Wake Up and Smell the Cafe Au Lait! A Story of Co-Pays and a Cash Based Service

Yum!  Here in New Orleans we really love our Cafe au Lait.  Even though I have changed the hot steamed milk for coconut milk these days, but I digress.

I work in two settings.  Two days a week I work in a busy orthopedic setting where I see a patient every 1/2 hour.  I have a waiting list of people to see me there for a few weeks.  Why?  Because I get results quickly.  However, this isn't about me per se.  This is about billing, co pays and the McKenzie Method® Mechanical Diagnosis andTherapy® (MDT): evidence based assessment, diagnosis and treatment for the spine and extremities.  Two days a week I work in my solo practice at Grimm Physiotherapy.  I really love working in both settings.

Here is the rub.  In the busy orthopedic setting we accept and bill insurance (a team of people are responsible for billing and collections). We don't accept every insurance but just a few plans.  If you have a co-pay of $75.00, $85.00, $95.00 or more ( I have seen the spectrum), you are expected to pay this for every visit.  Sometimes we spend part of your 1/2 hour debating the co-pay, but it really isn't up to us.  This just cuts into the allotted time we have to spend on your healthcare.  You may or may not get the opportunity to see me, a credentialed MDT physical therapist, but you may see one of our Physical Therapy Assistants, or have our Physical Therapy Technician help you with a few exercises, just like other traditional PT clinics.

Grimm Physiotherapy
"Everyone Deserves a Good Mechanical Evaluation and Treatment Plan!"

Now at Grimm Physiotherapy  the first visit runs $120.00 for evaluation, and $60.00 for one-half hour follow up care.  You get me, a credentialed MDT physical therapist, one on one for your entire visit.  There are 30 - 60 minute appointments available depending on your needs but generally follow up visits run about 1/2 hour.  I do not use aides, technicians, or assistants to manage your care.  I don't double book or dove tail treatment sessions.  You get to see me every appointment to improve the continuity of your care.  

Back to the dollars or numbers...If you see me at Grimm Physiotherapy 5 visits you would pay $360.00 (+ or -) out of pocket and you possibly could get reimbursed by your insurance company or apply it to your deductible.  If you elect to see me in the orthopedic clinic and you have a high co-pay, you may have to pay  $ 475.00 (+ or -) out of pocket and you may or may not get to see me for your treatments.  Are you getting the drift now?  This doesn't even include all of those appointments you paid cash for including massage therapists, chiropractors, and wasted time with other non-MDT clinicians. Imagine the cost of going to other non-MDT chiropractic and physical therapy clinics who book you 3 times a week for at least a month.  Imagine how much money that would be out of pocket.    

Do you want effective inexpensive healthcare?  Do you want to see your healthcare practitioner one on one for an hour?  This is what you get  at Grimm Physiotherapy.  I know, it is the way healthcare used to be, but with all the regulations, paperwork, and red tape you have to go through in a traditional settings this is getting to be rarer and rarer these days.  

You know what I am going to say..."Everyone Deserves a Good Mechanical Evaluation and Treatment Plan!"  Call 504-228-0524 or visit grimmpt.com to set up yours today. 

Low Tech vs. High Tech Treatment Options for Pain

Let's just say that my practice is as low tech as it gets... So when you are done with the High and Low Tech treatments that don't fix the problem, then check out the McKenzie Method® Mechanical Diagnosis and Therapy® (MDT).  MDT is evidence based assessment, diagnosis and treatment for the spine and extremities which is the preferred practice here at Grimm Physiotherapy.  MDT equally well in rural communities that don't have the high tech treatments listed below.  

Just for fun, let's look at just a few high tech ways to diagnose and treat low back, neck and extremity pain in the greater New Orleans area...

