Thursday, August 23, 2012

Why You Should See Me for Physical Therapy Rather Than An Office That Accepts Your Insurance

Anyone in New York who has received a referral from their medical doctor for physical therapy can relate to the following scenario: you have a high co-pay, anywhere from $15 to $50 for someone in-network, or you pay out-of-pocket until your $2000-$5000 deductible is met and then you’re responsible for about 30% of the billed charges. You get evaluated and treated and see your physical therapist for a total one-to-one time of about 5-15 minutes. The rest of the time is spent waiting with a hot or cold pack along with some electrical stimulation in which an aide sets you up with on whatever part of the body you are being treated for. And then you spend the rest of the time doing exercises in their gym being watched by the aide or even a personal trainer. You’re scheduled for 2-3 times a week of this for about 4-8 weeks.

The Problem

What you may not be aware of is that the physical therapist has his/her hands tied behind their back as it is the insurance companies that dictate what they can or cannot do. Health insurance is a business and as a business, the bottom line is profits. Every year they make it more difficult for providers to make a decent living as a therapist by 1) lowering reimbursement rates, 2) denying charges for treatments after a certain period of time regardless of medical necessity, 3) increasing the patient’s responsibility with higher co-pays & deductibles/out-of-pocket expenses, and 4) did I mention lowering reimbursement rates. It’s as if they change their rules every year and make it difficult for the provider to collect their charges. Because of this, the therapist has to over-book patients per hour in order to pay the rent and make a profit. It is common, if not standard, to schedule 3-6 patients per therapist an hour (I once worked in a local practice part-time that routinely scheduled me up to 8 patients an hour). As a patient, you may get annoyed and/or frustrated that your therapist is unable to spend more time with you and that your treatment is not improving your condition. In some practices, the patient may see a different therapist each visit. And of course, that 5-15 minutes with the therapist is because he/she is seeing 3-4 other patients at the same time as you.

For some patients, this is not an issue and they’re satisfied with this type of care since it works for them. This blog post is for those that can see through the ridiculousness and can smell the bullshit of the whole healthcare chaos/mess. As long as the provider is accepting health insurance within a distorted, profit-driven health-care industry, they are slaves to the system and slaves to the insurance companies. In other words, they don’t mind bending over and getting raped by the insurers.

The Solution

Presently, I wear two hats where I work a few days a week in an insurance-driven  medical practice providing physical therapy, chiropractic, and limited medical services in Forest Hills, New York and the other two days of the week, I see private, cash-paying clients in my home office in Howard Beach, New York. I don’t know how long I will be in Forest Hills, but for now the way I see things is in order to change the “game”, one must be within the “game” where Forest Hills is in the heat of the battlefield and I can at least soften the damage of the casualties of “war” by giving each patient I see the best treatment I can for the very limited time I am able to see them without getting sucked into the stress of the crazy “game”.  In my home office, patients pay me $150/hour and get my full Attention and thus get very significant results that they may have never achieved in an insurance-driven practice or if they did, would’ve have taken a much longer time (rare). For most cases, the insurance-driven practice is sufficient, but there is an alarmingly increasing number of patients with complex situations that medical doctors and therapists have no idea what to do with them and they’re sent to one specialist after the other, each with their own referred diagnostic tests that still tell them nothing that can help them achieve results. Frustrating? Obviously. Hopeless? No. 

I’m not saying I’m a miracle worker but I can truthfully tell you what I think may be going on with your situation based upon my thorough initial assessment which I base your treatment program upon where every session is an assessment & treatment at the same time and not some “one size fits all” protocol. I am not enslaved by the insurance companies so I will utilize whatever treatment modality I see fit for your condition. I’ve been doing this long enough to confidently state that I can help you feel better within 2-5 treatment sessions for the majority of cases where other more complex cases may take some more time (and commonly, the “simple” cases begin to unravel more complexities as one receives attentive care). Some cases, such as post-operative conditions will take several weeks to months – although, much more functional and effective results than conventional therapy.

The Bottom Line On Why It’s Worth Seeing Me As A Private Client:
1) Results. And not just any results but Better Results. And not just Better Results since there is always Hope, the Greater Awareness you will learn about your body and your “condition”, is quite simply,…Priceless.

