Unraveling the Factors Influencing Visit Frequency

Ask the Chiropractor-

Today the my staff shared two questions they get asked.  People often ask them questions prior to scheduling a first visit.  This is part one of two. #healthy815 #icachiropractor #palmerproud

www.rockforddc.com

Transcript

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- Hello, Dr. Brant Hulsebus here and welcome to another edition of Ask the Chiropractor. Ask the Chiropractor is my little podcast that I do when someone has a question about chiropractor or chiropractic care, I try to answer. I'm a chiropractor here in Rockford, Illinois. I'm a proud graduate of Palmer College of Chiropractic and I'm happy to be the team chiropractor of the Rockford Ice Hogs. Let's dive into it. Well, hello, I'm Dr. Hulsebus. Thanks for joining my podcast. So the podcast is basically if you have a question about chiropractic, you should always ask a chiropractor. People usually come in the office, ask me a question, meet me in public, ask me a question, or they might leave a message below on a link, email the office with a question. But this time I went to a different source and this is going to be part one of two. I went to a source, I went to my staff, we just had a staff meeting and they said, "Hey, we have a couple of questions that we get asked all the time on the phone for people who are thinking about coming in." So I'm going to address the first question they get asked this week and then come back next week and you'll hear part two. So my staff told me one of the questions they always have is somebody will call in and they say that, "Hey, I have condition X, Y, Z," whatever it is,"Does your chiropractor first, take care of that? And second, how many times do I have to come to take care of this?" So that's the real question. How many times do I have to come? They might call and say,"Hey, I've got sciatica. Does your chiropractor handle that?" And the staff goes, "Oh yeah, we have people that come in with sciatica all the time," or headaches or neck pain, whatever. My staff's well aware of how patients get better because they help with your histories and they hear why people come, but they get this question, how many times do I have to come? We hear that question over and over and over again and I sure do wish it was a simple black and white answer to this question. It would be so nice to say, "Oh you have sciatica. Well that'll be eight visits. You have a headache, that'll be seven visits." It would be a lot easier for us, as chiropractors, to know the answer to that question. But there are just so many variables and things that go into answering this question. It's just not that simple. Let's talk about some of those variables so maybe you have a better understanding of where you are to understand what it takes to get better. The first question is, I get this from a lot of people, like "Hey, I just bumped into so and so and they tell me whenever they have a headache, they run in and get adjusted and their headache goes away." Well the person that told them that has been coming to the office for maintenance care probably for six or seven years, and this is really easy for us to take care of a quick problem with a maintenance patient. Yeah, we usually do get them better on one or two visits, but that's because they come in so frequently. We're not working so far uphill, we just need to do a little minor adjustment and they get back on their way. But typically what we're looking at when you come in as a new patient, what is it going to take to make you feel better? We have to take so many things into account. First, we'll just talk about you. Are you the kind of person that's disciplined? If I give you an exercise or a stretch, will you do it? If I give you ideas on how to, maybe a supplement or something like that, will you take it? Are you that person? If you are, things go quicker. And if you already are doing those things and you already have an exercise program and you already are pretty healthy and you already know, understand what a healthy lifestyle is, you have to come a lot less. You get rewarded for those things. But if you're somebody who doesn't work out, the only time you sweat is because you don't work out and you get up off the couch and you're going to sweat because that's how bad you work out. And if you're somebody who never eats right, never takes care of their nutrition, or you're somebody who has a tremendous amount of stress, right? Maybe you do these things but maybe you have a tremendous amount of stress in your daily life or maybe your personal life, you're going through things. Well that those things work against us now, it takes longer to get you better than if you didn't have that emotional stress or if you weren't already doing physical and chemical and emotional stress that are positive. So the more physical, chemical and emotional stress you carry, the more care you're going to require to get better. Just because we're starting at a lower point health wise than we like to start at. The next thing is, how many times have you dealt with this? How many different times have you experienced this? Is this your, you know, I've been dealing with this for the last 10 years and I've finally decided to give chiropractic a try. Can you get me better in two or three visits? Probably not. Because it's, this is like the 10th time it's happened and you develop a thing called muscle memory. So every time you irritate this part of your spine, the muscle memory knows how to kick in to protect you the best they can with the situation you put it in. Doesn't mean it's good long term, it means it's good short term. So if you've got lots and lots of really, really bad muscle memory, we're going up against a real uphill climb again. It's going to take more to get you better. Also, you know, this is the first time it happened, boy we can get you better, quicker, faster. But if this is, like I said like the 10th time boy, we're going to be seeing you a little bit extra because we have to work against that muscle memory. Also, how have you treated this in the past before? Did you go to physical therapy? Maybe try different motion things to make it better? Because that's, that's better today than taking a bunch of drugs to try to just mute it, right? Because if you just take a bunch of drugs to mute it, well then you've really developed bad muscle memory. But if you went to a physical therapist or maybe an exercise thing, then you're trying to keep it loose. You're not trying to build that muscle memory. So how you've treated previously depends how many more times you have to come in, right? Those are things that we take into account. And then you know, in our office, we usually take X-rays of you. So if you take an X-ray of your spine and you've got all kinds of kinks up and down your whole spine, because I talk about in my podcast all the time, this thing called the writing reflex. The writing reflex says your eyes stay level at all costs with the horizon. So if you hurt your neck and you tilt your head in one direction, your lower back's going to go the other way to keep you balanced. So if we look at your spine and we see two spots, that's going to be less care than if we see eight spots, right? If we see eight different spots misaligned because you're constantly trying to battle this writing reflex to keep