High Tech

Platelet Rich Plasma Injections
Lumbar Transforaminal Epidural Steroid Injections

Lumbar Medial Branch Blocks
Cervical Facet Medial Branch Blocks
Lumbar Facet Radio-Frequency Denervation
Cervical Facet Radio-Frequency Denervation
Cervical Interlaminarl Epidural Steroid Injections
Cervical Transforaminal Epidural Steroid Injections
Caudal Epidural Steroid Injections
Ultrasound Guided Injections
Electrical Stimulation
Ultrasound
Iontophoresis
Diathermy
Transcutaneous Nerve Electrical Stimulation
Discography
Sacroiliac Joint Arthrogram
Magnetic Resonance Imaging
X-rays
CT Scans
Surgery
 Flexeril (Cyclobenzaprine)
Zanaflex (Tizanidine)
Lioresal (Baclofen)
Soma (Carisoprodol)
Tramadol (brand names Rybix, Ryzolt or Ultram)
Medrol dose packs  (methylprednisolone)
Cymbalta (duloxetine)
 Lyrica (pregabalin)
Neurontin (gabapentin)
 Elavil (amitriptyline) 
 Pamelor (nortriptyline)
Celebrex
 Voltaren (diclofenac)
 Mobic (meloxicam)
 Relafen (nabumetone)
Vicodin
Tylenol with codeine
Oxycodone

Yikes!  Do I need to go into the side effects and complications from these procedures and medications?  Probably not, since most of them are discussed at length in TV commercials for medications and lawyers.  

No wonder our healthcare system is bankrupt!

Now for a few examples of:

Low Tech

Accupunture

Dry Needling
Manipulations
Massage

Taping

Rest

Ice

You know these all feel good. I enjoy them all on occasion, but they just don't get to to the root of the problem like the McKenzie Method® Mechanical Diagnosis and Therapy® (MDT) does.

You know what I am going to say..."Everyone Deserves a Good Mechanical Evaluation and Treatment Plan!"  Visit grimmpt.com  or call 504-228-0524 to schedule your assessment today.

Do Your Hands Go Numb When You Sleep?

Here is a great review of why your hands may go numb at night MD-Health.com

They list several possibilities including:

Wrong Sleeping Position
Ulnar Nerve Entrapment
Stroke
Carpal Tunnel Syndrome
Cubital Tunnel Syndrome
Cervical Spondylosis
Alcoholism
Seizures
Low temperatures
Type 2 diabetes
Raynaud's disease
HIV/AIDS
Transient ischemic attack
Vitamin B-12 deficiency
Spinal cord injury
Amyloidosis
Neck injury
Enlarged blood vessels
Tumors
Broken shoulder blade
Ganglion cysts
Multiple sclerosis
Lyme disease
Sjogren's syndrome
Vasculitis
Syphilis
Side effect of chemotherapy/radiation therapy

It is very difficult to diagnose yourself over the Internet. The most common reason your hands go numb is the first one listed.  Sleeping posture.  Now it isn't easy to change anyone's sleeping positions, because you can't control anything once you fall asleep.  But you can change your sleeping surface.  The easiest recommendation is simply to change your pillow.  Pillows are supposed to support your head and neck.

I recommend a down pillow because it is easily mold-able to fit the natural hollow or curves in your neck without letting the head tilt to far to the side or too far forward.  If you sleep with too many pillows you

may be sleeping with your head in a prolonged "forward head" position which can cause pressure on the nerves to your arms.

Memory foam pillows are not adjustable and might be the wrong fit for your neck.  

A very inexpensive solution is the  McKenzie Cervical Roll.  It is designed to support the curves of your neck whether you are lying on your sides or your back.  It slides right inside your pillowcase to keep it in place.  You may purchase one here.

For more information on correcting sleeping postures I recommend you read Treat Your Own Neck by Robin McKenzie.  This may be all you need to stop the numbness in your hands at night.  You may purchase the book here.    Let me know how it works for you.  If the numbness continues and you have a stiff neck or neck pain as well, give me a call.

You know what I am going to say, "Everyone Deserves a Good Mechanical Assessment and Treatment Plan!"  Visit grimmpt.com  or call 504-228-0524 to schedule your evaluation today.  

Woo Hoo! Pain Can Be Retrained!

Here they are again, saying it better than I ever could!  

If you are experiencing chronic pain, learn how to take a more active approach at Grimm Physiotherapy.  A good mechanical assessment, lifestyle modifications, diet and the right exercise just might be the answer to a pain-free lifestyle.  I am fond of saying that once we get the mechanical problems off of the table, then we have a good idea of what we are working with which will make it easier to treat chronic pain.

You know what I am going to say!  Everyone deserves a good mechanical assessment and treatment plan.  Visit grimmpt.com or call 504-228-0524 to set up your evaluation today.

The Most Decadent Paleo Recipe Ever!

