resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
A House Divided?
The American Chiropractic Association's House of Delegates voted on 30 resolutions at its annual business meeting in Washington D.C., but two in particular took immediate center stage due to their controversial nature.
How Much Do You Know About the Benefits of Birds Nest?
Edible bird's nest is the nest made by the Swiftlet bird of Southeast Asia that is usually prepared as a soup and prized in Chinese culture as a healthful delicacy.
Integrating Art with Clinical Practice for Patients with PTSD: The Artemis Project
Are you restricted by those one-on-one clinic dynamics? Why not join colleagues and clients in experimental group settings? Three of us volunteered to do just that in Austin on behalf of women veteranss from all branches of the service.
A View From the ER
The University of Western States has inked an innovative agreement with local nonprofit health system Legacy Health whereby UWS sports-medicine fellows can experience observational clinical rotations in emergency-room settings within the Legacy system.
Term Limits: What's in a Word?
It was the French historian and philosopher Voltaire who once declared the Holy Roman Empire was neither holy nor Roman nor an empire.
Animal Acupuncture: A Case Study in the Treatment of Traumatic Injury in the Equine
The rise of animal acupuncture in the U.S. began in the early 1970's as a result of the work by members of the National Acupuncture Association in Westwood, Calif.
Sleep, Less Sleep or No Sleep?
I had a dream I wasn't getting enough sleep. It was a very realistic dream, even though I was probably slightly awake and not really deep dreaming. Most likely I had been dozing, caught in that twilight of sleep and wakefulness.
The Tide is Rising in the Acupuncture Profession
Former President Ronald Regan said, "When the tide rises all boats float." The tide is rising for the acupuncture profession. Many forces outside the profession are helping the tides to rise.
Applying the Thin Skull Principle
The "thin skull" principle, also known as the "you take your victim as you find them" principle, is a legal principle that can be summed up by the following statement.
Talking to Patients About Lumbar Facet Denervation (Medial Branch Neurotomy)
Lumbar facet denervation, more appropriately termed medial branch neurotomy (MBN), is a procedure that may be considered when patients suffer from recalcitrant non-radicular axial back and/or leg pain.
Functional Hip Impingement (Part 1)
Every time I sit down to write an article, I realize how much more there is to know about musculoskeletal pain. I also learn something new every time. (I want to give special thanks to Lucy Whyte Ferguson for assisting with this article.)
The Acupuncturist's Problem
I want share with you some observations and insights into what seems to be the most common problem my colleagues in the acupuncture profession struggles with. If you also struggle with this problem, I hope you get a valuable "aha" moment from reading this.
PCOM Granted Regional Accreditation
Pacific College of Oriental Medicine (PCOM) recently announce it has received regional accreditation from the Western Association of Schools and Colleges (WASC). This achievement reflects five years of hard work on the part of faculty, staff, and students.
5 Simple Steps to Create an Effective Marketing Calendar
In the educational experience of most healthcare practitioners, business and marketing are overlooked topics.
5 Tips for Using Pinterest to Market Your Practice
Pinterest is a very popular, but often under-utilized, social media platform where people can bookmark, or "pin," fun and interesting things from all across the internet.
Medicine is Clumsy, Don't You Be
All medical systems have clumsiness in them. If the technique isn't, the practitioner is. Everyone in every form of medicine is striving to improve. That is why we call it practice.
Marijuana, Apathy and Chinese Medicine, Part 1
This article was written in response to the unheeded acceptance of marijuana as a harmless substance that potentially does good when used for the medical relief of pain.
Optimism = Compassion = Trust
A randomized clinical trial recently published online in JAMA Oncology examined how patients viewed their doctor based upon how the practitioner presented bad news to the patient.
Low Back Pain in Professional Golf: A Common Muscular Relationship
Every sport creates its own unique demands on the body. Some sports require such a myriad of body positions that assessing pathology is often difficult and unpredictable.
Turning a Blind Eye to History – and Reality
The American Medical Association is taking the Supreme Court's Feb. 25, 2015 decision exactly as it always does – by turning a blind eye to history, legal precedent and reality.
July, 2008, Vol. 08, Issue 07
Giant Cell Arteritis
By Ruth Werner, LMP, NCTMB, Massage Therapy Foundation President
My previous column looked at polymyalgia rheumatica (PMR), an idiopathic condition affecting mainly Caucasian women from 50 to 80 years old and characterized by sudden onset of muscle and joint pain, especially around the shoulders and hips.This month, we will address a very different condition, giant cell arteritis (GCA), which has a very different etiology and symptomatic profile, but occurs so often in the same people affected by PMR that many researchers wonder if the two conditions might be connected.
