Lost A Sale, But Initial Phone Consultations — A Big Part Of Brilliant Customer Service
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The Ethics of Herbal Prescribing
While teaching ethics classes, I often encounter licensed acupuncturists who are surprised that our use of herbs and supplements has a specific section in the material. It is often an aspect within ethics that clinicians don't think of in practice.
Data: The New Frontier in Health Care
Your practice is empowered with the data you need to improve patient health, run a more efficient (read: profitable) practice, get paid in timely fashion and help show the efficacy of chiropractic on the national stage in the midst of sweeping changes in health care!
Preaching to the Choir: How to Extend Our Reach Beyond the CAM Community
Professional conferences offer unique opportunities to network, be exposed to cutting-edge innovators, share your interests and work, and be inspired.
Integrative Sports Medicine
One of the most rewarding and challenging clinical scenarios is the treatment of athletes.
An Unexpected Superfood: All About Eggs
About 40 years ago, excessive dietary cholesterol was labeled a public health concern. Specifically, it was thought that there was a causal link between consumption of cholesterol-laden foods and increased risk of heart disease.
It's Time to Wake Up
It is time for this profession to wake up and tell someone about the healing benefits of acupuncture. This is the time for Asian Medicine. Its popularity, growth and unusual acceptance is nothing short of amazing.
Lower-Extremity Overuse Injuries: Primer on Causes and Corrections
From ankle sprains to stress fractures, shin splints to plantar fasciitis, the research is clear: These common overuse injuries of the lower extremities – among dozens of others – may be related to abnormal foot function in your patients.
ASA Ready to Impact Profession
The American Society of Acupuncturists (ASA) is a 501(c)6 (pending), not-for-profit collaboration among state based, acupuncturist professional associations.
News in Brief
Support of F4CP Continues With Latest Donations; Walter Reed Honors Dr. William Morgan; Recognizing 40 Years of Public-Health Activism; Allstate Decision Reversed.
Healing the Core: AWB Nepal Earthquake Relief Project
With almost 9,000 people killed during the earthquakes in April and May, another 23,000 suffering injuries, hundreds of thousands left homeless when entire villages collapsed, and many sacred sites destroyed, no one in this country of approximately 28 million has been left untouched by the disaster.
Patient Retention Techniques
When talking about techniques to grow your business, we tend to focus on the "large" aspect of the patient base, that is, on strategies to attract new patients. However, it is important to remember that "loyal" is equally, if not more, important.
Fish Oil: A Key Component to Positive Clinical Outcomes
Patients seem to be presenting with more complex problems, and many are responding to care more slowly or have completely unexpected results. Why?
Treat Every Patient as an Athlete
Frontal-plane movement pattern dysfunction can set the stage for musculoskeletal injury. Frontal-plane stabilization is essential during the normal activities of daily living: think single-leg stance and gait cycle.
Making Public Health a Chiropractic Priority
As highlighted in this edition's News in Brief, Rand Baird, DC, MPH, FICA, FICC, editor and occasional author of our long-running column, "Chiropractic in the American Public Health Association", was recognized by the organization recently for 40 years of membership.
Aetna Updates 97140 Policy
In a development the Association of New Jersey Chiropractors is calling "a resounding victory for chiropractors nationwide," Aetna Insurance Company has updated its national reimbursement policy regarding 97140 (manual therapy), reaching an agreement two years after the association filed a declaratory judgment suit in federal court against the insurer.
Learning the Transformative Language of the Channel System: The Sinew Channels
The Chinese medical classics describe the energetic terrain of the body in much detail. The acupuncture channel systems, as presented in the Ling Shu illustrate the various expressions our qi energy can take.
A War You Can Help Patients Win
The average American consumes approximately 60 percent of calories from sugar, flour and refined oils. A donut is a good example of a so-called "food" that represents these calorie sources.
