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Thinking About Cohen's Kappa
Let's think about some notions of reliability and validity, and about what it means for diagnostic examiners to agree in meaningful ways. Diagnostic tests must obviously be both reliable and valid.
Healing Trauma: Cultivating Resilience and Presence Through Mindfulness, Part 2
In the last issue of Acupuncture Today, the first part of this article introduced the topic of trauma and resilience, and their relationship to the autonomic nervous system response and the concept of the spirit being grounded in the body, and suggested the importance of mindfulness as a tool for healing.
Practicing with Authenticity
To extrapolate from the above quote, patients love healthcare providers they can trust. One way to earn the trust of your patients is by practicing with authenticity. What does that mean, exactly?
The Zen Art of "One Point"
We were always told in our Zen Shiatsu training (by Japanese and Japanese American instructors) that our ultimate aim was to to find that "One Point." To be so focused we could touch just one point to transform Qi throughout a client's body.
Fertility and Poly-Unsaturated Fatty Acids
Starting or expanding one's family is a major milestone. It's something that more and more people seek out health care advice and support for.
An Acupuncturist's View of Medicinal Marijuana
The use of cannabis for medical purposes is very controversial. Use as a panacea by physicians uninitiated to the proper application of herbal medicine, as well as an excuse for recreational use have greatly confused the issue.
Why More Patients Don't Come to Your Office
Every so often, something turns out to be much easier than anticipated. It's like ordering a piece of furniture or a child's toy that comes in 167 pieces.
Help: A Need at Every Level
One of the great gifts of training in acupuncture is the ability to take good care of oneself. I recently had a bout of frozen shoulder — an inflammatory syndrome which can be debilitatingly painful and take years to resolve.
Acupuncture Rising: From Acupuncture Anesthesia to Assisted-IVF, Part 1
Acupuncture's cultural and historical roots go back to the emergence of Chinese civilization. For more than 2,000 years, acupuncture needling has been continuously practiced on the largest population in the world.
Oriental Medicine on the World Stage
"Let me win. But if I cannot win, let me be brave in the attempt." This simple, yet powerful statement was lived out time and time again by so many of the athletes from around the world during the Special Olympics World Games in Los Angeles.
The Short Leg Dilemma
When evaluating a new patient, it is common to note a relative shortening of one leg to the other. Some patients will even tell you they have one, and then pull out the store-bought heel lift they read about online.
We Get Letters & Email
It was with great interest that I read "Trouble in the Wellness Waters?" in the May 1, 2015 issue of Dynamic Chiropractic. I heartily applaud Dr. Hayes for his insightful and informative article.
Do Some Good and Grow Your Business with Cause Marketing
Cause marketing is truly one of the best ways that you can promote your services as a acupuncture professional. Cause marketing refers to a type of marketing where a business partners with a non-profit organization to help bring awareness to a charitable cause.
Getting a YES: An Effective Strategy for Overcoming Patient Objections
Patients make more excuses for declining care from an acupuncturist than perhaps any other type of doctor. Various reasons hold them back from making a commitment to care.
Managed Care Subverts Chiropractic
A study published in the American Journal of Managed Care underscores why so many chiropractic patients go out of network in order to get the care they need: Managed care may be effectively locking them out.
Improving Communication Between AOM and Biomedical Providers
How comfortable do you feel talking to Western medical providers? If you are like me, you may not feel as comfortable as you would like. Some of my interactions with MD's haven't been the fruitful steps toward integrative medicine for which I had hoped.
Do You Have a Post-ICD-10 Strategy?
Post-ICD-10 planning is critically important to the health of a practice, in part because ICD-10 is brand new to providers, payers and related affiliates alike.
Dietary Fat and Prostate Cancer: An Important Update and Review of Mechanisms
K.M. Di Sebastiano and M. Mourtzakis published a review paper examining the role of dietary fat on prostate cancer development and progression late last year that does a stellar job of summarizing the available data on fat and prostate cancer.
Active Care for Ankle Sprains
An ankle sprain is a common injury, since this joint is required to perform complex movements under high forces during normal walking. In fact, 10 percent of all emergency-room visits are ankle-sprain related and an estimated 25,000 ankle sprains occur in the United States daily.
The New Age of Communication
In the age of technology, everyone, including the patient, is seeking faster, easier ways to communicate. With a wealth of social media, blogs, websites and videos, we are constantly barraged with information – to the point of overload.
Troubleshooting: Billing Multiple Fees for the Same Service
I am afraid I may doing something illegal. I have heard I cannot bill different fees for the same service.
A Tribute to a True Chiropractic Leader
President of Texas Chiropractic College (alumnus, class of 1950) and the American Chiropractic Association (ACA) Board of Governors. President of the Texas Chiropractic Association and twice-appointed member of the Texas Board of Chiropractic Examiners.
When Patients Lie (Bribe or Flatter)
Recently, a new patient told me about what I thought was a novel twist on the doctor-patient relationship. She felt she had to lie to her DC to discontinue her treatment.
The Food Conversation: Nutrition and Your Practice
It's morning and your first patient rolls in with a triple espresso steaming in one hand and a frazzled, desperate look in her eye. "You gotta help me, doc, I am constipated unless I drink one of these, and I am exhausted and anxious all the time."
Nuts Reduce Risk of Heart Disease, Cancer and Other Health Problems
Several recent studies suggest regular consumption of nuts may provide a significant degree of protection against certain types of cancer, heart disease, possibly type 2 diabetes and some neurodegenerative diseases.
June, 2006, Vol. 06, Issue 06
When Are Symptoms Not Symptoms?
