resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Managing Today's Fertility Patient
I recently received an email from one of my fertility patients: "Got my lab results back. FSH is 11, AMH is 0.7. My doctor said these numbers aren't good. I guess I'm infertile. Just as a thought. Just set up an appointment to speak with an adoption agency."
CMT & Stroke Risk: Myth vs. Fact
By now, most of you have probably heard that the American Heart Association recently published a statement regarding the association between cervical dissection (CD) and cervical manipulative therapy (CMT).
Healing With TCM at San Quentin State Prison
For the prisoners at San Quentin State Prison, life-sentences are the reality of every day life. It is not often that prisoners get the opportunity to use alternative medicine to deal with common ailments they encounter behind bars such as, depression, anxiety and pain.
Commingling Money: 12 Questions for the ACA About the CHAMP / NCLAF Merger
The American Chiropractic Association recently announced it was merging the National Chiropractic Legal Action Fund and the Chiropractic Health Advocacy and Mobilization Project into a single entity that will support both legal and legislative actions.
The Case for Immunization
As long as I have been a chiropractor, I have seen many in this profession oppose vaccinations. Indeed, it has often been taken as a "given" that to be a principled chiropractor requires a curmudgeon's willingness to hold aloft that banner of opposition.
The Wonders of Light Therapy: An Interview with Wes Burwell
I first met Wes Burwell in 2011 when he was teaching a class on light. Since then, every time I hear him speak, his understanding of the benefits, function and capacity of light has evolved.
Simple Ways To Find True Happiness
Patients in our clinics are always seeking happiness. As their health advocate, we need to ensure we inform them that in order to find happiness, they have to make sure to identify what makes them happy in the first place.
The Tao of Gender
If you think gender is as simple as having a new client check off the "male" or "female" box on your intake form, we hope this article will expand your understanding and thus the reach of your health care.
Essential Orthopedic Testing: Tests That Involve Standing on One Leg
Since these tests have a common mechanism of performance (standing on one leg), there are differential diagnostic concerns during testing. The tests cannot be completely isolated from each other for performance.
Dr. George Goodman and His Legacy to Logan University
Those who knew him called him a revered leader, a visionary and one of chiropractic's biggest advocates. George A. Goodman, DC, Logan University's sixth and longest-serving president, passed away on Sept. 9. He was 70 years old.
Jingei Diagnosis: An Effective and Powerful Diagnostic
I graduated from the Kotatama Institute under the direction of Drs. Masahilo and Katsuharu Nakazono in 1984. As a student, I was exposed to the practice of most of the various theories and modalites of Oriental Medicine.
AOMA Strengthens Leadership Team
AOMA Graduate School of Integrative Medicine, a leading college of acupuncture & herbal medicine, announced the appointment of Donna LaPoint Hurta, MBA as the new VP of Finance & Operations this Fall.
Lime Jello on Morphine
Taste is in the eyes... actually the mouth... of the beholder. My food preferences have changed, lightening from the food of my youth. My parents loved heavy eastern European cuisine and I loved it as a child. Now I enjoy leaner, healthier whole foods.
Correcting Pelvic Rotation Around the Long Axis: Adjustment Protocol
The pelvis can be considered a ring that can misalign on the sacrum rotating around the long axis. The following is a description of an adjustment that helps to correct sacroiliac rotation around the long axis.
Managing Patient Expectations About Acupuncture
Last year, I attended the Pacific Symposium in San Diego for the first time in six or seven years. It was the 25th anniversary of this event, and on one evening there was a panel discussion with the title; "What is Qi?."
Sports Science: What's in That Drink?
Athletes frequently ask me what the best liquid is to drink during exercise – water or a sports drink? Water provides the necessary hydration, but unfortunately, it lacks the key nutrients to aid in performance and recovery.
Communication 101: Please Explain Yourself!
Twice this past week, I overheard conversations about chiropractic. As you can imagine, it is a topic my ears naturally pick up. In both cases, a patient was talking to a friend about their experience with a chiropractor.
A Commonly Missed Spinal Fixation: The Upper Lumbar Spine (Part 2)
As mentioned in part 1, using a flexion-distraction table is a great way to unlock this particular fixation. You have found the stuck segment. You have determined whether it is unilateral, midline or bilateral.
The Heart Protector
On the physical level, the Pericardium is a double-layered sac of fibrous tissue that envelops the Heart. The space between the layers is filled with serous fluid that protects the Heart from external shock or trauma and lubricates to allow for normal Heart movement.
Chiropractic Research in Review
Predicting Pain With Disability in Office Workers; Traction Approaches for Discogenic Cervical Radiculopathy; Intra-Articular Gas Bubbles Following Manipulation; Nonresponsive Chronic Ankle Sprains: Think Tendon Rupture.
To The Finish Line With the Help of TCM
When acupuncturist Eddy De Smedt pursued a career in Traditional Chinese Medicine, he knew he wanted to make a difference.
Uncle Sam Needs You (Part 2)
Where chiropractic care has been used in the military health services, it has been deemed very successful.
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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