resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Parker University Embraces New Era
Change is in the air at Parker University, which recently announced the selection of both a new president and a new consultant for its seminar program.
Billing One-on-One, Direct Patient Contact
This is often misunderstood and leads to trepidation when documenting and subsequently billing timed services.
Billing Timed Services
Q: I do not always use physical medicine services but in my state I do have a scope of practice that allows me to provide many of these services. I am trying to understand what "direct one-on-one patient contact" means in relation to physical medicine services.
News in Brief
NYCC Aggregates Degree Programs in New School; Palmer Chancellor Receives Education Award From ICA; Oklahaven Announces "Have a Heart" Winners.
Finger (Pad) Pointing: Repetitive-Use Injury Waiting to Happen
"My wrist and hand hurt. I spend all day working on computers and then I come home and spend more time on a computer, usually playing video games."
A Different Way of Looking at It
The way you and your chiropractic colleagues access information has changed over the past decade. According to a recent survey conducted by Dynamic Chiropractic, almost half (48 percent) of DCs read online articles on their personal computer or laptop daily.
Streamline Your Front Desk
Your front office can be your greatest source of efficiency or it can be a constant bottleneck. Increasing the productivity of this area, while not sacrificing the quality of patient interaction, can be a little tricky. However, with some focused effort and intention, your front desk can keep your practice running smoothly.
Living Well: Lessons From Our Oldest Old
Aging is a significant public health problem, important to chiropractors in practice and important to DCs who teach students training to become chiropractors.
Holistic Skin Care and Modern Technology
Anti-aging is a concept that we hear in reference to skin rejuvenation and growing older on a daily basis. Aging begins as soon as we are born; therefore "pro-aging" is embracing all stages of life gracefully, with vitality, wisdom, joy, and gratitude as the goal.
Low Fat vs. Low Carb & the Power of Protein
A science-based website recently posted a nice summary of 23 randomized, controlled trials from peer-reviewed journals pitting low-carb diets against low-fat diets.
The Need for Standards
ISO-TC-249: You may look at these letters and numbers and wonder what they are and what they might mean. They turn into: International Standards Organization- Technical Committee – 249. There is a global organization called The International Organization for Standardization.
Transforming Las Vegas
On a warm spring day in Las Vegas, Sonia Kim, clinic front desk staff, is busy preparing for a full day of intern shifts at Wongu Health Center. She greets patients, makes sure documents are properly signed, and lets the interns know that their patients have arrived.
Sleepless nights, anxiety, mood swings, euphoric energy bursts, obsessive thinking, and a strange feeling in his chest. That is what Matt was experiencing when he first entered my practice. Rather than being concerned, he was loving every minute of it.
A Whole-Body Approach to Chronic Tension Headaches
Nearly every day in our practices, we see patients with chronic headaches that have not responded to traditional treatment. They present in our offices with a feeble hope that "maybe" a chiropractor can help.
Keeping Malpractice Allegations at Bay
It has been suggested that in the litigious environment in which we live, the practice of chiropractic should be defensive and practitioners should constantly be watching their backs. An element of defensive practice is a good idea.
Hip Flexor Contractures & LBP in Above-the-Knee Amputations
Patients with above-the-knee amputations (AK or AKA) are particularly prone to developing hip flexor contractures. Not to be confused with muscle tightness, contractures are a permanent shortening of tissues which cause deformity or distortion.
One of the most common trends to see in clinical medical practice and public health is the cycles of health "buzzwords." These come and go depending upon the current cultural zeitgeist. One year, "parasites" are causing all the issues, and the next year it's "candida."
Building Bridges with Discipline
As practitioners of traditional Chinese herbal medicine, our role is to educate patients and medical practitioners about the various safety aspects of our medicine. Medical doctors that embrace Chinese medicine want to collaborate and include Chinese herbal medicine in more aspects of clinical care to support their patients.
Distal Style Treatment of Neurogenic Pain
Treat locally or distally? This question has frequented my thoughts for the treatment of pain throughout my acupuncture career. Each style has strengths and weaknesses, thus the versatile practitioner would do well to forgo dogmatic adherence to any one style in deference to the needs of the individual patient.
