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The Acupuncturist's Problem
I want share with you some observations and insights into what seems to be the most common problem my colleagues in the acupuncture profession struggles with. If you also struggle with this problem, I hope you get a valuable "aha" moment from reading this.
We Get Letters & Email
A House Divided? (May 1 issue) provoked significant response from readers. Here are several of the surprisingly similar comments we received.
Marijuana, Apathy and Chinese Medicine, Part 1
This article was written in response to the unheeded acceptance of marijuana as a harmless substance that potentially does good when used for the medical relief of pain.
The Challenges of Integrating Eastern and Western Medicine
My Masters thesis was titled, "The Challenges of Integrating Eastern and Western Medicine," which highlighted several reasons why it is hard for these two worlds to mix.
5 Simple Steps to Create an Effective Marketing Calendar
In the educational experience of most healthcare practitioners, business and marketing are overlooked topics.
ACA or ICA: Which Best Represents You?
Last June, I was honored to represent Texas ICA members as their representative assemblyman at the ICA Annual Meeting in Kansas City.
5 Tips for Using Pinterest to Market Your Practice
Pinterest is a very popular, but often under-utilized, social media platform where people can bookmark, or "pin," fun and interesting things from all across the internet.
How Much Do You Know About the Benefits of Birds Nest?
Edible bird's nest is the nest made by the Swiftlet bird of Southeast Asia that is usually prepared as a soup and prized in Chinese culture as a healthful delicacy.
PCOM Granted Regional Accreditation
Pacific College of Oriental Medicine (PCOM) recently announce it has received regional accreditation from the Western Association of Schools and Colleges (WASC). This achievement reflects five years of hard work on the part of faculty, staff, and students.
Rethinking Musculoskeletal Pain – A Public Health Perspective
The American Public Health Association (APHA) is the world's oldest and largest association of its kind, founded more than 140 years ago and boasting over 25,000 members.
Leg-Length Inequality and Pelvic Fixation: A New Approach to the Negative Derifield (Part 2)
As we noted in our previous article, with a positive Derifield (+D), the doctor observes the reactive (shorter) leg in the prone position that becomes longer or "crosses over" in the flexed position.
Reducing the Autogenic Inhibition Reflex: Making Weak Muscles Strong
The autogenic inhibition (AI) reflex is a sudden relaxation of a muscle in response to excess tension.
Integrating Art with Clinical Practice for Patients with PTSD: The Artemis Project
Are you restricted by those one-on-one clinic dynamics? Why not join colleagues and clients in experimental group settings? Three of us volunteered to do just that in Austin on behalf of women veteranss from all branches of the service.
Giving Vets the Care They Deserve
The Department of Veterans Affairs (VA) administers the largest integrated health care system in the United States.
First Do No Harm?
There's no questioning the frightening nature of breast cancer, which strikes one in eight women in the U.S. – eclipsed only by skin cancer in terms of prevalence.
A Poor Choice for Pain Relief
Acetaminophen is the most popular pain reliever in the U.S., accounting for an estimated 27 billion annual doses as of 2009. With 100,000-plus hospital visits a year by users, it's also the most likely to be taken inappropriately.
Medicine is Clumsy, Don't You Be
All medical systems have clumsiness in them. If the technique isn't, the practitioner is. Everyone in every form of medicine is striving to improve. That is why we call it practice.
The Tide is Rising in the Acupuncture Profession
Former President Ronald Regan said, "When the tide rises all boats float." The tide is rising for the acupuncture profession. Many forces outside the profession are helping the tides to rise.
Green Tea Improves Cognitive Function in Elderly Subjects
Publishing their results in the journal Nutrients in May 2014, researchers showed that drinking the equivalent of 2-4 cups of brewed green tea (or bottled tea) daily improved cognitive function or reduced the progression of cognitive dysfunction in elderly subjects.
Our Biggest Challenges to Compete in Wellness Care
In the first article in this four-article series [May 1 DC], I made the case that chiropractors should either embrace offering lifestyle wellness in their practices or face the possibility of losing their place in the wellness care marketplace.
Animal Acupuncture: A Case Study in the Treatment of Traumatic Injury in the Equine
The rise of animal acupuncture in the U.S. began in the early 1970's as a result of the work by members of the National Acupuncture Association in Westwood, Calif.
Spieth Thanks His Chiropractor After Historic Masters Win
Jordan Spieth didn't just capture the hearts of golf enthusiasts worldwide with his record-setting, wire-to-wire victory at the 79th Masters Tournament.
August, 2005, Vol. 05, Issue 08
Medical Conditions in Massage Practice, Part III: Interviewing for Medications
By Tracy Walton, LMT, MS
Thanks to better training and texts, massage therapists tell me their knowledge of contraindications is growing. But many still report gaps in knowing how to interview for contraindications and how to apply the answers in the session.This series of articles has offered some suggestions for closing those gaps. In Part I, I wrote about my own intake attempts early in my career and how my interview changed over time. I also offered one important interview question regarding client activity level and types of activities with examples of the information it can bring to light for the massage session. In Part II, we added the question "Are you in a physician's care?" with follow-up questions. This question alerts the therapist to medical conditions that might pose contraindications.
