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Economics of Complementary/Integrative Care
Although this column doesn't usually feature a book review, we're going outside of our usual public health format to discuss a new book written by Patricia Herman ND, PhD.
Remembering Joe Weider (1920-2013)
With the death of Joe Weider, the world's most famous body-building visionary, crusader, fitness magazine publisher and icon, on March 23, 2013, chiropractic has lost one of its greatest friends and supporters.
You are What You Eat Part II: Integrative Protocols
In the previous installment of this article I discussed important ideas concerning gastrointestinal health and foundational ideas from TCM, which can provide key insights into creating effective protocols for healing the gut.
Why You Should Get to Know the National Vaccine Information Center
Barbara Loe Fisher has been a diligent advocate for providing parents with the information necessary to make informed decisions regarding the usage of vaccinations for their children.
A Building Block of Healthy Aging
Coenzyme Q10 has gained enormous attention in recent years, and with good reason —it's the Energizer Bunny of the cellular world.
Energy is a hot commodity. Society pays dearly for it and for the expertise of those who know how to cultivate it.
The Potter's Wheel: Reflections on Practicing in a Technology-Driven World
In my very early years of practice, an older patient named Cora would call me at home, usually late Sunday night after she had consumed an unknown quantity of beer.
Happenings in Our Evolving Profession
Good things seem to be happening for our profession and recent developments show we are all on board. Talking about being on board, this September The Veterans Express-Purple Heart Tour is expected to make its way out of the station.
Are They Finally Fixing Medicare Reimbursement?
Even with federal sequestration cuts taking effect in March, including a 2 percent reduction in Medicare reimbursement to health care providers, hope may be on the horizon in the form of a much-anticipated, perpetually suggested overhaul of Medicare's Sustainable Growth Rate formula, which serves as the basis for determining physician reimbursement.
Helping Patients Through Pregnancy Loss
There is a lot of focus in the acupuncture world on fertility and helping women get pregnant. It's exhilarating to hear the news that a patient is expecting a baby. The other side of that is pregnancy loss. That includes abortion, miscarriage or stillbirth.
Going Shoeless: The Pros & Cons of Barefoot Running
With the subculture of barefoot runners and the products catering to them growing daily, just about every chiropractor has been asked at one point or another about their opinion regarding barefoot running.
What They Don't Say Could Hurt You
I have written previously regarding the difficulties of drawing information from patients who are poor historians, forgetful or just plain uncooperative. The thought to revisit the topic occurred recently during preparation for an upcoming seminar.
Peer Points: Stories of Practice Success
When patients go see Arizona-based acupuncturist Jing Liu, it is to get top care from an practitioner well versed in all aspects of Traditional Chinese Medicine.
We Get Letters & E-Mail
Patient Perception and the Farce of "Fast Relief"; A Fly in the Ointment; Persecuted for Choosing to Practice Chiropractic.
Research Abstracts From the Journal of Manipulative & Physiological Therapeutics
Effect of Pain Relief on Lumbar Muscle Function and Activation; Effects of Thrust Amplitude and Duration of HVLA Spinal Manipulation; Immediate Effects of Upper Thoracic Manipulation on Cardiovascular Response.
Helping Infertility Patients with the Spirit Essence
As many of you know, when it comes to treating infertility, we are dealing with a patient population that is, generally speaking, in emotional turmoil. These patients often experience fear, anxiety, despair, hopelessness, grief and anger.
Some Thoughts on the TMJ
The temporomandibular joint is an interesting and dynamic articulation that can cause a lot of problems.
Medicine Presents: A Great Opportunity
The changing nature of health care presents both opportunities and challenges. While we tend to focus on our profession, we can sometimes forget the impact other health care professions can have on us.
Have a Heart: Say No to Soda
It's not enough that soft drinks and other sugar-sweetened beverages have been linked to cavities and weight gain, among other negative health consequences.
The Spirits of the Points: The Gall Bladder Official
The Gall Bladder is known as The Official of Decision Making and Judgment. In any given day, this Official makes countless decisions – conscious and unconscious, which influence every aspect of our being.
Let's face it – patient evaluation takes time. Unless you are really into the diagnostic evaluation game, you probably have found the formal exam protocol tedious if not downright annoying.
Herbal Medicine: Go Mainstream
When it comes to practicing herbal medicine in a mainstream setting, there are a number of important points to understand when it comes to prescribing formulas. Some important questions to ask are - what method of prescribing and dispensing is most effective in this setting?
Side Effects From Big Pharma: Wellbutrin – Dangerous for You and Your Baby
Are some of your pregnant patients taking Wellbutrin? If so, it could be a danger to them and their baby. This drug is extremely popular, but it has a serious history.
What the Science Says About Magnesium Stearate
It's often been said that scientific studies can be used to support just about anything. But discoveries are never made one study at a time.
SOAP Notes: It's Time for a Cleaning
I have been planning for some time to write an article about how traditional SOAP notes do not fit chiropractic practice, and the unfairness of holding DCs to a model clearly created for and primarily applicable to medical physicians.
Chiropractic: The Right Choice for Relieving LBP
"Low back pain (LBP) is a common threat to medicine and a reasonable threat to all national health care systems. ... Reducing ineffective treatments is necessary to decrease the LBP associated costs."
News in Brief
Controversial Florida PIP Law Under Review; D'Youville Chiro. Students Learning Art of Co-Managing; And the Award Goes To...; F4CP Recognizes Major Contribution by ChiroTouch.
Correcting Kid Logic in Health Care and Research Design
A recent broadcast on public radio described a fascinating phenomenon known as kid logic.
