Archive for the ‘Pediatrics’ category

Age Them Out

January 12, 2017

Hello All! It seems I have a few new people following my blog post.  My grand total now must be about four.  Ha-ha, just kidding.  I have not posted in a while because if I am going to say something I hope it is new material, new knowledge or a new perspective that you can not get anywhere else.  I hope to continue to provide value for your eyeball time.  A couple of days ago a new mommy came in to discuss my philosophy regarding vaccines.  She was educating herself and she needed guidance on how to navigate these waters.  She just lit up and found our discussion helpful and informative.  It occurred to me that I have only shared these precious tidbits for parents who ask one-on-one.  Below is a snippet of what I discuss in an interview.

Right off the bat, let me reassure you that vaccines do not cause autism.  Having said that, there are some systems/bodies/patients/kids who are so sensitive/ill/different that they cannot handle the stress load of and may be allergic to a vaccine, any vaccine, or any injectable drug.

Here are a few items we discussed: 1. age them out; 2. vaccine dosages; 3. industry creep (ha…in more ways than one).

  1. certain vaccines are recommended at risk ages; for example, rotavirus vaccine is advised to be given at ages 2 months, 4 months, and 6 months.  If a new 9 month old patient came in I would not have to “catch up” the patient.  If you look at the vaccine schedule, link provided below, you can strategize, breastfeed to protect, wait out the risk window and…Age them out – for HIB, for Prevnar; I do have a lot more to say about rotavirus vaccine (its history, it is a winter virus -what if you have a summer baby – hmmmm…)

https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html

2. an older child who needs to be “caught up” would be caught up with the same vaccine dose that the infant gets; think about it…a child twice to three times as big gets the same vaccine.  Relatively, the vaccine and its ingredients is a larger dose because of the smaller body.  Why not minimize risks and wait a little?

3.  Hepatitis B started out designed to protect military recruits and college students (and drug users), populations at high risk for a sexually transmitted disease.  When I worked at a medical center that took care of the women’s prison population, you better believe we gave those babies the Hepatitis B vaccine regardless of maternal status.  Now any baby born anywhere has to get it.  Hmmm…can you see the industry creep?

There is a whole lot more to say, but hopefully this gives you an idea of how I think.

New Book & Rethinking Reviews

November 25, 2015

Hello all,

My new book below, Osteopathy for Children, is now officially available on Amazon.  My publishers would like to thank you ahead of time for your 5 star review of my book that you will post here at http://www.amazon.com/Osteopathy-Children-Holistic-Treatments-Developing/dp/1578266157/

So far the direct feedback I have been given are appreciated.  Please feel free to comment however you wish.  For whatever you have to say, my feeling is that either extremes make the review more “real.”

For instance, when I read Yelp reviews and I see over 50 reviews of someone, and they are all perfect, I want to “call it BS.”  Of course they were prompted to do it, so it is all fake.  I have read my own reviews and applied my contrarian views to myself.  I have been advised several times to respond to the “bad” reviews because the professionals have told me that it really affects people’s decisions.  I have read other doctors responses to bad reviews and it seems like it is too much for me.

  1. if I have time to address every bad review, then I must be a not so good doctor because I am trying to reel in more patients; even the ones who can’t find the balance between the good and the bad.
  2. I really do not have time because I am too booked seeing patients.
  3. I could farm out the responses, but then it would not be me and that would really be fake.
  4. My worst review and my best were written without my being aware of them:
    1. the worst – people will just have to read between the lines to get a sense of the person writing it; it was a frustrating relationship for me too.
    2. the best – Thanks Hillary! seems to me so genuine because it is and because I did not even think to ask.  Man, what a compliment, I never thought was MIT material.

osteo8

Doctor, Why Does My Child Twitch?

August 28, 2013

This month seems to be the month that I finally address this question. Parents, mostly mommies, will watch their children with an eagle eye and notice faint twitching happening throughout the body. Sometimes you will see a faint small one in an arm and within the next second one on the opposite leg. Then later the child is diagnosed as fidgety or worse ‘ADHD’ with suggestion that medication would help this hyperactivity. As they grow into the adult form of this symptom, they may still be labelled ADHD, and the twitching never goes away.

First, we need to answer, what is this twitching? It is not a full on muscular involuntary contraction. It is actually a fine muscle fiber contraction. I think that it is the body’s attempt to release or dissipate tension.

