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Keeping Malpractice Allegations at Bay
It has been suggested that in the litigious environment in which we live, the practice of chiropractic should be defensive and practitioners should constantly be watching their backs. An element of defensive practice is a good idea.
Finger (Pad) Pointing: Repetitive-Use Injury Waiting to Happen
"My wrist and hand hurt. I spend all day working on computers and then I come home and spend more time on a computer, usually playing video games."
News in Brief
NYCC Aggregates Degree Programs in New School; Palmer Chancellor Receives Education Award From ICA; Oklahaven Announces "Have a Heart" Winners.
With Low-Back Pain, Sometimes Little Things Matter
Typical treatments for low back pain involve large muscles like the quadratus lumborum, iliopsoas, and piriformis. However, there are situations when a very small muscle, the multifidus, can play a significant role in the diagnosis and treatment of low back muscular or spinal injury.
A Whole-Body Approach to Chronic Tension Headaches
Nearly every day in our practices, we see patients with chronic headaches that have not responded to traditional treatment. They present in our offices with a feeble hope that "maybe" a chiropractor can help.
Understanding Levels of Evidence
The concept of levels of evidence is a cornerstone of research literacy and a great starting point for understanding basic principles of how research works.
Constructing Our Reality, Part 2
My last article discussed perception and its relationship to the primary channels. Before we get to the channels most commonly used to treat sensory disturbances, the small intestine and triple heater, we should first talk about the bladder channel.
Sleepless nights, anxiety, mood swings, euphoric energy bursts, obsessive thinking, and a strange feeling in his chest. That is what Matt was experiencing when he first entered my practice. Rather than being concerned, he was loving every minute of it.
Billing Timed Services
Q: I do not always use physical medicine services but in my state I do have a scope of practice that allows me to provide many of these services. I am trying to understand what "direct one-on-one patient contact" means in relation to physical medicine services.
Distal Style Treatment of Neurogenic Pain
Treat locally or distally? This question has frequented my thoughts for the treatment of pain throughout my acupuncture career. Each style has strengths and weaknesses, thus the versatile practitioner would do well to forgo dogmatic adherence to any one style in deference to the needs of the individual patient.
Low Fat vs. Low Carb & the Power of Protein
A science-based website recently posted a nice summary of 23 randomized, controlled trials from peer-reviewed journals pitting low-carb diets against low-fat diets.
Billing One-on-One, Direct Patient Contact
This is often misunderstood and leads to trepidation when documenting and subsequently billing timed services.
A Different Way of Looking at It
The way you and your chiropractic colleagues access information has changed over the past decade. According to a recent survey conducted by Dynamic Chiropractic, almost half (48 percent) of DCs read online articles on their personal computer or laptop daily.
Living Well: Lessons From Our Oldest Old
Aging is a significant public health problem, important to chiropractors in practice and important to DCs who teach students training to become chiropractors.
Hip Flexor Contractures & LBP in Above-the-Knee Amputations
Patients with above-the-knee amputations (AK or AKA) are particularly prone to developing hip flexor contractures. Not to be confused with muscle tightness, contractures are a permanent shortening of tissues which cause deformity or distortion.
Holistic Skin Care and Modern Technology
Anti-aging is a concept that we hear in reference to skin rejuvenation and growing older on a daily basis. Aging begins as soon as we are born; therefore "pro-aging" is embracing all stages of life gracefully, with vitality, wisdom, joy, and gratitude as the goal.
Discovery: Finding Insights and Each Other in Different Disciplines
Recently I've been thinking about all sorts of things which are hidden from our daily direct experience. That general category is what links nearly everything that catches my attention and then demands some kind of investigation.
How to Reach Your World With the Chiropractic Message
My latest effort to share chiropractic occurred in mid-May while I was sitting at an introductory parent information night for high schoolers. The IT instructor informed us that each student would be receiving a computer for all their studies.
Transforming Las Vegas
On a warm spring day in Las Vegas, Sonia Kim, clinic front desk staff, is busy preparing for a full day of intern shifts at Wongu Health Center. She greets patients, makes sure documents are properly signed, and lets the interns know that their patients have arrived.