There Are No Secrets: Treating Complicated Conditions with TCM
Including standardized extra points, there are just over 400 acupuncture points on the body. You get 400 and I get 400 - same. Yet, time and time again treatment protocols are coveted as if they were some secret formula only intended for the right and privileged.
February, 2010, Vol. 10, Issue 02
Cancer, Treatment and Detoxification
By Tracy Walton, LMT, MS
Some time ago, a client going through intense chemotherapy treatment asked me if deep massage would help her cleanse the drugs from her system. She had read about a number of liver cleansing protocols that suggested very deep massage to facilitate the process of elimination.Her question touched on a number of issues in the oncology massage world and there were several layers to my response to her. I share my answers here, because the issues are relevant for our many clients in chemotherapy.
The Effects of Massage
In the massage profession, we have learned, read, taught and repeated the belief that massage helps move toxins out of the tissues and out of the body. However, we have not always been clear on which toxins, from which tissues, or through which routes of elimination. Almost any substance in the blood, even a nutrient, can be considered toxic if there is too much of it in the blood or tissues, so our use of the term is ambiguous. I once had a physician on my table that was a huge fan of massage therapy, but told me that the profession's liberal use of the word toxin always made him uncomfortable. Invariably, when he asked a massage therapist what the term meant, he received vague, unsatisfactory answers.
Our use of the word toxin seems to imply a waste product or poison that shouldn't be there. In the realm of chemotherapy, the reagents and products of breakdown are known to be toxic, so at least we are on more definitive ground there. But to my knowledge, there is no solid base of research to support the notion that massage moves toxins out of the tissues. By solid, I mean more than a single study. Instead, to be given serious consideration, we need multiple studies, from multiple investigators, in peer-reviewed publications, reporting similar results on this point.
That said, my client was talking about chemotherapy and wanting to eliminate chemotherapy drugs from her body. These medications and their metabolites do have toxic qualities which is why they are used to destroy tumors.
She was suffering greatly from the effects of these toxins she wanted them gone, period. I told her there wasn't much known about the effects of massage in the toxin department, so I couldn't say whether deep effleurage and petrissage would, in fact, speed it out of her system. I also told her I had other concerns about the detoxification approach, which I have described here.
The Intent of Massage
When we work with clients in chemotherapy, our intent is to ease symptoms and support our clients in integrating and managing the effects of treatment. For this reason, we do not impose additional challenges to the body by working it too hard (MacDonald, 2007). So I told my client that even if we knew for sure that deep massage strokes would chase the drugs out of her system more quickly, we wouldn't necessarily choose that approach.
Instead, it makes more sense to let the body set its own pace of detoxification. The organs of detoxification -- the liver, kidneys and skin -- are busy enough without the potential additional demand of a deep, draining, circulatory massage. I told my client that, even without research or clear understanding about massage and detoxification, this is our rationale for working gently.
Additional support for this gentle approach comes from our clinical observations: When clients in chemotherapy receive deep work, they feel worse, not better, afterward. Whatever the reason for that, deep massage is too much for them. These clinical observations inform our practice much more than any attempt to explain them.
A Good Referral
My client continued to press me about what I thought she should do after chemotherapy. She asked about a number of detoxification protocols involving ingesting large amounts of salt water and other substances. They had to do with cleansing the colon and liver. I listened, but stayed neutral. I told her I couldn't advise her either way, it was out of my scope of practice. I told her she had great questions, but that I thought such practices would be safest if done under the supervision of a naturopathic physician or another physician experienced in natural medicine after chemotherapy. And I urged her to raise her questions with her doctor and chemotherapy nurse.
These referrals gave her somewhere to go with her questions and her urge to detoxify. At the same time, I managed to stay within my scope of practice. This can be challenging when our clients ask us for our opinions and advice and these questions come up a lot when we have a whole hour available to our clients. It is important to navigate them in an unbiased way, with supportive listening and good referrals. In the end, this can be a great service to our clients.
Gloving for Chemotherapy
Whenever we talk about chemotherapy and massage, the question invariably comes up about chemotherapy eliminated through the skin: will the massage therapist, in continuous contact with the client's skin, unwittingly absorb some of these toxic substances? For our own safety, should we wear gloves when providing massage to clients in chemotherapy? Should we avoid contact with them altogether? Therapists are understandably concerned about the possibility of picking up chemotherapy by-products through their hands but, like any rumor, these fears have been overblown and somewhere along the line we came to believe it was dangerous to touch all patients in chemotherapy.
Space limits a full discussion of this issue here, but there is an excellent place to go for deeper understanding. The Society for Oncology Massage (www.s4om.org) provides detailed discussion for massage therapists, clients, caregivers and other health care providers. There is a Resource Link for massage therapists where the chemotherapy, toxicity and touch issues are well-addressed. Careful analysis of the risks is provided, bringing massage into alignment with nursing practices during chemotherapy. Conditions under which a therapist might wear gloves are identified, and the current understanding of the issues is made plain.
There clearly is room for more dialogue and research in the profession of massage about the precise effects of our work. There is growing energy devoted to these questions and more resources to turn to. We have the second Highlighting Massage in CIM Research conference to look forward to this May in Seattle (find out more at www.massagetherapyfoundation.org/researchconference2010.html) This conference follows closely on the heels of the second Oncology Massage Healing Summit in Minneapolis (find out more at www.nwhealth.edu/conted/seminars/oncology.html).
I attended both of these conferences the first time around, and they were some of my favorite experiences. In settings like these, the science and practice of massage are addressed by thoughtful people who bring their whole hearts and minds to their massage inquiry. Toxin or no toxin, movement or no movement; by holding massage therapy up to the light, we will come to more fully understand the work of our hands.
Click here for more information about Tracy Walton, LMT, MS.
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