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Billing and Coding for Moxibustion
Q: I am trying to locate a code for cupping and moxibustion, and have had various fellow acupuncturists indicate that they bill using the existing codes for heat, 97010 hot packs or 97026 infra-red for moxa and 97016 vasopneumatic device for cupping.
Chiropractic Around the World: WFC Country Reports December 2015
The following country updates are reprinted with permission from the December 2015 World Federation of Chiropractic (WFC) Quarterly World Report. Information is excepted for space and edited to DC-specific style guidelines.
Forgotten Options for Musculoskeletal Health
Challenges with musculoskeletal health are of tremendous concern for many people today.
Changing the Cultural View of Medicine
Many hospitals in the U.S. are incorporating integrative clinics that include Traditional Chinese Medicine. Cleveland Clinic has led the charge for adding a traditional Chinese herbal medicine clinic to their existing acupuncture program.
Taking Another Step Toward a Secure Future
In 2008, the Council on Chiropractic Guidelines and Practice Parameters (CCGPP) released a literature review on chiropractic care for low back disorders.
Integrative Medicine Can Shape the Profession
As the AOM profession struggles to define the role of "integrative" medicine within their practices their schools and organizations, students, faculty, alumni and administrators at schools wrestle with discussions of how much, where, how, and what to "integrate."
How to Humanize Your Content to Create Stronger Relationships
Content marketing is about building relationships, whether that is through updates on social media, offers on your website, blog posts, email campaigns, or even printed material. Now days a business needs to make a human connection.
The MRI: What to Do With the Results
As I wrote in my previous article on this topic, it is my goal for you, the doctor, to be an expert in interpreting MRI images yourself; and to be able to independently make decisions based upon a combination of clinical presentations and findings, followed by the MRI images.
From Antiquity to Modernity: Huang Qin Tang at Yale Medical School, Part 1
Traditional Chinese medicine is a coherent medical system with several unique characteristics: it originated almost 3,000 years ago; in its area of origin, it has been practiced without interruption since its inception.
The Roots of Insomnia
One of the most common clinical presentations is insomnia. Next to digestive disorders, sleep disorders are one of the most common complaints the clinician will encounter in daily practice.
Asking the Insurance Rep the Right Questions
One of the first or last questions a potential patient often asks is: "Do you take insurance?" An ill-informed or optimistic, "yes" can result in delayed or non-payment. Instead, just say: "Let me check if you are eligible first."
Window of the Sky Points
The acupuncture points known as Window of the Sky are a modern creation. There is no reference in Chinese medical texts for an acupuncture point category called Window of the Sky.
Treating Pain: The Hypermobile Coccyx
When I write about the coccyx, I recognize that I am talking about a relatively small subset of patients. When I write for Dynamic Chiropractic, I am trying to reach 60,000 chiropractors.
Yo San University Helps Make LA Communities Healthier
An element of healthcare training often overlooked is the residual benefit to communities served by Acupuncture and Oriental Medicine (AOM) schools nationwide.
Ethics: The Glue That Holds Us Together
Kudos to the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) for creating a code of ethics for the nationwide profession and for deciding to make courses in ethics a requirement for certification renewal.
The Clinical Versatility of Milk Thistle (Part 2)
Evidence is growing that the silymarin complex of flavonolignans from milk thistle can impact serum ferritin and iron overload in various clinical circumstances.
Do Doctors Lie to Patients? (Do You Lie to Yours?)
In a previous column ["When Patients Lie (Bribe or Flatter)," Oct. 1, 2015], I discussed the issue of patients lying to doctors, and the many reasons why this can occur.
Diet, Nutrition and the Context of Risk (Part 1)
Food and supplement safety is a topic that often comes up when I speak to chiropractors for CE relicensing, even when it is not the advertised subject.
Interprofessionalism: What it Means and Why You Should Care
Interprofessionalism in education and in practice is a growing trend across health care in the United States. The idea that team-based care and collaborative practice can improve health care has been around more than 50 years.
Lab Rats (Roaming the Streets)
The title of this article is an accurate description of American consumers (regardless of age) in the modern era.
Percussion Therapy: An Experiment
My study of qi began more than 20 years ago — long before my study of TCM, points or pathways. It all started with an awareness in my hands and physical manifestations in the way of blockages while working on clients.
RAND Study Recruiting DCs
Dr. Ian Coulter, RAND / Samueli chair for integrative medicine and senior health policy researcher for the RAND Corporation, has issued a call for participation, recruiting doctors of chiropractic for a practice-based research study that will examine "the impact of evidence, outcomes, costs and patient preferences on the choice of treatment for chronic low back pain and neck pain."
East Meets West
Gung Hay Fat Choi. Welcome to the year of the Monkey. There will be fireworks for both January and February this year. What great celebrations.
Enhancing Performance in Cross-Fit Athletes
Cross-fitness centers are expanding in number and increasing in popularity. To remain relevant to this growing portion of society, practitioners need to learn about the exercises and injuries common to this group.
