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Help Update the LBP Practice Guideline
The Council on Chiropractic Guidelines and Practice Parameters has announced the release of an updated Clinical Practice Guideline for Chiropractic Management of Low Back Pain for stakeholder review and comment.
Avoid Random Treatment of Trigger Points (Part 2)
We must acknowledge that the fascia, which surrounds literally everything in our bodies, including every muscle fiber, is more than just a covering.
Low Back Pain: Posture and Movement Analysis
When performing static and dynamic movement analysis of the lumbopelvic hip area, begin with standing visual posture analysis of the pelvis, and then perform lumbar range of motion and assess what you might see during normal versus abnormal lumbar flexion motion.
B Vitamins Improve Memory, Prevent Brain Atrophy
The 2010 OPTIMA study showed that the accelerated rate of brain atrophy in elderly with mild cognitive impairment could be slowed via supplementation with homocysteine-lowering B vitamins, which included folic acid, vitamin B12 and vitamin B6.
Synergy Doesn't Happen in Silos: Acupuncture in Hospitals and Other Healthcare Settings
As acupuncture and traditional East Asian medicine continue to intersect and integrate with biomedical approaches, the conversation about integration expands and becomes richer.
Converting More Patients to Your Practice
In 2013 and 2014, the theme was "the money is in the list." This meant that if you had a big email list, you were really making some "cha-ching." Unfortunately, having thousands of emails doesn't equate to thousands of dollars in profit.
Recreational Cannabis Use and TCM
Many people are drawn to cannabis for its effects physically, mentally and emotionally. Medically, cannabis has some legitimate uses, however the scope of this article is limited to the recreational use of cannabis.
An Excerpt from TCM Case Studies: Pediatrics
This excerpt is reprinted with permission from Jamie Wu. TCM Case Studies: Pediatrics was released in 2014 by People's Medical Publishing House.
Impacting Chiropractic's Future With Technology
When it comes to electronic health records (EHR), Robert Moberg and Dr. Steven Kraus are two of the leading industry experts on the topic.
Will You Be an Amplifer or a Mute?
These times are changing, and changing quickly. There have been many challenges to this profession throughout the past few years. The challenge is to talk, then talk and talk some more about this medicine.
There Really is No Room for Sexism
Recently, Matteo* (a transgender male) approached me during a break in an advanced shiatsu class in Berlin where he was one of two men in a group of 20 women. "Pamela. Don't forget to remind the translator to include male endings."
TCM Congress in Rothenburg is Largest in Western World
In the medieval town of Rothenburg, deep set within the Bavarian countryside in Southern Germany, the TCM Kongress Rothenburg each year draws around 1.200 participants from more than 40 different countries to attend the biggest TCM conference in the Western world.
The Dietary Supplement Research Dilemma
I do not care what the truth is, one way or another; I just want to know it. And when it comes to dietary supplements, the truth can be hard to find for a number of reasons.
The Need for a New Medical Model: A Challenge for Biopsychosocial and Ecopsychologica Medicine
Chinese medicine speaks of alignment between humans, heaven and earth. It is a complex view with a focus upon relationship. These are comprehensive ideas with no specific terms in contemporary medical practice.
Expanding Access, Branch by Branch
The big news coming from Capitol Hill isn't merely the recent introduction of a pair of bills designed to expand chiropractic services in the Veterans Affairs and military health care systems; after all, similar legislation has made its way through Congress before, never reaching the Oval Office for presidential signature.
The Way We Are Designed: A Conversation with Gil Hedley, PhD
I was first introduced to the work of Gil Hedley by Tom DiFerdinando. He gifted me Gil's DVD series.
A Reality Check – and a Chance to Educate
Imagine working in the public relations department of nutrition retailer General Nutrition Corporation (GNC) and reading the The New York Times announce...
Treating Beyond Pain
More often than not, when a patient presents to the office, it is for a pain complaint. Headache, neck pain, low back pain, sciatica, carpal tunnel... The pain is often the focus of the patient's mindset, and they don't often have any thought of what comes after the pain.
A Well-Kept Secret: 5 Element Acupuncture, Part II
Supervising acupuncture interns at a TCM college, it has always struck me how funny it is to hear the clinic manager tell the patients that the Five Element clinic specializes in treating emotions, as if patients with physical pain have no emotions!
Atypical Femoral Fractures and Bisphosphonate Use: What to Watch For
Bisphosphonates (BP) are popular drugs, with more than 8 billion in sales in 2008; however, profits have declined as patents began expiring. Nonetheless, BP remain the most commonly prescribed drugs for patients at risk of osteoporotic fractures, with several million prescriptions written every year.
Interpersonal Skills 101: Enhancing the Value of Our Patient Interactions
Recently, I read an interesting article in our local newspaper titled "The Value of Human Interaction." The article presented comments from a senior editor for Fortune magazine who discussed "Civility in the Business World."
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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