Lost A Sale, But Initial Phone Consultations — A Big Part Of Brilliant Customer Service
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Practicing with Authenticity
To extrapolate from the above quote, patients love healthcare providers they can trust. One way to earn the trust of your patients is by practicing with authenticity. What does that mean, exactly?
Patient-Centered Care vs. Payer Restrictions: Your Ethical Obligation
Do you have an ethical obligation to evaluate your patients, make a diagnosis and provide evidence-based, patient-centered health care, irrelevant to the payer restrictions?
Acupuncture Rising: From Acupuncture Anesthesia to Assisted-IVF, Part 1
Acupuncture's cultural and historical roots go back to the emergence of Chinese civilization. For more than 2,000 years, acupuncture needling has been continuously practiced on the largest population in the world.
Practice Policy (Gone Bad): The Sign
Every once in a while, you see something and think to yourself, That's a really bad idea. Case in point: I went to see my medical doctor the other day. Just after being "roomed," as they say, the nurse checked my vital signs. Then she left.
Healing Trauma: Cultivating Resilience and Presence Through Mindfulness, Part 2
In the last issue of Acupuncture Today, the first part of this article introduced the topic of trauma and resilience, and their relationship to the autonomic nervous system response and the concept of the spirit being grounded in the body, and suggested the importance of mindfulness as a tool for healing.
The New Age of Communication
In the age of technology, everyone, including the patient, is seeking faster, easier ways to communicate. With a wealth of social media, blogs, websites and videos, we are constantly barraged with information – to the point of overload.
A Chiropractor's Guide to Yoga
"Doctor, can I continue to do yoga while undergoing your care?" "Is it OK for me to go back to yoga while I'm getting my back treated?" "It is safe to start my yoga classes again after my neck pain improves?"
Surprising Reasons for Orthotic Efficacy
Clinical outcome studies show orthotics are effective in the management of a wide range of injuries, including plantar fasciitis, Achilles tendinitis and patellofemoral pain syndrome.
An Acupuncturist's View of Medicinal Marijuana
The use of cannabis for medical purposes is very controversial. Use as a panacea by physicians uninitiated to the proper application of herbal medicine, as well as an excuse for recreational use have greatly confused the issue.
Getting a YES: An Effective Strategy for Overcoming Patient Objections
Patients make more excuses for declining care from an acupuncturist than perhaps any other type of doctor. Various reasons hold them back from making a commitment to care.
More Chiropractors Required
An intriguing study published in the Journal of the American Board of Family Medicine examines how "chiropractic care affects use of primary care physician (PCP) services."
Help: A Need at Every Level
One of the great gifts of training in acupuncture is the ability to take good care of oneself. I recently had a bout of frozen shoulder — an inflammatory syndrome which can be debilitatingly painful and take years to resolve.
Modernization of Chinese Medicine
Language – written, spoken, signed, or otherwise is learned as a means to express our individualized perceptions about the world around us. Language is designed to communicate our personal experiences.
The Zen Art of "One Point"
We were always told in our Zen Shiatsu training (by Japanese and Japanese American instructors) that our ultimate aim was to to find that "One Point." To be so focused we could touch just one point to transform Qi throughout a client's body.
Do Some Good and Grow Your Business with Cause Marketing
Cause marketing is truly one of the best ways that you can promote your services as a acupuncture professional. Cause marketing refers to a type of marketing where a business partners with a non-profit organization to help bring awareness to a charitable cause.
Nuts Reduce Risk of Heart Disease, Cancer and Other Health Problems
Several recent studies suggest regular consumption of nuts may provide a significant degree of protection against certain types of cancer, heart disease, possibly type 2 diabetes and some neurodegenerative diseases.
Harvard Health References Flawed AHA Position Paper
In its special health report, "Stroke: Diagnosing, Treating, and Recovering From a 'Brain Attack,'" Harvard Health Publications includes information from the American Heart Association's 2014 position statement on cervical manipulation and cervical dissection – a statement the American Chiropractic Association emphasized in a letter to Harvard Health mixes "scientific facts with half-truths."
The Food Conversation: Nutrition and Your Practice
It's morning and your first patient rolls in with a triple espresso steaming in one hand and a frazzled, desperate look in her eye. "You gotta help me, doc, I am constipated unless I drink one of these, and I am exhausted and anxious all the time."
Oriental Medicine on the World Stage
"Let me win. But if I cannot win, let me be brave in the attempt." This simple, yet powerful statement was lived out time and time again by so many of the athletes from around the world during the Special Olympics World Games in Los Angeles.
The Short Leg Dilemma
When evaluating a new patient, it is common to note a relative shortening of one leg to the other. Some patients will even tell you they have one, and then pull out the store-bought heel lift they read about online.
Improving Communication Between AOM and Biomedical Providers
How comfortable do you feel talking to Western medical providers? If you are like me, you may not feel as comfortable as you would like. Some of my interactions with MD's haven't been the fruitful steps toward integrative medicine for which I had hoped.
Dorsiflexion Dysfunction: Evaluation & Manipulation Techniques
Almost every condition from the foot to the hip can be attributed to the inability to dorsiflex the ankle mortice and other joints that participate in dorsiflexion. Let's start by understanding normal versus abnormal dorsiflexion.
Fish Oil: A Key Component of Positive Clinical Outcomes
Patients seem to be presenting with more complex problems, and many are responding to care more slowly or have completely unexpected results. Why?
Fertility and Poly-Unsaturated Fatty Acids
Starting or expanding one's family is a major milestone. It's something that more and more people seek out health care advice and support for.
Change Lives by Supporting Chiropractic Research: Are You In?
The Palmer Center for Chiropractic Research (PCCR), in celebration of its 20th anniversary, has announced it is spearheading a fund-raising campaign to support chiropractic research.
What's Chiropractic Research Worth to You?
The Palmer Center for Chiropractic Research (PCCR), in celebration of its 20th anniversary, has announced it is spearheading a fundraising campaign to support chiropractic research.
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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