By Leon Chaitow, ND, DO
Have you noticed how buzz words and key phrases are emerging from the powers that be in the increasingly regulated application of health care? Evidence-based medicine is one of these and there's a lot to be said about this topic - but not in this article.Another phrase that is emerging is informed consent. At its heart, this phrase, and what it entails, simply tells us that patients need to know what a particular form of treatment involves, as well as the drawbacks, possible side effects, success rates, etc.
How could anyone take exception to this you might ask? Surely it's everyone's right to know if there is a risk attached to a treatment method, so they can make an informed decision to accept or decline? The risk-benefit ratio can only be considered once the relative benefits, as well as potential risks, are made available to the patient/client in the form of objective information.
I would say the answer to this question is not as clear-cut as it may seem. Let's look at this in relation to manual forms of treatment. The most invasive form of manual therapy is arguably the high velocity, low amplitude (HVLA) thrust technique, as used by chiropractors, osteopaths and increasingly by physical therapists, to manipulate (adjust) joints.
Many experts have suggested there are risks attached to this form of treatment,1 particularly when applied in the cervical region. The most serious possible negative effect is stated as being a risk of stroke (vertebral artery dissection). The problem with the statistics used to demonstrate damage from manipulation of this sort is that they seldom make clear just what type of manipulation is involved, and they seldom describe the competence of the individuals applying the manipulation.
Gibbon and Tehan,2 in regards to this very issue, report that in a study of Australian Manipulative Physiotherapists, who are required to undertake specific postgraduate study in manipulative therapy, there were no major complications in 4,601 physiotherapist years of manipulative practice. Despite allegations3 the evidence actually is that a causal connection between cervical HVLT manipulation and subsequent stroke is unproven, and when applied carefully the risk is virtually nil.4,5
To be absolutely clear, there are risks in all treatment (even massage), but these risks reduce to the point where they become statistically invisible when the methods are used safely, by well-trained people, in the correct situation (for the patient)! But in the informed consent model, every patient about to receive such treatment would need to be informed that there is a defined and explained risk (and in some countries would be required to sign a form saying they had been informed, and have consented to the treatment).6 Ask yourself whether such a protocol is likely to be conducive to the individual staying calm and relaxed during the procedure? In many instances is it not likely to result in a refusal of extremely effective modes of treatment?
Despite these reservations, I am bound (in the U.K.), by a legal requirement to obtain such informed consent before manipulating any part of the body. This also is true of application of soft tissue manipulation methods, including muscle energy techniques and neuromuscular techniques. And all this takes valuable (to the patient and to me) time, and creates (I believe) unnecessary bureaucratic management burdens, as well as anxiety for the patient.
This preamble brings me to what I really wanted to discuss in this article - the meaning of symptoms, including "reactions" to treatment (such as soft tissue manipulation). I would imagine there is very little disagreement with the basic premise that all healing is endogenous (i.e., the body is self-regulating and treatment, of whatever sort, is designed to either enhance that process or to remove obstacles to it). All treatment of the body demands an adaptive response.
Whether the response is helpful and health-enhancing or not, depends on whether it's appropriate for that particular individual/condition, at that particular time.
If a "therapeutic response" is forthcoming following treatment - manual or otherwise - there is bound to be some degree of a sense of change, as homeostatic modifications work their way through the systems, and these likely are to be reported as "symptoms," or "reactions."
In many therapeutic traditions, a "therapeutic response" is regarded as desirable, as evidence of self-regulating processes in action. It's easy enough to recognize that without inflammation, we would not recover from injury (and also that excessive or inappropriate inflammation is harmful). It's also not hard to grasp the idea that if you have ingested contaminated food, the rather undignified and unpleasant symptoms of vomiting and diarrhea are life-savers (or that excessive elimination of these types can be dangerous).
Understanding that effects of (or reactions to) treatment might fall into the category of "good symptoms" should be something that can easily be explained to patients. In homeopathy, the "law of cure" suggests that recovery of health occurs in a reverse order, so the most recent symptoms are likely to be the first to go. Reactions and response to homeopathic remedies are therefore keenly assessed and are seen as positive indications of healing in process. In naturopathy, the self-regulating responses looked for as treatment is initiated (e.g., fasting, nutritional reform or supplementation, botanical medicine, hydrotherapy, physical medicine) are thought of as being representative of the "healing power of nature." These changes are commonly eliminative, and are not considered to be "side effects" but are evidence of healing in action.
In chiropractic and osteopathy, similar processes to those mentioned in the homeopathy discussion may occur, as symptoms reappear and are then normalized by the body itself, in reverse order to their original appearance. In many forms of psychotherapy, and in somatic branches of those methods such as somatic experiencing, reintegration of dysfunctional adaptive states might well involve the reappearance of symptoms as part of the process of normalization, discharge of the effects of trauma, and restoration of health. These "side effects" are not side effects at all but signify change, part of the body/mind's adaptation towards a more balanced state.
In the "informed consent" model, we likely are to spend a great deal of time having to explain these concepts. My main concern is that people might not grasp the concept of "symptoms being good for you" or "symptoms as evidence of healing in action," and might decline what they need most once they have been "informed." Even worse, having been informed there is a risk of stroke following manipulation of the neck, what will go through a person's mind when normal responses to treatment such as deep tissue massage, or neuro-muscular technique, or trigger point deactivation, or muscle energy stretching (a degree of discomfort for 24 hours for example, or a slight degree of light-headedness perhaps) are experienced? A phone call to me (or you) at 2 a.m. might be the patient's reaction. I'm not sure what mine will be when that happens though. What do you think?
Click here for more information about Leon Chaitow, ND, DO.
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