is flipped, be the first in your area to be an NRCME examiner, then get your drug and alcohol training to complete the “trio” of DOT services. Our profession stands to be the leader in DOT work for the future. We should all explore this opportunity.

 

Clinton M. Smith, D.C., is President of NRCME Training Systems, LLC, located near St. Louis, MO. He is a practicing chiropractic physician specializing in DOT/FMCSA physical examinations, drug screening and breath alcohol testing. He is a past member of the Role Delineation Study for the Federal Department of Transportation/Federal Motor Carrier Safety Administration. His company instructs physicians in examination protocols and certification requirements for the soon to be implemented National Registry of Certified Medical Examiners. He has instructed for Logan College and Western States and now lectures for NRCME Training Systems throughout the country.

 
Sacral Subluxation?
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Written by Kirk Lee, D.C.   
Friday, 11 March 2011 00:00

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s. M is a 15-year-old female who has started a low-impact cardio program at her local health club. After the first week of class, she developed a pain that she describes as both a sharp pain and ache in her right buttock. She reports no pain, numbness or weakness in the lower extremities. The symptom is aggravated when going from a sitting to a standing position or going up stairs when she leads with her right leg. Other activities of daily living—like getting in and out of a car, up from a desk chair and rolling over in bed—all bring about a response of pain.

Examination included a static postural evaluation, which appeared unremarkable. Ranges of motion noted a slight worsening of her right buttock pain with flexion. A two-legged squat was performed with no pain and single-leg standing noted a positive Trendelenburg on the right. Performance of a single-leg squat on the right noted pain with a difficulty in performing the activity. She further described it as a “feeling of unsteadiness.” Further gait assessment noted a decreased weightbearing on the right and decreased right hip extension. Reflexes were normal and symmetrical. She was able to rise up on her heels and toes normally.

Palpation noted significant tenderness over the right sacroiliac joint and dorsal sacral ligaments on the right. The piriformis noted minimal tenderness.  The straight leg raise test was positive in producing right buttock pain.  There was minimal difficulty raising and maintaining a raised posture of the right leg. Braggard’s Test was then performed and was negative of eliciting radicular pain into the right leg.

Radiographs were negative of apparent fracture, but demonstrated slight right sacroiliac joint widening and increased densities. Both iliac crest and femoral heads were slightly lower on the right in comparison to the left. Axial rotation was noted in the lower lumbar vertebrae. Lateral film was unremarkable.

We have heard it too often from patients that their family medical doctor or therapist or friend told them they had nothing but arthritis and would “just have to live with it.”

Diagnosis & Treatment
Considering the history, examination and radiographic findings, Ms. M’s neuromusculoskeletal condition sounds like a typical case we, as doctors of chiropractic, would accept. Correlating all our information, we determine Ms. M has multiple subluxation complexes of the lumbars, sacrum and pelvis. Following a report of our findings and giving our care recommendations, I have Ms. M sign an informed consent form, indicating the possible risks of chiropractic manipulative therapy. Then I begin a care program of chiropractic manipulative therapy to reduce and stabilize the existing subluxation complexes. I include the use of an exercise resistance band to strengthen the weakened right hip musculature. Exercises with the resistance band involve extension for the gluteus maximus, abduction for the gluteus minimus and medius, and internal and external rotation of the hip. Finally, I also scan Ms. M’s feet to determine the correct custom-made orthotic to add more support and stabilization.

Think Outside the Box
Let’s take into consideration some other possible diagnosis or related conditions that might be causing Ms. M’s neuromusculoskeletal condition. Based on the location of Ms. M’s pain, she is having some type of sacroiliac joint involvement, primarily resulting from mechanical alterations or joint dysfunction. Considering no history of trauma was mentioned, we must look at her activities of daily living as a potential cause. Other considerations might be within her case history or be extracted with a thorough consultation.

We have heard it too often from patients that their family medical doctor or therapist or friend told them they had nothing but arthritis and would “just have to live with it.” When assessing our patients, especially with no history of trauma, we should consider what other possible causes could attribute to the problem. We are aware that there are several progressive, inflammatory rheumatic diseases that commonly affect the axial skeleton and sacroiliac joint. This is sometimes referred to as spondyloarthritis, ankylosing spondylitis, reactive arthritis, undifferentiated spondyloarthritis, and arthritis associated with inflammatory bowel disease.

