Physical Therapy
“I come to you”
At-Home, In-Office, At-Fitness Facility
The Physical Therapy service that I provide is delivered to you at your home, at your office, or at your fitness facility. I come to you.
It is cash based Physical Therapy.
Cash based service allows me to provide direct one on one high quality service. Traditional health insurance based Physical Therapy is burdened with administrative requirements which take time away from the services that I provide. Removing the requirements from health insurance plans provides a unique opportunity to take control of your problem.
Depending on what your expectations and goals are you can have a Physical Therapy visit last as long as you want or as short as you want. Depending on what your expectations and goals are you can have as many Physical Therapy visits as you want or as few visits as you want. We have control.
Are you looking for Physical Therapy service that provides?
•good enough healthcare
•all the healthcare you need to get back to what you want to do
•healthcare that is all the way well care
Together we can take the time to identify, clarify and measure your expectations and goals. We can become a team without hassles from a health insurance company. When the goals and expectations are agreed upon as Steven Covey said, we “can begin with the end in mind”. If we do not come to agreement on your expectations and goals, I will assist you in finding a more appropriate healthcare professional team member to help.
The expense of this type of healthcare is not necessarily more expensive than insurance based healthcare it is differently expensive.
•The expense/cost can be less than traditional insurance based Physical Therapy. National benchmarks for traditional health insurance based Physical Therapy is typically10 Physical Therapy visits per episode of care. I have honed my craft to a point where the average number of visits per episode of care is 3 visits. Using a standard outcome measure that is used by over 7 million Physical Therapists my score for improvement per visit ranks in the 97th percentile I provide effective and efficient service.
•If you have a health insurance plan with a high deductible, and are healthy, using cash based fee for service makes sense. I provide statements to you which you can submit and apply to your out of network deductible.
•All of the time during the visit with me is one on one with me. If you are going to pay for skilled Physical Therapy visit it makes sense to spend all of the time with the Therapist, as opposed to a PT Tech or exercising on your own during the PT clinic visit.
•If you have used all your allotted visits allowed by your health insurance plan for the year and you need additional Physical Therapy, using traditional insurance based Physical Therapy will be higher than using cash based Physical Therapy services. You will be responsible for the entire bill including co-pay. And, the time spent with the skilled Physical Therapists typically is only 15 minutes/visit.
•If you do not have health insurance the quality and efficiency of cashed based fee for service Physical Therapy is better than traditional insurance Physical Therapy.
•If you prefer privacy and convenience of At-Home, At-Office, At-Fitness Facility, I can help. Scheduling times are available early morning, evening, and weekends. On-line access is available.
Give me a phone call for a free consultation +65 9733 0932. I will provide details of benefits and costs of cash based Physical Therapy and a worksheet you can use to determine what your health insurance benefits and costs for Physical Therapy would be. You can than compare to determine if using cash based Physical Therapy makes sense.
Services provided:
•Orthopedic Physical Therapy
•Second opinions regarding Orthopedic Physical Therapy
•In home/office/vehicle ergonomic evaluation
•Assistance in ordering adaptive medical equipment, and home modifications to address movement system dysfunction
•Education on treatment/prevention or movement system disorders, and wellness
•Gait evaluation gait training motion analysis
If you combine, time saved, less time in pain, less time traveling to clinic, greater knowledge and understanding of your problem and being empowered to self-manage the problem, At-Home, At-Office, and At Fitness Facility Cash Based Service can be a real bargain.
Fluid Replacement Controversy: Too Little – Too Much
In 1996 the American College of Sports Medicine (www.acsm-msse.org) position stand on exercise and fluid replacement recommended that during exercise athletes should start drinking early and at regular intervals in an attempt to consume fluids at a rate sufficient to replace all the water lost through sweating (i.e. body weight loss), or consume the maximal amount that can be tolerated. Since 1996 studies have documented athletes can over drink, leading to water retention, weight gain, and in a few cases death from exercise associated hyponatraemic encephalopathy. Hyponatraemia is water poisoning; there is far too much water and too little sodium in the body. Symptoms associated with hyponatraemia include nausea, vomiting, head aches, cramps, convulsions, leading to coma. A study in 2002 documented that 13% of the Boston Marathon runners suffered from hyponatraemia. Hyponatremia is defined as a serum sodium level of less than 135 mEq/L and is considered severe when the serum level is below 125 mEq/L.
In July 2006 the International Marathon Medical Directors Association (www.aimsworldrunning.org) published a position statement “Update Fluid Recommendation”. The IMMDA presents 6 practical recommendations one of which is drinking to thirst will protect the athlete from hazards of both over and under drinking.
This recommendation of “drinking to thirst” is contrary to the common interpretation of the 1996 ACSM guidelines that drinking according to the dictates of thirst leads to “dehydration”, which impairs exercise performance and promotes risk of ill health. Frequently, I have heard the recommendation that you should start drinking early in the race even though you are not thirsty; because in order to stay hydrated you need to drink early and often. Dr. Tim Noakes argues that this practice increases the risk of drinking too much water and slower runners are at greater risk for hyponataemia, as they have more time to consume more water
(2007).
