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In the last blog, we talked about the article in the January edition of Dynamic Chiropractic discussing chiropractic and potential causations with vertebrobasilar artery dissection. Even among the experts the jury is still out whether or not a manual cervical adjustment can cause the actually tearing of the artery leading to the stroke or not. I was thinking, why not do some more review on the whole phenomena and make sure that as chiropractors we are prepared for a VAD presentation.   First things first…what would be a reason or two a patient with an impending VAD show up in the chiropractors office?  Oh you're going to love this, head and neck pain. I know, one of the bread and butters of the chiropractic profession head and neck pain and it happens to have a very dark side. According to PubMed aka the US government, they found that the headache pain was always located on the same side as the artery or in the posterior neck or have no symptoms at all! Are you kidding me right now?! No symptoms before the artery tears?!!! However, I continued my search through the literature and found some more keys to this mysterious and morose subject.   More often than not, a patient presenting in our offices would be complaining of a headache.  It’s possible to confuse it with a tension or migraine headache, however it appears in most cases there will be some other distinguishable symptoms. Sever, sharp, sudden onset of pain. With any headaches, that is a question that is supposed to be ask routinely anyways. Severe, sudden, coming out of nowhere pain (anywhere in the body) is a red flag. The severe, miserable out of nowhere headache almost always has neurological symptoms. Same side face pain/numbness, hoarseness, contralateral loss of pain and temperature sensation in the upper body and limbs. Hiccups, vertigo, nausea and vomiting Any potential signs of having a stroke like trouble walking, speaking, comprehension, numbness, paralysis, droopy face, slurred speech, etc.   Now for some more caveats.  VAD is more common in the younger folks (50 years old or younger).  Let’s say you have a new patient who is young and is complaining of migraine like symptoms.  Depending on the age of the patient, this could in fact be their first migraine.  The key here is, to do a thorough exam and history.  The likelihood is, is that it is a just a headache which chiropractors are very good at treating.    Having certain diseases can also lead to an increase chance in VAD.  Connective tissue disorders like Marfan’s, Ehlers-Danlos, rheumatoid arthritis, sickle sell disease, Down’s syndrome and neurofibromatosis all have a higher likelihood of vascular insufficiency.   According to the top result on google vertebral artery dissection occurs after physical trauma to the neck. Blunt force trauma, car accidents, sudden neck movements (which they lovingly put chiropractic under) and even coughing.    Painting the picture of a patient with a VAD lying in wait Under 50 Certain diseases (see above) Recent blunt force trauma Severe-sudden, worst headache ever (only on one side) Stroke like symptoms   With reviewing the signs, symptoms and reasons for VAD along with our vigilance we should continue to feel that chiropractic is safe and effective.  If by chance a patient shows up in your office and you even have the tiniest iota of suspicion that a VAD or stroke is coming on, likely or in the process call 911 immediately and DO NOT ADJUST THEM! For More Information www.ncbi.nlm.nih.gov emedicine.medscape.com ahajournals.org   Kassandra Schultz DC
Original article in Dynamic Chiropractic Vol 37, Number 12, December 2019   As I was reading the latest addition of Dynamic Chiropractic, I couldn’t help but cringe when I saw the title.  As a chiropractor or a chiropractic enthusiast how could you not? One of the potential dark clouds of our profession splashed across the front page.  I remember at Palmer, this was certainly a topic of concern.  This was ten years ago and I still remember the stat, in 100 years the medical community was trying to link 20 cases of stroke with chiropractic.  Considering the amount of adjustments given daily, weekly, monthly since the late 1800’s, the odds are still in our favor.  No matter how small the risk, our profession is still held liable and I know it’s one of the biggest concerns by new patients when they come through my doors.  Knowledge, more research and chiropractors staying on their toes, the risk of a vertebral artery dissection can still be very low and preventable.   The main thrust of the article is reviewing a collage of cases in which a manual cervical adjustment was administered to a patient and subsequently they experienced a vertebral artery dissection. Yep, heavy stuff for sure. Even in the article (all written by chiropractors) there is a debate whether the administering chiropractor did everything in their power to rule out the possible risk of their patient have a vertebral artery embolism just lying in wait. One examiner says they did and the other says they did not.   Let me explain… A female patient presented to their chiropractor with neck pain and idiopathic onset of headaches. The patient had not seen the chiropractor in many months.  The chiropractor assumed it was the same cervicalgia and headaches the patient always had.  No range of motion, neuromuscular or orthopedic tests were done on the head and neck. The chiropractic did do a history and brief examination and determined “out of adjustment at C2.” A manual cervical adjustment was given and within 20 seconds the patient suffered a vertebrobasilar artery dissection. The conundrum of the article is, was the artery already tearing free at that moment or did the adjustment break it free? With a thorough re-examination would the chiropractor have caught the symptoms before giving the adjustment which would allowed the chiropractor to refer the patient for immediate medical attention?  Immediate medical attention could have minimized the effects of the stroke and with the patient being transported to the hospital with suspicion of vertebrobasilar artery dissection the chiropractor would also not have done a manual cervical manipulation…hopefully. The verdict (literally) is still out and how much responsibility the chiropractor is being held too.   What exactly is a vertebral artery dissection? For your reviewing pleasure, “VAD is a flap like tear of the inner lining of the vertebral artery, which is in the neck and supplies blood to the brain. After the tear, blood enters the arterial wall and forms a blood clot, thickening the artery and blocking blood flow.”   Symptoms chiropractors need to watch for: Ipsilateral facial pain & numbness Hoarseness Contralateral loss of pain and temperature sensation in the trunk and limbs Ipsilateral loss of taste Hiccups Vertigo Nausea and vomiting   Some of these symptoms are similar to a stroke, any indications of a potential stroke or VAD DO NOT TOUCH or MANUALLY ADJUST the patient. Call 911, have them transported to the nearest hospital. This way you will be deemed a hero.   There are lots of websites with VAD information   www.ncbi.nlm.nih.gov acepnow.com clevelandclinic.org  Kassandra Schultz D.C
