resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Billing One-on-One, Direct Patient Contact
This is often misunderstood and leads to trepidation when documenting and subsequently billing timed services.
One of the most common trends to see in clinical medical practice and public health is the cycles of health "buzzwords." These come and go depending upon the current cultural zeitgeist. One year, "parasites" are causing all the issues, and the next year it's "candida."
A Different Way of Looking at It
The way you and your chiropractic colleagues access information has changed over the past decade. According to a recent survey conducted by Dynamic Chiropractic, almost half (48 percent) of DCs read online articles on their personal computer or laptop daily.
Living Well: Lessons From Our Oldest Old
Aging is a significant public health problem, important to chiropractors in practice and important to DCs who teach students training to become chiropractors.
Prostate Cancer Risk
A large study published in January 2016 in the American Journal of Clinical Nutrition showed that men who are vegans had a 35% lower risk of developing prostate cancer compared to non-vegan men. The study followed more than 26,346 men who are part of the Adventists Health Study-2.
Low Fat vs. Low Carb & the Power of Protein
A science-based website recently posted a nice summary of 23 randomized, controlled trials from peer-reviewed journals pitting low-carb diets against low-fat diets.
Building Bridges with Discipline
As practitioners of traditional Chinese herbal medicine, our role is to educate patients and medical practitioners about the various safety aspects of our medicine. Medical doctors that embrace Chinese medicine want to collaborate and include Chinese herbal medicine in more aspects of clinical care to support their patients.
With Low-Back Pain, Sometimes Little Things Matter
Typical treatments for low back pain involve large muscles like the quadratus lumborum, iliopsoas, and piriformis. However, there are situations when a very small muscle, the multifidus, can play a significant role in the diagnosis and treatment of low back muscular or spinal injury.
The Need for Standards
ISO-TC-249: You may look at these letters and numbers and wonder what they are and what they might mean. They turn into: International Standards Organization- Technical Committee – 249. There is a global organization called The International Organization for Standardization.
Finger (Pad) Pointing: Repetitive-Use Injury Waiting to Happen
"My wrist and hand hurt. I spend all day working on computers and then I come home and spend more time on a computer, usually playing video games."
Discovery: Finding Insights and Each Other in Different Disciplines
Recently I've been thinking about all sorts of things which are hidden from our daily direct experience. That general category is what links nearly everything that catches my attention and then demands some kind of investigation.
Transforming Las Vegas
On a warm spring day in Las Vegas, Sonia Kim, clinic front desk staff, is busy preparing for a full day of intern shifts at Wongu Health Center. She greets patients, makes sure documents are properly signed, and lets the interns know that their patients have arrived.
A Whole-Body Approach to Chronic Tension Headaches
Nearly every day in our practices, we see patients with chronic headaches that have not responded to traditional treatment. They present in our offices with a feeble hope that "maybe" a chiropractor can help.
In This Current Age of Anxiety
Anxiety, also referred to angst or hysteria, goes by many names. One, popularized by the sagacious Zhang Zhong Jing, who many practitioners of Chinese Medicine may be familiar with, is known as Restless Zang/Fu disorder.
Sleepless nights, anxiety, mood swings, euphoric energy bursts, obsessive thinking, and a strange feeling in his chest. That is what Matt was experiencing when he first entered my practice. Rather than being concerned, he was loving every minute of it.
Hip Flexor Contractures & LBP in Above-the-Knee Amputations
Patients with above-the-knee amputations (AK or AKA) are particularly prone to developing hip flexor contractures. Not to be confused with muscle tightness, contractures are a permanent shortening of tissues which cause deformity or distortion.
Understanding Levels of Evidence
The concept of levels of evidence is a cornerstone of research literacy and a great starting point for understanding basic principles of how research works.
Parker University Embraces New Era
Change is in the air at Parker University, which recently announced the selection of both a new president and a new consultant for its seminar program.
Streamline Your Front Desk
Your front office can be your greatest source of efficiency or it can be a constant bottleneck. Increasing the productivity of this area, while not sacrificing the quality of patient interaction, can be a little tricky. However, with some focused effort and intention, your front desk can keep your practice running smoothly.
Billing Timed Services
Q: I do not always use physical medicine services but in my state I do have a scope of practice that allows me to provide many of these services. I am trying to understand what "direct one-on-one patient contact" means in relation to physical medicine services.
How to Reach Your World With the Chiropractic Message
My latest effort to share chiropractic occurred in mid-May while I was sitting at an introductory parent information night for high schoolers. The IT instructor informed us that each student would be receiving a computer for all their studies.