In Feb 2007 the ACSM published a replacement position stand on Exercise and Fluid Replacement. The goal of drinking during exercise is to prevent excessive (>2% body weight loss from water deficit) dehydration and excessive changes in electrolyte balance to avert compromised performance. The ACSM no longer recommends that during exercise athletes should start drinking early and at regular intervals in an attempt to consume fluids at a rate sufficient to replace all the water lost through sweating (i.e. body weight loss), or consume the maximal amount that can be tolerated. The 2007 guidelines recognize that drinking too much
fluid can also be dangerous. Athletes should weigh themselves before running and write the results on their race bibs. If anything goes wrong, emergency workers can use the weight information to tell if the patient had consumed too too little or too much water. The ACSM cites data water quenches the sensation of thirst before body fluid replacement is achieved, so thirst should not be the only determinant of how much fluid is consumed.
Dr T Noakes critics the 2007 ACSM position stand on Fluid Replacement relative to using body weight as a measure of dehydration. Dr. Noakes suggest body weight is not an accurate measure of body fluid and electrolyte volume during exercise. He suggest that the controller of the balance between body fluid and electrolytes particularly sodium is the thirst mechanism. Dr. Noakes has concluded there is no conclusive evidence that athletes who drink sparingly during exercise develop specific medical conditions and the ability to sweat profusely while exercising in the heat is on of the most important determents of human evolution. Research by S Schwellnus (2007) found no relationship between dehydration and cramping. During his study athletes measured their levels of electrolytes, body weight changes, and found those who cramped were no different from those who did not cramp.
He suggests cramping is likely related to meuromuscular control at the spinal cord level in response to fatiguing exercise.
The bottom line according to Dr. Noakes is drink according to the dictates of your thirst during exercise, and do not ignore thirst. This approach works for every creature on planet earth even the slower runners. According to Dr. Noakes when athletes drink according to thirst, the risk that they will over drink is minimized, and there is no evidence that they are at any significant disadvantage from the 3-5% level of dehydration that develop as a result.
The ACSM and the IMMDA disagree on whether thirst should be the guide regarding fluid replacement, but they agree that considerable variability exists among individuals, and blanket advice to widely variable population of individuals seeking simple answers is out of place. Athletes should be encouraged to explore, understand, and be flexible to their own needs. Look for multiple signs suggesting dehydration including thirst, body weight, volume and color of urine, and rectal body temperature.
“I come to you”
At-Home, In-Office, At-Fitness Facility
The Physical Therapy service that I provide is delivered to you at your home, at your office, or at your fitness facility. I come to you.
It is cash based Physical Therapy.
Cash based service allows me to provide direct one on one high quality service. Traditional health insurance based Physical Therapy is burdened with administrative requirements which take time away from the services that I provide. Removing the requirements from health insurance plans provides a unique opportunity to take control of your problem.
Depending on what your expectations and goals are you can have a Physical Therapy visit last as long as you want or as short as you want. Depending on what your expectations and goals are you can have as many Physical Therapy visits as you want or as few visits as you want. We have control.
Are you looking for Physical Therapy service that provides?
•good enough healthcare
•all the healthcare you need to get back to what you want to do
•healthcare that is all the way well care
Together we can take the time to identify, clarify and measure your expectations and goals. We can become a team without hassles from a health insurance company. When the goals and expectations are agreed upon as Steven Covey said, we “can begin with the end in mind”. If we do not come to agreement on your expectations and goals, I will assist you in finding a more appropriate healthcare professional team member to help.
The expense of this type of healthcare is not necessarily more expensive than insurance based healthcare it is differently expensive.
•The expense/cost can be less than traditional insurance based Physical Therapy. National benchmarks for traditional health insurance based Physical Therapy is typically10 Physical Therapy visits per episode of care. I have honed my craft to a point where the average number of visits per episode of care is 3 visits. Using a standard outcome measure that is used by over 7 million Physical Therapists my score for improvement per visit ranks in the 97th percentile I provide effective and efficient service.
•If you have a health insurance plan with a high deductible, and are healthy, using cash based fee for service makes sense. I provide statements to you which you can submit and apply to your out of network deductible.
•All of the time during the visit with me is one on one with me. If you are going to pay for skilled Physical Therapy visit it makes sense to spend all of the time with the Therapist, as opposed to a PT Tech or exercising on your own during the PT clinic visit.
•If you have used all your allotted visits allowed by your health insurance plan for the year and you need additional Physical Therapy, using traditional insurance based Physical Therapy will be higher than using cash based Physical Therapy services. You will be responsible for the entire bill including co-pay. And, the time spent with the skilled Physical Therapists typically is only 15 minutes/visit.
•If you do not have health insurance the quality and efficiency of cashed based fee for service Physical Therapy is better than traditional insurance Physical Therapy.
•If you prefer privacy and convenience of At-Home, At-Office, At-Fitness Facility, I can help. Scheduling times are available early morning, evening, and weekends. On-line access is available.