We are going to keep rolling with my Jordan Belfort Kick.  If you do not know who is he then please read my blog “ How to Convert More Sales in Less Time .”  Let’s begin on a positive note.  Here are some things you should be doing if you want to close more patients and have them stick around longer for care and pay you more money. You’re Sharp as a Tack: when you talk to the patient on the phone or when they walk through your office door, you need to act like someone who can help that potential patient fulfill their needs and solve their problems. Enthusiastic as Hell: you have to sound upbeat, positive and full of energy.  If you wanted to have a terrible bedside manner you would have been an MD right? An Expert in Your Field: it’s been ingrained in us our whole lives to trust and believe those in power and authority. During your sales process, you have to show them you know what you are talking about. Tonality: there are almost 30 different tonalities we as humans use all the time in our conversations. Here are few that can really make a difference: “absolute certainty,” “the reasonable man” and “sincerity.” I would recommend either his program to learn more about them or a NLP program that focuses on tonality.   Here are a few ideas of what you shouldn’t be doing: Don’t say dumb things! I love this one, but sometimes the urge is overwhelming. Try and control your urges, stick to the plan & close some patients for life. Screwing up the First 4 Seconds: you only have 4 seconds in the beginning of an interaction to demonstrate that you are “sharp as a tack,” “enthusiastic as hell” and “an expert in your field.” Even if you're tired, crabby and didn’t sleep well the night before, it’s still a better idea to slap a smile on your face and get to it in those first 4 seconds. Otherwise you may lose the patient right away, or the rest of the sales process will be even more arduous. Not Weeding out the People who aren’t a right fit for your practice: I will give you a great example. I stopped accepting insurance about a year into when I first opened my practice.  I could not wrap my mind around not getting paid for 3-4 months on top of fighting for the money from insurance companies. Subsequently, when a new patient calls in and they ask about insurance and my standard flat fees, I tell them.  I do not want an insurance based practice.  Why would have someone who insists on using their insurance even walk through the door? Don’t waste your time on people who don’t want or need your service, shouldn’t be buying it (because it’s not a good fit for them) and/or can’t afford it Some People are Never Going to Buy: some people are just not closable for what you selling. The only time it becomes an issue if you don’t close them and then the potential patient goes down the street and pays out of pocket for a different chiropractic service.  Then there might be a glitch in your process.   For more info on the “Straight Line Persuasion” system by JB check out: https://www.jordanbelfortmembers.com Kassandra Schultz D.C.
I have done quite a bit of sales training over the years and one of my absolute favorite sales guys is Jordan Belfort. I will be the first to say, JB is a unique individual. If you are easily offended by colorful language then he probably isn’t the guy for you.  Depending on if you are a movie buff or how much you remember news stories it’s possible JB’s name might ring a bell for a different reason. His story was depicted in the movie “Wolf of Wallstreet” and his character was played by Leonardo DiCaprio. The movie was about the penny stock company he grew illegally into a billion dollar empire until the US Federal Government shut it down and sent him to jail for a couple of years. What does all of this have to do with selling?  JB is a master of teaching anyone how to sell.  Since his prison stint, he now only uses his skills for good.  I have never seen a selling program that is as simple and easy to follow as his “Straight Line Persuasion System”.   I’m going to commandeer a few ideas from JB’s “Straight Line Persuasion System”. After you read this, I highly recommend checking out his program.  Here we go: The goal is to take a customer/patient from start to close as fast as possible.  The shortest distance between any two points is a straight line.  As the salesperson, you want to keep the person in front of you on the right track.  If the conversation veers from where you want it to go, then you redirect the conversation back to the straight line. Develop rapport with the customer Asking specific questions to gather intelligence and the customers needs Controlling the sale by keeping it on the straight line.   I loved the point he makes about developing rapport with your customer. The rapport should not be talking about golf, sunshine, kittens and rainbows in the beginning it needs to be a meaningful conversation showing that you care about them and their needs. Talking about bike riding in the first, 5 minutes of the conversation will not help them understand how fixing a subluxation will contribute to their overall quality of health or life.   Part of the questions to ask will be done during the history and exam but especially if you are selling a significant amount of chiropractic care upfront you may need to go a step farther with how their lives will become better or worse if they don’t signup to receive treatment from you.   When the patient sitting in front of you, starts talking about random things or getting off topic from the specific questions you asked, then it’s your job to redirect them back to where you were going with the conversation. It’s your job as the salesperson to keep the conversation going in the direction you want it go, and not let them get distracted or get off topic.   It’s sounds simple enough but it takes practice, body language, tonality and possibly even a script to help keep the process moving in a relatively straight line.    For more information on Jordan Belfort’s “Straight Line Persuasion System” check out https://www.jordanbelfortmembers.com   Kassandra Schultz D.C.