your eyes level, it's going to take more care. Also, do you have other big mis-alignments in your spine? Did you maybe have a whiplash accident five years ago that you never took care of through chiropractic care and not it's healed funny, that's going to work against us, your previous injuries. Also, do you have a bunch of kinks in your spine? I mean, do you have like a scoliosis curve or a scoliotic curve or a big curve where there's an angle to your spine, the spine doesn't rotate and everything is involved. Or do you just have one little spot that's just kind of slightly misaligned? So the more that your X-rays show, the more severe, there's more going on, well, the more care you need. The less severe it is, the less care you need. And we don't know that without an X-ray. We've even had people that come in here that are professional athletes and we X-ray, we're like, "Well your spine's actually really good for being a professional athlete." We have other professional athletes, we X-ray, we're like,"Holy cow." So we don't really know these things until we actually look at your X-rays. So X-rays are a huge clue. Not only that, but do you have any bony changes to your spine? We see some people have a really bad curve in their lower back. And so like, your L5 or L4, all the weight only hits one side of it, like the left or right side. And there's a thing called Wolff's Law, wolf like the dog or the animal and Wolff said that the more stress you put in the bone, the bone will start to reshape and restructure to accommodate that stress. If you come in and take your X-ray and you've got this mal-shaped vertebrae because of all the stress you've put on it, it's going to take a little extra than if you just had normal shaped vertebraes. Again, maybe waiting to do chiropractic as the last results and then coming in and saying,"Hey, I only want to come, you know, you guys have like four times to fix me. I've waited 14 years to come in, but I'm only going to give you four shots to help me." I don't even accept those patients because it's just not realistic. I'm not saying that person has to come 40 times, but it's just not realistic. So how long you waited to get care, how many instances you've had in the past, the overall health of your spine, those are huge clues that we all use. Not only that, but what about your discs? Have you started getting arthritis? Remember when two vertebraes move or get misaligned, what we call a subluxation, the body will try to freeze those in order to prevent further injury. But when they're not moving, they're frozen, the disc starts to dehydrate and go away. As the disc dehydrates, it goes away, those vertebraes come closer and closer together and as it happens, it becomes more and more unstable and the body starts throwing calcium around there to help protect it. Because this is going to be a, their body believes it's a chronic issue because you waited too long to go to the chiropractor and you start to get degeneration. You know, that horrible word they say all the time, degenerative disc disease. It's not a disease, it's just a dehydrated disc and you start to get early signs of arthritis. Now if you have that going on, is it going to be one or two visits before it goes away? Well, probably not because you've got these big bony spurs that are now hyper inflammatory. Hyper inflammatory means it doesn't take much to make them hurt. So we're working uphill against that too. So what's the chiropractor to do? Well when you call in, we say,"We don't know until we see you." And here at my office, you come in the first day, we do our evaluation of you. We probably take some X-rays of you and we give you care. Then we have you come back like, the next day or two days later and then we see how you did. Right, because we don't know you. We don't know what you do when you're not here. Are you someone to exercise? Well, everyone tells me they exercise because they're hoping I'll tell them less visits. Even though you know, you might as well be honest if you want the honest results. But you know, everyone's going to tell me that. But we see you the second day and then we see how you adjust. Are you loose? Are you easy to take the adjustment? Was your body receptive to what we did? Did you have a bad night and inflammation because you have a lot of scar tissue in there? We find those results the second day. The second day after we see you, then every chiropractor sits you down for what we call a report of findings. We do that on our third visit typically, after we kind of know how you respond. And then what we'll do is we'll tell you what we think it's going to take to get you better. We need to see you X number of times for this number of weeks. And then we're going to do some, we're going to take a break, do an evaluation, maybe teach you some exercises, some stretches. And then we're going to see you like maybe like, once a week for X number of weeks as you're doing those to make sure you and them work together. And then we might back it off for like, every two weeks or maybe once a month for so long, just to make sure you're holding it. But again, there's no cookie cutter answer. It's going to take X number of visits. Because I just went over the variables I can think of in the top of my head. If other chiropractors are watching this, they're like, dude, you forgot to mention this and this and this. I know there's more, I'm just doing this off the top of my head, how many variables I can come up with. But again, you know, not to be all negative. If you exercise and you've done, you know, even some physical therapy a little bit and you eat right, you have a good mental attitude and you're willing to do the things we ask you to do, then we're cutting time down too. So even though I talked about some things make it longer, a lot of things make it shorter. So you know, that's the conversation, you have to have an honest conversation with your chiropractor to see where you are on the health spectrum to how fast you can get better and turn everything around. So there you go. How many visits do I have to come? I just threw a ton of stuff at you about the variables. The best thing to do is ask the chiropractor, hence the name of the podcast. So ask the chiropractor what the chiropractor thinks. And any good chiropractor should give you a layout of what they think you need. And if your chiropractor's not doing it, ask for it or ask the chiropractor for another chiropractor. All right, so there you have it. Ask the chiropractor what do they think it takes to get you better? And by the way, most patients, I tell them,"You got to gimme at least six visits to see if we're going in the right direction." Not six visits to fix it. Now some people, yeah, some people, four visits, they're doing great and that's awesome, right? And that's incredible, we love it. But you got to give me at least six visits most of the time to make sure that we're actually moving in the right direction. All right, if you have a question for the chiropractor, go to rockforddc.com. That's R-O-C-K-F-O-R-D-D-C.com. You'll see my website, you'll see our previous blogs. And come back next week for part two of this. The second question my staff get asked the most on the telephone from patients calling in who are thinking about starting chiropractic care. All right, everyone, thanks and we'll talk again next week.