Practice Spotlight: Carrie Zvonar, DC, MS

Carrie Zvonar’s care and vision for her patients’ health as well as for her profession as a doctor of chiropractic, is inspiring.  And her enthusiasm is efficacious.

Carrie’s passion for chiropractic medicine stems from being injured in a car accident at age nineteen. Her own healing prompted a growing fascination with the human body and nutrition which led her to pursue a career helping others discover their potential for health and healing.  Carrie and her husband Steve graduated together from Logan College of Chiropractic in 1985, set up their first practice in his home state of Maryland, then later moved to Carrie’s home state of Minnesota in 1994. Their daughter Alyse also inspires wellness as a massage therapist in their practice. 

Over the years Carrie realized that while chiropractic provides excellent results for acute care such as sprains, strains and other soft tissue and joint injuries, chronic pain conditions were often frustrating.

Carrie enthusiastically shared the following:

Lifestyle education and motivation go hand-in-hand.

“We realized the need to educate and motivate these patients in lifestyle factors that would benefit their structure because those who can make positive lifestyle changes recover faster and do better. Chiropractors are trained in lifestyle medicine, though we might not be calling it such.  I have a Master of Science degree in Human Nutrition through the University of Bridgeport.  One of the reasons I went for the Masters was to solidify my knowledge of nutritional biochemistry and physiology, as well as to improve the functional medicine aspect of my practice, where I have a strong desire to follow evidence-based standards and apply the research that exists to support such care.

We offer standard chiropractic care and believe that the best results are obtained when lifestyle and health habits are addressed.  Even though my patients and the general public are mostly aware of healthy lifestyles, they do not make the changes.  Over the past few years we have pondered why that is, and what we could do to help people make permanent, significant changes, at their own pace. For that reason, both Steve and I are being trained as Wellness Coaches with Wellcoaches, Inc (endorsed by the American College of Sports Medicine).

It can be very challenging to suggest that patients need a paradigm shift from their current definition of health.  Many (most?) define health as the absence of symptoms, but we know this isn’t true.  However, our medical system and insurance reimbursement is set up to pay for specific diagnoses, and this is not consistent with health promotion, only disease care. 

Special successes in practice have been patients who have taken charge of their own health, followed recommendations, and achieved desired results.  They have perseverance and were able to hang on to their vision through the hard process of change.”

Promoting their practice includes being involved outside their practice.

“In addition to serving the general public through our practice, we have done community lay-lectures and series on a variety of wellness topics.  We work with local gyms and I do Weight Loss for Optimal Health classes at a local wellness center serving the 50 and up population. Our practice is word-of-mouth and many new patients come to our office based on the fact that we participate with their insurance plans.  We are listed in the Yellow Pages but do not run a large ad. We promote our practice by speaking and being involved in the community.

We have worked through our local community education department to give a variety of talks.  Several times we worked with them to offer a 12-week program that involved individual evaluation at weeks 1, 6, and 12, plus weekly classes and group exercise. Last year we assisted a local personal trainer in a program she developed for clients to have a contest in improving body composition.”

Excellent rapport with patients is a must.

“Compliance is often very good, because patients who seek this type of care in our office are often “sick and tired of being sick and tired.”  I’ve heard them referred to as “walking wounded” – these are people who have been to doctors, had examinations and testing and are told “Good news, your tests are normal” and have been sent along.  The problem is, they still feel lousy and have a sense that their health and vitality should be better.  We spend time from the beginning discussing why our patients want to invest their time, efforts and money to get better, and this helps when the going gets tough, to keep reminding them of why they’re doing this. 

With this type of care, we have found it essential to have excellent rapport and communication with patients.  Often they are paying out of pocket, and we want to be sure that they find value in their care, and that we are not creating a financial stressor.  For that reason, as doctors we discuss the length of time recommended for visits, and in the beginning of care, make sure the patients understand the fees.  We make recommendations for length and frequency of visits, but the patient chooses what works for them.

Patients don’t care how much you know until they see how much you care. In order to motivate behavior change, there has to be a relationship where patients value your input and where they feel that you have their best interests at heart.  They want to be encouraged, and often need to be reminded of their successes, no matter how small, and they need to take ownership of their health.”

Vitamin D and other labs are revealing, as are questionnaires.

“We utilize a variety of labs, but I want to comment that we very commonly check Vitamin D levels in our patients and rarely find an initial result in the normal range.  

I believe it’s critical to be aware of this, especially in a chiropractic practice, since musculoskeletal pain is common with vitamin D insufficiency.  With proper supplementation and monitoring, it is usually easy to get levels within normal.

We use other lab tests to establish our diagnosis and treatment plan, including lipids and blood glucose, hs-CRP, CBC, blood chemistries, and other tests.

We utilize lab re-testing and re-examinations to document improvement and to modify treatment as needed.  We also utilize questionnaires that allow us to score symptoms, and to get feedback on patient satisfaction.”

Managing insurance reimbursement is vital to the vitality of the patient and the practice.

“Because chiropractic typically incorporates some aspects of lifestyle medicine, such as exercise, this is reimbursable by many group health plans, as are services such as exams, x-rays and chiropractic manipulation. If a patient’s lifestyle medicine care is related to their structural diagnoses, we document E & M services and bill appropriately.  However, I have found that I must stick with chiropractic diagnosis codes and not what would be considered medical codes, such as irritable bowel syndrome.

I encourage other chiropractors to incorporate lifestyle medicine in their practices, while also being sure that patients understand a clear distinction regarding what fees are covered and are not, and why each protocol is recommended. I would love to see lifestyle medicine practices become more mainstream and reimbursable by insurance. It is frustrating when patients are limited from this important type of care because they can’t afford it out-of-pocket.”

Carrie’s advice for our readers is about ‘balance.’

“I learned about balance the hard way, experiencing a long-lasting crash-and-burn period about 10 years ago.  As a result, I had to seek care and advice from others and it took about four years to find a new healthy normal.  In the process, both Steve and I began to learn about functional medicine and apply it in our practice.  For me, it reignited the passion for nutrition that I have had since high school.”

Goals and dreams for the future?  “I am looking forward to increasing the lifestyle medicine area of my practice, integrating health coaching for even better support for my patients.  I am currently attending courses and workshops in advanced healthcare management and innovative changes in healthcare through the University of St. Thomas (Minneapolis) and would love to become involved in encouraging insurance reimbursement and/or in seeing health coaching and lifestyle counseling as a common employee benefit.”

Advice for students pursuing a career in LM?

“Go for it; this field is growing, and the research is supportive of its benefit.  Get involved and do your part to get this approach to health care and health promotion accepted as mainstream.  It has the potential to change health care delivery, which in turn impacts budgets and expenditures and, most importantly, quality of life.”