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Help Update the LBP Practice Guideline
The Council on Chiropractic Guidelines and Practice Parameters has announced the release of an updated Clinical Practice Guideline for Chiropractic Management of Low Back Pain for stakeholder review and comment.
Converting More Patients to Your Practice
In 2013 and 2014, the theme was "the money is in the list." This meant that if you had a big email list, you were really making some "cha-ching." Unfortunately, having thousands of emails doesn't equate to thousands of dollars in profit.
A Well-Kept Secret: 5 Element Acupuncture, Part II
Supervising acupuncture interns at a TCM college, it has always struck me how funny it is to hear the clinic manager tell the patients that the Five Element clinic specializes in treating emotions, as if patients with physical pain have no emotions!
There Really is No Room for Sexism
Recently, Matteo* (a transgender male) approached me during a break in an advanced shiatsu class in Berlin where he was one of two men in a group of 20 women. "Pamela. Don't forget to remind the translator to include male endings."
Expanding Access, Branch by Branch
The big news coming from Capitol Hill isn't merely the recent introduction of a pair of bills designed to expand chiropractic services in the Veterans Affairs and military health care systems; after all, similar legislation has made its way through Congress before, never reaching the Oval Office for presidential signature.
An Excerpt from TCM Case Studies: Pediatrics
This excerpt is reprinted with permission from Jamie Wu. TCM Case Studies: Pediatrics was released in 2014 by People's Medical Publishing House.
B Vitamins Improve Memory, Prevent Brain Atrophy
The 2010 OPTIMA study showed that the accelerated rate of brain atrophy in elderly with mild cognitive impairment could be slowed via supplementation with homocysteine-lowering B vitamins, which included folic acid, vitamin B12 and vitamin B6.
TCM Congress in Rothenburg is Largest in Western World
In the medieval town of Rothenburg, deep set within the Bavarian countryside in Southern Germany, the TCM Kongress Rothenburg each year draws around 1.200 participants from more than 40 different countries to attend the biggest TCM conference in the Western world.
Synergy Doesn't Happen in Silos: Acupuncture in Hospitals and Other Healthcare Settings
As acupuncture and traditional East Asian medicine continue to intersect and integrate with biomedical approaches, the conversation about integration expands and becomes richer.
Avoid Random Treatment of Trigger Points (Part 2)
We must acknowledge that the fascia, which surrounds literally everything in our bodies, including every muscle fiber, is more than just a covering.
Impacting Chiropractic's Future With Technology
When it comes to electronic health records (EHR), Robert Moberg and Dr. Steven Kraus are two of the leading industry experts on the topic.
Treating Beyond Pain
More often than not, when a patient presents to the office, it is for a pain complaint. Headache, neck pain, low back pain, sciatica, carpal tunnel... The pain is often the focus of the patient's mindset, and they don't often have any thought of what comes after the pain.
Atypical Femoral Fractures and Bisphosphonate Use: What to Watch For
Bisphosphonates (BP) are popular drugs, with more than 8 billion in sales in 2008; however, profits have declined as patents began expiring. Nonetheless, BP remain the most commonly prescribed drugs for patients at risk of osteoporotic fractures, with several million prescriptions written every year.
Interpersonal Skills 101: Enhancing the Value of Our Patient Interactions
Recently, I read an interesting article in our local newspaper titled "The Value of Human Interaction." The article presented comments from a senior editor for Fortune magazine who discussed "Civility in the Business World."
The Way We Are Designed: A Conversation with Gil Hedley, PhD
I was first introduced to the work of Gil Hedley by Tom DiFerdinando. He gifted me Gil's DVD series.
The Need for a New Medical Model: A Challenge for Biopsychosocial and Ecopsychologica Medicine
Chinese medicine speaks of alignment between humans, heaven and earth. It is a complex view with a focus upon relationship. These are comprehensive ideas with no specific terms in contemporary medical practice.
Primary Spine Care: Addressing Concerns & Criticisms
The Dec. 1, 2013 issue of Dynamic Chiropractic included an article describing the implementation of a training program for primary spine practitioners (PSP) within a metropolitan region and supported by a large BC/BS plan.
Recreational Cannabis Use and TCM
Many people are drawn to cannabis for its effects physically, mentally and emotionally. Medically, cannabis has some legitimate uses, however the scope of this article is limited to the recreational use of cannabis.
The Dietary Supplement Research Dilemma
I do not care what the truth is, one way or another; I just want to know it. And when it comes to dietary supplements, the truth can be hard to find for a number of reasons.
Will You Be an Amplifer or a Mute?
These times are changing, and changing quickly. There have been many challenges to this profession throughout the past few years. The challenge is to talk, then talk and talk some more about this medicine.
A Reality Check – and a Chance to Educate
Imagine working in the public relations department of nutrition retailer General Nutrition Corporation (GNC) and reading the The New York Times announce...
Low Back Pain: Posture and Movement Analysis
When performing static and dynamic movement analysis of the lumbopelvic hip area, begin with standing visual posture analysis of the pelvis, and then perform lumbar range of motion and assess what you might see during normal versus abnormal lumbar flexion motion.
January, 2005, Vol. 05, Issue 01
Verruca Vulgaris: Warts!
By Ruth Werner, LMP, NCTMB, Massage Therapy Foundation President
Happy New Year! I am writing this in early December when the challenges of the holiday season are still in front of me, and the New Year appears to be far, far away, but I realize that soon we will be looking back at 2004 with nostalgia.I hope it has been a wonderful transition for all of you.