Second, how is this tension acquired? Because this is a blog about osteopathic philosophy, the tension is usually always traumatically acquired, and most of the time this is acquired through a high velocity impact. Of all my twitchy cases, there has not been one that was acquired slowly over time in the manner of a repetitive stress injury. They have been from falls (by rolling mostly) off the bed, pushed or shoved off the bed by a sibling, or at worse months to years after being involved in…a car accident.

After an accident, most parents don’t notice any problems that they can immediately attribute to the impact. They brush it off and soon it is out of their mind. Maybe a year or so later, mom will see something, get suspicious and then continue observing.

Why does it take months or years for this twitching to appear? At the time of impact, children are mostly water and their bones are mostly cartilage. They rarely break anything on impact. They just bounce. But that impact makes an impression of shock and the tissues (and future muscles) will seize up into that form. Later, when the child’s body attempts to growth out of that contractured state, tensions will develop along those lines. The child usually does not feel pain from these tensions primarily because their body, brain and spinal cord developed around these strains and mold them into the developmental pattern as ‘normal.’

Just like my “Doctor, Why are My Legs Heavy?” this post will answer a simple question that remains unaddressed or ignored by medical professionals all over the world. How do I know this with such certainty? Let me prove this to you and predict what will happen. Let’s prove this…First, have your child lay down. Have him or her pull he knees to chest, use the arms to hold the knees to chest. Have your child relax and keep the eyes closed…and just wait and watch…more twitching will come out! Sorry, I cannot explain to you how to disengage this activity from the brain and spinal cord, to reboot the system and reset it…too complex and esoteric…I only discovered this in the last several months. Let me now predict what will happen with the physical body. As your child growths up, there will be tensions on the lower extremity which might manifest in growing pains, tightness, or more twitching. From above, the development in the shoulders will be restricted, and they will be relatively narrow to the size and height of the child. Those restrictions will also impinge on the front portion of the head and neck. The neck will be pulled down and forward in hyperextension and the jaw and chin will be narrow and pointy giving your child an elfish or pixie look. Don’t worry…again, this is not painful…it is just evidence of constraints and tensions…it is not dangerous. It is a tension state that the body learns to accomodate. Later, when they grow up, these physical features remain. They will be relevant when your child has any further trauma or just ages. It becomes another load for the body to bear in addition to the gravitational work, at some point, somethings going to give…How do I know? I’ve seen it and I have treated it and the precise treatment results in instantaneous changes, which proves the theory.

Villain #2

August 19, 2013

All right…here it is…after discovering The Intubated Head and Neck Syndrome as a huge contributing factor in human disease, pain and suffering, I have decided that I found the second most villainest villain in all the history of villainy to be… the…dentist…

Most doctors studying the development of the head and neck focus on the first 3 cervical vertebrae because their structure are significantly different for different functions. These neck bones form from different parts. As they mature, these parts fuse to form permanent solid adult bony structure. On average, stages of fusion occur at 3, 5 and 7 years of age…The dental associations now have a pediatric dental subspecialty. Pediatric dentists say that children should start their first dental exam at around 3 years of age. Supposing their primary teeth are rotted out because of milk bottle caries, it is so bad that they want/have to do baby root canals and other procedures…So these kids are anesthetized, their heads and necks are positioned for ease and convienence of the dentist to access and yank, tug, drill, etc. Their undeveloped brain and spinal cord, once they wake up, are now reset to a hyperextended head and neck position as being “normal.” They grow up not knowing any different. Until they age, have sports injuries, head injuries, get into car accidents, have babies and one day the wake up with a migraine, or have symptoms of a herniated disc. Then they have chronic pain for which the CMS prescribe meds, injections or surgeries. If they seek nonmeds, nonconventional options they have massage, deep tissue massage, chiropractic, acupuncture, PT, other types of “bodyworkers” whose imprecise hands at best help the injuries peripherally and at worst, imparts additional force and strain. it is unfortunate but the conventional medical system does not take into account all these procedures as injuries loaded onto and straining a system. even worse still, osteopathic medical education does not teach us this either. i had to come to this understanding on my own 13 years after becoming a pediatrician. In effect, these injuries are permanently embedded because no one in the world recognizes them as such. Even now that i am shouting out to the world the insidious pernicious dangers, the public may take heed, but to find an osteopathic physician who can undo them is pretty much close to impossible (other than me).

