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Professionalism and Evidence-Based Health Care
Today's chiropractors are facing a conundrum with the Affordable Care Act and its health care reform requirements, including evidence-based practice and health technology assessment.
Fight Colorectal Cancer With Folic Acid
CRC is the second most common cause of cancer mortality in the U.S. and Canada. Although genetic susceptibility plays a role in the etiology of CRC, dietary factors, including certain vitamins, have also been shown to influence the development of the disease in various studies.
The Conscious Evolution of Healing: Importance of Opening the Sensory Portals in Classical Chinese Medicine
The Chinese medical classics are not just clinical guides. They give advice; ways we can awaken more fully into conscious awareness.
Acupuncture and its Place in the Integrative Healthcare Practice: The Need to Move from Modality to Profession
Acupuncture and oriental medicine (AOM) has grown and flourished from its inception thousands of years ago in China. In surrounding regions of Asia, AOM developed as a response to differing cultural, pathological, health and wellness care needs.
Happy New Year 2015 Gong Hoy Fat Choi
Welcome to the year of the sheep! We begin a new year guided by the sign of a quietly and creatively organized animal.
Age and Fertility: Why We Should Worry Less About Age and More About Overall Health
Recently, on one of the acupuncture alumni forums, the topic of age and fertility came up when a practitioner posted a question regarding a patient that was about to turn 40-years-old.
I Felt it in My Fingers First
I'm not afraid to say it. Massage therapists make better acupuncturists. I'll tell you how I know, but first I have a question: What do a microcurrent device, a laser and a hippie massage therapist have in common?
Ringing in the Billing New Year
What are the new modifiers that replace modifier 59? Will they allow doctors of chiropractic to be paid for 97140, manual therapy, when done with chiropractic manipulation?
Show Up and Show Respect
I was recently asked about my chiropractic philosophy. My answer surprised my questioner.
Three for One: The Cervical Distraction Test
Taking the time to do an exam is important, but it is time spent. The exam serves as a way to physically validate your clinical impression following a history and clinical consultation.
The Static Postural Pelvic Exam
I include a static postural analysis in my evaluation routine whether you are a patient in pain or an elite-sport athlete in training. In my day-to-day practice, I require patients to stand still while I "just look" at them.
Animal Acupuncture Gaining in Popularity
We have just finished the year of the fire hoarse and now it is time to spend some time alone, daydreaming and thinking outside the box in terms of where our profession is headed. The sheep person is well organized and creative so this should not be difficult to do.
How to Use Online Video as a Tool to Market Your Practice
Health care practitioners, including chiropractors, should consider online videos as a key element of their Internet marketing strategy. In the next three years, videos are expected to account for nearly 70 percent of all consumer online traffic, according to Cisco.
AWB Makes a Difference in the Yucatan
We are in the sleepy town of Izamal, located about an hour from the Merida airport where our group arrived last night. Later that morning, on a bus winding through the dusty roads of the Yucatan, fourteen acupuncturists, two facilitators from AWB and two tour guides make their way to the small rustic town of Popola.
Helping to Create the Healthiest Generation
The imperative to create the "Healthiest Generation by 2030," envisioned by the American Public Health Association (APHA), was in full force at the APHA's 142nd Annual Meeting held in New Orleans from November 15-19, 2014.
The App Advantage: Get More for Less
You may have noticed the list of "app-exclusive" articles in the directory on the front page of the print issue and in the Table of Contents on page 4. You can't find these articles in print or even in our online archives.
We Get Letters & Email
Rethinking Our Approach to Immunization; Coming Together for the Good of Our Patients.
Chiropractic Research in Review
Occupational LBP in Primary- and High-School Teachers; Treating MVA Complications With Chiropractic Care; Neck Pain: Immediate Effects of Active Scapular Correction; Taping Benefits Stride, Step Length in Fatigued Runners.
Environmental Toxins: Cause of Modern Illness, Part 2
In Part I of this article, we detailed the variety of environmental toxins assaulting our bodies. These include pesticides and herbicides; plastics; preservatives; cosmetics; gasoline additives, solvents and glues; and heavy metals.
Taking the Freeze Out of Adhesive Capsulitis
Adhesive capsulitis or "frozen shoulder" is a relatively common condition resulting in severe shoulder pain and global loss of glenohumeral joint range of motion. Incidence of the condition is approximately 3 percent in the general population.
News in Brief
While indignation may be your immediate reaction to H.R. 5780, the Protecting the Integrity of Medicare Act of 2014, the American Chiropractic Association suggests the legislation is just what the chiropractic profession needs.
Two for One: The Cervical Distraction Test
In today's healthcare system, diagnoses and treatment plans follow a western medical model - especially if you work with attorneys or insurance companies.
Trouble Down Under: San Zhen Therapy for Lower Jiao Issues
In the last several columns, I have discussed many clinical options for utilizing San Zhen or Three Needle Therapy. In this installment, I will continue this trend and discuss several foundational patterns which can be found in several very common clinical presentations.
Right Back Where We Started?
More than 25 years after Judge Susan Getzendanner issued her historic opinion in the Wilk v AMA anti-trust case, evidence suggests that despite increasing collaboration between doctors of chiropractic and their allopathic medical counterparts, when it comes to organized medicine, we may be right back where we started.
