resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Interprofessionalism: What it Means and Why You Should Care
Interprofessionalism in education and in practice is a growing trend across health care in the United States. The idea that team-based care and collaborative practice can improve health care has been around more than 50 years.
Window of the Sky Points
The acupuncture points known as Window of the Sky are a modern creation. There is no reference in Chinese medical texts for an acupuncture point category called Window of the Sky.
Chiropractic Around the World: WFC Country Reports December 2015
The following country updates are reprinted with permission from the December 2015 World Federation of Chiropractic (WFC) Quarterly World Report. Information is excepted for space and edited to DC-specific style guidelines.
Lab Rats (Roaming the Streets)
The title of this article is an accurate description of American consumers (regardless of age) in the modern era.
Ethics: The Glue That Holds Us Together
Kudos to the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) for creating a code of ethics for the nationwide profession and for deciding to make courses in ethics a requirement for certification renewal.
RAND Study Recruiting DCs
Dr. Ian Coulter, RAND / Samueli chair for integrative medicine and senior health policy researcher for the RAND Corporation, has issued a call for participation, recruiting doctors of chiropractic for a practice-based research study that will examine "the impact of evidence, outcomes, costs and patient preferences on the choice of treatment for chronic low back pain and neck pain."
Enhancing Performance in Cross-Fit Athletes
Cross-fitness centers are expanding in number and increasing in popularity. To remain relevant to this growing portion of society, practitioners need to learn about the exercises and injuries common to this group.
The Roots of Insomnia
One of the most common clinical presentations is insomnia. Next to digestive disorders, sleep disorders are one of the most common complaints the clinician will encounter in daily practice.
Do Doctors Lie to Patients? (Do You Lie to Yours?)
In a previous column ["When Patients Lie (Bribe or Flatter)," Oct. 1, 2015], I discussed the issue of patients lying to doctors, and the many reasons why this can occur.
Taking Another Step Toward a Secure Future
In 2008, the Council on Chiropractic Guidelines and Practice Parameters (CCGPP) released a literature review on chiropractic care for low back disorders.
How to Humanize Your Content to Create Stronger Relationships
Content marketing is about building relationships, whether that is through updates on social media, offers on your website, blog posts, email campaigns, or even printed material. Now days a business needs to make a human connection.
Is There a Neurological Basis and Correction for Macular Degeneration?
Macular degeneration, aka AMD (age-related macular degeneration), is a common eye disease and a leading cause of blindness in people age 50 years and older, according to the National Institutes of Health National Eye Institute.
East Meets West
Gung Hay Fat Choi. Welcome to the year of the Monkey. There will be fireworks for both January and February this year. What great celebrations.
Changing the Cultural View of Medicine
Many hospitals in the U.S. are incorporating integrative clinics that include Traditional Chinese Medicine. Cleveland Clinic has led the charge for adding a traditional Chinese herbal medicine clinic to their existing acupuncture program.
Diet, Nutrition and the Context of Risk (Part 1)
Food and supplement safety is a topic that often comes up when I speak to chiropractors for CE relicensing, even when it is not the advertised subject.
Billing and Coding for Moxibustion
Q: I am trying to locate a code for cupping and moxibustion, and have had various fellow acupuncturists indicate that they bill using the existing codes for heat, 97010 hot packs or 97026 infra-red for moxa and 97016 vasopneumatic device for cupping.
Asking the Insurance Rep the Right Questions
One of the first or last questions a potential patient often asks is: "Do you take insurance?" An ill-informed or optimistic, "yes" can result in delayed or non-payment. Instead, just say: "Let me check if you are eligible first."
Treating Pain: The Hypermobile Coccyx
When I write about the coccyx, I recognize that I am talking about a relatively small subset of patients. When I write for Dynamic Chiropractic, I am trying to reach 60,000 chiropractors.
From Antiquity to Modernity: Huang Qin Tang at Yale Medical School, Part 1
Traditional Chinese medicine is a coherent medical system with several unique characteristics: it originated almost 3,000 years ago; in its area of origin, it has been practiced without interruption since its inception.
Integrative Medicine Can Shape the Profession
As the AOM profession struggles to define the role of "integrative" medicine within their practices their schools and organizations, students, faculty, alumni and administrators at schools wrestle with discussions of how much, where, how, and what to "integrate."