Many of these inflammatory conditions are characterized by insidious onsets, onset before age 40 to 45 years, improvement with exercise, no improvement with rest, morning pain or stiffness, and greater than three months duration of the pain. Inflammatory back pain that involves sacroiliitis has been shown to be a possible early sign of spondyloarthritis.
lee
A 1980 graduate of Palmer College of Chiropractic, Dr. Kirk Lee is a member of the Palmer College of Chiropractic Post Graduate Faculty and Parker College of Chiropractic Post Graduate Faculty. He has lectured nationwide on sports injuries and the adolescent athlete, and currently practices in Albion, Michigan.

References:
1. Braun J. “The Sacroiliac Joint in Spondyloarthropathies.” Curr Opin Rheumatol. 1996
2. Goodman, CC, Snyder, TEK. Differential Diagnosis in Physical Therapy; 3rd Ed. Philadelphia; Saunders, 2000
3. Khan MA. “Update on Spondyloarthropathies.” Ann Intern Med. 2002
4. Yochum TR, Rowe, LJ. Essentials of Skeletal Radiology, Second Edition: Vols.1 & 2. Williams & Wilkins

 
Forum: Ben Altadonna Shares His Side of the Story
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Written by TAC Staff   
Thursday, 17 February 2011 16:17

yellowpagesforumRe: Vol 33, Issue 1

To the Editor:

The American Chiropractor only told one side of the story in its January 2011 issue, when it republished misleading information from the Danville Express in its “Chiropractic Around the World” section.

Contrary to the claims being made by the Alameda County District Attorney, I am not a practicing Chiropractor and never marketed DRX9000 or any other decompression system directly to patients.  I did not develop, manufacture or sell the DRX9000, nor did I create the product advertising claims.

Like many others in our field, I relied on statements from Axiom Worldwide in recommending the DRX9000 to doctors who purchased the product directly from the manufacturer.  I was unaware that some of the information and claims I received from the manufacturer were erroneous and misleading.  My products and services have not contained the manufacturer’s claims since 2006.

I intend to vigorously fight these charges to attempt to intimidate Doctors of Chiropractic away from the use of spinal decompression.

My company, The Practice Building Alliance, continues to create high quality patient education material, which have been praised by doctors across the country, including Dr. Michael Roizen, the chief wellness director of the Cleveland Clinic.

I have cooperated fully with the District Attorney, and am disappointed her office has chosen to pursue this misguided, non-criminal civil lawsuit.  The public’s interest would be best served by focusing on Axiom Worldwide, the manufacturer who knowingly created the misleading claims.

In defense of doctor’s right to use this technology, I intend to vigorously fight these charges to attempt to intimidate Doctors of Chiropractic away from the use of spinal decompression.  The fact of the matter is that spinal decompression is extremely safe and continues to help countless back pain sufferers.

I would hope The American Chiropractor would seek to balance its news coverage by providing both sides of an issue in the future.

Sincerely,

 

Ben Altadonnna

 “The Practice Building AllianceTM

 
Acupuncture and Chiropractic…. Is there a relationship???
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Written by John A. Amaro D.C., L. Ac., F.I.A.M.A., Dipl. Ac. (N.C.C.A.O.M.), Dipl. Med. Ac.   
Monday, 31 January 2011 19:00

It is a historical fact, throughout numerous cultures in the world, spinal vertebral mobilization has been used extensively for literally centuries. Evidence exists from the ancient Mayans, Babylonians, Greeks, Egyptians, Sumerians, American Indian cultures, not to mention virtually every Asian and Middle East country, as well as the European and African nations.

Even though most people who hear the word acupuncture, relate it specifically to a Chinese healing art, the stimulation of certain key skin points on the body have been a part of the healing approach of almost every nation on earth in one form or another. From contemporary motor points, trigger points, reflex points, tender points, to the Indian “marmas,” Aboriginal “wantoo” and the Asian “jing luo mai” or acupuncture points to name just a few cultures, they are all basically the same thing.

When seen by the uninitiated, acupuncture appears to come from ancient methodologies based on myth, and pre-scientific superstition. It bases its energy flow on imaginary channels of which Western science has been unable to prove the physical existence. It has utilized a variety of stimulation devices from rubbing stone or bone over a specific skin point to the most accepted and recognized approach today, which is the insertion of a slender needle just below the surface of the skin. Modern acupuncture procedures, since the mid 20th Century, use TENS, laser and motorized mechanical stimulation to affect the skin point the same as the needle. However, all of these contemporary approaches have only been developed within the last few decades, as their discoveries and application have proven to elicit a similar response as the classic needle.