Now let's turn to a third all-purpose intake question, which follows the second question nicely: "Are you taking any medications?" Along with a few follow-up questions, this question yields useful information during an intake. Unfortunately, the information in this territory can seem cryptic: drug names are notoriously foreign-sounding and long (amoxicillin, amitryptiline), sound similar (celexa, celebrex, cialis), and many of us misspell them. The good news is that massage therapists can use information about meds without having to go to pharmacy school. By asking a few follow-up questions for each medication and doing a little investigation, we can determine which massage contraindications or modifications to use. Below are some follow-up questions with some examples of how the MT might use the answers.
How do you spell that?
Correct spelling may come from the client or a little more investigation. Correct spelling is key to looking up a medication - perhaps not in the moment, but at some point for your learning. If the client can't provide the correct spelling ("It's those little yellow pills" or "The ones I use for thyroid"), it's still possible to get the needed information. But at some point determine the closest spelling possible. Search engines on the Internet can be quite forgiving with less than perfect spelling. For example, suppose you have a client with Crohn's disease on a medication that neither of you can spell correctly. If you type in "methatrexate" or even "methatrexate Crohn's disease," Google will return a kind message to you: "Did you mean methotrexate?" There are numerous sites about medications. One I use is www.drugs.com, which lists consumer information alphabetically by drug. Many drugs also have their own Web sites, including coumadin.com or prednisone.com. These sites have general information about the drug, including why it's prescribed and side effects.
What is the medication for? What is it designed to do?
This may unearth a medical condition to ask more about, especially if the condition affects tissue or organ function. Bringing it to light, the MT may need to follow contraindications for the condition itself. Suppose a client lists medications for hypertension and heart disease. The medication may not resolve the problem entirely but may just control it, and the disease is still present. Hypertension or heart disease could require modifications in client position, pressure used on the legs in case of a risk of blood clots (DVT), and other modifications. If the condition itself puts someone at risk for stroke, the massage therapist should not use pressure near the carotid artery or on any pulse points. If the client is taking ibuprofen or aspirin for the pain of an unstable injury, treat the area as unstable and avoid stretching or other strong passive movement in that area, and refer the client to his/her physician. Stronger pain medications, such as narcotics, interfere with perception and the ability to give the MT feedback about pressure. The practitioner should only use gentle pressure and joint movements to avoid causing injury.
Self-medication is vital information that comes from asking this question. Upon finding out that a client self-medicates for musculoskeletal pain, sleeplessness, headaches, etc., the massage therapist should suggest (sometimes strongly) for the client to see a physician or other health care provider for diagnosis and additional help.
Is the medication effective?
This question gets at over- or under-treatment, and there is some overlap with the question above. If a medication is not effective in reducing blood pressure, for example, treat the client as if he/she has high blood pressure and investigate massage contraindications accordingly.1 If a medication is good at preventing blood clots it will probably cause easy bruising, so lighten the massage pressure. Coumadin, a blood-thinner (anticoagulant), is one such medication. It is commonly presented as a massage therapy contraindication, but only one element of massage - pressure - is contraindicated. Use follow-up questions to determine how much pressure is too much. Some people experience mild bruising as the medication carries out its task; others have more severe problems as the right dose is determined over time. Other elements of massage therapy, including stroking, kneading, joint movement, etc., may be perfectly acceptable as long as they are carried out with gentle pressure.
Are there any side-effects or complications of the medication?
If so, other massage adaptations may be necessary for each side-effect or complication. This question has some overlap with the question above. If pain medication is so strong that it causes drowsiness in a client, he/she should not receive a vigorous massage. If it makes the client urinate frequently, he/she may need to get up during the session. If a drug (such as prednisone or other steroid medication) causes a change in fluid balance and produces swelling, massage should not attempt to shift fluids dramatically from tissue to vessels, or along vessels. A gentle session is in order. Some practitioners have advanced training and specialization in stronger work with pathologies, injuries, swelling, and scars, but most basic therapists should follow an important rule of thumb: a body adapting to strong medicine does not need the additional burden of adapting to a strong massage. More information on massage and medications is available from trainings and textbooks.2
Looking back at the questions above, note that some overlap can occur in the information gleaned. This is as it should be. The best interviews give the client several ways to respond to the most vital information. If the client doesn't mention "easy bruising" after the third question, perhaps he or she will recall it after the fourth question. Avoid too many redundant questions that prolong an interview, but give clients more than one chance to recall and mention key information.
This series has provided three all-purpose questions for the interview:
Each question can spark longer conversation, and it takes skill to move the interview along in the right direction - toward the massage table for a safe, effective, thoughtful massage. Interviews are longer for some clients, shorter for others. In most cases, ideal intake interviews are brief but also allow for a thorough, efficient transfer of information. At times these goals seem at cross-purposes, but with experience interviewing becomes easier. Thorough interviews lead to safe treatment for the increasing number of people seeking massage therapy. In addition, a good interview enriches each massage session and the therapeutic relationship with each client.
Click here for more information about Tracy Walton, LMT, MS.
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