Thursday, August 9, 2012

The Dirty Side of Howard Beach

So it's been exactly one week since I posted about the garbage on the Joseph Addabbo Bridge in Howard Beach towards the Rockaways. I did manage to email Senator Joseph Addabbo, Jr. on a Thursday in which he (or an intern) responded back to me on the following Monday writing that he will get the Department of Transportation and the Sanitation Department to take care of the mess. Of course, I'm not holding my breath waiting for this to happen but this is more of a test to see how fast our city's politicians respond to a quality of life issue such as pollution from a single, yet relatively unknown, tax-paying, law-abiding citizen, and most importantly, a registered VOTER (this would be me of course).

So today I took my baby girl for our morning walk towards the Addabbo Bridge and wasn't surprised to see that much of the same garbage from last week was still there and there was even more new trash dumped as well. Below are the latest pictures I took on my walk on the late morning of Thursday, 8/9/12 around 11 AM:

Good old McDonald's bag

Same illegally dumped couch from last week

Someone decided to dump an old rug on the sidewalk

Lovely view down the sidewalk with garbage everywhere

View from the bridge of the beach below-gets worse every week

Thursday, August 2, 2012

Hey Congressman Addabbo, How About Cleaning Up Your Bridge?

Walking South towards the Addabbo Bridge
Usually on Thursdays, since it's my day off, I get to take care of my two kids and one of the things I enjoy is to take a walk with my 6 month old daughter through the neighborhood I grew up in and love, Howard Beach. Like any other neighborhood, Howard Beach has its bright side to it as well as its dark side. This particular morning I decided to take another route towards the Joseph P. Addabbo Bridge going towards the Rockaways. I haven't been down this route in awhile but the first thing I noticed was the illegal garbage dumping all throughout the sidewalk path. And if that wasn't enough, as I approached the bridge, looking West towards the Jamaica Bay, by the beach underneath the bridge was  even more washed up garbage and the scavenger seagulls having a feast with the trash. It reminded me of a scenery I am familiar with whenever I travel to South America and beyond the "cleanliness" of the richer neighborhoods, are the filthy, mountains of garbage in the "slums" or outskirts of the heavily populated cities.

The beach underneath the Addabbo Bridge
Here's a sign of our times where we accumulate more than what we need and it is quite disheartening to see in the neighborhood I was raised in and the place where I choose to raise my children that such disregard for the Land, the very soil in which our houses are built upon, where what we call our Homes, are garbage dump mountains in the making. What went wrong? Does everyone else in Howard Beach aware of this? Does anyone in Howard Beach care?

They should care. We all should care.

Excess garbage breeds excess parasites/scavengers which breeds disease which infiltrates our soils and water supply. Of course, on the micro-scale of things many would reply, "what's the big deal?", considering the city has sewage treatment centers and our water is filtered and treated with fluoride and other chemical treatments to sterilize the water. True, but only a partial truth. What do you think will happen if no one does anything about the accumulating garbage on the beach and surrounding areas by the bridge??? Ever watch the Pixar movie Wall-E where we Humans in the Future have to leave the Earth and live in spaceships because we fucked up our planet and made it into a planetary dumping ground?

Walking North away from the Addabbo Bridge. Someone felt the need to dump an old couch on the sidewalk.
What's really going on? I don't have the answer to that but we can all agree it's about Responsibility. In this case, not taking Responsibility for our actions. Those who choose to dump their garbage wherever they want are disrespecting others who also share the land with them. In fact, no one truly owns Land. That is an illusion. You may be able to "buy" property, but did you Create it? The Truth of the matter is that we are merely Stewards of this Land and as Stewards, it is our Responsibility to take care of it. We may satisfy our egos to think that we own land because we paid money for it but that doesn't necessarily mean we "own" it. It's like the way the Native American Indians, before the Conquistadors "conquered", or "bought", them believed the Land in which they lived was a gift and it was their Responsibility to take care of it in an interdependent relationship. They believed that if you kill the land, you kill your people. And isn't that what's going on with illegal garbage dumping and the neglect to clean it up? Maybe many people are too distracted from their own little "big" worries of Life to even care about this but I think Awareness is a great initial step to effect change. Quite possibly, if more people were aware of the effect of their actions, maybe they wouldn't be so irresponsible and disrespectful towards others and thus themselves.

And finally, what if someone dumped their junk all over your place. How would you feel? The "it's not my problem" attitude is getting a bit thin since some of the shit is hitting the fan much closer to Home....Meditate on that.

