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Integrative Sports Medicine
One of the most rewarding and challenging clinical scenarios is the treatment of athletes.
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?
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.
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.
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?
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Preaching 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.
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.
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.
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.
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.
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.
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.
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!
Learning the Transformative Language of the Channel System: The Sinew Channels
The Chinese medical classics describe the energetic terrain of the body in much detail. The acupuncture channel systems, as presented in the Ling Shu illustrate the various expressions our qi energy can take.
December, 2003, Vol. 03, Issue 12
Depression and the Stress Response System, Part III
By Ruth Werner, LMP, NCTMB, Massage Therapy Foundation President
In the first part of this series, I introduced the concept of depression and its relationship to touch deprivation and a sluggish stress response system. Last time, I looked at different types of depression and the consequences of living with this disorder.This month, I will discuss treatment options, including, of course, massage.
Most types of depression can be treated successfully: Up to 90 percent of all depression patients eventually find a treatment that significantly improves their quality of life. A combination of medical intervention and psychotherapy appears to be the most effective way of treating most types of depression.
Antidepressants - Medications used for depression usually fall into one of three categories: selective serotonin reuptake inhibitors (SSRIs), monoamine oxidase inhibitors (MAOIs) or tricyclics. These classes of medication aim to make neurotransmitters more easily accessible in the mood-determining areas of the brain. SSRIs, such as Prozac and Zoloft, work by preventing the recycling of secreted serotonin into axon terminals. In other words, serotonin lingers in synapses for longer than it normally would, which reinforces its power to work. Tricyclic antidepressants, including amytriptaline, essentially do the same, although they do not focus specifically on serotonin. MAOIs, such as Nardil and Parate, limit the action of an enzyme that would normally break down and clear away secretions of neurotransmitters. Lithium is used specifically to treat bipolar depression. Rather than altering levels of neurotransmitter reuptake or recycling, lithium works simply to "smooth out" mood swings.
Antidepressants are effective for most people, but they have two major disadvantages: They take several weeks to establish any noticeable mood changes, and they tend to produce unpleasant side-effects during the initial adjustment period, including dry mouth, dizziness, constipation, skin rashes, sleepiness or sleeplessness, and restlessness. Side effects usually subside within four to six weeks - about the same time the medication starts to work.
St. John's Wort - This herbal extract has received a lot of attention as a mood enhancer without the side-effects that other antidepressants carry. Early experiments indicate that it might work like SSRIs or tricyclic antidepressants by preventing the reabsorption of neurotransmitters at the synapses. The National Institutes of Health recently began a three-year study of St. John's wort in comparison to amytriptaline for the treatment of mild dysthymia.
Psychotherapy - Psychologists and psychiatrists may also employ various types of "talk therapy" to help patients improve coping skills and reduce the effects and recurrence of depressive episodes. Three major approaches are useful, depending on the personality and needs of the affected individual. Cognitive-behavioral therapy focuses on the patient's skills at managing life and making positive choices. Interpersonal therapy focuses on how relationships color a person's life, for better or worse. Psychodynamic therapy examines how unresolved inner conflicts can affect the way a person makes choices and lives with those choices. Psychotherapy, combined with medication, often works better than medication alone, because it can help the patient take control of a situation - a feeling many depressive people do not often have.
Light therapy: Individuals living with seasonal affective disorder (SAD) do not need medication or therapy; they need sunlight. Exposure to broad-spectrum lights can help to reduce symptoms.
Electroconvulsive therapy (ECT): Some depression patients do not respond to medication, but the symptoms persist and make their lives miserable. ECT or "shock" therapy may be the best choice for these patients. While this may bring up disturbing memories of the movie "One Flew Over The Cuckoo's Nest," modern ECT is conducted under light anesthesia, and with muscle relaxants to limit uncontrolled contractions. It is not entirely clear why it works, but it can be a highly effective intervention for people who do not get relief from other options.
Massage: Most people suffering from depression will reap several benefits from bodywork. Touch improves the efficiency of the pituitary-adrenal axis. Receiving non sexual, nurturing, non threatening touch is one of the most important ways humans and other mammals have to keep a healthy stress response. Massage moves people from a sympathetic to a parasympathetic state. This brings about several physiological and chemical changes in the body, including an increase in serotonin secretion and a decrease in cortisol. Research about how massage affects mood indicates a shift in electroencephalogram (EEG) activation from the right frontal lobe (usually associated with sad affect) to the left frontal lobe (usually associated with happy affect), or at least to a symmetrical reading.1 Massage is one of the few distinctively pleasurable things people can do that is also really good for them. The act of receiving a massage is a step toward self-determination that depressed people can take with little risk of having it backfire.
Be cautious when working with depressed patients. Some clients who receive massage and enjoy its benefits may wish to stop taking their medication; well-meaning massage therapists may view this as a successful outcome and encourage their clients to try it, but balancing medication for depressive people is a difficult business. Only the patient and his or her doctor should be involved in this decision.
Depression often accompanies complex emotional issues that a client may have trouble sorting out. Client-therapist relationships run the risk, in some cases, of becoming distorted when boundaries are not carefully respected. If a massage therapist has a client who is depressive in connection with other problems (for instance, recovering from emotional, physical or sexual abuse), the relationship can be precarious, especially if the client is not getting adequate support outside the massage clinic. In these cases, therapists are obliged to refer clients for other kinds of help, and to prevent the client-therapist relationship from becoming more central to the client's life than it should be.
I will be taking a short break from my column until next May. Until then, many thanks and many blessings.
Click here for previous articles by Ruth Werner, LMP, NCTMB, Massage Therapy Foundation President.
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