How to Reach Your World With the Chiropractic Message
My latest effort to share chiropractic occurred in mid-May while I was sitting at an introductory parent information night for high schoolers. The IT instructor informed us that each student would be receiving a computer for all their studies.
Understanding Levels of Evidence
The concept of levels of evidence is a cornerstone of research literacy and a great starting point for understanding basic principles of how research works.
With Low-Back Pain, Sometimes Little Things Matter
Typical treatments for low back pain involve large muscles like the quadratus lumborum, iliopsoas, and piriformis. However, there are situations when a very small muscle, the multifidus, can play a significant role in the diagnosis and treatment of low back muscular or spinal injury.
Constructing Our Reality, Part 2
My last article discussed perception and its relationship to the primary channels. Before we get to the channels most commonly used to treat sensory disturbances, the small intestine and triple heater, we should first talk about the bladder channel.
Discovery: Finding Insights and Each Other in Different Disciplines
Recently I've been thinking about all sorts of things which are hidden from our daily direct experience. That general category is what links nearly everything that catches my attention and then demands some kind of investigation.
Prostate Cancer Risk
A large study published in January 2016 in the American Journal of Clinical Nutrition showed that men who are vegans had a 35% lower risk of developing prostate cancer compared to non-vegan men. The study followed more than 26,346 men who are part of the Adventists Health Study-2.
January, 2009, Vol. 09, Issue 01
Anaphylaxis: A Sudden and Deadly Progression, Part 1
By Dale G. Alexander, LMT, MA, PhD
From the author: The purpose of this column is to provide our profession with a broad reference of anatomy and physiological science, which have guided my ability to assist so many with chronic difficulties. Understanding how the body works from the inside-out and how progressions from stress-related disorders evolve toward physical pathology allows us the opportunity to supply our clients with the best possible care.
The purpose of this two-part series is to raise our collective awareness as massage therapists of anaphylaxis progression that potentially can be prevented by asking your clients a few simple questions. On Aug. 31, 2007, I got lucky and survived a severe anaphylactic reaction. In July 2008, a dear friend's brother did not. I am introducing Dr. Thomas Walsh, DDS, as the co-author of this article, as his perspective on anaphylaxis was most helpful in assisting me to understand the full scope of this progression.
Anaphylaxis can exhibit a sudden, rapid, and deadly progression. Such systemic allergic reactions typically become progressively more severe with each additional exposure to an allergen. However, even the second exposure can be fatal if an individual has had a sensitization experience.1 Acute anaphylactic shock which results in death is most often associated with the ingestion of peanuts for children and penicillin for adults or, as a result of an insect venom for all ages.2
There are two primary important questions to ask your clients that seem most relevant to Dr. Walsh and myself. First, have you ever had any severe allergic reaction in which you have experienced one of the following: itching and hives over much of the body; swelling in the throat or tongue; difficulty breathing or swallowing; dizziness, severe headache; stomach cramps, nausea, or diarrhea; rapid decrease in blood pressure; or shock and loss of consciousness?
The second most important question is whether or not they had a previous exposure to a suspected allergen without any reaction. Remember that penicillin, peanuts and insect stings tend to be the most deadly, but other triggers of anaphylaxis do exist. The third question is if they have told their physician about their reaction and requested testing to determine the severity of their allergy.
My most important lesson from Dr. Walsh has been the notion of a sensitization experience. I had such a sensitization in February 2007, during a dental cleaning at another dentist's office. My internal sensations included a sudden onset of severe itching spreading throughout my vascular system, my face turned bright red and became puffy, and my hands and feet swelled to the point of mild discomfort. My dentist administered 50 mg of benadryl by mouth, and a hygenist sat with me for 50 minutes while the symptoms gradually subsided.
In discussion before I left the dentist's office, we speculated about what might have been the trigger for my reaction. Since nitrous gas was being administered, an iodine solution was used, and I had requested amoxicillin because of my genetic heart history, it was unclear what might have been the specific reactive cause. My dentist instructed me to seek out allergy testing to make this determination.