Give me a phone call for a free consultation +65 9733 0932. I will provide details of benefits and costs of cash based Physical Therapy and a worksheet you can use to determine what your health insurance benefits and costs for Physical Therapy would be. You can than compare to determine if using cash based Physical Therapy makes sense.
Services provided:
•Orthopedic Physical Therapy
•Second opinions regarding Orthopedic Physical Therapy
•In home/office/vehicle ergonomic evaluation
•Assistance in ordering adaptive medical equipment, and home modifications to address movement system dysfunction
•Education on treatment/prevention or movement system disorders, and wellness
•Gait evaluation gait training motion analysis
If you combine, time saved, less time in pain, less time traveling to clinic, greater knowledge and understanding of your problem and being empowered to self-manage the problem, At-Home, At-Office, and At Fitness Facility Cash Based Service can be a real bargain.
Fluid Replacement Controversy: Too Little – Too Much
In 1996 the American College of Sports Medicine (www.acsm-msse.org) position stand on exercise and fluid replacement recommended that during exercise athletes should start drinking early and at regular intervals in an attempt to consume fluids at a rate sufficient to replace all the water lost through sweating (i.e. body weight loss), or consume the maximal amount that can be tolerated. Since 1996 studies have documented athletes can over drink, leading to water retention, weight gain, and in a few cases death from exercise associated hyponatraemic encephalopathy. Hyponatraemia is water poisoning; there is far too much water and too little sodium in the body. Symptoms associated with hyponatraemia include nausea, vomiting, head aches, cramps, convulsions, leading to coma. A study in 2002 documented that 13% of the Boston Marathon runners suffered from hyponatraemia. Hyponatremia is defined as a serum sodium level of less than 135 mEq/L and is considered severe when the serum level is below 125 mEq/L.
In July 2006 the International Marathon Medical Directors Association (www.aimsworldrunning.org) published a position statement “Update Fluid Recommendation”. The IMMDA presents 6 practical recommendations one of which is drinking to thirst will protect the athlete from hazards of both over and under drinking.
This recommendation of “drinking to thirst” is contrary to the common interpretation of the 1996 ACSM guidelines that drinking according to the dictates of thirst leads to “dehydration”, which impairs exercise performance and promotes risk of ill health. Frequently, I have heard the recommendation that you should start drinking early in the race even though you are not thirsty; because in order to stay hydrated you need to drink early and often. Dr. Tim Noakes argues that this practice increases the risk of drinking too much water and slower runners are at greater risk for hyponataemia, as they have more time to consume more water
(2007).
In Feb 2007 the ACSM published a replacement position stand on Exercise and Fluid Replacement. The goal of drinking during exercise is to prevent excessive (>2% body weight loss from water deficit) dehydration and excessive changes in electrolyte balance to avert compromised performance. The ACSM no longer recommends that during exercise athletes should start drinking early and at regular intervals in an attempt to consume fluids at a rate sufficient to replace all the water lost through sweating (i.e. body weight loss), or consume the maximal amount that can be tolerated. The 2007 guidelines recognize that drinking too much
fluid can also be dangerous. Athletes should weigh themselves before running and write the results on their race bibs. If anything goes wrong, emergency workers can use the weight information to tell if the patient had consumed too too little or too much water. The ACSM cites data water quenches the sensation of thirst before body fluid replacement is achieved, so thirst should not be the only determinant of how much fluid is consumed.
Dr T Noakes critics the 2007 ACSM position stand on Fluid Replacement relative to using body weight as a measure of dehydration. Dr. Noakes suggest body weight is not an accurate measure of body fluid and electrolyte volume during exercise. He suggest that the controller of the balance between body fluid and electrolytes particularly sodium is the thirst mechanism. Dr. Noakes has concluded there is no conclusive evidence that athletes who drink sparingly during exercise develop specific medical conditions and the ability to sweat profusely while exercising in the heat is on of the most important determents of human evolution. Research by S Schwellnus (2007) found no relationship between dehydration and cramping. During his study athletes measured their levels of electrolytes, body weight changes, and found those who cramped were no different from those who did not cramp.
He suggests cramping is likely related to meuromuscular control at the spinal cord level in response to fatiguing exercise.
The bottom line according to Dr. Noakes is drink according to the dictates of your thirst during exercise, and do not ignore thirst. This approach works for every creature on planet earth even the slower runners. According to Dr. Noakes when athletes drink according to thirst, the risk that they will over drink is minimized, and there is no evidence that they are at any significant disadvantage from the 3-5% level of dehydration that develop as a result.
The ACSM and the IMMDA disagree on whether thirst should be the guide regarding fluid replacement, but they agree that considerable variability exists among individuals, and blanket advice to widely variable population of individuals seeking simple answers is out of place. Athletes should be encouraged to explore, understand, and be flexible to their own needs. Look for multiple signs suggesting dehydration including thirst, body weight, volume and color of urine, and rectal body temperature.
