resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Chiropractic: The Right Choice for Relieving LBP
"Low back pain (LBP) is a common threat to medicine and a reasonable threat to all national health care systems. ... Reducing ineffective treatments is necessary to decrease the LBP associated costs."
The Spirits of the Points: The Gall Bladder Official
The Gall Bladder is known as The Official of Decision Making and Judgment. In any given day, this Official makes countless decisions – conscious and unconscious, which influence every aspect of our being.
Herbal Medicine: Go Mainstream
When it comes to practicing herbal medicine in a mainstream setting, there are a number of important points to understand when it comes to prescribing formulas. Some important questions to ask are - what method of prescribing and dispensing is most effective in this setting?
Helping Patients Through Pregnancy Loss
There is a lot of focus in the acupuncture world on fertility and helping women get pregnant. It's exhilarating to hear the news that a patient is expecting a baby. The other side of that is pregnancy loss. That includes abortion, miscarriage or stillbirth.
Remembering Joe Weider (1920-2013)
With the death of Joe Weider, the world's most famous body-building visionary, crusader, fitness magazine publisher and icon, on March 23, 2013, chiropractic has lost one of its greatest friends and supporters.
The Potter's Wheel: Reflections on Practicing in a Technology-Driven World
In my very early years of practice, an older patient named Cora would call me at home, usually late Sunday night after she had consumed an unknown quantity of beer.
What They Don't Say Could Hurt You
I have written previously regarding the difficulties of drawing information from patients who are poor historians, forgetful or just plain uncooperative. The thought to revisit the topic occurred recently during preparation for an upcoming seminar.
Why You Should Get to Know the National Vaccine Information Center
Barbara Loe Fisher has been a diligent advocate for providing parents with the information necessary to make informed decisions regarding the usage of vaccinations for their children.
Medicine Presents: A Great Opportunity
The changing nature of health care presents both opportunities and challenges. While we tend to focus on our profession, we can sometimes forget the impact other health care professions can have on us.
News in Brief
Controversial Florida PIP Law Under Review; D'Youville Chiro. Students Learning Art of Co-Managing; And the Award Goes To...; F4CP Recognizes Major Contribution by ChiroTouch.
Some Thoughts on the TMJ
The temporomandibular joint is an interesting and dynamic articulation that can cause a lot of problems.
Have a Heart: Say No to Soda
It's not enough that soft drinks and other sugar-sweetened beverages have been linked to cavities and weight gain, among other negative health consequences.
Economics of Complementary/Integrative Care
Although this column doesn't usually feature a book review, we're going outside of our usual public health format to discuss a new book written by Patricia Herman ND, PhD.
Going Shoeless: The Pros & Cons of Barefoot Running
With the subculture of barefoot runners and the products catering to them growing daily, just about every chiropractor has been asked at one point or another about their opinion regarding barefoot running.
What the Science Says About Magnesium Stearate
It's often been said that scientific studies can be used to support just about anything. But discoveries are never made one study at a time.
Correcting Kid Logic in Health Care and Research Design
A recent broadcast on public radio described a fascinating phenomenon known as kid logic.
Energy is a hot commodity. Society pays dearly for it and for the expertise of those who know how to cultivate it.
Research Abstracts From the Journal of Manipulative & Physiological Therapeutics
Effect of Pain Relief on Lumbar Muscle Function and Activation; Effects of Thrust Amplitude and Duration of HVLA Spinal Manipulation; Immediate Effects of Upper Thoracic Manipulation on Cardiovascular Response.
Side Effects From Big Pharma: Wellbutrin – Dangerous for You and Your Baby
Are some of your pregnant patients taking Wellbutrin? If so, it could be a danger to them and their baby. This drug is extremely popular, but it has a serious history.
Helping Infertility Patients with the Spirit Essence
As many of you know, when it comes to treating infertility, we are dealing with a patient population that is, generally speaking, in emotional turmoil. These patients often experience fear, anxiety, despair, hopelessness, grief and anger.
Are They Finally Fixing Medicare Reimbursement?