I was able to make the 40-minute drive home and finish my afternoon schedule of three clients. Though quite tired that evening, I mentally and emotionally minimized the experience because there were no lingering effects over the next few days. Still, I was curious, so the next weekend, I consulted a couple of physician friends who specialize in emergency medicine. Neither seemed alarmed by the description of my symptoms, noting that if 50 mg of benadryl had been effective, they considered it a relatively mild reaction.
The key question that could have been the focus of our discussions was whether or not I had a previous allergic reaction to anything. I have taken penicillin and its antibiotic derivatives all my life without any degree of reaction. This is what made the dental office experience qualify as a sensitization.
As part of our clients' early-detection team, we need to be aware of this notion of a recent sensitization. The general population has yet to be educated about this, and even well-trained physicians sometimes forget to ask the most pertinent question. Once a sensitization experience has been identified, follow-up allergy testing is a must - something that had been recommended by my dentist, which I did not do.
So, the short tale of my near-death anaphylaxis experience began with a client confusing our appointment time and my grousing a bit, wondering how to spend my time. I coughed a few times, jogging my memory that my last client from the evening before had been violently coughing and I had neglected to wear a face mask for self-protection. I thought that I could take a couple of the antibiotic pills left over from a previous prescription as a hedge against any possible contagion. I had done this a few times before with success. Guess what I forgot in that moment? It was amoxicillin, one of the possible triggers of my reaction six months earlier. (It is amazing how the mind compartmentalizes.)
Immediately, the uncomfortable itching feeling began to spread throughout my veins. Oh, my gosh! I remembered my previous experience and began to evaluate my options - one being to just lay on my table and wait for it to pass. My instincts then motivated me to drive to a pharmacy a half-mile away to purchase benadryl. I never once entertained the idea of calling 911, as I did not have the knowledge that such a reaction had the ability to escalate so fast or actually could kill me. As my symptoms escalated beyond what I had experienced in the dentist's office, I abandoned the pharmacy idea.
Instead, I drove to an urgent care center located seven blocks away. Along the way, I had numerous visual white-outs during which I only had peripheral vision, and one moment of total blindness. I stopped my vehicle completely in that moment until I was able to regain some slice of vision. The angels were watching over me.
Upon reaching the physician's office and clutching at the door, I collapsed completely. The urgent care center's owner, Dr. John Van Tuyl, MD, reached me as quickly as he could. Finding no pulse, he pronounced me in full cardiac arrest and instructed his staff to call 911. He later recounted to me that I rallied momentarily, lifted my head and stated, "No, I am not...amoxicillin." As an emergency care specialist he split the difference between the possible protocols and placed an atropine patch on my heart to increase its cardiac output. He later explained to me that the visual whiteouts I had experienced were in response to the lack of blood flow to my brain as my heart was being crushed by the sudden swelling of the pleural and pericardial sacs.
What is most important is to anchor this notion of sensitization in your awareness and to specifically ask your clients if they have had allergic responses to any of the common triggers (food, medication, insect venom, latex and exercise); especially a recent one. If they have, please do encourage them to seek out allergy testing with the guidance of their physician.
Beyond my personal story, it is important as a massage therapist to know that anaphylaxis affects more than 10 percent of our population in North America and is increasing in frequency. In more than 25 percent of cases, there is a delayed or biphasic course, with severe symptoms occuring three to five hours after exposure. In more than 20 percent of cases hypotension or laryngeal edema occurs without hives and can be difficult to identify. Most fatal reactions occur in people who knew they were allergic but had accidental exposures. The cause is often not the most obvious and may include combinations of factors including food and exercise. Moreover, most individuals do not inform their personal physicians that they have had severe allergic reactions during routine history and examination.2
In part 2, we will discuss persons medically identified as susceptible to severe anaphylactic reactions along with common products or triggers found in any massage therapist's arsenal.
Click here for more information about Dale G. Alexander, LMT, MA, PhD.
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