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Too Many to Remember: Tips to Revive Your Ortho / Neuro Test Skills
When I was at Palmer in the mid-1980s, we were given a set of notes in one of our diagnostic courses. The notes covered approximately 70 orthopedic and neurological tests for various regions of the body.
One Size Does Not Fit All: Exercise and Nutrition According to Your Yin/Yang Body Type
There are countless new exercise and nutrition plans out there, emphasizing the latest ground-breaking research and claiming to revolutionize the way we view health.
Acupuncture and Oriental Medicine in the West
We know acupuncture and Oriental medicine as the indigenous medicine of East Asia; in particular China, Korea and Japan are the countries of origin of this wonderful healing system.
The Concussion-Subluxation Complex
In the Aug. 1, 2014 issue of Dynamic Chiropractic, I reviewed some of the literature demonstrating the role of the chiropractic adjustment in post-concussive care.
Dietary Fat and Prostate Cancer: An Important Update
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.
Your Billing Questions Answered
I hear a lot of the following questions: I am afraid I may doing something illegal. I have heard I cannot have different fees for the same service.
North Carolina Acupuncture Board Files Dry Needling Lawsuit
In early September, the NCALB filed a complaint against the North Carolina Board of Physical Therapy Examiners over the issue of dry needling, a form of acupuncture that uses solid needles to puncture the skin and muscle tissue to relieve pain.
Acupuncture Rising: From Acupuncture Anesthesia to Assisted-IVF, Part 2
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.
Chinese Herbs and Pulmonary Fibrosis: A Case Study
"Mary M."* recently celebrated her 90th birthday. Even the former sheriff dropped by to kiss the hand of this diminutive retired teacher, to honor the years she interpreted for him during interviews with Latinas and Latinos.
F4CP Making a High-Impact Impression
The Foundation for Chiropractic Progress has released details of its 2016 strategy, certain elements of which are already in play. The strategy includes ads, posters and other resources available to all F4CP members.
Which Way is the Energy Going? Are You Burning Yourself Out?
One of the simple methods that I use to define Yin/Yang theory to patients is to ask the question, "Which way is your energy going?"
Targeting the Bad Apples in the Bunch
While everyone was focused on the conversion to ICD-10, the Office of Inspector General for Health and Human Services released a new report on chiropractic titled "CMS Should Use Targeted Tactics to Curb Questionable and Inappropriate Payments for Chiropractic Services."
Designing a Fitness Plan (Part 1)
It doesn't matter if you come to my practice for pain relief, weight loss, healthy aging or something else. The formula I talk about for each patient's fitness strategy is pretty much the same.
Diagnose Sprain Injuries in MVA Cases With Dynamic X-Rays (Pt. 1)
Am I the only person to notice hospitals are doing a seemingly insufficient job lately in their initial radiological workup of motor vehicle accident (MVA) victims?
Mechanism: Experimental Approaches to Understanding Acupuncture, Part 1
The clinical benefits of acupuncture are difficult to ignore, but also can be difficult to explain to a Western audience. For nearly 50 years, relentlessly inquisitive scientists and physicians have been working toward a conceptual model to explain acupuncture.
Pro-Con: Swaddling for Newborns
The practice of swaddling has been used for thousands of years and was popular until the 1700s, when it was slowly abandoned by many cultures that considered it old-fashioned or barbaric.
Syncretism: Acupuncture and Public Health in Cuba
"Syncretism" is defined as a union of diverse tenets or practices. On a recent trip to Cuba designed to demonstrate the integration of Traditional Medicine and biomedicine, our group witnessed this union firsthand.
It's Time to Review
It is amazing to see the changes that are occurring in the acupuncture profession. Let's look at some of the news and events that have contributed to this growth and awareness.
Born to Energize the Human Spirit: Recollections of Sig Miller
Sig Miller, longtime executive director of the Association of New Jersey Chiropractors (ANJC), passed away on Sept. 17 after a long battle with cancer.
Footsteps of the Sages: An Apprenticeship with Dr. Kezhan Zhang
When I met Dr. Kezhen Zhang in May 2013, I was his translator and the integrity, creativity, and passion he demonstrated as a practitioner and advocate of the medicine convinced me to travel to Beijing to study with him.
Tailor-Made Knee Pain: The Sartorius Muscle
A patient was referred to my office after receiving treatment from various providers with no results. The patient was training for the Olympics as a marathon runner and was unable to run or walk without severe medial knee pain.
Omega-3 Fish Oil: An Underappreciated Element of Men's Health
As a clinician with many male patients -- and as a man myself -- I am all too aware of the fact that we like to convince ourselves that we are doing great, when that may be the farthest thing from the truth.
The Modern Application of Ancient Mei Rong
Chinese Medical Cosmetology (Mei Rong) has a well-documented and venerated history dating back to the Qin (221-206 BC) Dynasty.
March, 2008, Vol. 08, Issue 03
When Is It Safe to Treat a Patient Taking Antibiotics?