Even with federal sequestration cuts taking effect in March, including a 2 percent reduction in Medicare reimbursement to health care providers, hope may be on the horizon in the form of a much-anticipated, perpetually suggested overhaul of Medicare's Sustainable Growth Rate formula, which serves as the basis for determining physician reimbursement.
SOAP Notes: It's Time for a Cleaning
I have been planning for some time to write an article about how traditional SOAP notes do not fit chiropractic practice, and the unfairness of holding DCs to a model clearly created for and primarily applicable to medical physicians.
A Building Block of Healthy Aging
Coenzyme Q10 has gained enormous attention in recent years, and with good reason —it's the Energizer Bunny of the cellular world.
You are What You Eat Part II: Integrative Protocols
In the previous installment of this article I discussed important ideas concerning gastrointestinal health and foundational ideas from TCM, which can provide key insights into creating effective protocols for healing the gut.
We Get Letters & E-Mail
Patient Perception and the Farce of "Fast Relief"; A Fly in the Ointment; Persecuted for Choosing to Practice Chiropractic.
Let's face it – patient evaluation takes time. Unless you are really into the diagnostic evaluation game, you probably have found the formal exam protocol tedious if not downright annoying.
There Are No Secrets: Treating Complicated Conditions with TCM
Including standardized extra points, there are just over 400 acupuncture points on the body. You get 400 and I get 400 - same. Yet, time and time again treatment protocols are coveted as if they were some secret formula only intended for the right and privileged.
Happenings in Our Evolving Profession
Good things seem to be happening for our profession and recent developments show we are all on board. Talking about being on board, this September The Veterans Express-Purple Heart Tour is expected to make its way out of the station.
November, 2004, Vol. 04, Issue 11
Herpes Simplex Demystified
By Ruth Werner, LMP, NCTMB, Massage Therapy Foundation President
Author's note: I would like to thank Lippincott, Williams & Wilkins for the use of the pictures in this article. These photographs appear in A Massage Therapist's Guide to Pathology, 2nd ed., Ruth Werner, Lippincott, Williams & Wilkins, 2002.
The original citations for these photos are: 1) Herpes [reprinted with permission from Rassner G.Atlas of Dermatology, 3rd ed. Philadelphia, PA: Lea & Febiger: 1994:42.] 2) Herpes Whitlow [reprinted with permission from Goodheart HP. A Photoguide of Common Skin Disorders: Diagnosis and Management. Baltimore, MD: Williams & Wilkins; 1999:90.
As a person who has been involved in massage education for 20 years, I know that one of the things students and therapists fear most is the threat of contagious skin diseases; however, as with all things fearful, the best defense is knowledge. In that spirit, I offer this month's topic: herpes simplex. The good news about herpes is you probably already have it; the bad news is it's possible to get it in new places. My hope is that by reading this material you will feel better prepared to protect yourself and your clients from this tough, sturdy virus.
Definition of Herpes Simplex - The word herpes comes from the Greek root herpein, meaning "creeping thing," or serpent. It is an interesting description for this family of viruses that, once introduced into the body, are never fully expelled. They can become inactive, but infections may recur at any time, often when the immune system is sluggish or overtaxed. Herpes viruses include: herpes simplex, Epstein-Barr virus (associated with mononucleosis), varicella zoster (chickenpox and shingles), cytomegalovirus, which typically becomes active when people are immune-suppressed, and others.
Herpes simplex is occasionally discussed as Type I and Type II viruses: Type I has traditionally been associated with oral lesions (the euphemisms for these are "cold sores" or "fever blisters," probably because they tend to occur when the immune system is overtaxed), while Type II virus has been associated with genital herpes.
Examinations of oral and genital lesions show significant crossover between Type I and Type II virus; both have the same treatment options, so the delineation between them has little significance.
Etiology - Herpes simplex is spread through mucous secretions. A person's first outbreak, which usually occurs two to 20 days after exposure, is called primary herpes. All subsequent outbreaks are called recurrent herpes. Recurrent herpes usually occurs in the same place as the primary lesion, because the virus has taken up residence in the affected nerve root. A primary herpes outbreak is often unnoticed.