In This Current Age of Anxiety
Anxiety, also referred to angst or hysteria, goes by many names. One, popularized by the sagacious Zhang Zhong Jing, who many practitioners of Chinese Medicine may be familiar with, is known as Restless Zang/Fu disorder.
Streamline Your Front Desk
Your front office can be your greatest source of efficiency or it can be a constant bottleneck. Increasing the productivity of this area, while not sacrificing the quality of patient interaction, can be a little tricky. However, with some focused effort and intention, your front desk can keep your practice running smoothly.
The Need for Standards
ISO-TC-249: You may look at these letters and numbers and wonder what they are and what they might mean. They turn into: International Standards Organization- Technical Committee – 249. There is a global organization called The International Organization for Standardization.
Parker University Embraces New Era
Change is in the air at Parker University, which recently announced the selection of both a new president and a new consultant for its seminar program.
Prostate Cancer Risk
A large study published in January 2016 in the American Journal of Clinical Nutrition showed that men who are vegans had a 35% lower risk of developing prostate cancer compared to non-vegan men. The study followed more than 26,346 men who are part of the Adventists Health Study-2.
Building Bridges with Discipline
As practitioners of traditional Chinese herbal medicine, our role is to educate patients and medical practitioners about the various safety aspects of our medicine. Medical doctors that embrace Chinese medicine want to collaborate and include Chinese herbal medicine in more aspects of clinical care to support their patients.
November, 2005, Vol. 05, Issue 11
Avian Flu: How Threatening Is It?
By Ruth Werner, LMP, NCTMB, Massage Therapy Foundation President
Fall is here, and with it, another flu season. Last year, we were bombarded with information (some of it pretty alarmist) about flu, flu vaccines and the emergence of a dangerous new player on the field of infectious disease: avian flu.Since massage therapists work closely with lots of people, and because we are health care professionals, it behooves us to be up to speed on the latest developments about flu, and I am here to help.
A brief disclaimer: this information changes almost daily, but it's accurate as of mid-September, 2005.
What is It?
Flu (short for influenza) is a viral infection of the respiratory tract. Flu viruses are classified as type A, B or C. Type A flu is by far the most aggressive, with the highest risk of significant complications or even death.
In the United States, often we don't consider flu to be a significant health issue, but for at-risk populations it can be a life threatening infection. Anywhere from 5% to 20% of the population has flu each year. It accounts for 200,000 hospitalizations and 36,000 deaths, mostly from pneumonia. The people most at risk for the serious complications of flu are the very young, the elderly or people with underlying diseases that affect lung or immune system function.
How Does It Work?
Flu viruses work in the usual way of infectious agents: they gain access to the body (often inhaled as airborne particles, although it can be spread by hand from contaminated surfaces) and then they invade their target cells. In this case, mucus-producing cells that line the respiratory tract. Once the infection becomes established, the immune system response causes most of the extreme symptoms, which appear one to three days after exposure. Flu is most communicable for three to seven days from onset of symptoms, depending on the age and health of the infected person.
Signs and Symptoms
In most cases, flu symptoms look like a bad cold: respiratory irritation with runny nose and dry cough; sore throat, headache, chills and a long-lasting high fever. Flu-related fevers often go over 102° in adults, and they might last for three days or more.
Unlike colds, flu infections affect more than the upper respiratory tract. Many patients experience aching muscles and joints, as well as debilitating fatigue. (One area flu viruses generally won't attack, however, is the gastrointestinal tract. What commonly is referred to as "stomach flu" is far more likely to be infection with norovirus or a case of food poisoning).
Flu symptoms usually appear one to three days after exposure to the virus, and they might persist for up to two weeks. If they last longer than that, or if the coughing begins to produce a lot of phlegm, the original viral infection might have opened the door to bacterial pneumonia: a potentially serious or even life threatening complication.