Today I thought I would do a little something different with the blog.  Matt and I had some good friends over to watch the LSU-Mississippi State football game. Ugh!  Plain old painful.    We normally tailgate with them for the Saints night games at Emerils.  I know, I know...suffering! Anyways, I have been thinking about  my favorite dish there which is Smoked Mushroom and Tasso Pasta.  Of course, being all Paleo and everything you know I won't be ordering that anytime soon but thought what if?  What if I tried to make it at home with uncured bacon instead of tasso, coconut milk instead of heavy cream, and zucchini instead of pasta?  So that is what I did.  For you non-paleo people out there here is the original recipe...you can stop reading the rest here.  Smoked Mushrooms and Tasso over Orecchiette

Boy, do I love Emeril Lagasse's food!

I was so worried it would be like "SWYPO" like the whole 30 people talk about.  Honestly, it was just as good and equally satisfying.  Take my word for it. So here it the recipe and I know you are going to thank me...so you are so welcome!

Smoked Mushrooms and Bacon over Zoodles
Serves 6 normal people or 3 Crossfitters here is the recipe:

3 - 8 oz cartons fresh button mushrooms with stems removed and quartered
3 Tablespoons olive oil

My Big Green Egg

3 Tablespoons Emeril Essence (I made my own with this recipe here )

First, you need to smoke the mushrooms.  Emeril sells a stove top smoker, but hey we have a Big Green Egg that is great at smoking so we did that first.  Believe me, that is the secret ingredient and it is so easy and so good. Toss these together and smoke in a  stove top smoker or regular smoker about 25 minutes. (You should consider getting a good looking guy to do this for you like I did, because they will taste that much better!)  Set aside and cover with plastic wrap or you will eat all of them before you finish the dish.

For the next step you will need the following:
3 tablespoons coconut or olive oil
1 chopped onion
2 large cloves of garlic chopped
1 bunch green onions chopped
1 package of Pederson's  uncured sugar free Paleo approved bacon chopped (uncooked)
2 cans full fat coconut milk
1 tablespoon Lousiana hot sauce
6 zucchini cut on a spiralizer or julienned to resemble spaghetti noodles

Zoodles -  spiralized zucchini 

Heat oil and add chopped onion and bacon.  Cook until onions and bacon begin to brown,  add garlic and green onions and stir til garlic and green onion softens but don't brown.  Add coconut milk, hot sauce and mushrooms and simmer to combine  favors.  Add zucchini or zoodles to the sauce and simmer for 3-4 minutes until zucchini are cooked.  Serve warm.

I like to add more protein on the side so we served this with smoked chicken wings from Nom Nom Paleo which are almost as awesome.



Let me know if you make this and what you think.  Hail Emeril for inspiring this dish!

See Paleo can be just as good as anything you have ever had!!

  Smoked Mushrooms and Bacon over Zoodles

However, if this dish doesn't ease your aches and pains you know what I am going to say.  "Everyone Deserves a Good Mechanical Assessment and Treatment Plan!"  Visit grimmpt.com or call 504-228-0524 to set up your evaluation today.

Why What I Do Won't Work

As my mother used to say, and probably still does..."I wish I had a quarter for every time  you said that!"  Geez, thanks mom...What I wish is if  I could get a quarter for  every time a patient comes back for a follow up visit and says they aren't 100% better.  When questioned further, I generally hear that they didn't do the exercises as prescribed or at all.   Well...

It doesn't work if you don't do your homework!  Period.  The McKenzie MDT evaluation for your lumbar and cervical spine or extremities is extremely reliable and validated.  This means it has been proven by research to be very useful in diagnosis and preferred treatments.

I have worked extremely hard to fine tune my evaluation skills so that we are wasting very little of your time (and mine too).  I have also worked very hard to determine which movement or prescribed therapeutic exercise you need to do to remedy your condition.  Occasionally, I come across a few problems that PT or MDT cannot correct and this is made clear by the evaluation.  Sometimes the evaluation will take a few visits and include many repetitions of one or two movements over time to determine if this is something you can actually treat yourself.  If you do the work and your condition isn't rapidly resolved, maybe you need another intervention.  Just remember the magic will only happen if you do the work...

MDT is almost magical if you do the exercise enough and as prescribed!

Don't you think it is worth it to give it a chance?  However, I want to make it clear here.  If you are not interested in learning to treat yourself and to resolve your issues in the least amount of time and are unwilling to do your homework, don't bother coming to see me. Why?  Because it won't work!   There are plenty of others out there who will gladly take your money and your time.  If you want I can refer you to them.