Most cases of oral herpes are picked up during infancy or early childhood, and the new carrier may never be aware of his or her infection. In rare cases, however, the primary infection may be very extreme, accompanied by fever, swollen glands and many painful sores that may last from two to six weeks.
Signs and Symptoms - Herpes simplex has a fairly predictable presentation: the affected area may experience some pain or tingling a few days before an outbreak (the "prodromic" stage), then a blister or cluster of blisters appears on a red base. The painful, itchy blisters erupt and ooze virus-rich liquid all around the area. The blisters scab over after a week or 10 days, ending the most contagious phase of the disease. Altogether the outbreak lasts about two to three weeks.
Many of us are familiar with oral herpes; these lesions are typically on the lips, but may be elsewhere on the face or even inside the mouth. (Most sores that occur inside the mouth are not herpes, however.)
Genital herpes is not limited to appearing only on the genitals; these lesions may appear virtually anywhere between the knees and the waist, affecting the sacrum, the buttocks and the thighs - all places massage therapists may work.
Two other herpes simplex patterns are worth noting: herpes Whitlow and herpes gladitorium. Herpes Whitlow appears on the hands, especially the nail beds. Herpes gladitorium is named for its habit of appearing virtually anywhere on the bodies of wrestlers: friction burns and contaminated wrestling mats are probably the mode of transmission for this group.
Communicability - The herpes virus is famous for its communicability. Unlike many pathogens, it can remain dormant and healthy outside of a host body for hours at a time. Exactly how long is a matter of some debate. This means that the face pad that an infected client used may now pass the virus to another client. Used face cloths and towels may also harbor the virus. Even leaving aside the possibility of infecting other people, herpes is notorious for spreading to other parts of the body.
While it doesn't happen often, touching a cold sore and then touching the eye can result in a painful and dangerous herpetic infection of the cornea (herpes keratitis). One of the most dangerous aspects of a herpes infection is that a patient could be shedding the virus during the prodromic stage, with no visible lesion. This means that all it takes to catch herpes from another person is skin-to-skin contact with live virus. No sore or break in the skin is necessary.
While exposure to herpes is almost a given for adults in this country, herpes antibodies provide only limited protection against the establishment of new sites of infection. This is why massage therapists, even those who know they have been exposed, must work to prevent contracting herpes simplex at a new portal of entry.
Treatment - Herpes is a viral infection, which means there's little to do for it but wait for it to be over. Antiviral drugs may shorten the duration of an infection, but they don't prevent future outbreaks. Prevention is the main thrust for treatment of this condition; this means isolating towels, bedding and clothing, and avoiding sexual contact while lesions are present. Keeping as healthy as possible between outbreaks is an important way to reduce the frequency and severity of herpes episodes.
The good news about herpes is that the social stigma that used to be attached to this infection has been largely lifted. Many people no longer feel a need to hide this part of their medical history. If a client has a history of herpes, it's important to explain why it's a bad idea to receive a massage during an outbreak, and to request that he or she reschedule if prodromic symptoms or blisters are present. Even after a lesion has scabbed over, herpes is at very least a local contraindication. Because this virus can survive outside of a host, consider the sheets of any client with herpes as "hot": isolate them in a closed container and either have them professionally laundered or add extra bleach to their wash cycle.
Sometimes it is impossible to avoid working with a client who has an active cold sore. This might be a good time, however, to avoid not only this person's face, but also his or her hands. Those of us who get occasional outbreaks of herpes know how hard it is not to touch the blisters, even when we try to be conscientious about good hygiene.
For next time: What's it to be, readers? Right now warts are at the top of my list, but flu season is upon us, and last year's outbreak of avian flu around the globe may create an interesting season. Or do you have something else you want to find out about? Let me know: What's on your table?
Ruth Werner, LMP, NCTMB
Click here for previous articles by Ruth Werner, LMP, NCTMB, Massage Therapy Foundation President.
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