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International Congress on Integrative Medicine
"Bridging Research, Clinical Care, Education and Policy" was the theme for the International Congress on Integrative Medicine and Health 2016 (ICIMH).
Analyzing Acupuncture Case Studies
Confirm the answer quickly by the elimination method. Take this case study as an example. After two treatments for back pain, a patient presents for a third session complaining of rapid breathing and wheezing that is made worse during cold weather.
Know Your Research: Tips for Evaluating Literature Reviews
Clinical and experimental studies are not the only types of published research we might encounter as we look for evidence to inform our practices. One of the most useful types is the literature review, which summarizes a group of studies.
What are the Meridians?
The meridian and collateral system (jing luo, hereinafter referred to as "Meridians") is comprised of the main meridian channels (jing mai) and the collateral vessels (luo mai). Jing takes from meaning of the Chinese word pathway (also jing) and are the main branches of the system.
MPA Media Wins More Publishing Awards
The American Society of Business Publication Editors (ASBPE) has honored Dynamic Chiropractic with a national award and two regional awards for editorial excellence, and sister publication DC Practice Insights with two regional awards for graphic design excellence.
Don't Ignore the Lower Half of the Pelvis (Part 1)
When your patient complains of lower back or pelvic pain, but your usual treatments are not getting the job done, what do you examine and treat? You may be missing important structures in the lower half of the pelvis.
Illuminating the Hidden, Freeing the Source
Amongst the Primary Channels, from a classical point of view, the small intestine is perhaps the most important channel to understand. It is one of the least used acupuncture channels in modern acupuncture, yet it within it can be found a wealth of theories from the Ling Shu.
What's New in the NCCIH Strategic Plan
The NIH National Center for Complementary and Integrative Health (NCCIH) released its draft strategic plan 2016-2021 for public comment in early spring of 2016.
Traditional Chinese Herbal Medicine in Taiwan Hospitals
This spring, a team of Western medical doctors and TCM practitioners from Cleveland Clinic traveled to Taiwan to visit Kaiser Pharmaceutical Co. (KP), and China Medical University (CMU), Taiwan's leading integrative medicine hospital.
Adventures with the Pericardium
My previous column on the San Jiao deserves equal time for SJ's loving partner, the pericardium. I nicknamed SJ the travel meridian – but pericardium can also play a crucial role in air travel.
Guidelines for the Use of Modifier -52
Modifier -52 identifies that a service or procedure has been partially reduced or eliminated at the physician's discretion. This is to indicate the basic service described by the procedure code has been performed, but not all aspects of the service have been performed.
Work Stress and Musculoskeletal Health: Do Your Patients Get the Connection?
Most people underestimate the impact their job has on their health, especially if that job isn't particularly physically demanding. Big mistake.
Time to Fight for Your Medicare Right
I have heard a lot of noise and a lot of debate about what is going on with Medicare. As an ACA delegate, I often get asked: 'What is the ACA even doing?'
A Study of Relationships
Sa-Ahm's five element acupuncture method is known to be one of the most effective acupuncture techniques in Korea because it gives an instant response at the time of treatment and has a high success rate in resolving chronic problems.
Lessons from Functional Neurology
Chiropractic neurology, also known as clinical neuroscience or functional neurology, is moving the chiropractic profession forward by leaps and bounds.
Less Time Than Required
Q: When is it appropriate to use a modifier -52? Can I use it for a timed service when I do less than the time required by the code?
The National Institutes of Health (NIH) lists more than 80 common autoimmune diseases including asthma, Crohn's disease, Guillain-Barré syndrome, multiple sclerosis, myasthenia gravis, psoriasis, rheumatoid arthritis, and lupus.
Are Probiotics Doing More Harm Than Good?
Considerable controversy exists concerning the efficacy of probiotic supplements. Very few human studies show any real positive impact on the microbiome or health. The "promise" of probiotics is based on the few animal studies that suggest a positive effect.
Chiropractic in the Eyes of the Public: 2nd Gallup-Palmer Poll
The second Gallup / Palmer College poll has been completed, yielding significant additional data regarding Americans' experiences with and perceptions of chiropractic care.
Overuse Injuries in Young Athletes (Part 1)
More than 45 million children ages 6-18 participate in some form of organized athletics, and 75 percent of American families with school-aged children have at least one child participating in organized sports.
Let's Talk About Biceps Injuries at the Elbow
While most muscles cross over only one joint, the biceps crosses two joints: the elbow and the shoulder. Injuries to the lower biceps cause considerable elbow pain. Here's how to assess and treat an injury to this area conservatively.
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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