Acupuncture bases its general philosophy on the Yin and Yang, which are two dynamic polarities which affect all living and other structures of life. It is the positive and the negative. This balance of negative and positive is critical to the healthy functioning of the human body. The ancient Asians had no other way to describe this critical energetic event in the body other than by their own language, thus balancing of the Yin and Yang became paramount within the practice of acupuncture. Many will view the descriptions of acupuncture as being archaic, based on myth and folklore; however, the Asians described these applications and explanations in the only way they could, as Latin had not either been created or had not reached Asia to describe it in terms that a Western scientist today could understand.

On the other side of the world, the founder of the chiropractic profession, Daniel David Palmer, described health and disease in his classic 1910 book, The Science, Art and Philosophy of Chiropractic, sometimes known as The Chiropractors Adjuster. The title page specifically states this science is “Based on Tone.”

D.D. Palmer stated: “Life is the expression of tone. From tone originates all the principles which constitute the science and philosophy of chiropractic. It is a self evident fact that any change in tissue, other than that of normal tension, produces disease. Consequently, the cause of disease is any variation of tone, too much or too little.” This summation of Chiropractic literally parallels the basic concept of Acupuncture, as it describes the balance of Yin and Yang, the negative and positive. For example, on palpation, the DC may find on pressure, exquisitely tender points which are hypo tonic (Yin) or hypertonic (Yang). These tender points, which are utilized globally as “acupuncture points,” rely totally on the balance or imbalance of, as Palmer described it, “Tone.”

From the earliest days of chiropractic’s history, reflex points along the body include “zone therapy” utilizing points on the fingertips and toe tips which unequivocally relate to the famous “tsing” points used in acupuncture. Early DC’s knew of a variety of specific points on the body that, when stimulated, were predicted to elicit a response.

Perhaps the most pertinent of all of the similarities of chiropractic to acupuncture comes from the famous physician Huo Tuo. This physician, revered to this day, discovered over 2,500 years ago a series of acupuncture points which carry his name as the “HuoTuojiaji points.” These points correspond exactly to what would be discovered centuries later as the sympathetic trunk ganglionic chain, which is specific to the chiropractic “chart of spinal subluxations,” and the basis of the so-called “straight” philosophy of chiropractic. In this approach, it is known that the vertebral nerve root of C5 affects the thyroid, whereas the lungs are innervated by T3. This is carried out throughout the entire spine from Atlas to Sacrum. The ancient physicians of Asia and the Middle East were very aware of this approach to healing; D.D. Palmer made use of this ancient knowledge, which launched an entire profession. Today, with acupuncture, the contemporary practitioner makes vital use of the Huo Tuo points, which are one-half inch on either side of the midline of the spine directly over the lamina.

One major similarity of acupuncture and early chiropractic revolves around the ancient physician Mei Hua. Living at approximately the same time period as the previously mentioned Huo Tuo (2,500 years ago), Mei Hua expounded on a specific approach to healing. In this system, in all cases of any illness, before doing anything else, always treat an acupuncture point known as “Jizhong” (Middle of Spine) which today translates to GV6 between T11-T12 vertebrae. In addition, stimulate “shendao”, GV11 between T5-6. This would be followed by stimulating the points at the vertebral level of the spine, namely the famed “HuoTuojiaji” points.

Interestingly, 25 centuries later, D.D. Palmer stated in his early teachings that, in any case of any disease or dysfunction, always adjust “Kidney Place” and “Center Place” before adjusting the vertebral level of the condition. Kidney Place is the segment of T11-T12 (GV6), whereas Center Place is GV11. This approach parallels the Mei Hua approach to health identically, which is thousands of years old. Unfortunately, it is no longer taught in chiropractic but was the basis for the early profession.

There are scores of specific reflex points which have been used by the chiropractic profession in a variety of established chiropractic techniques over the last century. If one uses a needle to stimulate the reflex point then, classically and officially, it is considered “acupuncture”. However, should a practitioner use any physiotherapy modality allowed under their State Law to stimulate the same point, the procedure is referred to as TENS, Reflex Therapy, Trigger Point Therapy, etc. Today, the profession uses a variety of inexpensive electronic, laser and motorized manual approaches with stunning clinical success. It may be practiced by any practitioner, as it is non-invasive and falls within Scope of Practice Laws.

The fact of the matter is that there is a stunning relationship between acupuncture and chiropractic. Unfortunately, most people think of needles when mentioning acupuncture, however it must be borne in mind, just like chiropractic, “Acupuncture is a principle, not a technique.” It is not how you stimulate a specific reflex (acupoints), but where you stimulate.

Learning this work will insure your future clinical, financial and personal success.

 
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