Tuesday, July 17, 2012

Beetroot Juice

A couple of weeks ago while on vacation, I went out to eat with family and ate some things that were outside of my usual diet. This often happens when one is away so you try to do your best with what you have. I happened to wake up the next day feeling like absolute shit and because this commonly happens in these types of situations, and being that Health is one of my biggest priorities in Life, I knew of some old-fashioned remedies that always come in handy when away. My wife and I went to a local Whole Foods Market that had a juice bar and I had a carrot-apple-beet juice. Within the hour, my symptoms of lethargy, GI discomfort, bloating, and joint achiness disappeared.

Another instance was when my wife decided that she no longer cooks on Fridays and bought some take-out fried chicken from Dirty Bird in NYC. Now Dirty Bird isn’t so bad since they use free-range Amish chickens but their biggest downfall is that they fry their chickens in canola oil. Canola oil is an industrial by-product oil that use been maliciously promoted as a “healthy” oil due to its “omega-3” fatty acid content. This oil is unstable and goes rancid very easily facilitating a significant inflammatory/immune response in our bodies when consumed. It’s cheap and that’s why food establishments use it. It’s NOT healthy at all. Anyway, I’ve recently eliminated about 90-95% of all vegetable & nut/seed oils, as well as grains from my diet for the past 6 months since our baby girl was born earlier this year. Eating the fried chicken after an 11 hour work day, I was so hungry and had little reserve to prepare my own food, it did taste great but as I always tell my clients, “you play, you pay”. The next morning I woke up with a soreness in my right sacroiliac joint that interfered with bending movements. Historically for me, this happens when I eat too much gluten-containing grains and other processed food junk. I become a bit constipated, flatulent, bloated in the abdomen, and increased joint pain, mainly in the low back due to the viscero-somatic relationship of the gut and lumbo-sacral spine. To remedy this, I decided to drink some freshly strained beetroot juice a few days after I had the fried chicken. Beetroot juice is an absolutely powerful beverage and should not be taken for granted. You can do a Google search on its benefits and you’ll find that it’s a blood purifier, liver & gallbladder detoxifier, lowers blood pressure, has anti-cancer properties, aids digestion & elimination, and may even improve one’s skin health. I don’t know about all these benefits but I do know from personal experience with experimenting with several “liver & gall bladder cleanses/flushes” (for several years) and with extreme fasting, what it feels like to manipulate liver & gallbladder and GI tract functions. The beetroot juice appears to have an effect in stimulating bile release which assists the liver & gallbladder in unloading stored toxins and releasing them into the colon to be eliminated from the body. In layman’s terms: it can clean you out and make you poop more effectively. I drank a large amount of beetroot juice alone, about 12 ounces and immediately felt nauseous and had to lie down for about 20 minutes. Afterwards, when the nausea subsided, it stimulated a massive bowel movement and about an 80-85% reduction in my low back soreness. Pretty awesome, huh? I used to feel similar experiences after going through a liver/gallbladder flush protocols. Beetroot juicing can be considered somewhat of a “mini-liver/gallbladder flush” as a quick way to reset one’s metabolism after highly stressful conditions.

When you eat junk, the body will store toxicities from that junk if it doesn’t have the reserves to do it right away. Over time, excess toxicities can be stored in our organs and most commonly, into fat tissue. This creates an excess physiological load on the bodily systems and if not unloaded eventually, will lead to perceived symptoms. Usually when symptoms appear, the body’s compensatory mechanisms have already been overly taxed for quite some time. Food like beetroot juice greatly assists the body in unloading the stored toxins.


I do not suggest drinking beetroot juice alone and not greater than 1-3 ounces in the beginning. This may elicit a huge detoxification reaction such as nausea and GI discomfort. Try the juice of 1-2 beetroots along with some carrot and apple juice. Drink as needed to offset any undesirable effects of eating crap food or being excessively stressed out. At the most you may see your urine turn pinkish (possible sign of having low HCL (gastric acid) levels) and your poop turn reddish. Don't be alarmed. That's normal.

Also, do not use this as a “quick-fix” for a poor diet. You may become very uncomfortable and feel extremely sick if you do. There is no quick-fix to Health. Pay Attention. Experiment and Be Truthful with your experiences.

The How-To:
If you don’t have a juicer, you’ll need a blender. And a strainer as well.

1-2 small beetroots, peeled and sliced
1-2 small carrots, peeled and sliced
1-2 medium apples, peeled and sliced

-Add the produce into the blender along with some bottled spring water (enough to cover the produce)
-Blend until liquefied.
-Pour into glass over strainer.
-Drink and enjoy!

