May 2003 Newsletter

May 2003

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Utah's Best Chiropractic Seminar

Thursday, May 22, 2003 from 7:30 a.m. - 4:30 p.m.
Please see attached flyer for more information and directions to the Miller Campus.

This seminar has been approved for 4 Continuing Education Credit hours.

Please send a check made payable to Bryan A. Larson, P.C. in the amount of $40 per person to:
P.O. Box 95921
South Jordan, UT 84095-0921

Receipt of your check reserves your spot.
Deadline to sign up is Monday, May 19, 2003 at 12 noon.

The following article was taken from Injury Briefing a publication provided by Keith Hansen, D.C.

Dizziness Following Whiplash Injury

Dizziness is a common symptom after whiplash injuries, affecting between 40 and 70% of all patients with chronic pain. Patients with dizziness may report loss of balance or falls from the disorder. Symptoms of dizziness after whiplash have been attributed to brain injury or even trauma to the inner ear. The latest studies, however, seem to point towards the cervical spine as the culprit.

A group of Australian researchers has just published a study that looks specifically at the cervical spine to see if dizziness arises from lesions in the neck.

The authors used a technique known as "joint position error testing" (7PE). The technique uses motion sensors to record a patient's ability to position his or her head in space after flexion/extension and rotation of the neck. In previous studies, patients with neck pain (traumatic or non-traumatic) were found to have deficits with RE testing.

This study examined 102 patients with persistent whiplash pain and compared them to 44 control subjects. Each participant completed a set of pain and dizziness questionnaires. The results were then analyzed:

Of the 102 whiplash patients, 76 reported dizziness or unsteadiness.
The whiplash patients with dizziness had higher scores on the neck pain index than did the whiplash patients without dizziness.
On the joint position error tests, whiplash patients had significantly higher JPEs than the non-whiplash control subjects
Within the whiplash group, the patients with dizziness or unsteadiness had significantly more joint position errors than the non-dizziness patients.
For those patients with dizziness, the words most commonly used to describe the symptoms were "lightheaded," "unsteady," and "off balance."

Delayed Onset of Symptoms

The authors found that 17% of the patients reported delayed onset of symptoms after their whiplash trauma. They found that these patients with delayed onset also had significantly higher joint position errors.

"This perhaps suggests that the development of symptoms may be as a result of prolonged altered range of movement and decreased neuromuscular control rather than random occurrence. The tendency for larger JPEs in the group with delayed onset may also suggest that prolonged altered range of movement and neuromuscular control generates as much if not more problems for cervical proprioception than the initial proprioceptive barrage following the accident."

The authors also recorded the other symptoms associated with dizziness in the whiplash patients:

Description of Symptoms:

Lightheaded - 60%
Giddy - 27%
Falling/veering to side - 23%
Vague imbalance 19%
Unsteady - 52%
Imbalance - 25%
Trouble with stairs - 21%
Fainting - 15%
Off balance - 48%
Focus when walk - 25%
Imbalance in dark - 21%
Might fall - 15%
Clumsy - 30%
Motion sickness - 25%
Vision/eyes jiggle - 21%

Exacerbating Factors:

Increased neck pain - 60%
Neck movements - 44%
Moving quickly - 36%
Stress - 21%
Standing/sitting up - 57%
Neck positions - 42%

Associated Symptoms:

Headache - 56%
Decreased concentration - 35%
Sweating - 30%
Confusion - 21%
Nausea - 40%
Blurred vision - 38%

The authors conclude:

"The increased JPE in the WAD subjects complaining of dizziness suggests a cervical cause of the dizziness. The description of the dizziness or unsteadiness provided by the WAD subjects reinforces this suggestion. The common reports of unsteadiness and lightheadedness are those previously nominated for dizziness of cervical origin. Furthermore, 48% of subjects with these symptoms reported at least one episode of loss of balance with 21% reporting an associated fall which relates well to those symptoms reported from experimentally induced cervical vertigo."

From this study, it seems that most dizziness after whiplash injury originates in the cervical spine mechanoreceptors. Treatment of the cervical spine injury - and specifically the joint capsules with injury - should reduce the symptoms of dizziness experienced by these patients.

Treleaven J, Jull G, Sterling M. Dizziness and unsteadiness following whiplash injury: characteristic features and relationship with cervical joint position error. Journal of Rehabilitation Medicine 2003;35:36-43.

Maybe we should all be investing in insurance companies! See below: Allstate profits up 70%

Thursday, February 6, 8:14 a.m. Allstate Profits Up as Premiums Rise

NORTHBROOK, Ill. (Reuters) - Allstate Corp., the No. 2 U.S. car and home insurer, on Wednesday reported its fourth quarter profit rose almost 70 percent as it increased some premium rates and trimmed expenses. The Northbrook, Illinois-based company, second only to industry leader State Farm, said fourth-quarter profit rose to $447 million, or 63 cents per share. That compares with $264 million, or 37 cents per share, a year earlier. Total revenues rose 3 percent to $7.59 billion, helped by modest premium increases. "They beat expectations," said Deutsche Bank analyst Alain Karaoglan. "They have reached price adequacy - they don't need to fix their margins that much any more." Allstate, which has been looking to raise premium rates in areas it was losing money. That strategy is taking effect. In the fourth quarter it paid out 97.8 cents in claims and expenses for every dollar of premium it received. It lost $1.04 for ever premium dollar in the year-ago quarter. "While we took some rate increases in the fourth quarter, the need for rate actions abated somewhat in the second half of 2002 as rates taken earlier in theyear proved to be adequate," said Allstate Chief Executive Edward Liddy. Liddy also said that claims for mold damage in Texas - which has cost insurers hundreds of millions of dollars - were reducing as it limits mold claims in its new policies. Excluding certain items, Allstate reported 87 cents a share operating profit. Wall Street expected 77 cents a share, on average, according to analysts polled by research firm Thomson First Call. Looking forward, it forecast 2003 operating earnings, assuming average losses from storms and earthquakes, of $3.20 to $3.40 a share. That is in line with analysts' estimates, as polled by First Call.

Dr Jack Cracker

Jack Cracker is on vacation in Mexico to celebrate Cinco De Mayo. He will return next month.

The following article is the second of the two articles submitted by Heather Berube.

CA. SUCCESS

Speed the Way to Timely Claim Submission and Payment

Supply a section on your intake forms for your patients to provide all applicable insurance and payment sources including:

Patient's auto insurance carrier
Adverse party's ("at-fault" or "liability") insurance carrier
Patient's group health carrier
Patient's attorney's name, address and phone number

Verify this information with calls to the adjuster(s), customer service, and attorney's office. Although you may not need to bill these other sources right away or at all, when needed, you can submit claims promptly and avoid payment delays.

Once PIP is exhausted, which may be much sooner than later if the patient went to the hospital or any other provider prior to your office, bill the remaining balance to the patient's health insurance. Don't forget to include a copy of the notification letter from the PIP carrier that benefits have been exhausted - the claims will be "pended" without it!

If a patient does not have health insurance or an attorney, the liability carrier can be billed and should pay after treatment is completed, although payment is more secure with attorney representation and a signed lien.

Asking for information on all possible sources of payment up-front saves your patients' time and hassles down the road to recovery and can get you paid faster!