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How to Bill Evaluation and Management Codes
Q: I am in need for guidance on how to bill evaluation and management (E&M) codes in addition to acupuncture the same date of service, I have never been paid for an exam when done with acupuncture and I believe I am doing it wrong.
The Effectiveness of Chinese Medicine in Treating Infertility in the Philippines
Infertility is defined as the inability to achieve a successful pregnancy after 12 months or more of regular unprotected intercourse.
Who is Your Ideal Patient?
Being in a healthcare practice requires you to think critically about many things including your equipment, techniques, documentation, financial goals, and the retention of clients and staff.
Treatment of Type 1 Diabetes Mellitus: The Latest Breakthroughs
There are now more than 29 million diabetics in the U.S. and 10% of them have Type 1. The incidence has been increasing in recent years at an epidemic rate.
What Should You Call Your Patients (and What Should They Call You)?
When I walked into the exam room, the new patient looked uneasy, fumbling with his cellphone. He was a huge Polynesian man, probably in his 40s, with unrecognizable island tattoos.
Introducing the Dynamic Chiropractic Digital Edition
In response to the changing habits of our readers, Dynamic Chiropractic is proud to introduce a digital edition of the publication beginning with the July 2016 issue.
Herbal Medicine Continues to Evolve
Product manufacturers, industry partners, distributors and practitioners work as a collective Traditional Chinese Herbal Medicine (TCHM) community to produce high quality TCHM prescriptions that bring low-risk healthcare to thousands of patients everyday.
F4CP Campaign Addresses Public Misperceptions of Chiropractic
In late 2015, results of the Gallup-Palmer College of Chiropractic Inaugural Report: Americans' Perceptions of Chiropractic were published. The report found that 33.6 million U.S. adults (14 percent) had utilized chiropractic care within the previous 12 months.
Diet, Nutrition and the Context of Risk (Part 2): Food Poisoning
Other than the morbidity and mortality linked to eating too much food, "all-natural" organisms that contaminate our food cause more illness, more hospitalizations and more death than food contaminated by heavy metals, plastics, preservatives, artificial colors, emulsifiers, artificial sweeteners and pesticides combined.
Does Anyone Know You're a Good Chiropractor?
If you had a chance to read the recent article in Time magazine (April 6), you know it provided some good information about the efficacy of chiropractic to the magazine's substantial consumer audience.
Time for World-Wide Growth
Acupuncture is the organically growing around the world. The legislative body in Quatar has said acupuncture is "okay." The United States has five states to go to have every state recognized and regulated.
Shoulder Rehab: The Gait Connection
Shoulder problems can be difficult to rehab completely for several reasons. The shoulder is made up of several joints that must function together smoothly to provide the extreme mobility that is possible and necessary for many activities.
Five-Element Reaches Out to Serve the Community
In 2006, a student at the Institute of Taoist Education and Acupuncture (ITEA) approached the administration about an idea for his senior project.
Immunotherapy: Where Molecular Medicine Crosses Into Holistic Thinking
Immunotherapy, and its promise as a cancer treatment, has been in the news a lot in the last few years, and for good reason. Real shifts are happening in oncology and exciting researchers, clinicians, and patients.
Chiropractic Needs a Lesson in Education
The American Chiropractic Association has launched a campaign, The National Medicare Equality Petition, to enact federal legislation that would achieve full physician status for DCs in Medicare.
Bring on the Bitters
Out of all the possible flavor choices with foods, such as sweet, sour, salty, and umami (deliciousness), which would you choose first? Bitter, though not as enjoyable, is also a flavor.
Acupuncture at a Pain Clinic
Introduction: Pain is the most comprehensive human experience. The experience of pain is associated with the somatic, emotional and social impact. Pain has not only somatic symptoms, but also psycho-social dimension, especially in case of chronic pain.
The Eight Extraordinary Confluent Points
The eight extraordinary confluent points are a very popular set of acupuncture points in the modern practice of acupuncture. They are also called the intersection, meeting, command, opening, master, and the flowing and pooling points of the eight extraordinary vessels.
Case Studies and Answer Analysis for NCCAOM Exam in Foundation of Oriental Medicine
Case studies are very common for acupuncture school students, either in class exams or during taking the national board exam. Most test takers feel they have no idea where they should start and how they should start to analyze those complicated cases.
2016 Trudy McAlister Foundation AOM Scholars
This year, the Trudy McAlister Foundation (TMF) received a record number of excellent applications for the 2016 scholarship awards and has awarded five scholarships for $2000 each. More information is available on our website: AOMScholarship.org
The Liver: The Official of Planning
The Liver, with its paired Official, the Gall Bladder, belongs to the Element Wood within us. Wood grants us the power of birth – new beginnings, growth, breaking through boundaries and surging forward. It is the vigorous, exuberant energy of the spring season.
We Get Letters & Email
Another Slap in the Face for DCs; I Know Where to Find the Missing Chiropractic Patients; Clarification on Vitamin D Study.
Are Herbs Useful for Chronic Pain?
The human nervous system is what makes us special, but our greatest strength also makes us vulnerable: witness the growing incidence of chronic addictions, anxiety, depression, sleep disorders and chronic pain syndromes.
The Good, the Bad and the Successful in Social Marketing
You might be thinking, "social marketing, don't you mean social media?" No, I mean social marketing. Every day, I keep reading, hearing and learning more and more about the changes happening in social media.
July, 2004, Vol. 04, Issue 07
Toxic Brain Injury (Encephalopathy)
By John Upledger, DO, OMM
Health problems that occur secondary to the bodily absorption of toxic substances can come on acutely and result in life-threatening crises, or occur gradually over months or years. When symptoms present themselves one at a time, very slowly, the period of latency or incubation can be extremely variable in length.