The MRI: What to Do With the Results
As I wrote in my previous article on this topic, it is my goal for you, the doctor, to be an expert in interpreting MRI images yourself; and to be able to independently make decisions based upon a combination of clinical presentations and findings, followed by the MRI images.
Percussion Therapy: An Experiment
My study of qi began more than 20 years ago — long before my study of TCM, points or pathways. It all started with an awareness in my hands and physical manifestations in the way of blockages while working on clients.
The Clinical Versatility of Milk Thistle (Part 2)
Evidence is growing that the silymarin complex of flavonolignans from milk thistle can impact serum ferritin and iron overload in various clinical circumstances.
Yo San University Helps Make LA Communities Healthier
An element of healthcare training often overlooked is the residual benefit to communities served by Acupuncture and Oriental Medicine (AOM) schools nationwide.
January, 2003, Vol. 03, Issue 01
Working With Clients Who Have Hyperthyroidism
By Ruth Werner, LMP, NCTMB, Massage Therapy Foundation President
In my previous article on thyroidism (October 2002 issue), I discussed how insufficient levels of thyroid hormones circulate in the bloodstream, or receptor cells become resistant to these hormones (or both).Hypothyroidism is a fairly common condition, but getting an accurate diagnosis can be challenging. Its symptoms can overlap with those of fibromyalgia syndrome, candidiasis, chronic fatigue syndrome and other conditions. Furthermore, current measuring standards for "normal" hormone levels are rough at best, which means a person with a borderline case, but significant symptoms, may have difficulty getting a useful diagnosis.
This article focuses on a corollary disorder: hyperthyroidism. Hyperthyroidism and hypothyroidism are closely linked. Both may result in the development of a goiter - a painless enlargement of the thyroid gland. People who begin with hyperthyroidism may end up with hypothyroidism as a result of their treatment. Also, as one reader informed me, a baby born to a mother with hypothyroidism may develop hyperthyroidism as an overcompensation response.
Before we begin this discussion, I'd like to include an excerpt from a correspondence I had with David Ponsonby, a massage therapist from Dallas, Texas, who generously shared his experience with hyperthyroidism:
My mother had the iodine deficiency variety of hypothyroidism, which I believe initially causes the thyroid to enlarge in an attempt to meet demand, then to fail. My mother was the Anglo-Australian equivalent of a "G.I. bride." She went to Western Australia and had two babies. Away from fish and pre-iodized salt, she developed goitre (English spelling). I came across one reference that suggested the fetus will overcompensate for a deficiency and become hyperthyroid - i.e., me. She had two surgeries in the next four years, and a third almost 50 years later that resulted in pneumonia and death. Throughout the 50 years, her breathing, speech and activity level were impaired.
My own hyperthyroidism had some curious "coincidences" at initiation. I developed an apparent cellulitis after being bitten by a mosquito near a city sewer plant. (No association, they tell me?)
My lower right leg swelled up. When the swelling went down, it was very lumpy -- pretibial myxedema. The parathyroid is mixed in, with calcium deposition around the periosteum - like a soccer player's shin. I am a former soccer player, and it was interesting that the site of some of my old injuries seemed to be the focus.
My eyes popped out, I became very hot, my skin was flushed and itchy, my blood pressure went up, my heart pounded in my ears, and I fainted on two occasions -- very scary. I tried to maintain my exercise, although the sweating and fainting made it scary because there was always the possibility that I could collapse while riding my bike, etc.
I tried acupuncture, which seemed to relieve the swelling on one side, under the eye. I tried detoxification, energy therapy, homeopathy, etc. Gradually, most of the symptoms went away. I still have some swelling under one eye.
What Is Hyperthyroidism?
Hyperthyroidism is a condition in which the thyroid gland produces excessive amounts of two forms of thyroid hormone (T3 and T4), resulting in the metabolism of fuel into energy - lots and lots of energy. A person with hyperthyroidism has an engine that runs hot all the time, and never really lets up.
Demographics: Who Gets It?
Hyperthyroidism affects between 1 percent to 2 percent of all people in the United States at some time in their lives. About 500 thousand new cases are diagnosed each year. Women are affected more often than men, by a margin of about 3 or 4 to 1. Most cases are diagnosed between the ages of 20 and 40.
Etiology: What Happens?