The Way of Zen Performance Enhancement
Working with elite athletes and implementing various techniques to keep athletes focused and at their optimal performance for a sustained period of time includes incorporating various meditation techniques that counterbalance their sport-specific physical and mental demands, which is an important element of success throughout the years.
July, 2005, Vol. 05, Issue 07
Amyotrophic Lateral Sclerosis: Part 1 of 2
By Ruth Werner, LMP, NCTMB, Massage Therapy Foundation President
In my last article I put out a call for massage therapists who work with Amyotrophic Lateral Sclerosis (ALS) patients to get in touch with me. I hoped to share some of their stories with Massage Today readers. Well, the response was amazing. I have lots of information to share, both on the development and latest research into this disease (part 1), and on what therapists are doing to help improve the quality of life of their clients who have it (part 2).
Amyotrophic Lateral Sclerosis: What Is It? Also known as Lou Gehrig's Disease, ALS is a rapidly progressive, irreversible condition that destroys motor neurons in the central and peripheral nervous systems, leading to the atrophy of voluntary muscles. ALS usually affects people between 40 and 70 years old; the average age at diagnosis is 55. It can occur in higher rates within families, but the distribution and incidence of this disease is usually random. Men have it slightly more often than women. Approximately 20,000 people in the U.S. are living with ALS at this time, and life expectancy between diagnosis and death for most patients is two to 10 years.
Etiology: What Happens? The primary feature of ALS is the destruction of motor neurons. In most cases, it begins in the anterior horn cells and the descending tracts in the spinal cord. Large motor axons degenerate and are replaced with fibrous astrocytes, a type of glial cell. This is the derivation of the name of the disease: "lateral sclerosis" refers to the scarring of the motor tracts on the lateral aspects of the spinal cord. Without stimulus from the upper motor neurons, lower motor neurons (that take messages from the spinal cord to the neuromuscular junction) atrophy. Ultimately, the skeletal muscles deteriorate without sufficient motor stimulus: "amyotrophic" refers to muscle wasting.
While we have a reasonably clear idea about how this disease progresses and changes function, its causes are still unknown. At this point in time, the features of ALS that are being intensively studied include abnormal glutamate levels (this is an excitatory neurotransmitter that accumulates in the synaptic cleft, killing the affected neurons); exposure to neurotoxins (including lead, agricultural chemicals and others); free radical activity (this is an issue especially when ALS runs in families); a deficiency of neurotrophic factors (these are chemicals that allow for healing or new growth of nerve tissue); and a new avenue of inquiry: Almost half of all ALS patients show signs of retroviral exposure. Further explorations of these factors may eventually open new doors to effective treatments to stop or even reverse this mysterious disorder.
Signs and Symptoms. ALS presents different early symptoms in different people. The most common pattern is stiffness, weakness and awkwardness in one body part, which slowly spreads to other parts of the body. About two-thirds of ALS patients have their first symptoms in the arms or legs; these cases are called spinal ALS. The final third will begin with "thick speech," excessive salivation, and difficulty with swallowing. This implies damage to cranial nerves rather than spinal nerves and is called the bulbar form of ALS. Fasciculations, or visible muscle twitching, may be present, along with painful cramping. One side is typically worse than the other, and the stiffness eventually moves proximally up the limbs, eventually to affect the trunk muscles for breathing. The leading cause of death for ALS patients is respiratory failure.
The nerve damage seen with ALS is to motor neurons only; sensory neurons are not affected. This can be a painful disease, however, as the body gradually collapses and gravity puts musculoskeletal stresses on muscles that have no power to respond. ALS does not influence intellectual capacity at all. While depression and anxiety are certainly a part of the process, the disease itself does not affect cognition or awareness.
How Is It Treated? Traditionally, treatment for ALS has been strictly palliative; that is, aimed at managing the severity of the symptoms only. Recently, some medications have been developed that can slow but not stop or reverse the progress of the disease. Other interventions include drugs for muscle spasms, along with moderate exercise and speech, and physical and occupational therapy to maintain muscle strength as long as possible. (This turns out to be a delicate balance. Too little exercise allows muscles to degenerate; too much exercise puts a dangerous demand on low-functioning neurons - which can also cause muscles to degenerate.)
Assistive devices such as leg braces, arm braces or wheelchairs can improve a patient's ability to function. In advanced cases, swallowing may be so difficult that the insertion of a stomach tube (gastrostomy) may be recommended. Since this disease does not impede cognitive or emotional processes at all, psychological therapy for ALS patients and their families is an important part of the treatment plan.
Massage? We'll get into specific ideas about massage techniques for clients with ALS in part 2. In the meantime, bear in mind that this is a disease that involves the degeneration of motor neurons but not sensory ones, and the client is fully aware of the changes occurring in his or her body. This combination of factors makes massage a great choice for many ALS clients because sensation is intact and the client can communicate (until he or she is very advanced) about how the massage feels and what is needed. Massage therapists who work with a client who has ALS are probably going to be working with someone in the process of dying. What a gift and privilege to be invited into this holy process.
I'm still accepting communications from therapists about their experiences with clients who have ALS - please share your wisdom with other readers through this column.
Until then, many thanks, and many blessings,
Ruth Werner, LMP, NCTMB
Editor's note: Read part 2 of Ruth Werner's article in the Sept. issue.
Click here for previous articles by Ruth Werner, LMP, NCTMB, Massage Therapy Foundation President.
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