Thursday, June 28, 2012

Chocolate Coconut Marshmallows Recipe

Warning: Making these marshmallows and eating them may result in spontaneous bouts of happiness and sudden urges to hug & kiss those around you...

Who doesn’t like marshmallows? As a kid I was never concerned with what these sweet little treats were made of and just enjoyed them but as an adult who is very much concerned about Health and living a meaningful Life, I am. The marshmallows you’d typically find in stores are loaded with highly processed additives and preservatives and other crap that if you really knew how to make your own marshmallows, you’d wonder why they put so much unnecessary junk in the first place. Marshmallows require simple ingredients and if you’re going to make them you might as well make them clean ingredients. The main ingredient is not just sugar, but gelatin. Gelatin is the cooked collagen parts of an animal that is rarely eaten in industrialized modern society such as the bones, hooves, knuckles, etc. The truth is that these parts have a great number of health benefits. Rather than write about the benefits of gelatin, you can watch these videos from my friends and fellow C.H.E.K. practitioners, Josh Rubin and Ruben Serrano & Aram Hovsepian

Now let’s get to the recipe. I love marshmallows. I love chocolate. And I absolutely love coconut (I am Filipino afterall). What better recipe than to put them all together. I just made a batch the other day modifying a recipe by another friend and fellow C.H.E.K. Practitioner, Linda DeFever. You will need a hand mixer (or similar); if not, it’ll take a lot of muscle power to thicken the batter.

Chocolate Coconut Marshmallows

Actual ingredients I used

Sprinkle 3 tbs Great Lakes Gelatin onto ½ cup water and let sit for about 10 minutes until solid. You can experiment with a little more gelatin if you require more protein.

In a saucepan, heat ½ cup water, 1 ½ cups of organic sugar, 3 tbs raw organic cacao, and ¼ cup organic coconut flakes until it thickens a little. Linda’s recipe calls for a temperature of 220 degrees F but I didn’t have a thermometer so I just went by intuition. You can use less sugar, maybe a cup, and more cacao (maybe 4-6 tbs) depending on your taste. I plan on trying a batch with less sugar, more gelatin and cacao, and a little bit more coconut flakes next time.

Pour the heated mixture over the gelatin mixture and mix using a mixer for about 5-10 minutes until it thickens.

Grease a 9” x 10” baking tray (or similar) with coconut oil and pour the thickened mixture. Flatten it until level. Place into refrigerator for a few hours and then cut into squares. I prefer to keep the marshmallows in the fridge rather than keeping them in room temperature.

Enjoy and share with others…. 

Thursday, April 5, 2012

NKT Podcast

NKT Podcast

Go to the link above to listen to a recent podcast of Perry Nickelston of Stop Chasing Pain talking with David Weinstock and his Neurokinetic Therapy (NKT) approach. You'll hear incredible testimonials from four physical therapists who have been utilizing the NKT approach in their daily practice. Yours truly will be the last therapist to talk and as you'll see I like to talk a lot, especially about things I'm passionate about, like helping others with their healing Process. Enjoy!

Saturday, February 18, 2012

Case Study: Radiocarpal joint sprain/strain with resulting 4th & 5th digit palmar interossei inhibition due to medical incompetence

About a month ago my nephew injured his left wrist while playing basketball in which he fell onto his left arm where his wrist was extended, MTPs extended, and IPs flexed. I actually saw him before he he went to a medical doctor and from my clinical exam I didn't suspect any fracture of the left radio carpal joint. He did present with moderate swelling by the lateral wrist with hypo mobility of the joint as well with no deep point tenderness of the radius and scaphoid as well as all neighboring bones upon palpation. When he went to the doctor (PCP), he was diagnosed with a possible fracture of the "snuff box" (already you begin to sense some medical incompetency) and was casted from the wrist to the MTP joints (again,more incompetency) for about a week. After the x-rays were negative for fracture the cast was removed and there was some obvious increase in wrist and hand stiffness.  A couple of weeks after the cast was removed, my nephew had moderate weakness of the 4th & 5th digits into finger adduction and much difficulty extending them as well.  He needed to go to an orthopedist to get a note for school and he went to a local one in Howard Beach who said that he had nerve damage and referred him to get an EMG to another local doctor. When asked about his plan of care and prognosis he said that if the nerve is damaged that there was nothing that can be done and that physical therapy would be useless.  This is where it gets personal...

