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The Boston Benevolent Chiropractic Clinic: Standing Up for the Needy
Our chiropractic assistant, Bridget, greeted an arriving patient at the Emmanuel Church in downtown Boston. She said, "Hi, Michael, good to see you. It's been awhile. Have a seat and Dr. Ken will see you soon."
CRREW Rallies for Ongoing Acupuncture Relief Effort in the Philippines
On November 8, 2013, Typhoon Yolanda (Haiyan) made her way through the Philippine Islands, leaving in her wake at least 7,000 people dead, millions homeless and complete communities destroyed.
Employers Need Chiropractic First and Sooner
From the Journal of Occupational and Environmental Medicine comes a study that gives excellent direction to employers (and insurers) regarding the management of low back problems (LBP).
Halt Allergies With Moxibustion Therapy
An allergy is an immune system disorder in which the body is hypersensitive to normally harmless substances in the environment.
New Leadership Era at the WFC
The World Federation of Chiropractic recently announced not only a new president, as is customary every two years, but also an incoming secretary-general, marking the first time since the WFC's inception in 1988 that someone other than David Chapman-Smith, Esq., will serve in that capacity.
Medial Knee Pain: 11 Potential Causes (and Corrections)
We have all seen patients with medial knee pain that either has no traumatic origin or lasts well beyond when it should be resolved. How can we help these patients? Here is an overview of clinical scenarios and how we can provide conservative care.
Changes in Herbal Medicines from Ancient Times to the Present
The classical literature of Chinese medicine remains highly relevant in the modern era, as many of the basic theories and herbal combinations emphasized in clinical practice were first established in texts that are nearly 2000 years old.
Working With The Yuan-Source Level: Resonance and the Extraordinary Vessels
How do we stay fresh with our medicine? As healers, how do we balance our medical selves with creative artistry? Chinese Medicine is not a fixed dogmatic entity, but a living system, reliant on a mysterious force called "resonance."
The Search for the Origin of the Wiggle Technique
When Bob had adjusted me previously, most of the time I knew what he was doing. But this time, he had me lie on the treatment table in the usual side-posture position, and he "wiggled" my sacroiliac with the fingers of both hands, while stabilizing my pelvis with his forearm.
Medical Qigong for the Heart: Part I
According to the Center for Disease Control and Prevention, heart disease is the leading cause of death in the United States, affecting people of all ages and backgrounds. Coronary heart disease, in just the United States alone, costs close to 109 billion dollars a year.
We Get Letters & E-Mail
Imagine What More Could Be Achieved With Your Support; A Lesson in Hygiene: What Do You Do in Your Office? Open Letter to the Profession.
News In Brief
Pacific College of Oriental Medicine obtains grant funding from NIH; Yo San University of Traditional Chinese Medicine Announces New President; Kentucky Gets Licensed; PCOM Receives Approval from WASC to Offer FPD.
Home Sweet Medical Home
While the Affordable Care Act (ACA) has received its fair share of praise and criticism since its adoption, few question the value of its emphasis on collaborative, patient-centered health care.
Wellness: A New Buzzword at the Aging in America Conference
Aging in America is "the nation's largest gathering of a diverse, multidisciplinary community of professionals in healthcare, social service, government, business and philanthropy with expertise in providing services and products for older adults."
Shared Mechanisms Between Computer-Assisted Mechanical Adjusting and Contemporary Acupuncture?
Can contemporary acupuncture provide clues to the mechanisms responsible for pain relief provided by computer-assisted mechanical adjusting instruments, and clarify whether certain mechanical frequency combinations are superior to others for modulation of acute peripheral pain?
Don't Trust What Your Patients Say
When a patient presents to the office for care, they typically have a specific complaint – lower back pain, whiplash, sinus congestion, sciatica, etc. They are often not interested or engaged in what they consider "unrelated" personal health history.
Low Melatonin Linked to Risk of Advanced Prostate Cancer
Epidemiological and experimental studies suggest the hormone melatonin, which plays a role in regulating the sleep-wake cycle, may play a role in the development of prostate cancer, as lower melatonin levels have been associated with an increased risk of prostate (and breast) cancer.
Vibrational Medicine: Frequency Micro-Current and Color Acupuncture
Vibrational medicine involves the application of various forms of energy frequencies to the body for pain relief, healing and rejuvenation. Vibrational medicine will become a major growing trend in our medical systems for the following reasons:
Replenishing and Restoring Jing
I learned an important principle from my great Taoist Master Sun Hak. He taught me that all people "leak" Jing, and that we can mitigate or stop this leaking, and as a result strengthen our life force, develop enhanced adaptability and lengthen our life.
Deciphering the New CMS-1500 Claim Form
Q: I am confused about how and when to use the new 1500 form, particularly block 14 and block 15. What is required and how do I properly fill out these fields? And do I actually have to use this new form or may I continue using the old version?
News in Brief
D'Youville Vet Program Gets High Praise; A Moment of Silence for Dr. Paul Reginald ("Reg") Hug.
Don't Trust What a Patient Says
When a patient presents to the office for care, they typically have a specific complaint in mind – lower back pain, whiplash, sinus congestion, sciatica, etc.
"Doctor ... Always Do the Right Thing"
So says "Da Mayor" in the iconic Spike Lee movie. As a fresh grad questioning in-network versus out-of-network, it struck me that some doctors have explicitly skirted the issue, while others have argued adamantly for the latter and "sticking it to the man."