December, 2008, Vol. 08, Issue 12
Body Art: Tattoos and Piercings
By Ruth Werner, LMP, NCTMB, Massage Therapy Foundation President
A couple of years ago, I was teaching a class about massage and the parasympathetic effect. To make my point, I stood behind a student, put my hands on her trapezius and then began to do some gentle petrissage through her sweater.Chatting blithely away about blood vessel dilation, changes in breathing, and dropping blood pressure, I failed to notice that this poor, polite student was not enjoying her massage. She was wincing, tightening up and leaning away. When I finally noticed and asked her what was going on, she said she had just had a big tattoo put on her shoulders. The whole class gasped in sympathy.
On a related topic, a reader named Tamra sent me this note: "I was standing behind a person in the grocery store with surgical steel ball implants in her cervical area (bilaterally) from about C3 to C7, in what would be considered the lamina groove. I wondered as I was standing there: If she were my client and she had neck pain, what would I do? How would I treat her? I had no answers, only avocados."
I know that I am a good deal older than many of my peers in the massage profession, and I freely confess to being a bit of a fogey about body art. I was so grateful that the threat, "Whatever you have pierced, I'll have pierced. And then I'll show all your friends," worked on my children and I never had to shop for a navel ring. That said, for many people tattoos, piercings and other physical modifications are a mode of self-expression that is important and deeply meaningful. While, like anything, body art can be abused, it can also be very creative and empowering. In the words of Andy Barnett, a professional piercer and tattoo artist, "I want to adorn the body, not mutilate it."
Many of us have clients with various forms of body art. Under some circumstances this can require some adjustments in our work. This article offers a brief primer on tattoos and piercings, the challenges that they may pose for massage, and strategies that can help us be safe and effective practitioners in this context.
Tattoos are pictures drawn on the skin through shallow injections of colored ink. Tattoo artists use tiny needles and a rapidly pulsating machine to deposit the ink just under the skin. Standards for hygiene in licensed tattoo studios are high, so the risk of infection from contaminated equipment is minimal. With "garage artists," this is not always the case, meaning blood-borne infections like HIV, or hepatitis B or C can be spread this way.
The dyes in tattoo ink can be a problem for some people. While inks are safer than they used to be, a lack of regular oversight means that not all inks are hypoallergenic. Allergic reactions are rare, but not unheard of. Because they most often occur in reaction to any color in the red family, new tattoo clients may be counseled to begin using red in small amounts until they know how they'll react. Reactions can cause itching, blisters and bumps (called granulomas) around the edges of a tattoo.
A person with a new tattoo is usually counseled to cover it for a day, avoid submerging it in water for up to two weeks, and rub it frequently with ointment and then with unscented lotion to promote speedy healing. New tattoos involve compromised skin - an obvious contraindication for massage. After the initial tenderness subsides, many people experience intense itching for a few days. This is another caution for massage, which can make itching worse by drawing blood to an area. The safest course in this situation is to wait for any pain and itching to resolve before doing massage in an area with a new tattoo.
Piercings are self-evident, and the variety of body parts that are pierced continues to expand. I remember being both shocked and vastly curious the first time we had a massage student with a nipple ring. (In my own defense, I will point out that these were the days when it was daring to have more than one hole in an earlobe.)
Piercings involve using a special needle to penetrate the skin. Various types of instruments are then inserted into the opening and secured from both sides. The piercing heals when scar tissue forms a tunnel around the instrument. The young woman Tamra described had several long instruments that were inserted to reach horizontally under her skin across the back of her neck.
Depending on the site, piercings can take anywhere from a few weeks to several months to heal completely. At that time, jewelry can be removed and replaced easily. (There's the answer to Tamra's question, by the way: She can take the studs out of her neck to receive massage, if necessary.) Most piercing jewelry is made of surgical steel. Surface piercings, like those on the young woman with the nape studs, have a relatively high rejection rate, but they tend to be most successful when the jewelry is made of surgical-grade Teflon or acrylic, which can conform to the body's curvature. While piercings are healing, the person is advised to keep the area clean and avoid letting anything like hair or clothing catch on the jewelry.
The size of the jewelry is an important safety factor. If it is too short, it can be drawn into the skin, and if it is too long, it can create unnecessary friction as it rubs on nearby structures. Tongue studs that are the wrong size are notorious, for instance, for causing damage to teeth and gums. Other risks with piercings include the possibility of excessive scar tissue or keloids, or trauma if the jewelry is torn out.
Guidelines for massage in the context of piercings are clear: New piercings involve injured skin and must be locally avoided until the lesion has scarred over. On the other hand, older piercings pose no contraindications, and the jewelry can be removed to make massage more effective whenever necessary.
Many thanks to Tamra, who posed this interesting question, and to Andy Barnett of Frankie's Tattoo in Clearfield, Utah, who generously allowed himself to be interviewed for this article. For next time, the floor is once again open. We can continue in this vein with additional information about body art (implants, braiding, scarification, etc.), or we can pick up something entirely different. It's up to you: What's on your table?
Until then, many thanks and many blessings.
Click here for previous articles by Ruth Werner, LMP, NCTMB, Massage Therapy Foundation President.
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