The Flu Vaccine
Every year, a flu vaccine is created from live, weakened viruses, based on predictions about which types of virus will be most active. Because predominant viruses change quickly, the vaccine is only effective for a year. For the 2005/2006 flu season, the vaccine is being distributed only to high-priority populations until late October; then it will become available to the general population. It's available in an injectable form or as a nasal spray (although the spray is recommended only for people between four and 49 years old).
I'm not going to open the floor to a debate about vaccinations here; that is a completely personal decision, and each individual must weigh possible benefits and risks. The Centers for Disease Control and Prevention caution, however, that persons who are allergic to chicken eggs, who have a history of Guillain-Barre syndrome or who have had an extreme reaction to a previous vaccine should not receive the flu vaccine.
Avian Flu: What's the Difference?
The avian flu that made the news last year is an infection with a particular subset of type A virus, called H5N1. (Other subtypes infect birds as well, but they appear to be much less dangerous to humans). The "H" stands for hemagglutinins; the "N" stands for neuraminidase. These are surface proteins on the virus; every flu virus is classified by what type of H or N it is. Water birds (ducks and geese) particularly are vulnerable to H5N1, although they often don't die from it. They shed virus in oral and nasal secretions, and in bird droppings. Wild birds can spread the infection to domestic poultry it's far more likely to kill chickens than ducks and from that point humans might be exposed.
Here's where it gets tricky. Bird-to-bird transmission of H5N1 is easy. Bird-to-human transmission of H5N1 is harder, but not impossible; it has happened a few dozen times in Thailand, China, and Vietnam. Symptoms are similar to human flu, with the added risk of conjunctivitis and viral pneumonia, but the mortality rate among infected humans is very high, close to 50%. So far, human-to-human transmission of H5N1 is very rare indeed, and might have happened only a few times that we know of. That's because H5N1 doesn't have many of the properties that make viruses easily transmissible between humans.
But that could change, and that's what health officials are worried about. At this moment, researchers foresee two possible ways for H5N1 to become easily transmissible between humans:
How high is this risk? That depends on whom you ask. While some public health officials are talking about "a time bomb waiting to go off," others point out that we are much better prepared to deal with an aggressive infection like H5N1 today than we were the last time a threat with a similar scope (Spanish flu, 1918-1921) hit the scene. Specifically, we are better at diagnosing the problem and aggressively isolating infected people, which, as we saw with SARS (Severe Acute Respiratory Syndrome), can quickly and effectively contain the problem.
On the other hand, no vaccine for avian flu has yet been developed (although this is being worked on), and it turns out H5N1 is resistant to the two most common anti-viral medications we have available: amantadine and rimantadine. So, our ability to shorten the lifespan of the infection is limited.
Massage and Flu
A person with flu who receives a rigorous, circulatory massage might find themselves with a much more serious infection than they would otherwise have. A person who receives massage after the infection has peaked and is on the mend, might find that recovery comes more quickly. However, two cautions must be kept in mind. The first is that squeezing several days of recovery into one or two days might make the client feel sick again. The client should know this is a possibility. The second is that a person recovering from flu still might be shedding virus.
What about our own self care? Like it or not, massage therapists are role models for taking excellent care of our own health. This means eating right, exercising, and getting good quality sleep: we all know these measures are the most important parts of keeping our immune systems strong. I will add one final point: if you're sick, be sick. Stay home. Drink hot fluids, get some rest. Do yourself and your clients a favor by investing your time and energy into conquering your infection, not into hiding your symptoms.
For Next Time
I would like to continue our exploration of emerging and re-emerging infections with a discussion of pertussis: whooping cough. This disease, which can be quite dangerous for young children, is on the upswing for two reasons: incomplete childhood immunizations and the fact that the pertussis vaccine doesn't have the lifespan we once thought it did. So, adults who were assumed to be protected are not. I would be especially interested to hear from people who have had this or seen this infection among their clients or children. Write to me and let me know: what's on your table?
Until then, many thanks and many blessings.
Special thanks to David Jackson, Communicable Disease Surveillance Program Manager, Utah Department of Epidemiology.
Click here for previous articles by Ruth Werner, LMP, NCTMB, Massage Therapy Foundation President.
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