Constructing Our Reality, Part 2
My last article discussed perception and its relationship to the primary channels. Before we get to the channels most commonly used to treat sensory disturbances, the small intestine and triple heater, we should first talk about the bladder channel.
Holistic Skin Care and Modern Technology
Anti-aging is a concept that we hear in reference to skin rejuvenation and growing older on a daily basis. Aging begins as soon as we are born; therefore "pro-aging" is embracing all stages of life gracefully, with vitality, wisdom, joy, and gratitude as the goal.
Keeping Malpractice Allegations at Bay
It has been suggested that in the litigious environment in which we live, the practice of chiropractic should be defensive and practitioners should constantly be watching their backs. An element of defensive practice is a good idea.
News in Brief
NYCC Aggregates Degree Programs in New School; Palmer Chancellor Receives Education Award From ICA; Oklahaven Announces "Have a Heart" Winners.
Distal Style Treatment of Neurogenic Pain
Treat locally or distally? This question has frequented my thoughts for the treatment of pain throughout my acupuncture career. Each style has strengths and weaknesses, thus the versatile practitioner would do well to forgo dogmatic adherence to any one style in deference to the needs of the individual patient.
October, 2002, Vol. 02, Issue 10
Working with Patients Who Have Hypothyroidism
By Ruth Werner, LMP, NCTMB, Massage Therapy Foundation President
In my last article on cerebral palsy, I was happy to find lots of material not only on the condition itself, but on how massage can play a part in the life of a CP patient.I duly related this latter point in my article, expecting little controversy, since this is a well-researched and well-understood condition. Well, duck, because the fallout is still coming down.
I made a few errors in the CP article that I'd like to clear up. First, I misstated the locations in the brain where the damage takes place. Unable to find any specific information on this issue in my pathology resources, I pulled out my anatomy texts and listed the movement centers I know about: the basal ganglia, frontal lobe, and cerebellum.
Gary Bruce, LMT, NCTMB, who works extensively with special needs individuals, corrected me in an e-mail he sent me:
Second, I referred to the tight muscles of a CP patient as a "spasm"- this is quite incorrect: the proper term is spasticity, and the way it responds to massage is quite different. (For more information, please refer to my spinal cord injury article in the May edition of Massage Today.) These are technical errors, and I take full responsibility for not catching them.
At this point I'd like to restate (or state for the first time) what my job is: I am a translator. I read through scads and scads of material: some boring, some fascinating. Then I try to translate that material into accessible terms, so I can share it with anyone who is interested. Sometimes I get lucky and I find people who help me understand a topic, either because they themselves live with it, or they work with people who do. Sometimes, unfortunately, I don't get in contact with a valuable resource until it's too late. Such was the case with the CP article.
I want to voice my appreciation to everyone who wrote me with their own opinions about this issue, which proves that we are people who take our work and the well- being of our clients very seriously. It also proves that what the mainstream medical community promotes is not always the last word. To illustrate this fact, I'd like to quote from another response I got to the CP article, from Mary Green, LMT. Her comment relates to the statement that CP is non-progressive, but nontreatable. (Remember, I just report this stuff, I don't make it up!)
And that's all I'm going to say about CP for the time being.
In my last article, I asked what people would like to read about next, and thyroid disorders won the election in a landslide. I had planned to combine both hyper and hypothyroidism into one article, but it's just too much information, so I decided to limit this discussion to one of the most frustrating and controversial issues in chronic disorders: hypothyroidism.
What Is Hypothyroidism?
Hypothyroidism is a condition in which circulating levels of thyroid hormones are abnormally low, or in which levels of thyroid hormones may be normal, but target cells have become resistant to their action. This interferes with the body's ability to generate energy from fuel.
Demographics: Who Gets It?
Hypothyroidism may be a fairly common condition, affecting about one-tenth of one percent of the population overall. Women are five times more likely to develop hypothyroidism than men. Statistics rise with age; within women over 65 the incidence of this disorder may be as high as 10%. These numbers reflect reported cases; many people may experience hypothyroid symptoms without achieving a diagnosis.
Etiology: What Happens?
Before we get into the specifics of this disorder, we need to discuss some massage school anatomy. You may remember that the thyroid gland, that butterfly-shaped structure that wraps around the trachea, is an endocrine gland that secretes hormones related to metabolism: the use of fuel for energy or growth. It does this under orders from the pituitary gland, which secretes thyroid-stimulating hormone (TSH).