Exercise Recommendations for Healthy Aging
Aging is inevitable, but how you age is not. Common physical signs of aging include decreased muscle mass, decreased muscular power, increased body fat, and decreased aerobic (lung) capacity.
Online Marketing Basics: Website Creation
The various online marketing options make it a challenge, especially when all you want to do is help your patients feel better. With such a broad topic, I'm going to share some basics you should know about website creation.
ICD-10 Is Not Scary (and Not About Billing)
In my 13 years of consulting with doctors on billing and coding matters, ICD-10 has aroused the biggest combination of misguided fear and ignorance I can remember.
Technology Meets Practice: Chiropractic Every Day
About a year ago, I had an interesting conversation with a DC who made house calls. When I asked why, she was quick to explain she learns much more about her patients when she sees them at home than she could ever observe in the office.
Relationship Marketing: A Modern Approach
Remember when you used to get real letters in the mail? Not the automated type, but the real deal, hand written with a personal message just because someone was thinking about you? You know what I'm talking about.
Healing Trauma: Cultivating Resilience and Presence Through Mindfulness, Part 1
All humans, by the very nature of being human, will experience moments of trauma and suffering. What, then, makes the difference in how the individual who experiences trauma, suffering, and spiritual loss reacts to such experiences?
Teaching Qi Gong to Children
Many of us have come to embrace Qi Gong or Tai Chi practice as a regular part of our lives. Qi Gong has been a stabilizing factor in my life for the last twenty years.
Acupuncture Treatment of Trauma in the Canine
From 1972 until 1976, John Ottaviano and I were treating dogs at five different veterinary clinics in the Los Angeles county area. Usually, we were at a clinic for seven to eight hours.
What to do When Today Sucks
Have you ever had one of those days when nothing went the way it should have? The patient with migraines got worse instead of better from a treatment similar to one you've effectively used on him before.
Treating LBP in Golfers: Beyond Basic Assessment
The drive to master the most efficient swing demands a tremendous amount from the lower back. Maintaining stability in a flexed posture, supporting torso rotation and repetitively supporting the golf swing all put the lower back in a vulnerable position.
November, 2006, Vol. 06, Issue 11
A Study of Foot Massage and Cancer Symptoms
By Tracy Walton, LMT, MS
In my May 2006 column (www.massagetoday.com/archives/2006/05/13.html), I discussed a wonderful study on massage and healing touch for patients in chemotherapy.1 Here, I'll continue the research theme by describing another solid research paper, this one published in 2000 in a nursing journal.One might not think that an article published six years ago is news, but I find myself repeatedly referring to it in my teaching and practice. It's not just the newer studies that should make a splash; the enduring "solid citizens" of past research bear repeating and celebrating. I introduce the study here not only to acknowledge the work, but also to highlight some things in massage and cancer research: The importance of noting the massage providers and their credentials; the actual massage therapy protocol used in the study; and the results they found.
In "Foot Massage: A Nursing Intervention to Modify the Distressing Symptoms of Pain and Nausea in Patients Hospitalized with Cancer,"2 the investigators studied a sample of 87 inpatients. To bring this study most vividly into the present, I ask you to imagine you were a patient in the study. You were studied over a period of three consecutive nights during your hospital stay. On two of those evenings, you received foot massage; on the other evening, you were asked to stay in bed for a "quiet activity" (usually reading or watching television) only. The sequence of these was random (massage-control-massage or control-massage-massage, and so on). The same measurements - your heart rate and your "zero to 10" reports of your pain, nausea and relaxation levels - were recorded before and after the intervention each night.
A Crossover Study
The fact that you "crossed over" between massage and control conditions makes this a "crossover study" - a nice design when it's done well. You were your own control. Since you effectively served in both groups, the control and experimental groups were comparable. Interventions occurred at roughly the same time each day, because regular medications in the hospital tend to make symptoms follow characteristic patterns each day.