I am increasingly skeptical and cynical that human health and preventative services really serve to improve over health conditions. Maybe what we should do is practice common sense traditional ways of raising our children, eating whole unprocessed diets, staying in an active lifestyle and then waiting for problems to show up and then only intervening when they are severe. Maybe we should continue to be ever skeptical, cynical and vigilant against guilds and professional ‘trade associations’ and their proclamations of ‘preventative visits’ as a means of early intervention in the service of mankind.

This week, one of my old established patients came in for a minor eye infection. I had not seen her in a few months. In the meantime she completed the first phase of braces, which is palate expansion. i looked at the way her head sat on her first cervical vertebrae and her chin and nose seemed angulated/cocked upwards…Her head and neck thought that she was still sitting in that dental chair. I watched her through the visit and she and her mother were unaware. We discussed the problem but the parent reported that the dentists really want to get these corrections done early before dental permanence…but lets consider their rationale…the trade off then would be imparting changes in the head and neck and locking those injuries in permanently…

Yes…i am now an anti-dentite. My kids are 5 and 3.5 years. So what if their primary teeth have cavities? Those teeth would have to be rotted before i take them in. I am going to try to not take them in until they are 10 years old at least. Yeah, I know, some people are going to say…hmmm…bad mommy…well…i will just have to tolerate it quietly to myself…because i do know better…hopefully you will consider this for yourself and your family.

Update: It is 7 months later and my work on a daily basis, confirms my this post and my feeling that we are doing much too much, much too soon…this is something I label “The Dental Chest.” All you men out there who look at yourselves in the mirror, while you are showering, and wonder but have never thought to ask, “Doctor, why is my chest caved in?” Well, now at least this doctor will read your mind and provide you with some insight. Concomittant with sunken in chest, the structure of the rib cage is such that the lower ribs flare out and appear raised (when you lay down) and down the middle of the rib cage there is a narrowing. These are adaptations to the strain in the neck caused by the insidious dental positioning. Unfortunately, there are also long term alterations to the drainage of the veins in your skull. When I see this in my patients, I am always horrified at how heavy the head is and even more so by the fact that you patients are unaware of it. So yes guys, if this sounds and looks like you, I can predict that you had a lot of dental work and/or braces in your teenage years. The good news is that this is fixable, your body wants to change. The bad news is…they don’t teach this to us in school…you will have to find a good DO osteopathic physician who can understand this post and fix it for you.

This is Jason's sternum. Note the depression in the middle of his chest.  His sternum is caved in and sunken.

This is Jason’s sternum. Note the depression in the middle of his chest. His sternum is caved in and sunken.

Here is Jason's chest.  I call it The Dental Chest.  He had braces for 3 years in his mid teens.

Here is Jason’s chest. I call it The Dental Chest. He had braces for 3 years in his mid teens.