The primary hormone associated with the thyroid gland is called thyroxine. When thyroxine levels are high, metabolism is fast - hyperthyroid symptoms include weight loss, heart palpitations, minimal menstrual periods, and bulging eyes. When thyroxine levels are low, metabolism is slow. Weight gain, low energy, and hypersensitivity to cold may ensue. As with most things concerning hormones, this description is an oversimplification.
The thyroid actually secretes several different substances, including T4 (also called thyroxine, this is a molecule with four iodine atoms) and T3 (a molecule with three iodine atoms). T4 is generally secreted in greater amounts than T3, but T3 is more potent. Enzymes elsewhere in the body may help to convert T3 to T4, or vice-versa. In the etiology of hypothyroidism, it is the presence of T4 that is usually tested and treated with a synthetic version of thyroxine (Synthroid).
Beyond simple low levels of circulating hormones or cellular resistance, several other contributing factors to hypothyroidism have been identified:
Signs and Symptoms
Signs and symptoms of hypothyroidism are often subtle but steadily progressive. A person may not realize the extent of the problem until someone points it out. The result of not being able to convert fuel into energy means that a person gains weight, feels fatigued and depressed, and has a sluggish digestive system with chronic constipation. The person will have poor tolerance of cold, and the skin will be puffy, but dry. Hair will be flat and brittle, and may even fall out. In women, menstrual periods tend to be heavy and long-lasting. Some hypothyroidism patients will develop goiter: a painless enlargement of the thyroid.
It is common for hypothyroid patients to develop atherosclerosis, as liver function to produce the chemicals that expel cholesterol from the body is sluggish. High cholesterol levels from hypothyroidism do not respond to cholesterol-lowering medications. Fluid retention in the arms and wrists raises the risk of carpal tunnel syndrome; fluid retention in the neck along with goiter may cause chronic hoarseness. Very severe cases may cause patients to become so cold and drowsy that they becomes unconscious. This is called myxedema coma, and it is a significant cause of death among elderly hypothyroidism patients.
Many people who fit the profile for hypothyroidism also have symptoms of fibromyalgia syndrome, depression, candidiasis, or chronic fatigue syndrome. It can be a daunting and frustrating process to sort out which is which, since none of these conditions is well-understood or easy to treat.
Physical exams for hypothyroidism look for goiter, along with a significantly slowed heart rate. Reflexes are often slow in hypothyroid patients.
Blood tests may be conducted to look for elevated levels of antithyroid antibodies, which would point to a diagnosis of Hashimoto's disease. Levels of thyroid stimulating hormone (TSH) might also be evaluated. If the thyroid is underactive, the pituitary usually will pour more of this chemical into the bloodstream.
It is especially important for pregnant women to be tested for thyroid function. Pregnancy can hide some symptoms of hypothyroidism, which can create serious repercussions for the unborn child. Most newborns are tested for thyroid function as a matter of course; early intervention in the rare cases when thyroid function is subnormal can prevent stunted growth and mental retardation.
The most common treatment for hypothyroidism is to supplement thyroid hormone. In the early days of understanding this disease, desiccated thyroid glands of a variety of animals were prescribed to treat hypothyroidism. The doses were difficult to regulate, since potency could vary widely. Today, thyroxine is replaced with a synthetic version of the hormone, called Synthroid.
Some researchers, however, suggest that the symptoms of hypothyroidism may be related to other factors: general toxicity, for instance, or cellular resistance to thyroid hormones, or a need to supplement T3 instead of or in addition to T4. And of course the added challenge for treatment lies in the possibility of fibromyalgia syndrome, chronic fatigue syndrome, candidiasis, and any number of other chronic disorders that may mimic or accompany hypothyroidism. These factors, which are often neglected by some "mainstream" medical professionals, may account for why many people who have hypothyroid symptoms do not feel that taking synthetic thyroxine successfully treats their disorder.
Can Massage Help?
Outside of the risk of atherosclerosis (which is a risk for many mature clients regardless of thyroid function), massage is a perfectly appropriate choice for hypothyroidism clients. Although it is unlikely to restore the normal production of thyroid hormones or cellular sensitivity to them, massage can certainly improve the quality of life of people who feel chronically drained and lethargic.
In my next column, I'll examine hyperthyroidism. I'd love to hear from any readers who live with this disorder, or whose clients do. How has it impacted the quality of your life? What have you done, or what are you doing to treat it? What kind of impact has massage had on your situation? Share your experiences and wisdom - pathology readers want to know!
Ruth Werner, LMT, NCTMB
Click here for previous articles by Ruth Werner, LMP, NCTMB, Massage Therapy Foundation President.
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