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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.
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.
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.
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.
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.
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.
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.
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.
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."
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.
Billing One-on-One, Direct Patient Contact
This is often misunderstood and leads to trepidation when documenting and subsequently billing timed services.
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.
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.
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.
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.
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.
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.
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.
News in Brief
NYCC Aggregates Degree Programs in New School; Palmer Chancellor Receives Education Award From ICA; Oklahaven Announces "Have a Heart" Winners.
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.
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."
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.
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.
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.
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.
October, 2009, Vol. 9, Issue 10
Your Clients With Lyme Disease
By Ruth Werner, LMP, NCTMB, Massage Therapy Foundation President
I am writing this in high summer, which is prime tick season. Consequently, in this installment, we will examine one of the most mysterious and frustrating conditions associated with summertime activities: Lyme disease. This comes about thanks to the comments of Joy Sablatura in response to my article about Sjogren's syndrome.
One of the things that I have a passion about is educating the public about Lyme disease. So often it is diagnosed as the symptoms that it presents with, such as arthritis, fibromyalgia, chronic fatigue, Bell's Palsy, Parkinson's, Sjogren's, lupus, multiple sclerosis, ALS, ADD, bipolar disorder, anxiety, meningitis or IBS. Reading about Sjogren's makes me wonder how many people with that diagnosis have Lyme as the causative agent? I think it's possible that the Lyme spirochete invades the joints, crosses the blood brain barrier, and spirals into the organs and tissues, causing inflammation. This is why the antibodies attack tissues and organs: They are trying to get to the spirochetes, which are masters of disguise and know where to hide in the body.
Lyme Disease History
In 1974 a group of children in Lyme, Conn., were diagnosed with juvenile rheumatoid arthritis. Because this supposedly noncontagious condition occurred in such concentration in an isolated area and over a short period of time, intensive research was conducted. The conclusion was that the diagnosis of juvenile rheumatoid arthritis was incorrect. Instead, these children had a bacterial infection that had settled in their joints. A scientist named Willy Burgdorfer isolated the spirochete, now called Borrelia burgdorferi. He found it in highest concentrations in the midgut of deer ticks. Burgdorfer's discovery in 1982 began a process of surveillance that continues today. The incidence of Lyme disease rises yearly. About 19,000 cases were diagnosed in 2006, the most recent year for which statistics are available.
Borrelia-carrying ticks have been found all over the Northeast, the mid-Atlantic, parts of the Midwest and in specific areas of the West coast. However, Lyme disease has been diagnosed throughout the country, because the people who have the infection often travel after their tick bite.
It is important to emphasize that a person with Lyme disease cannot transmit it directly to another person. This is a vector-borne infection. In most cases, it is a tick that carries the bacteria from one host to another, but theoretically it could also be spread through contaminated blood products or organ transplants. Humans are not the only species affected; dogs can also get Lyme disease. Of course, deer and mice are the reservoirs of bacteria that infect the ticks to begin with.
Process of the Disease
Lyme disease infection begins with exposure to a tick that carries the bacteria. Only a few species do this in the U.S., which is why the infection is associated with geographic areas where the ticks are common. Deer ticks are very small when they are in the nymph stage and when they haven't taken a blood meal: They are roughly the size of a period in 12-point font. Adult and fully fed ticks are much larger. For an excellent array of tick photos, see www.cdc.gov/ncidod/dvbid/lyme/ld_transmission.htm. Ticks are slow feeders. The risk of transmission within the first 24 hours of having a tick attach are quite low. This is why it is important to do thorough tick-checks every day when spending time in areas where they are common.
Lyme disease usually moves in three stages, although its progression may vary from one patient to another:
Stage 1: Early symptoms generally appear between 7 to 30 days after an initial tick bite. They include a circular red rash (a "bulls-eye" rash) that is hot and itchy, but not raised from the skin, accompanied by high fever, fatigue, night sweats, headache, stiff neck and swollen lymph nodes. If no rash appears, these early symptoms may be mistaken for flu, mononucleosis or meningitis. Many people with Lyme disease have no memory of a bulls-eye rash or this acute phase of the infection.
Stage 2: Systemic symptoms emerge during this phase. These include irregular heart beat and dizziness, chronic headaches, facial paralysis, numbness, tingling, forgetfulness and poor coordination, along with debilitating fatigue.
Stage 3: Many Lyme disease infections eventually involve extreme inflammation of one or more large joints, especially knees, elbows and shoulders. Most patients don't have the infection in more than three joints at a time. The inflammation can be extreme enough to damage the joint permanently, especially if it is left untreated.
Lyme disease presents multiple challenges both to the people who have it and to the health care providers who are charged with treating it. One of the most frustrating aspects of this disease is that it can be so difficult to identify. Blood tests for antibodies are often misleading, and they give no information about the timeline of the disease. In other words, a positive blood test only demonstrates a history of exposure. It doesn't explain whether current symptoms (which can be subtle and nonspecific) are related to that exposure.
Further, a certain percentage of people infected with Lyme disease don't respond to the typical 30-day prescription of antibiotics. They have what is sometimes termed "chronic Lyme disease" and are often resistant to treatment. Some experts theorize that the bacterial infection triggers an autoimmune response in these patients. In the meantime, the arthritis and central nervous system consequences of the infection can be debilitating.
Finally, the symptoms of Lyme disease are so unpredictable that it is often missed. People who are diagnosed with multiple chemical sensitivity, fibromyalgia, chronic fatigue syndrome, multiple sclerosis or lupus might be interested to pursue the possibility of Lyme disease. Even a disease as serious as amyotrophic lateral sclerosis (Lou Gehrig's disease) can be misdiagnosed when Lyme disease generates similar neurologic symptoms.
Massage therapists who work in areas where Lyme disease is common should know what deer ticks look like and proper removal techniques. With tweezers, grasp the tick as close to the skin as possible, pull up with steady pressure, then disinfect the puncture site. Never put noxious chemicals or a hot match head on the tick, as this may cause it to regurgitate; exactly what you don't want to have happen.
Clients who have been diagnosed with Lyme disease may have any number of infection-related problems that can be addressed with massage. Tendon, bursa and joint pain may be relieved, but of course therapists must avoid irritating inflamed areas. Headaches can be addressed, along with other neurological issues like facial paralysis and neuropathy, as long as sensation is intact and the client can give good feedback about comfort. Perhaps more than anything else, massage therapists can be receptive, supportive givers of comfort to clients who live with a frustrating and often very threatening condition.
Click here for previous articles by Ruth Werner, LMP, NCTMB, Massage Therapy Foundation President.
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