October, 2010, Vol. 10, Issue 10
Chasing the Pain
By Rita Woods, LMT
Cholesterol lowering drugs are one of the most widely prescribed medications. Statins, the class of cholesterol lowering drugs are HMG-CoA reductase inhibitors. In short, they suppress the enzymes the liver needs to produce cholesterol naturally.The body makes its own cholesterol which is important for many bodily functions including lubricating the joints. Some people are genetically predisposed to over produce their own cholesterol and some people lack dietary discretion and consume foods high in cholesterol. High cholesterol is viewed as a risk factor for cardiovascular disease which has prompted the prolific use of drugs intended to lower it.
Several types of statins exist such as atorvastatin, cerivastatin, fluvastatin, lovastatin, mevastatin, pitavastatin, pravastatin, rosuvastatin, and simvastatin. These medicines are sold under several different brand names including Lipitor (atorvastatin), Pravachol (pravastatin), Crestor (rosuvastatin), Zocor (simvastatin), Lescol (fluvastatin) and Vytorin (combination of simvastatin and ezetimibe). Mevastatin is a naturally occurring statin that is found in red yeast rice.
Over 20 million people in the United States take statins. Muscle and joint pain are some of the most common side effects of cholesterol lowering statins. These side effects are clearly stated by the drug manufacturers and in some cases, may be serious.
Giving any medical advice is not within our scope of practice. There is no real or implied intent to give advice or join in the great debate about the use or misuse of said drugs.
The intent of this article is to bring to light those side effects that a massage therapist may encounter. They include but are not limited to muscle aches or weakness, tendon problems, muscle cramps and arthralgia.
Encourage your client to read the pamphlets included with their prescription and educate yourself on possible side effects that may play a role in your practice as a bodyworker. Older clients may not have Internet access so keep a copy of The Pill Book in your office as a helpful reference for them (and for you). Typically, the consumer information section on the drug's Web site is short and easy to understand. You may want to copy those pages for some clients. For example, at www.lipitor.com I was able to get clear and concise information.
While muscle and joint pain complaints are common for many people taking statin medications, neuropathy - often experienced as the tingling, numbing, pins and needles feeling in the extremities, has also been cited as a side effect.
In an article "Statins and Risk of Polyneuropathy" (American Academy of Neurology), the authors concluded: "Long-term exposure to statins may substantially increase the risk of polyneuropathy."1
In Annals of Internal Medicine, Michael Jacobs, MD, reported on a case study with the following conclusion: "The appearance, disappearance, and reappearance of symptoms in association with treatment and retreatment with related cholesterol-lowering medications strongly suggest that a peripheral sensory neuropathy may occur with the use of HMG-CoA reductase inhibitors."2
As massage therapists, we are trained to think of pins and needles, tingling and numbness as probably involving nerves or circulation. Medically induced myalgia and neuropathy adds a new dimension to your treatment plan and a new perspective on patient interaction and education.
While the information from clinical and medical sites is helpful, I find that listening to the stories of real people is most helpful when building a basis for dialoging about a condition. One Web site that I found particularly interesting was www.medications.com. While I don't recommend that you take the information as medical advice or as actual case studies, I find it helpful in understanding how the daily activities of these patients has been impacted. These statements would be similar to the subjective comments on your SOAP notes. These anecdotal comments were screened to include only those that provided a direct correlation to the use or cessation of the medication. Let's listen to some of them:
"My body has aches and pains all over. I'm having knee issues and weak ankle issues and also the top part of my arms hurt so bad (feels like symptoms someone with 'frozen shoulder' would have). I have developed lower back pain. I bend over to bathe my puppy and I can barely raise back up."
"The worst of it all, was the shooting pains up and down my right leg all the way down to my foot. It felt like barbed wire being raked across the inside of my leg."
"I get leg cramps, jimmy legs, shooting arm pains and severe back pain. He upped my dose and my back pain is a lot worse than before."
In an article, "Tendon Disorders Due to Statins" (PubMed.gov3), tendons were cited as being affected by statins. According to the article, "French authors have analysed about 100 reports of tendon disorders attributed to statins. The Achilles tendon was most often affected. This adverse effect mainly occurred during the first year of treatment and appeared to be more frequent in patients with diabetes, hyperuricaemia or a history of tendon disorders, and in persons engaging in strenuous sports. In practice, tendinopathy appears to be a rare adverse effect of statins, but patients should be closely monitored during the first year of treatment, especially when they have associated risk factors."
I spoke with a pharmacist about the side effects and asked what complaint he heard most often. "Joint pain. Elbows and knees, especially," he said. "However, back pain is common but I think most people consider that normal. They attribute it to everyday aches and pains but joint pain will be experienced as something different and out of the norm. So they notice that."
Mayo Clinic Cardiologist Thomas Behrenbeck, MD, advises: "If you have muscle aches or other troubling symptoms after starting statin medications, talk to your doctor as soon as possible." In many cases, the symptoms started or worsened after an increase in the drug dose or with the addition of other medications. High blood pressure and diabetes are linked to a higher risk of statin complications, according to a recent paper (Golomb and Evans) in the online edition of American Journal of Cardiovascular Drugs.
It's now more important than ever to get a full medication list from your client as part of your medical intake forms. I interviewed one therapist about her medical questionnaire with the following response, "It's vital to get the list of medications. I had one client who was taking 11 different medications and came to me for migraine headaches. Upon researching the meds, I discovered that three of them listed migraine headaches as a side effect. She was, by the way, on a migraine headache medication. I made a chart for her listing pertinent side effects using reputable medical resources and presented her with the list at her next appointment."
The key for us as therapists is to listen as the client describes their symptoms to determine if it's systemic (meaning all over pain), if it started after beginning a medicine, or if the pain has been triggered by normal activity such as playing tennis. If no known cause can be found, then look to the possibility of medically induced pain. Without a thorough client intake evaluation that includes medications, you may spend time chasing the pain that can never be caught.
Click here for more information about Rita Woods, LMT.
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