Nerve Damage? WTF?

My nephew is 13 years old and why would you recommend an invasive procedure such as an EMG to a young kid if regardless of the results, you didn't think anything can be done? Why? I'll tell you why: Money. Unnecessary medical testing rather than a simple, COMPETENT clinical exam makes more money for the medical practitioner.  Here's an orthopedist who clearly did not perform a basic clinical exam. Here's what I found when I started to treat my nephew: Inhibited 4th & 5th palmar interossei by facilitated dorsal interossei; inhibited extensor carpi ulnaris by facilitated flexor carpi ulnaris; inhibited forearm pronators by facilitated biceps; and inhibited latissimus dorsi by facilitated left posterior superior oblique; hypertonicity of the left deltoids, upper trapezius; inability to adduct the 5th & 4th digits mostly with the wrist in extension, moderately with the wrist in neutral, and minimally with the wrist flexed (but not completely adducted).  Movement assessment revealed a bias/shortening towards the Superficial Front Line (ala Tom Myers myofascial meridians) with insufficient bending pattern lacking flexion from the hips with excessive flexion from the thoracic and lumbar spine, knees, and toeing-out of the feet.

If there was any nerve damage it would most likely be of the ulnar and median nerves. The ulnar nerve gives off a dorsal cutaneous branch a little bit proximal to the wrist where it has no motor function. As it enters into the wrist through Guyon's canal (between the pisiform and hamate carpal bones), it has 2 deep motor branches in the hand and 1 superficial sensory branch in the palmar aspect of the medial hand.  If the sensory branch is compromised, a loss or decrease in sensation would be noted on the palmar aspect of the ring and pink fingers. If the motor branches are compromised (along with median nerve damage), a classic sign would be a claw hand deformity where there's a loss of intrinsic muscle function and overactivity of the extensor digitorum and hyperextension of the MTP joints; another sign would be a benediction hand deformity where the compromised motor branch of the ulnar nerve results in wasting of the interossei muscles, the hypothenar muscles, and the two medial lumbrical muscles (basically, the ring and pinky fingers would be flexed while the other fingers are extended.  My nephew did not exhibit any loss of sensation in the wrist and hand and did not exhibit any hand/finger deformities. His main difficulty since having the cast removed was with adduction of the ring & pinky fingers.

My Assessment

Since his hand and wrist were casted in a way where the dorsal interossei were in a shortened position, especially of the 4th & 5th digits, this may explain the difficulty to adduct them upon cast removal. It is not uncommon for soft tissue contracture to occur as an adaptation to immobilization for even a short period of time such as one week.  Also, regardless if there was any "nerve damage", there exists inhibition of motor function as a compensation of the nervous system to create a sense of stability to the system with accompanying facilitation of other surrounding musculature.  As I always teach my patients, "the nervous system always goes towards strength and avoids weakness", as a survival/protective reflex.


After just three treatment sessions of soft tissue manipulation, joint mobilization, and neuromuscular re-education, my nephew has regained greater than 50% of his 4th & 5th finger adduction active mobility and is now able to practice dribbling and shooting hoops with his left hand.  Each treatment session focused on manual therapy based upon an updated reassessment each time we started each session followed by corrective exercises, and ended with functionally integrated movement training.  My prognosis is that within one to two weeks he may be able to return to playing basketball unrestricted. The above picture was of some kinesiotaping I applied after the third treatment session.


My 13 year old nephew sustained a left wrist sprain/strain injury while playing basketball and further unnecessary medical intervention caused inhibition of the 4th & 5th palmar interossei inhibition with an inability to adduct those fingers and a weakening of his overall grip/hand functions.  With basic, sound, and competent clinical physical therapy evaluation & treatment, an orthopedist's medical opinion of hopeless "nerve damage" is disproved.  Moral of the story: Medical doctors in Howard Beach are more businessmen than actual "healers". But seriously, it's time for the public to become more aware and skeptical and to challenge the medical establishment and know that with the current health care environment, many providers are sinking into the easy money route and drifting away from actually caring for their patients...

BTW, if you live in Howard Beach, the orthopedist is Dr. Eswar; and the EMG referral was to Dr. Bieber...Living in Howard Beach my whole life, I've noticed a trend among  medical practices here: they're all "mills", which are high volume practices with poor quality care.  High quality care is possible in a high volume practice; how do I know?  I work in one.   ;)