It is an irony that while a chiropractor helps his patients, he may cause injury to himself.

This was the case with Tom Marcuzzo, DC, FASA. "About three or four years ago, I realized the toll that adjusting was taking on my body—particularly on my shoulders," he says. "I was living in more pain than my patients." The Omaha, Neb-based chiropractor has been in practice since 1996.

So he decided to help himself and purchase an adjusting instrument—the PulStar. He has been using the device since March 1, 2006, and has not looked back.

The device has not only helped guarantee that he will add years to his ability to practice pain-free, but has also made him much more efficient. In fact, he was so taken with the instrument that he implemented its use on 95% of his patients almost immediately.

Transition Period

By his own admission, Marcuzzo fast-tracked the use of the PulStar in his office. "The PulStar representatives recommend that you introduce the PulStar

slowly over a 6-month period, and then only to new patients," he says. "I was really gung ho, and within a 1-week period I was using it on 80% of my patients."

This reflects his practice philosophy. "If I'm going to use it, I'm going to use it," he says. "Jumping in to use it full time in 1 week may not be the best way to go—that's just my personality."

Though he sped up the transition, he did introduce the PulStar gradually during that first week. Of the 40 patients that he treated on that March 1, between eight and 10 were adjusted with the PulStar; the next day that number increased to between 15 and 20; the next day about 25; and by the end of the week it was more than 30 of the 40 or so patients who came to see him. The following Monday, Marcuzzo removed his manual adjusting table and put it in his garage, where it sits to this day. He removed the table as much to rid himself of a temptation as to signal that he was committed to using the adjusting device. "I'd have been tempted to use [the manual table] if I didn't take it out," he says.

Marcuzzo received intensive training on using the PulStar.

Marcuzzo had not chosen the PulStar on a whim. He had carefully researched the devices on the market and decided that the PulStar was the system that best fit his and his patients' needs. "I had a lot of confidence in it. It's a new, more modern device. I believe in it myself," he says.

This confidence has helped to convince new and old patients to give the device a chance. "I ask new patients to give me four or five treatments. If they're not satisfied, then I try something different," he says.

But confidence in the research and belief in the product were not enough. The numbers had to add up. "I decided to go full blast for a year, and see what the numbers looked like, the results, the referrals," he says. "I knew after 60 days that I'd keep it."

Although the number of his patient visits has remained the same, Marcuzzo has found that his revenues have risen. On the face of it, this is a contradiction, since the PulStar decreases the number of treatments from 18 on average to 12. According to his analysis, Marcuzzo says that the reason for the climb in revenues is that he is getting more new patients, which translates into more first-visit fees (which tend to be higher because of the need to take x-rays and do an examination). "This is the best revenue year I've ever had," he says.

Marcuzzo says the reason for the referrals is that the PulStar has delivered long-term results for patients. And this is a testament to the effectiveness of the device's analytic and adjusting capabilities.

Diagnostics and Adjusting

The PulStar consists of a multiple impulse adjustor, an iMac computer system, and a color printer.

While Marcuzzo does not use the PulStar on every patient (about 5% are treated manually), he does use the analytic software to pinpoint the source of the patient's pain on all of them. "For example, pain in one area, such as a headache, may be caused by a problem in the low back," he says. This allows him to be much more specific and effective in his treatments.

Marcuzzo says the diagnostic software is the main selling point for the machine.

Before the analysis begins, Marcuzzo inputs all of the patient's personal information into the system. This includes the patient's name, address, insurance information, and all the background about his or her problem. The system also stores the treatment information for each visit (an unlimited number of the patient's visits can be stored in the system, and a maximum of 300 can be viewed at one time). This information then can be transmitted electronically, if necessary, to the patient's insurance provider or to their attorney—if they have filed a workers' comp claim. Because of the comprehensive record keeping, Marcuzzo has found that it has been easier to track patients and make sure billing and appointments are kept up-to-date.

Marcuzzo says that the software—which is proprietary—is very simple to use. Though Marcuzzo was primarily looking for a device that could be used to treat, he says that the diagnostic software is really the selling point for the machine. "You don't have to use the PulStar to treat [in order to get a benefit from the system]," he says.