Hyperthyroidism is usually caused by one of three things: a thyroid infection; a nodule or group of nodules that become hyperactive for unknown reasons (this is called toxic nodular or multinodular goiter); or an autoimmune attack against the thyroid gland that causes it to secrete excessive amounts of metabolic hormones (also called Grave's disease).
Grave's disease is by far the most common variety of this disorder, accounting for 70 percent to 80 percent of all cases. In this situation, antibodies called thyroid-stimulating immunoglobins (TSI) mistakenly attack the thyroid gland, causing it to grow to huge dimensions (this is called a goiter) and so to secrete excessive levels of both forms of thyroxine.
Under normal circumstances, pituitary secretions of thyroid-stimulating hormone (TSH) tell the thyroid when and how much to metabolize fuel into energy. When Grave's disease is well-established, the thyroid produces its own TSH for local action, so circulating levels of this hormone drop significantly. At the same time, levels of TSI, the antibodies that attack the thyroid, increase systemically throughout the circulatory system. The result is that the conversion of fuel into energy increases by 60 percent to 100 percent.
While genetics clearly play a major part of developing Grave's disease, its onset often seems to be connected to a stressful situation like a death in the family or a job change. Other risk factors for developing this disorder include exposure of the thyroid to X-rays, or previous use of antiviral medications such as interferon or interleukin.
Signs and Symptoms
The primary symptom of Grave's disease is the development of a goiter: the thyroid becomes enlarged enough to create a visible, painless swelling in the neck. Other signs and symptoms are mostly related to the emphasis on metabolizing fuel for energy, rather than growth or storage.
Grave's disease patients may show anxiety, irritability, insomnia, rapid heartbeat, tremor, increased perspiration, sensitivity to heat, and unintentional weight loss. Skeletal muscles, especially in the arms, often become weak. Other symptoms may include a lighter flow during menstrual periods, dry skin and brittle nails. Grave's disease can also affect the muscles that lift the eyelids. When the eyes seem to protrude, this is called exophthalmos. (Think of Marty Feldman in Young Frankenstein - he was a famous hyperthyroidism patient.) Grave's ophthalmopathy is a rarer disorder that causes the eyeball to protrude beyond its protective orbit because tissues and muscles behind it swell. The front surface of the eye can dry out, causing light sensitivity, double vision, decreased freedom of movement within the orbit, pain, and excessive tearing.
Some Grave's disease patients develop red raised patches of skin on their shins and feet. These rashes are called pretibial myxedema, and they are generally not painful or dangerous.
One of the most serious complications of Grave's disease is the risk of episodes of dangerously accelerated metabolism called thyroid storms. In these episodes symptoms may include rapid heartbeat, fever without infection, intolerance to heat, confusion, agitation, and finally fainting or shock. Thyroid storms can be medical emergencies and require immediate intervention to slow the heart and bring down the fever.
Grave's disease is usually diagnosed through a physical exam, a blood test, and an examination of how the thyroid takes up radioactive iodine. The physical exam concentrates on issues like goiter, temperature, heart rate, muscle weakness, and tremor. Blood tests will look for low levels of TSH combined with high levels of TSI, along with abnormally high levels of thyroxine. The ingestion of radioactive iodine shows how quickly the thyroid absorbs iodine (a primary component of thyroxine), along with which parts of the thyroid appear to be hyperactive. This test helps to delineate between Grave's disease and nodular hyperthyroidism.
Hyperthyroidism can be treated in a number of ways, depending on the underlying causes and the severity of the symptoms.
Alternative therapies for hyperthyroidism focus on the use of certain foods and/or vitamins that inhibit thyroid activity, but I couldn't find any information on modalities that can actually interrupt the immune system attacks on the thyroid gland.
What About Massage?
As long as the skin is healthy and intact, and the cardiovascular system can adjust to the changes we bring about, massage of all types may be beneficial to clients with hyperactive thyroid glands. The calm, relaxed response bodywork creates may provide a welcome change to the sympathetic-like symptoms of hyperthyroidism.
In my next article, I will discuss reflex sympathetic dystrophy syndrome (RSDS). Also referred to as causalgia, sympathetic maintained pain syndrome, or complex regional pain syndrome, this chronic pain syndrome presents special challenges for massage therapists. If any of you live with this, or have clients who do, I'd love to hear from you.
Until then, many thanks, and good health and happiness.
Click here for previous articles by Ruth Werner, LMP, NCTMB, Massage Therapy Foundation President.
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