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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.
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.
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.
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.
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.
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.
In This Current Age of Anxiety
Anxiety, also referred to angst or hysteria, goes by many names. One, popularized by the sagacious Zhang Zhong Jing, who many practitioners of Chinese Medicine may be familiar with, is known as Restless Zang/Fu disorder.
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.
News in Brief
NYCC Aggregates Degree Programs in New School; Palmer Chancellor Receives Education Award From ICA; Oklahaven Announces "Have a Heart" Winners.
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.
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.
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."
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.
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.
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.
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.
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.
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.
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."
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.
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.
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.
March, 2010, Vol. 10, Issue 03
By Elaine Stillerman, LMT
The encouraging news about uterine fibroid tumors is that they are almost always benign, especially for women in their 30s and 40s. However, they can cause a multitude of discomforts, including heavy menstrual bleeding (menorrhagia), painful menstruation (dysmenorrhea), backaches, and/or abdominal or pelvic bloating and heaviness.If the fibroids grow large enough to protrude into the pelvic cavity, other pelvic organs may be involved, resulting in urinary frequency and urgency, or constipation. Most fibroids, however, are asymptomatic and many women don't know they have them until they cause a problem or a gynecological exam detects them.
Uterine fibroids are solid, noncancerous tumors made of fibrous and smooth muscle tissues. The preeminence of fibrous tissue gives these tumors their name. Their etiology is unknown, but they seem to be estrogen-dependent because they don't develop before a woman gets her first period and they decrease in size and occurrence after menopause, when estrogen levels are low. Oral contraceptives that contain estrogen compounds, and pregnancy can stimulate the growth of these tumors. (I have seen pregnant women who looked as if they were carrying twins when, in fact, one mass was a fibroid.) There also might be a predisposition based upon genetics.
The sizes of fibroids vary from microscopic to ones that takes up the entire abdominal cavity. Fibroids affect nearly 20 percent of women over the age of 20 and approximately 40 percent of women 35 to 45 years of age. In the United States, Asian-American and African-American women are two to five times more likely than Caucasian women to have them.
There are several different types of uterine fibroid tumors based upon their location within the pelvis:
The diagnosis of fibroids usually is made when the provider palpates a mass during a routine gynecological exam. An ultrasound confirms the diagnosis and determines the type of fibroid.
When a client with a confirmed fibroid comes for a massage, it is important to avoid massaging the abdomen with any deep strokes. If any type of pressure causes pain, the abdominal massage should be stopped. Client positioning also is determined by comfort level. If prone positioning is uncomfortable, position her side-lying with a pillow under her neck and others placed between her knees.
Women have many options to treat uterine fibroids. The most extreme is a hysterectomy to remove the uterus. Only about 10 percent to 20 percent of fibroids require surgery. While it is certainly an effective way to remove the fibroids that have been causing pain, it puts women into an immediate surgical menopause if the ovaries also are removed and, like any surgical procedure, has many risks. An incision is made in the lower abdomen, although it can sometimes be performed vaginally. Recovery from this major surgery can take as long as six weeks.
A less invasive treatment is a procedure known as myomectomy. During this surgery, which may be done as an outpatient procedure depending on the number, size and location of the fibroids, the uterus is left intact. If an abdominal incision is made, the recovery takes as long as a hysterectomy. It may be performed using a laparoscope - lighted surgical tubes inserted near the navel - or through the vagina with a hysteroscope.
Rather than going under the knife, some women opt for embolization of the fibroids. This nonsurgical procedure cuts off the blood supply to the fibroids, which effectively shrinks them, although they don't necessarily disappear. A catheter is inserted through the patient's femoral artery and gently moved to each affected uterine artery. Tiny pellets are inserted through the catheter which blocks the blood supply. A woman must remain in the hospital for a day or two and is able to resume normal activities within the week. Embolization studies have found an 85 percent to 95 percent reduction in fibroid symptoms, while not actually eliminating them.
Prior to undergoing any type of surgery or medical procedure, women might opt for acupuncture, with or without herbal remedies, to treat their fibroids. The first mention of uterine fibroids in traditional Chinese medicine was in the Ling Shu (ca. 100 BC), which described them as "stony tumors." Chinese medicine categorizes fibroid tumors as zheng xia, or "masses in the uterus with a feeling of pain, swelling or fullness, and with bleeding in severe cases." TCM recognizes three patterns of uterine fibroids and treats them accordingly: qi stagnation and blood stasis; yin deficiency and empty-fire blazing; and liver qi stagnation and spleen deficiency. Once the appropriate pattern has been determined, acupuncture and specific herbs are provided. TCM is very effective in reducing or eliminating many types of uterine fibroids, especially if they are caught early.
Pharmaceutical drugs also can be taken to reduce the size of these fibroids and control the bleeding they often cause. Nonsteroidal anti-inflammatory drugs (NSAIDs) can be taken alone or with the addition of progesterone. A synthetic form of gonadotropin-releasing hormone (Lupron) controls the supply of estrogen and progesterone, which causes the fibroids to decrease in size. However, its use is limited because long-term use contributes to osteoporosis and once a woman stops taking Lupron, the fibroids grow back. It is more effective when used prior to a myomectomy to shrink the tumors and make the surgery easier.
A cutting-edge procedure (which is not necessarily covered by insurance) is an MRI-guided ultrasound. High-intensity ultrasound is directed at the fibroids, heating them and breaking down their outer walls. The procedure takes a few hours and the patient has to remain in a prone position in an MRI machine with her head outside of the machine and her abdomen submerged in a pool of water. Risk factors include burns and nerve damage, and the effects of this intensive ultrasound on future pregnancies have not been determined.
Uterine fibroids are not life-threatening growths, but the symptoms they cause can have a major impact on a woman's quality of life. Thankfully, there are many options available today, and women can make their decisions based upon their own needs.
Click here for previous articles by Elaine Stillerman, LMT.
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