By Charlotte Michael Versagi, LMT, NCTMB
Patients often arrive at a massage therapist's doorstep after a recent hospital release, recovering from bronchitis or another "bug." During intake, we discover they are taking some form of an antibiotic. Upon hearing these words from a client or patient, a red flag needs to pop into the therapist's consciousness. This isn't always a contraindication, but ingesting antibiotics presents certain precautions and demands certain questions are answered before proceeding with the massage treatment.
To clarify up front, in this article, massage treatment is defined as standard, full-body, Swedish-style massage consisting of effleurage, petrissage, some range of motion, perhaps some tapotement, etc. We are not referring to lymphatic drainage, energy work or other forms of bodywork. Those modalities are performed after advanced training and affect the body slightly or significantly different than normal Swedish massage.
First, what is an antibiotic? Antibacterial agents usually are called antibiotics. These medications cause irreversible and lethal damage to a bacterial pathogen or at least create bacteriostasis, inhibiting bacterial growth. You've heard of the common families of antibiotics: the penicillins, tetracyclines, sulfonamides and cephalosporins.
Here are some questions to ask when your client informs you they are on antibiotics. Why are they taking the medication? When did they start taking it? Are they suffering from an infection? Is the infection systemic or local? Do they presently have a fever? If so, is it spiking or is it low-grade? And at this point, you may be thinking to yourself, "What's the difference between inflammation and infection?" and "What effect will my massage have, based on the answers my client just gave me?" Our concern, as always, is safe treatment.
Let's clarify some definitions before discussing your treatment. An infection, according to Stedman's Medical Dictionary, 28th Edition, is an invasion of the body with organisms that have the potential to cause disease. Our own Ruth Werner tells us inflammation is a tissue response to the threat of bodily injury or invasion by antigens. The response is controlled by chemical, cellular and vascular functions. It's a chain of events; a reaction of injured tissue to defend and protect the body from invasion. The aim is to get rid of the pathogen, prevent the spread into the body (a massage therapist's primary concern) and prepare the injured area for healing.
Now prepare yourself for a generalization here, but it will help you with your treatment decision. Antibiotics most often are given to fight infection, something that is systemic or carries the threat of becoming systemic (although some infections can be quite local). Steroids and some other medications often are administered for inflammations; a problem we normally think of as local, yet sometimes is systemic.
You remember the cardinal signs of local inflammation, right? Redness, heat, swelling, pain and sometimes, lost function. The point is to help you intelligently understand what you are treating before you proceed. Does your client suffer from a local inflammation/infection (e.g. infected tooth socket after wisdom tooth removal) or are they taking antibiotics prophylactically before a procedure? Have they been diagnosed with bronchitis and started antibiotics three days ago? Do they have a fever of unknown origin and the doctor is simply experimenting with an antibiotic to try to allay symptoms?
Now let's put two and two together. You learned in massage school that one of the primary effects of massage is an increase in circulation, right? OK, if a one-hour massage is going to increase circulation, you must be as sure as you can about exactly what you are sending through that body. Are you potentially spreading infection or are you helping with waste removal and lymph flow to assist the body's fight toward health? The effects of massage are vast and wonderful; just keep reminding yourself that one of those effects is vascular. With infection and inflammation, you are dealing with the body's vascular (and immune) response.
As for the answer to the question of whether to treat a client, according to Werner, acute inflammation is a contraindication for circulatory massage. But massage may be appropriate for subacute conditions. (Think of a twisted and swollen ankle, for example. No massage therapist in their right mind would massage locally, but effleurage proximal to the injury, as well as massaging the rest of the body, would be completely appropriate.)
The mantra I learned in massage school was: "An antibiotic has to be taken for three full days for the patient to achieve a blood level (of antibiotic) before a massage can be safely given." Although this is generally sound advice, Jane Brown, director of the 1,000-hour massage program at Carnegie Institute in Troy, Mich., reminds us, "All antibiotics have different saturation levels in the blood; so although the three-day rule holds most of the time, you never really know which antibiotic has reached its height of effectiveness and when."
Jen Green, a naturopathic doctor and researcher practicing in Shelby Township, Mich., offers massage therapists a holistic view of treating patients who are taking antibiotics: "Antibiotics generally help control the bacterial population. But tell your massage therapists that the antibiotics are not doing the whole job - the immune system is still working. It needs a boost to work effectively and massage gives it that boost. I'd agree with waiting a couple of days (from the onset of taking the medication) to begin massage but after that, it would help the patients to stimulate the immune system by increasing circulation." Dr. Green continues, "Antibiotics, too, have a bacteriostatic effect; they can keep the bacteria from growing - but the body has to move. Increased blood and lymph flow helps get the problem out of the system."
It is probably safe to treat your patients after they have been taking antibiotics for two or three days and are manifesting none of the cardinal signs of heat, fever, swelling or pain. Remember, ask all the right questions, determine in your mind exactly what effect your increasing circulation will have on the body, and then proceed with intelligence and compassion.
Charlotte Michael Versagi is a medical journalist, national speaker and educational director of the School of Oncology/Hospital Massage in the Beaumont Hospital system in Michigan. Her private practice focuses on oncology patients.
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