What Is It?
Giant cell arteritis, also called granulomatous arteritis, is a condition in which medium and large-sized arteries become inflamed. This inflammation might be body-wide, but symptoms often center around the face and head, so synonyms for this condition are temporal arteritis and cranial arteritis.
GCA usually affects a specific population: Caucasian women between the ages of 50 and 80. (Men can have it, too, but they account for a small percentage of diagnoses.) In this group, the incidence of the condition ranges from 0.5 to 27 per every 100,000 people. The further north, the higher the incidence. Scandinavia has the highest rate of GCA in Europe, while Mediterranean countries have a low rate.
The causes of GCA are not well-understood. Most experts agree it probably is a combination of genetic predisposition and dysfunctional immune response that might be triggered by a pathogenic exposure.
A high overlap exists between people who have GCA and people who have had polymyalgic rheumatica. Statistics vary, but about 15 percent to 25 percent of those with PMR have GCA and vice versa. This raises the question about whether these two conditions truly are freestanding, or if they indicate different stages of progression in immune system anomalies.
The vessels most at risk are the superficial temporal arteries, the ophthalmic arteries, and more rarely, the aorta, subclavian and brachial arteries. The inflammation permeates disconnected patches of the tunica media of these arteries, and biopsies reveal characteristic abnormal "giant cells" that give the condition its name.
What Are the Signs and Symptoms?
The most predictable sign of GCA is a slow or sudden onset of a headache in a new pattern. It usually is restricted to the temporal-occipital area of one side, but it can be diffuse and bilateral. The pain feels superficial rather than deep. Sometimes, simply stroking the hair on the affected side can elicit symptoms.
The headache seen with GCA might be preceded by "prodromic" symptoms that resemble polymyalgia rheumatica: general muscle and joint pain, especially at the shoulders and hips. The jaw might become extremely painful, leading to problems with chewing and swallowing. Loss of appetite, weight loss and fever also might be present, but these are not consistent for every patient.
Perhaps the most alarming symptom of GCA is a change in vision including blurring, double vision or complete vision loss in one eye. It's important to act on this symptom immediately, as the vision loss with GCA might be permanent.
How Is It Diagnosed?
GCA is diagnosed through several measures. Blood tests look at the erythrocyte sedimentation (SED) rate and levels of C-reactive protein as indicators of inflammation. These tests are informative, but not conclusive; a biopsy of the temporal artery is necessary to confirm the diagnosis. This is a simple procedure that can be performed in an outpatient setting, but because the complications of GCA are so serious, treatment might be initiated before the results of the biopsy are obtained.
What Are the Complications?
The most common complication of GCA is permanent vision loss. This usually is the result of a condition called anterior ischemic optic neuropathy. In other words, the optic nerve is damaged because of ischemia. This occurs in up to 50 percent of all people diagnosed with GCA. In addition, inflammation of the major blood vessels can cause blood clots in the brain (leading to transient ischemic attack or stroke) or the larger arteries can weaken and bulge (aortic aneurysm).
How Is It Treated?
High-dose steroidal anti-inflammatories are the first recourse for someone with GCA. The sooner this regimen is begun, the better the chance of saving the patient's vision, so it's worth being aggressive. Low-dose aspirin often is recommended as well, to reduce the risk of forming dangerous clots in inflamed arteries.
The steroid prescription for GCA typically is a long-term commitment: two years or more, tapering off when inflammatory markers in the blood come back to normal ranges. The consequences of prolonged steroid use, especially for mature women, can be serious. They include bone loss (which might be mitigated with medications to increase bone density), hypertension, muscle weakness, cataracts, hyperglycemia, risk of diabetes, immune system suppression and thin skin with easy bruising.
What About Massage?
A client in her 50s or older who reports a headache in a new pattern, especially with vision changes, should go to a doctor before going to a massage therapist. A client with polymyalgia rheumatica must be vigilant about visual disturbances, as this is considered a medical emergency. Because the vision problems with GCA can be permanent, it's important to begin anti-inflammatory therapy as quickly as possible.
A client being treated for GCA might be a candidate for massage, but here the concerns shift to the consequences of long-term steroidal anti-inflammatory use: bone density loss, skin damage, hypertension and other side effects. Furthermore, these medications can interfere with pain responses (their job, after all, is to suppress inflammation!), so the practitioner must be conservative to avoid the risk of overtreatment.
For Next Time
The table is clear and I have no specific requests in the pipeline. So, dear readers, I leave it up to you. What would you like to talk about? What's on Your Table?
Click here for previous articles by Ruth Werner, LMP, NCTMB, Massage Therapy Foundation President.
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