During latency, the body's adaptational or defense mechanisms may be countering the effects of the toxic substances as best they can.Yet as toxins gradually overpower these mechanisms, symptoms may begin to appear slowly and increase in intensity as the body's adaptational or defense mechanisms founder and - perhaps - ultimately fail. Usually, acute responses to toxic substances occur either with large-dose exposure or when there is a severe allergic response to the toxin, no matter the dosage. Should the allergic response be severe enough to result in toxic shock, the situation becomes life-threatening.
In the case of slowly progressing symptoms, there may have been an acute dosage of the toxic substance. The body's resistance to the toxin input, however, may have been strong and appropriately tuned in, taking the edge off the exposure and resulting in mild symptoms that may or may not progress. The symptom pattern that progresses in severity over months or years, however, more likely resulted from ongoing exposure to smaller doses of toxic materials. The organs most obviously affected by toxic substances are the lungs, heart, kidneys and liver. Usually, we see less obvious effects in the gastrointestinal tract, pancreas, spleen, and the bones and joints of the musculoskeletal system.
It generally takes longer to recognize the effects of toxic substances on the brain, spinal cord, autonomic nervous system and voluntary peripheral nervous system. The brain seems to be a keen competitor for the title of slowest responder with the most endurance. What we have been calling "senescent changes in brain function due to normal aging processes" may actually be due to slowly advancing toxic brain inflammation. I refer to that as toxic encephalitis, or toxic encephalopathy.
Recently, toxic substances have been traced through the blood-brain barrier into the hypothalamus, and from the hypothalamus into the pituitary gland, where they cause dysfunction. Should the toxicity compromise the posterior pituitary gland, the result can be diabetes insipidus, secondary to dysfunction of the posterior pituitary gland. This posterior part of the pituitary gland produces anti-diuretic hormone. When production of this hormone is curtailed, the tubular reabsorption in the kidneys is impaired.
This situation results in the passage of large amounts of urine, great thirst, and often a voracious appetite. The increased quantities of urine do not contain significant amounts of sugar. Thus, it is differentiated from diabetes mellitus, which is due to a deficiency of insulin, or a problem with insulin receptors in the cell membranes. There are large quantities of sugar in the urine of diabetes mellitus (type I) patients. In type II diabetes (maturity onset), there is also increased urine output that contains significant quantities of sugar (glucose).
It is clear that diabetes insipidus may be caused by toxic substances that were eaten, taken in with water, inhaled, absorbed through the skin, etc., and eventually wound up in the brain and affected the posterior pituitary gland. Presently, there is little, if any, evidence to support the concept that either type I or type II diabetes mellitus is caused by toxic substances, although the possibility may exist.
When toxic substances get into the hypothalamus, there is a strong possibility that they will also get into the anterior pituitary gland, the master gland of the total endocrine system. Imagine that the repetitive inhalation of organic solvents, such as those that vaporize in gasoline fumes and cleaning solutions, may be the underlying cause of anterior pituitary gland dysfunction that might easily result in hypothyroidism (low thyroid); hypoadrenalism (poor adrenal response to emergencies, stresses, etc.); abnormal menstrual cycles; infertility; poor lactation, with the inability to nurse; and poor immune response, resulting in increased vulnerability to infections caused by low-potency bacteria, viruses, fungi, and on and on. Any of these symptoms could result from toxic substance infiltration of the pituitary gland.
Also, consider that these toxic substances probably invaded the hypothalamus of the brain en route to the pituitary gland. What happens when hypothalamic function is disturbed? First, the hypothalamus more or less governs the anterior pituitary gland. It doesn't seem to have much say over the posterior pituitary gland. However, the hypothalamus has a private connecting system with the anterior pituitary, and the highways between the two run both ways.
There are both nerve- and blood-system highways connecting the hypothalamus and anterior pituitary; therefore, they intercommunicate by both nerve impulses and hormonal molecules that are transported through their connecting blood vessels.Besides its influence on menstrual function via the anterior pituitary gland, the hypothalamus also strongly influences appetite and satiation, and a wide range of emotions, including pleasure, aggressiveness and sadness.
Imagine the possibility that being around cleaning solutions that are organic (and many are) and breathing the fumes every few days can affect your emotions; your sexual and reproductive function (including sperm count and vitality); your appetite-satiety balance (and hence your weight); and other functions. Organic solvent fumes can change your whole life, and you wonder how it is happening.
I suspect we should seriously look for ongoing and possibly hidden sources of toxin input. Perhaps if the input is stopped, the body may be able to effectively clear the remaining toxic substances/molecules. I am also sure that CranioSacral Therapy (CST), in conjunction with some other modalities, such as lymph drainage therapy, can assist in the clearing process.
Exercising the craniosacral system enhances the ability of cerebrospinal fluid to flush unwanted toxic materials from the brain and spinal cord tissues. Since it is now known that cerebrospinal fluid carries small molecule-chelating agents, clearly the enhanced flushing may remove unwanted metallic deposits from brain and spinal cord tissues. CST may also remove traumatically induced obstructions related to the meningeal and myofascial systems that interfere with cerebrospinal fluid flow.
All in all, it's better to include a modality in your protocol that stimulates fluid flow and helps flush the tissues than to ignore the body of evidence pertaining to toxic encephalopathy.
For a more in-depth article on toxic encephalopathy, please call 1-800-233-5880 and ask for the Toxic Brain Injury monograph.
Click here for previous articles by John Upledger, DO, OMM.
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