Head Injury

November 3, 2012

Hello All.  It has been quite a while.  Lots of things developing lately…i will announce when ready.  Recently something happened, and how I reacted, reflects on how differently we osteopathic physicians assess and look at a situation.  Hopefully by sharing this episode, the broader public can assess their current health situation in context and compare between MDs and DOs.  Four days ago, I received a call from my chidren’s daycare.  You need to come.  Something happend to Kathleen.  What happened? You just need to come and pick her up.  Another kid ran into her on his bike.  Her head whacked the handle bar and she had this gigantic blue lump on her forehead the size of an egg…really it was quite a chickenegg.  The skin was scraped so thank goodness I did not have to sew her up.   My best friend, who is also a pediatrician with her kids in the same school prods me.   Did K hit the kid or did the kid hit K?  Her little one “saw the whole thing,” told her mommy that he did it and that K was the innocent bystander.  My best friend was really concerned and freaked out, more so than I.  The next day when i went in to drop her off, the staff was very nervous.  Her teacher who was present and watching the kids, felt so bad, she was crying and very apologetic.  I said to her, “Ahh, its okay. I’ve seen worse.  Accidents happen.” Really…I’ve seen worse…concussions, gigantic gaping cuts that lead to thick scars, etc…besides, the worst brain injuries happen when the force is transmitted deeper and absorbed by the skull or neurons; if her skin and scalp is bruised than, logically, it took most of the force and some minor residue is absorbed internally…better that than a “brain bruise,” i.e., concussion with brain swelling risks…  I let it pass.  I think everybody thought that I would flip out, threaten them and expect some head rolling.  Even my best friend was suprised at how lightly I was taking this.  She called me the next day and said that she was amazed at how Kathleen was healing.  Overnight, the lump and swelling practically went away.  It could have been the 2 doses of arnica that we gave her that night…but I suspect that she drained well simply because her head had been treated in the past.  Today, 4 days post injury, she is already starting to get the raccoon eyes when blood in the injured tissue starts to break down and ooze underneath the skin and bruising appears around the eyes (usually takes about a week).  My friend, who is an MD, whose two kids have great big giant melons, and traumatized ones at that, have really hard heads consequently, had never seen such quick resolution.  (I should have taken pictures…next time…told her to do the same for her kids and we will compare).  She was suprised that I was unfazed by this event.  She stated that if it was her kid she would be completely freaked out, paranoid and upset and try to get to the bottom of the cause of this accident.  I said accidents happen all the time…we see it…it will not be her only one…besides…she going to be smart-er for it…???????what?????how did you arrive at this conclusion???? you want her to have head trauma??? no…of course not…if it happens, if its minor, i’m not going to fuss over it.  Kathleen is already smart, primarily because of good genes and secondarily because she has an intact family with social support and involvement; everyone who comes in contact with her comments on how bright she is.  I proceed to explain that she took a blow to her forehead, frontal lobe, location of executive function.  The pressure and force of the trauma shocked her system, the brain and all those lovely neurons, 6 layers of gray matter (in humans, 3 in monkeys).  The pressure will force the neurons to cope and adapt and form new connections.   I plan on waiting for 2-3 weeks to let the pressure build up before i decompress her head…once new connections are made, releasing the pressure will not make them ‘unconnect,’ i.e., they will be permanent…it is not the size of the brain that counts, or necessarily the number of neurons, but the complexity and number of connections between the neurons that count…Some of you may be agast at how I plan on caring for her…allowing “pressure to build up”…mind you i can wait because she is subclinical, meaning it has not (yet) affected her sleep, behavior, personality…believe me, if she showed any signs, i would certainly throw my plans out the window and intervene sooner…Read my prior post on how Genius is Made and you will hopefully get a clearer understanding…Just today I treated a teenager who slipped and fell and severely whacked his head that he immediately and for hours afterwards got a headache, very likely a mild concussion…I treated him immediately because I did not want him to suffer.  The traumatic force alone was probably enough to cause connection formation, so that it would continue even if i decompressed him enough to eradicate the pain of the pressure.  I told his mom this, and she commented that this was the most unusual of perspectives that she has heard about head injury…she commented that he always seemed to be a bit brighter than his peers, but that she had attributed this to his being a 7 month preemie…i agreed with her, that the gravitational forces upon a premature infant head causes it to be heavy and dense, sometimes misshapen, but that they do end up smart, the only problem is that they also have focus, attention and impulse control issues…now on the other hand, what happens to fully mature and formed brains that undergo a traumatic injury…less plastic, less pliable tissue, less likely to form new connections, but with the same or even worse tendency to vascular congestion? is it reasonable to postulate that the protein build up in the brains of alzheimer’s patients is not so much the result of a genetic tendency to excess production and deposition but rather, poor clearance and drainage of normal protein production?  how about those ex-football players now who have early dementia, or Mohammed Ali’s neurologic issues, how can these diseases not be linked to trauma? or that during a critical developmental period in autistic children, when they are still neurologically plastic, from past traumatic injuries, instead of forming connections of those few neurons, the are developing “garbage collecting” white matter cells whose sole function is to try and dispose of those proteins because the drainage can range from mildly affected or severly compromised (hence the ‘spectrum’).  Osteopathy is very common sense medicine.  The nerds in their ivory towers would rather attribute genes and genetics to a biochemical process of deranged excessive metabolism and engineer (pharmaceutically, genetically) a product that will interfere or disrupt those processes.  Ahhh…how about we undo the trauma, let the tissue drain itself, clear and heal itself…i like this way better because it is profound and far more beautiful in its precision as to…causation…and the patient can be whole again and not have to be forever dependent on any medical system or drugs or machines.  i think that most patients suffering and lost in the vast CMS (conventional medical system) would consider this perspective refreshing and appreciate its beauty and simplicity.   ADDENDUM:  today is 11/3/2012, 5 days after her head injury…Kathleen has been difficult, whiny, clingy and just plain unpleasant this whole day.  As in a prior post, emotional lability is a sign of traumatic head injury.  I checked her head tonight and it is completely whacked out.  She slammed her head pretty hard and the force was still fully impressed in her forehead and the front part of her skull and brain.  I treated her and she said that she felt better.  Poor thing! ADDENDUM: Kathleen is now 8 years old and we just had her parent-teacher conference.  Her teacher says that she likes math! Who knew?? Well, I kinda did…Maybe she likes math because I show her my shortcuts…Next real post, I will update you on her lisp and that tongue…still driving me crazy.