No "Brainer" if you do the work!

 However, if you want more information about the McKenzie or Mechanical Diagnosis and Treatment Method, you may click here.   Also, check out this video below.  Its a good one!

You know what I am going to say..."Everyone Deserves a Good Evaluation and Treatment Plan!"  If you are willing to put in the time to do your prescribed homework then check out GrimmPT.com or call 504-228-0524 to set up your assessment today.

New Approved Medical Screen Mandatory, Prevents Disease, Falls, and Improves Overall Health and Longevity!

We are health conscious, or at least we are trying to be.  We count calories,  fat grams, amount of carbohydrates and weigh our food.  We monitor our blood sugar, heart rate, and blood pressure. 

We weigh ourselves regularly and watch our belt lines.  We test our cholesterol and our bone densities.  We measure our respiratory rates and our body mass indices.

Don't get me started on what I think of all of these tests.  We don't have all day!


But are we really measuring what matters?  Are you measuring your strength?  Flexibility? Endurance?  How about quality of movement?  Probably not.


Is there really a new approved Medical Screen that is mandatory...no, not really.  I was just wishfully thinking. 


When I was in Physical Therapy school one of my professors really enjoyed working with the "geriatric" population.  Her shtick was to make sure that her patients could get on the floor and off of the floor at least once a day.  When was the last time you did that?  I can hear the snickers out there right now.  Do you have any idea how many patients I see every week who can't do that?  We aren't talking about the geriatric population either.   Can you imagine how many people are unable to do this simple feat?


Can you touch your toes? Can you do a real push up?  Can you crawl? Can you climb stairs? Or a ladder? Can you squat below parallel with your heels on the ground?  Can you carry a 5 gallon water jug for 25 feet?  How about a suitcase on vacation?   If you are female can you blow dry your hair and fasten your bra in the back?  Can you hang from a bar like you did when you were a kid for at least 15 seconds?  Can you turn your head over your shoulders when you drive so that you can actually see something when  you merge into traffic?  Can you work overhead?  Can you stand on one leg with your eyes closed or even open for that matter?  Can you help pull a bike out of the ditch? Could you change a flat tire by yourself?




I could go on and on.  If you can do all of these things, GREAT!  Make sure that you keep the ability to do so.  If you can't, think about it, this is a huge wake-up call!  WAKE UP PEOPLE!  It isn't getting any better with time.

Movement as a study is extremely complex.  I am trying to learn as much as I can about functional movement and it is a little overwhelming, to say the least.  You can develop your own method of screening yourself if you wanted to but it is difficult to be objective and to record change.   However, there are standardized screens out there that you can benefit from.  I am most familiar with the Functional Movement Screen or FMS.   I love to use this in my practice once painful conditions have been addressed.   I also think it should be mandatory in all schools and gyms so that everyone would have an opportunity to measure their quality of movement. 

The FMS is used to rank movement.  It is not a test that you can pass.  It is a screen that highlights imbalances, weakness, and asymmetries.  It is comprised of 7 functional movements and 3 clearing tests including:  the deep squat, hurdle step,  in-line lunge, shoulder mobility, impingement clearing test, active straight leg raise, trunk stability pushup, press-up clearing test, rotary stability, and the posterior rocking clearing test.  It takes approximately 15 minutes and provides you, your healthcare provider or athletic trainer some valuable information.   Once you have completed this screen you are able to see quite clearly where problems exist in your basic movement patterns.  Corrective exercises can now be applied so that you can improve your movement before dysfunctional patterns are ingrained.  Of course, you have to actually do the exercises, about 15 minutes a day to see change for the better. 

To see how the Seattle Seahawks have benefited from the FMS check out this link here and you all know what happened after they introduced this screen and the corrective exercises...the dang Super Bowl!  If it is good enough for them it is definitely good enough for me too.  Maybe the New Orleans Saints could add this into their training too.



Wouldn't you think that this should be part of our quest for health and longevity?  I certainly do. Maybe instead of getting your cholesterol tested you should get your movement tested...just saying!


You know what I am going to say..."Everyone Deserves a Good Mechanical Assessment and Treatment Plan!"  This includes a Functional Movement Screen.  To schedule yours today, visit GrimmPT.com  or call 504-228-0524 to schedule your screen today.