resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Uncle Sam Needs You (Part 2)
Where chiropractic care has been used in the military health services, it has been deemed very successful.
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).
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.
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.
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.
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.
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.
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.
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.
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.
Pulse Diagnosis: What We Know
I am still finding pearls of wisdom from the books and papers that I inherited from my pulse diagnosis mentor Jim Ramholz.
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.
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?."
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.
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.
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."
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.
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.
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.
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.
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.
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.
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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