Gap In Baby Teeth

March 10, 2012

All right…I am going to confess right now.  I have been obsessing over my 2 girls upper lip frenulum for something as minor as a future cosmetically thin upper lip.  Will they ever have full symmetrical lips?  At first I thought, and will admit, that I may be a psycho crazy momma.  Women pay to inject synthetics into their thin upper lips.  Women who can’t afford injections draw out a fuller lip with lipstick, daily.  What a way to live!  So I did a minor surgical procedure on them, which I will not detail, but will mention that it made their daddy nervous.  Good news is that it has helped.  Because I also happen to be a pediatrician, I started to notice other mommies cosmetic concerns, which is the gap in the upper incisors caused by persistence of this tissue flap.  I resorted to doing this to my kids, because I can.  I did not want to do it, but who else would do so?  I first thought of a dentist. Some won’t do it because it would be a cosmetic procedure and insurance won’t pay.  Then I thought of an ENT (ear, nose, throat) doctor.  But those guys are so busy doing reconstruction for cancer patients, patients with breathing problems.  They don’t want you to waste their time on such a minor…superficial issue.  So I decided today to start doing this for other mommas as a preventative and cosmetic procedure.  As you can see below, the results cosmetically for the lip is immediate and dramatic.  I will update in the future with photos of the teeth to show you how they progress.  This little guy was not happy with me, but both his momma and I agree that it was all for the best.  Braces in the future are costly, in terms of time and money, not to mention the potential for headaches and jaw pain for adolescents, or worse, adults with image issues who want to close that gap.  I am literally, nipping this in the bud. Call the office if you want this done.  Letrinh Hoang, D.O.  51 North Fifth Ave., Suite 201, Arcadia, Ca 91006 626-358-2500

www.doctorhoang.com

Unusual Symptoms

May 10, 2011

It has been a while since I last posted and I am now supercurious.  I continue to see unusual things.  If I am seeing these kinds of cases, then I have to believe there are plenty of you out there who are searching…For example…Doctor,…

My Child Has Chest Pain (and the Cardiologist says the heart is fine)

My Child Gets Sick All the Time

I Have Trouble Swallowing Water

I Have Anxiety After Neck Surgery

I Have Digestive Problems After C-Section

I Have a Red Face

Is There a Cure for My Bell’s Palsy? (yes)

and…

a lot of you out there have ocular migraines while you are driving!  what??!!! why, of all things you could possibly do, would it come out with driving????

how many of you out there have been injured, damaged by chiropractic cracking?

 

They Know

April 2, 2011

Again, I have confirmation that they, of the CMS (the conventional medical system) know.  The head of Cedars-Sinai Orthopedic Spine Surgery is a DO.  The head of Harvard’s Spinal Orthopedic and Rehabilitation is…a DO.  In 2007, they, Harvard, an allopathic MD school hosted a continuing education course for MDs, with full cooperation from New England DOs, to teach basic OMM (osteopathic manipulative medicine) 101 to MDs.  Ha-ha, joke’s on them, it will take about another 7 years of daily exposure to get even somewhat good.  For the course alone, they charged $1500.  Do the math.  They see the value and they are co-opting us, it, osteopathy.

There are MD neurologists, neuroradiologists, orthopedic surgeons, pain management, phys med and rehab doctors who know that surgery is not, most of the time, an answer, that PT fail frequently, that chiros injure and that traditional DOs are effective, so much more effective that they, of the CMS, would…lose patients…they dare not refer patients to us.  The gravy train of sick people needing help would…slow, if not stop.