The handheld probe does double duty. First, Marcuzzo uses it to palpate and scan the patient—measuring differences in temperature, tissue resistance, and joint mobility. The probe sends data to the computer, which looks for areas of most resistance. It can measure up to five areas of subluxation. Marcuzzo uses clinical judgment to diagnose the patient—the computer simply identifies areas of possible fixation. This analysis is typically performed while the patient is in the prone position, but for more complex cases, the chiropractor can use the PulStar to analyze the patient in a position (standing or sitting) in which he is in the least amount of pain.

Once Marcuzzo has identified the areas of subluxation, a push of a button turns the probe into a multiple- impulse adjusting device. In terms of adjusting, Marcuzzo credits the multiple-impulse adjusting device for the good treatment results. He says that instead of just treating the spine, it treats the muscular components as well. The adjustment is much gentler and more specific than a traditional, manual one, he says.

Marcuzzo has done some extremity adjustments with the PulStar. He also performs acupuncture on about 98% of his patients (he is certified to perform clinical acupuncture) and has found that this traditional treatment meshes well with the high-tech one. "They complement each other very well," he says.

After an adjustment with the PulStar, patients notice results quickly, Marcuzzo says. "In manual techniques, there is instant gratification [but it might not last]. With the PulStar, they will feel relief in 1 to 2 hours as their body adapts to the adjustment [which is longer lasting]. The specificity of the adjustment is the best thing about the PulStar," he says.

The computer controls the number of thrusts that the multiple-impulse adjusting device delivers. Once it reaches that number, which can be a few thrusts or several dozen, it will shut down. It also will slow the frequency of the thrusts as the site becomes more mobile. Marcuzzo still uses manual techniques—mainly diversified. "Some patients still prefer manual treatments," he explains.

Once the adjustment is done (no matter if it is with the adjusting device or a manual technique), Marcuzzo will rescan the area—and show the patient the before-and-after measurements, pointing out the positive changes. "It's very objective," he says. "It's a very visual thing, and patients love that."

If printouts are needed, the PulStar can send a report to a wireless printer located in the front of the office.

While the PulStar quickly proved itself to be an invaluable tool in his practice from the first day it was installed, Marcuzzo did need some help in learning how to use it effectively.

Company Training

Marcuzzo says that PulStar has several training options, and he opted for the more expensive choice. He hired one of the company's trainers for one-on-one, intensive training. The trainer came to Omaha, staying in a local hotel. Marcuzzo paid for the trainer, his transportation, lodging, and food. Over the Saturday and Sunday prior to his March 1 launch, Marcuzzo received intensive training. Though he admits he was not an expert, he says, "I felt comfortable [using the PulStar] on Monday. It's pretty easy to use."

The PulStar is also easy for his single staff member to use as well. Her access is to the computer system, using it to recall records for billing and other administrative purposes. This allows the practice to be as efficient as possible (a front-desk office-management system is provided at no extra charge). Marcuzzo, a solo practitioner, sees about 50 patients a day.

Though the PulStar has provided numerous benefits for his practice, Marcuzzo notes that it is simply a tool. "[The trainer] wasn't teaching me how to be a chiropractor," he says.

His confidence in his abilities increased rapidly at the 30- and 60-day marks. A sign of his recognized expertise is that he provided demonstrations of the PulStar at a chiropractic conference in South Carolina by the end of the first year he used the PulStar.

Marcuzzo says that the company offers good support for the product. This included providing him with his representative's full contact information—including his home phone number. But the need to call has been rare, since Marcuzzo has had virtually no problems with the equipment—both in terms of the software and the hardware. "It's worked better than I ever could have imagined," he says.

Marcuzzo is not one to sit on his laurels. He is currently entering the next chapter of his chiropractic career, and the PulStar will be part of it.

Going Forward

Recently, Marcuzzo purchased a 1,440-square-foot business condominium, which will be the new home of the Marcuzzo Chiropractic and Acupuncture Clinic. "It's designed in a way for growth," he says.

And part of that growth is the addition of another PulStar to his practice. Though he will remain a solo practitioner, Marcuzzo says that one of the downsides of the PulStar is that there is lag time between treatments, mainly due to patients having to readjust their clothing after a treatment. This can slow the transition times, which have to remain fairly quick, because of patient volume. "When you have 50 patients a day, you need two units," he says.

C.A. Wolski is a contributing writer for Chiropractic Products. For more information, contact .