Lost A Sale, But Initial Phone Consultations — A Big Part Of Brilliant Customer Service
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Fish Oil: A Key Component to Positive Clinical Outcomes
Patients seem to be presenting with more complex problems, and many are responding to care more slowly or have completely unexpected results. Why?
ASA Ready to Impact Profession
The American Society of Acupuncturists (ASA) is a 501(c)6 (pending), not-for-profit collaboration among state based, acupuncturist professional associations.
Relationship Marketing: A Modern Approach
Remember when you used to get real letters in the mail? Not the automated type, but the real deal, hand written with a personal message just because someone was thinking about you? You know what I'm talking about.
Exercise Recommendations for Healthy Aging
Aging is inevitable, but how you age is not. Common physical signs of aging include decreased muscle mass, decreased muscular power, increased body fat, and decreased aerobic (lung) capacity.
It's Time to Wake Up
It is time for this profession to wake up and tell someone about the healing benefits of acupuncture. This is the time for Asian Medicine. Its popularity, growth and unusual acceptance is nothing short of amazing.
Teaching Qi Gong to Children
Many of us have come to embrace Qi Gong or Tai Chi practice as a regular part of our lives. Qi Gong has been a stabilizing factor in my life for the last twenty years.
Data: The New Frontier in Health Care
Your practice is empowered with the data you need to improve patient health, run a more efficient (read: profitable) practice, get paid in timely fashion and help show the efficacy of chiropractic on the national stage in the midst of sweeping changes in health care!
Healing the Core: AWB Nepal Earthquake Relief Project
With almost 9,000 people killed during the earthquakes in April and May, another 23,000 suffering injuries, hundreds of thousands left homeless when entire villages collapsed, and many sacred sites destroyed, no one in this country of approximately 28 million has been left untouched by the disaster.
Acupuncture Treatment of Trauma in the Canine
From 1972 until 1976, John Ottaviano and I were treating dogs at five different veterinary clinics in the Los Angeles county area. Usually, we were at a clinic for seven to eight hours.
Making Public Health a Chiropractic Priority
As highlighted in this edition's News in Brief, Rand Baird, DC, MPH, FICA, FICC, editor and occasional author of our long-running column, "Chiropractic in the American Public Health Association", was recognized by the organization recently for 40 years of membership.
What to do When Today Sucks
Have you ever had one of those days when nothing went the way it should have? The patient with migraines got worse instead of better from a treatment similar to one you've effectively used on him before.
News in Brief
Support of F4CP Continues With Latest Donations; Walter Reed Honors Dr. William Morgan; Recognizing 40 Years of Public-Health Activism; Allstate Decision Reversed.
The Ethics of Herbal Prescribing
While teaching ethics classes, I often encounter licensed acupuncturists who are surprised that our use of herbs and supplements has a specific section in the material. It is often an aspect within ethics that clinicians don't think of in practice.
Peaching to the Choir: How to Extend Our Reach Beyond the CAM Community
Professional conferences offer unique opportunities to network, be exposed to cutting-edge innovators, share your interests and work, and be inspired.
Online Marketing Basics: Website Creation
The various online marketing options make it a challenge, especially when all you want to do is help your patients feel better. With such a broad topic, I'm going to share some basics you should know about website creation.
Treat Every Patient as an Athlete
Frontal-plane movement pattern dysfunction can set the stage for musculoskeletal injury. Frontal-plane stabilization is essential during the normal activities of daily living: think single-leg stance and gait cycle.
Aetna Updates 97140 Policy
In a development the Association of New Jersey Chiropractors is calling "a resounding victory for chiropractors nationwide," Aetna Insurance Company has updated its national reimbursement policy regarding 97140 (manual therapy), reaching an agreement two years after the association filed a declaratory judgment suit in federal court against the insurer.
Technology Meets Practice: Chiropractic Every Day
About a year ago, I had an interesting conversation with a DC who made house calls. When I asked why, she was quick to explain she learns much more about her patients when she sees them at home than she could ever observe in the office.
Treating LBP in Golfers: Beyond Basic Assessment
The drive to master the most efficient swing demands a tremendous amount from the lower back. Maintaining stability in a flexed posture, supporting torso rotation and repetitively supporting the golf swing all put the lower back in a vulnerable position.
ICD-10 Is Not Scary (and Not About Billing)
In my 13 years of consulting with doctors on billing and coding matters, ICD-10 has aroused the biggest combination of misguided fear and ignorance I can remember.
An Unexpected Superfood: All About Eggs
About 40 years ago, excessive dietary cholesterol was labeled a public health concern. Specifically, it was thought that there was a causal link between consumption of cholesterol-laden foods and increased risk of heart disease.
Healing Trauma: Cultivating Resilience and Presence Through Mindfulness, Part 1
All humans, by the very nature of being human, will experience moments of trauma and suffering. What, then, makes the difference in how the individual who experiences trauma, suffering, and spiritual loss reacts to such experiences?
Lower-Extremity Overuse Injuries: Primer on Causes and Corrections
From ankle sprains to stress fractures, shin splints to plantar fasciitis, the research is clear: These common overuse injuries of the lower extremities – among dozens of others – may be related to abnormal foot function in your patients.
Patient Retention Techniques
When talking about techniques to grow your business, we tend to focus on the "large" aspect of the patient base, that is, on strategies to attract new patients. However, it is important to remember that "loyal" is equally, if not more, important.
A War You Can Help Patients Win
The average American consumes approximately 60 percent of calories from sugar, flour and refined oils. A donut is a good example of a so-called "food" that represents these calorie sources.
Integrative Sports Medicine
One of the most rewarding and challenging clinical scenarios is the treatment of athletes.
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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