resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Energy: For Life and For Death
Energy is a deep topic in Traditional Chinese Medicine. Qi is understood to underlie all of existence, animated or not, and the qi of the living is studied with special attention.
An Alarming Lack of Accountability
Accountability seems to be a lost quality today. The simple act of taking responsibility and doing the right thing just doesn't happen as often as it should. Maybe it is the litigious nature of our society.
F4CP Launches New Social Media Campaign
The Foundation for Chiropractic Progress has launched a new service to help member doctors: a social media campaign called "Accelerator."
Day in the Life of an Advanced-Practice DC
Can you tell us a little about your background in the profession? Why did you want to become a DC? I studied at Boston University from 1968-1972 as a pre-med student majoring in biology.
The Value of Melatonin in Breast Cancer Prevention and Adjunctive Treatment
Although melatonin (MLT) is best known for its sleep-aid properties and as a natural remedy to prevent jet lag, extensive experimental studies suggest it possesses anticancer activity through several biological mechanisms.
The Art of Listening
One of the most important clinical concepts for me was voiced by the legendary physician William Osler. "Listen to your patient, he/she is telling you the diagnosis." After treating literally thousands of patients, it can become almost second nature to quickly discover clues which reveal the underlying diagnosis.
An Interview with Amanda Shayle
JW: Can you share with us some of your history and how you became an acupuncturist? What did you do prior to becoming an acupuncturist? Where did you go to school?
Misconceptions & Opportunities With Medicare
As I speak around the country on how to properly document Medicare patient encounters, I get questions regarding opting out of Medicare. There are many misconceptions about opting out of Medicare, including just what it means to opt out.
NCCAOM Launches New Membership Organization
The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) recently launched a new national membership organization, the NCCAOM Academy of Diplomates.
Health and Wellness Partnership
Yo San University of Traditional Chinese Medicine and The Wellness Center at the LAC + USC Historic General Hospital recently joined forces to extend care to the residents of Boyle Heights area of Los Angeles.
Designing a Fitness Plan (Part 4): Blending Pain Relief With Healthy Aging
Pain relief is still the No. 1 reason patients come to my office. However, most of my patients have other goals as well, such as: "I want to lose 10 to 20 pounds"; "I feel old and want to slow down the aging process"; "My doctor says I am becoming a diabetic and need to exercise"; or "I'm tired and want more energy."
Roots in the Community, Branches Far Beyond
The Jung Tao School of Classical Chinese Medicine (JTS) was founded in 1998 by Sean Christian Marshall in Sugar Grove, North Carolina, a small community near Boone in the state's westernmost mountains.
Excited to Share the Science of Chiropractic: An Interview With Dr. Heidi Haavik
Dr. Heidi Haavik has become known in the circle of chiropractic researchers as not only a rising star, but also one willing to do research that can have a major impact in the scientific world and how chiropractic is perceived.
Constructing Our Reality: The Primary Channels and Perception, Part 1
My favorite topic of discussion within Chinese medicine is the acupuncture channel systems. First of all, each of us have them. They are part of our bodies; not something external to us. To learn about the acupuncture channels is to learn about ourselves.
Filling the Gap: The Role of Alternative Practitioners in a Broken Health Care System
I have been asked many times what got me into alternative medicine. My answer is simple: I want to truly help and make a difference in people's health.
Let's Streamline Your Front Desk
Your front office can be your greatest source of efficiency or a constant bottleneck. Increasing the productivity of this area without sacrificing the quality of patient interaction can be a little tricky.
Identify & Adjust the Apex Posterior Sacrum
Low back pain involving an apex posterior sacrum (+θX-axis misalignment) typically presents with signs of lumbosacral joint impingement or facet syndrome.
Transparency is Key at ASA First Annual Meeting
On March 4th and 5th the American Society of Acupuncturists (ASA) held a successful first annual meeting in Albuquerque, New Mexico.
The Rest of the Patient Story
I've written previously about allowing a patient to tell you their story – about taking the time to listen and engage all the aspects of their case history, the injury in question, and the related issues.
Building Relationships and Referral Networks with Allopathic Practitioners
Dr. Doug, an orthopedist of 20 years, had heard stories from patients who tried acupuncture. While he was able to address many of their complaints effectively, some appeared to gain additional benefit when their care included TCM.
Specialized Pro-Resolving Mediators: 21st Century Inflammation Fighters
Specialized pro-resolving mediators, or SPMs, are a portion of the omega-3 fatty-acid spectrum that have been shown to have a powerful effect on reducing inflammation.
Asking Patients the Right Questions
When was the last time you asked a patient a question? Maybe 30 seconds ago? But, are you asking the right questions to elicit valuable and useful information? As a healthcare provider, you've likely spent hundreds of hours learning to ask the right questions to gather critical health information from your patients.
How Many of Your Patients Have Sarcopenia?
Figure 1 demonstrates the typical appearance of sarcopenia in the paravertebral muscles. Have you considered evaluating your patients for this problem? Sarcopenia is the progressive loss of skeletal muscle mass and function that affects the older population.
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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