The Massage Provider and Protocol
In the study, you received foot massage from a nurse "experienced in the administration of massage." This sometimes raises eyebrows among massage therapists who ask about credentials and whether this truly reflects massage therapy practice. In this case, the authors wanted to restore massage to nursing care when needed, not try to pass off a nursing intervention as massage therapy. But, their description of the massage, a very detailed, fixed protocol, suggests that the authors clearly understand some of the important essentials of massage. This is the massage session described by Grealish, et al. "The massage was performed using slow, firm or gentle strokes toward the heart, from the base of the toes up the foot and lower leg to the knee ... The fingertips were used to make small circular movements around joints and between deep and superficial muscles, including the ankle, and between the metatarsals. A rhythmic lifting and squeezing of the flesh using both hands was alternated with the other movements. Joints were rotated in a clockwise and counterclockwise direction three times. When doing massage, the nurse's hands were warm. The foot not being massaged was covered with a towel and the massaged foot was held firmly. A non-fragrant vegetable oil was used."
Two things are important to note about the protocol. First, the title of the study depicts "foot massage," yet it included both foot and low leg. In fact, "foot massage" might have been good shorthand for the study, but this discrepancy suggests it's important to read what actually happened in the session. I meet MTs in my trainings who claim to be allergic to reading research, but even they become engaged when flipping through a study to read the actual massage protocol. Second, this massage protocol is very clear. This is one of my favorite massage research protocols because it describes so clearly what actually happened. I can imagine each toe being rotated three times in each direction! The researchers clearly share practices with massage therapists and note them in the study. Cover the nonmassaged area with a towel. Firm touch matters. The kind of oil you use bears mentioning. Moreover, each patient received an "introductory massage" before the study began, so they would know what to expect. These things suggest the researchers understand important elements such as safety, warmth, depth and firm touch. Regardless of whether I agree with their choice of protocol, the description is so clearly written I could easily replicate it in practice, especially if good things seem to come from it!
Measurements and Findings
The authors measured immediate effects of massage, not sustained or long-term effects. They asked questions just prior to the massage, and then 20 minutes after it was over. On the control night, they did the same, but left the patient in a quiet activity, and then measured again 20-30 minutes later.
Three "subjective outcomes" (pain, nausea and relaxation) and one "objective outcome" (heart rate, a function of relaxation) were measured in this study. Patients were asked to complete three "visual analogue scales" before and after each condition. On a 100 mm line, showing "no pain" at 0 mm and "worst possible pain" at 10 mm, patients were asked to mark their symptom level on the scale. Somewhat similar scales were used for relaxation and nausea. While subjective, the VAS is a convenient measurement tool that therapists easily can incorporate into clinical practice, before and after the session.
The study found that immediate self-reports of pain and nausea dropped on the massage nights compared to the control nights. Relaxation appeared to increase after massage, shown in heart rates and self-reports. This was associated with only two short foot massages; perhaps a greater effect would occur with a higher massage therapy dose. In their discussion, the authors note the positive findings. But, instead of making sweeping, grandiose claims of benefit, they list limitations of their own study and directions for further research. (A humble tone is a good sign in a research paper; look for it any time you read the discussion section.) We should follow their lead and not overstate results. This study still is relatively small - 87 in the sample - although it's one of the largest of the small studies. We need a larger body of research evidence before we truly can claim, "The evidence shows massage helps symptoms." For now, we can state that small "controlled trials" (as both Grealish and Post-White provide, with control conditions and good design) are "beginning to suggest a relationship between massage and symptom relief." This study, along with some other solid contributions, is beginning to point the way. Cautious claims aside, let's focus on the individual stories again. If you were a patient whose nausea or pain subsided, would you insist on the data to support your experience? Probably not. You would simply feel better. Perhaps you'd feel grateful for having your feet and low legs massaged with firm, warm hands. Your single story is worth telling, too. Indeed, individual stories are as compelling as the group story here. All should be examined closely and noted, told and retold. Each story contributes something to our understanding of massage and symptom relief.
Click here for more information about Tracy Walton, LMT, MS.
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