Search engine optimization…is it just me or are there really some down sides to owning your own business? I’m not saying SEO’s are bad but to me there are so many more interesting and exciting things to do as a business owner.  But hey, in the age of technology, speed of information and the majority of research and shopping is done online, I guess I better put SEO’s at the top of my to-do list.   If you are a little lack luster about SEO’s like I am, keep reading to find out why they are super important and will help grow your chiropractic office.   SEO really works… google alone is processing over 3.5 billion requests everyday!! Thats almost unfathomable. The cold, hard truth is the higher up on Google your website appears the more likely someone is to click on it. Really when was the last time you went to page 20, let alone page 2 of a google search? Um…I’m gonna guess probably never.   Cell Phones/Tablets=Bigger Opportunities for Small Business Owners… have you ever been walking down the street or driving around in a new town and decide you would like some coffee, pizza or ice cream? The first thing you do is go on your phone, type in “Coffee shops near me” and google brings up a list of surrounding coffee shops. This is the opportunity for a small business to up their google SEO so their shop appears before Starbucks.   Those on top Win… consumers give more credibility to websites listed at the top of the google search. Part of the reason is, your website probably has relevant information or content to the search.  Just like with anything, the more relevant you are the more people want to know you and use your services.   Organic Searches… this idea also ties back into “those on top win.” When a consumer does a google search, they generally look past the paid advertisement and click on one of the top websites that google brought up. Organic searches are leading in web traffic at 51% compared to 10% from a paid search, 5% from social and 34% coming from other source (BrightEdge).   Better ROI… think about…if most searches now are organic (non-paid) that means more money in the pockets of the small business owner. Organic searches which result in a lead opt-in will also reduce the cost of lead generation which again means a better return on investment.   SEO is Measurable… if you like this kind of stuff you can totally geek out over it. There are a bunch of numbers that can be tracked.  Google analytics is a good place to start with trying to sort through all the data. You can see all kinds of cool stuff like learning about your audience, traffic sources and viewed content/ most clicked pages, etc.   SEO and Voice Searches… ”Siri search for chiropractors in my area”… now with consumers using voice searches at least 50% of the time it’s good to have your website optimized so that it will still pop up at the top of google.   Kassandra Schultz D.C
I know as business owners, our frustrations can be endless.  Payroll, rent, advertising, taxes, customer fulfillment, patient complaints and employee drama just to name a few…but what happens if you have a rockstar employee or associate? What if your associate or front desk staff are really bringing the magic with patient satisfaction? What if the clinic hits the financial goals for the month? What would be some simple, yet thoughtful ways to really say thank you to a kick butt employee?   Lunch with the Boss: nothing says camaraderie like breaking bread with someone. Let them choose the restaurant.  As you are out to lunch, try and keep the conversation to a minimum about work stuff.  Use it as an opportunity to get to know them better, build some good rapport (you might need it later) and it also allows you as the boss to become more human to them.  Depending on finances consider dinner with some drinks.  Team Shopping Spree: this one is very much dependent on hitting financial goals/numbers. Let’s say you have 3 employees.  The gross goal for the clinic for the month is 30k. Each employee would get 3 hours, $300 to spend at the mall.  Afterwards everyone could get a snack, grab a glass of wine or maybe even dinner to conclude the day. CEO for the Day: they get to be the boss for the day. Let them choose something like a jeans day or a potluck.  (For added fun for you, let them field the complaints and write the checks..just kidding).   Need some more simple ideas? Keep on reading… Public Recognition… if a particular employee has been doing something really well don’t be afraid to acknowledge their good work in front of the other team members. Thank You Meeting: call them into your office to tell them specifically what they are doing well and thank them for their hard work. Certificate of Achievement: create and hand out a certificate for a specific achievement. Impromptu Time Off: send a text or an email that says come in late or go home early tomorrow. “Its a beautiful afternoon go enjoy it or “snow day!”…this one will be greatly appreciated and maybe helpful in the future if there is a day when they have to come in early or leave late. Coffee, donuts, on my!…. learn what their favorite breakfast treat is and bring them in one day. It always goes over well when I am on my way and I send everyone a text saying “what do you want from Starbucks?” Recognition Bulletin Board… hang up achievements, accomplishments, milestones, etc. Gold stars aren’t just reserved for kids. Indoor Food Truck… when it’s hot out you can walk around the office passing out Klondike bars and lemonade. When it’s cold out make a chili, coffee, hot chocolate cart (or some kind of hot food cart). Kassandra Schultz D.C.
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