My last article on herpes simplex generated a fair amount of feedback: Some readers wanted more information on the prodromic stage of the infection, specifically, how to protect themselves before the lesions are visible. There is no easy answer to this question.
The best I can offer is that because herpes is a much less stigmatized infection than it used to be (we have way more serious sexually transmitted infections now!), people are more likely to tell us the truth on client intake forms about their condition. When we know someone has a history of herpes, it is fair and even responsible to ask them to reschedule their appointments, particularly if they know they are prodromic or in the midst of an episode. Outside of that, we are limited to using standard precautions and taking excellent care of our health and our hands. Ultimately, this is very effective. In my years of teaching this material to thousands of people, I've met maybe two who thought they might have picked up a herpes infection from a client.
Other readers wanted more information about what therapists with active lesions can do. Again, it depends mainly on you and your clients' comfort levels. Topical and oral antiviral medications can shorten the length of a herpes outbreak, but they don't prevent them and they don't reduce communicability of an active lesion. If a therapist has an active lesion, covers it to the best of his/her ability, and shares that information with the client, then the client should be able to decide if the appointment needs to be rescheduled.
One thing that didn't generate a lot of discussion was my request for you to let me know what you'd like to read about next. In the absence of a consensus, I will proceed with everybody's favorite viral infection, warts.
Definition and Etiology: Common warts, or verruca vulgaris, are caused by an infection with a type of human papilloma virus (HPV). This is a pathogen that targets keratinocytes in the skin, leading to an excessive pile-up of the hard, crusty proteins that make us waterproof. (Some varieties of HPV cause genital warts, which may lead to cervical cancer; it is not the same virus that causes verruca vulgaris.)
Common warts can affect anyone, but they are especially prevalent among teenagers. They are often discussed as a contagious disorder because any skin that flakes off around a wart, or any blood that seeps from around an irritated wart, may carry the virus. However, bear in mind that this is a slow and lazy pathogen, and a massage therapist would have to work hard to "catch" someone else's warts.
Warts do not typically create a strong or aggressive immune system response as other infections usually do. This allows them to grow for months or even years if they are not removed by other means. That said, they are notoriously tenacious, and many self-administered remedies (specifically with salicylic acid) may miss some infected cells deep in the lesion, leading to secondary rings of warts around the original site of infection.
Signs and Symptoms: Warts look like hard, cauliflower-shaped growths on the skin. They are especially common around joints on knuckles, fingers, elbows, and knees. They can also grow on the plantar surface of the foot (these are plantar warts), where they protrude upward into the soft tissues, causing pain and making it difficult to walk. It is important to be able to distinguish between plantar warts and callus, which can have a similar appearance. Some key differentiating factors:
When we have a client who we think has plantar warts, it is not appropriate to say, "Oh, look, you have a plantar wart." It is appropriate, however, to give some good advice about having the area checked by a dermatologist or podiatrist before the person tries to remove it with a pumice stone or a pair of clippers, since this is an excellent way to turn one mildly annoying plantar wart into several large, painful, and even crippling growths on the feet.
Treatment: Warts are usually self-limiting - that is, they eventually go away by themselves - but this can take weeks, months, even years. More often, people try varieties of methods to eradicate them, including salicylic acid, liquid nitrogen, lasers, scalpel excisions, and a newly proven technique:wrapping the wart in duct tape (It's almost all you need sometimes.)*
But where warts get really interesting is when they disappear in response to more subtle triggers. Warts are highly suggestible - so much so that our literature is laden with stories of how people have rid themselves of warts.
The plot of Tom Sawyer turns on his swinging a black cat over an unconsecrated grave at midnight, all to cure his warts so Tom can take Becky to the picnic.
Other folk remedies include rubbing the wart with a rooster comb and then burying it; wrapping a horsehair around the wart and sleeping on it; "selling" the warts to a loving relative; and, of course, the time-honored potato cure. These instructions came verbatim from one of my students: "Cut a potato into six pieces. Bury each piece in a different place, and never tell anyone where you buried them. Your warts will fall off in two weeks, because mine did."
All this points to a remarkable connection between belief systems and immune system activity. If a person at any level believes that having her Russian grandmother chant and then spit on her warts (another cure shared by a student) will work, it works! The branch of medicine called psychoneuroimmunology specifically addresses the often-mysterious links between mental and emotional state and immune system status. The study of warts may provide a "way in" to explore this highly promising field.
Massage and Warts: Massage therapists should consider warts to be local contraindications. Massage won't make them go away (unless the client thinks it will!), but the flaking skin or any crusting around the wart may carry some virus that may spread. Minimizing direct contact with the wart is adequate; however, this again is a slow and lazy pathogen that doesn't easily or aggressively spread from one person to another.
For next time: I've had a few general requests to address topics specific to our aging population: Alzheimer's disease and Parkinson's disease, in particular. Other readers have been interested in amyotrophic lateral sclerosis, or Lou Gehrig's disease. What would you like to read about? Let me know: What's on your table? All my best wishes for a healthy and happy 2005!
*Focht DR, Spicer C, Fairchok MP. The efficacy of duct tape vs cryotherapy in the treatment of verruca vulgaris (the common wart). www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=
Click here for previous articles by Ruth Werner, LMP, NCTMB, Massage Therapy Foundation President.
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