Please continue to read through the prior posts so that you understand this medical system.  It is important for you to understand how you, your health, your family and friends fit into this system, that there is a far more cost effective (in the long run) alternate system out there.  Stay tuned for my next post in a couple of weeks.  Please forward this blog to friends and family read as, it will not be the same.   I fear very soon, I will be forced to reign in my voice, be more politically correct and censor myself.

Aspirations II

March 15, 2011

Supposing that on our road to greatness, we discover that we are not as skilled and we do not get the results that we expect.  What happens then?  Do we turn our backs on this osteopathic stuff that we love so much?  Probably not, it would be too costly.  In addition, it would be an admission of failure.  In any profession,  most people end up compromising. 

In my pediatric practice, I am pleased to say that I have not had to do this.  I do not accept Medi-Cal so that you don’t have to sit in a crowded waiting room, your child exposed to other sick children (sorry, I’ve done my time, mission trips, volunteering in free clinics -this was before children, when i was still young and idealistic).  I have not compromised on my stance regarding informed consent as the basis for a reasonable vaccine schedule (i.e., i have not succumbed to the HMO incentives for vaccination along the CDC schedule; yes, there is one financial incentive – this is another post for another day).

So the lesson of this post is Aspiration is inversely proportional to Compromise; in non-mathematical terms, they are diametrically opposed, they are antithetical to each other.  As you give up aspiring, you end up compromising.  As you compromise (your standards), you have really stomped on any spark that was once aspiration.  What is happening with “healthcare insurance?”  This is an oxymoron.

Insurance, in any other business arena, is just that.  They take your money and you don’t want to have to collect; life insurance is really death insurance and you don’t want to have to collect.  Health insurance, is no longer insurance.  I would call it medical contracts cards, that is what we are buying monthly with our premiums.  People use and consume.   Healthcare is no longer healthcare, it is disease maintenance.  It then, in effect, our premiums purchase a “disease maintenance medical discount contracts card.”  What a mouthful.  Believe it or not, most doctors, we are stuck in this cycle as well and we usually choose not to consume and we ourselves purchase super high deductibles so that we don’t not use.  When we do use, the cost to us at the discounted contract rate is considered a reasonable expenditure for information.

What happens then is that the increased cost of medical insurance comes from usuage.  When usuage increases, the insurance companies squeeze profits from employers, the insured, and the doctors.  So usuage leads to cuts, which leads to decreased quality, increased volume in waiting rooms, less time with patients.

So as you can well guess, insurance and the standard, biochemical, biostatistical model of medicine is not is not compatible with osteopathy.  For those of us who are traditional osteopathic physicians aspiring to greatness, we merely tolerate insurance for a short time…

Again, it is very important for you to share this blog with your friends, co-workers and families…more in the next few posts…

Aspirations

March 5, 2011

Hello all.  It has been a couple of weeks sinces I have posted.  I want to share with you the aspirations of us traditional osteopathic physicians.  By now you have a sense of how special this traditional osteopathic hands on stuff is to me, to us.  We love this work.  It takes so long to be this good.  It costs so much in terms of time, dedication, work, and yes, in dollar terms as well.  We do it because it has meaning.  It is profound beautiful work.  For our patients, we want them to understand their body, connect with the health that resides within, do the best that can be done, naturally and avoiding drugs, needles, scaples as much as possible.  The OMT work serves to guide the patient back towards the roadmap of health.  Once that memory is rejiggered, you no longer need us nor any other doctor or ancillary health care provider (including, podiatrist for arch supports, dentists and bite guards, massage therapists and deep tissue, yes, even, theoretically, glasses and optometrists/ophthamologists).  In what other medical field is the ultimate goal…you leaving us…to go out on your own…to be healthy?  Remember, I have said this before and I will say it again.  The mechanically unstrained body does not need anything or anyone. 

In doing this work we learn from our patients how to be better physicians. Most normal physicians want to spend time with our patients and to be compensated for the investment we have made in our knowledge, skill and experience.  Ultimately, what we want for ourselves is to be able to solve a case in as few visits (for the patient) as possible.  Patients are thrilled!  After wasting their time and money on multiple specialists who charge them, but then don’t get them any tangible results, the $500-$1,000 is the best cash they ever spent.  The trust is that philosophically, we want what you want, which is to not come back because you are better.  While we ambitiously strive for this goal, we continue to develop our treatment skills…we aspire…to greatness…

I will continue this thought in the next post.  In the meanwhile, it is very important that you share some of your favorite past blogs with friend, co-workers and family…