Lost A Sale, But Initial Phone Consultations — A Big Part Of Brilliant Customer Service
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Online Marketing Basics: Website Creation
The various online marketing options make it a challenge, especially when all you want to do is help your patients feel better. With such a broad topic, I'm going to share some basics you should know about website creation.
Exercise Recommendations for Healthy Aging
Aging is inevitable, but how you age is not. Common physical signs of aging include decreased muscle mass, decreased muscular power, increased body fat, and decreased aerobic (lung) capacity.
Healing the Core: AWB Nepal Earthquake Relief Project
With almost 9,000 people killed during the earthquakes in April and May, another 23,000 suffering injuries, hundreds of thousands left homeless when entire villages collapsed, and many sacred sites destroyed, no one in this country of approximately 28 million has been left untouched by the disaster.
Relationship Marketing: A Modern Approach
Remember when you used to get real letters in the mail? Not the automated type, but the real deal, hand written with a personal message just because someone was thinking about you? You know what I'm talking about.
An Unexpected Superfood: All About Eggs
About 40 years ago, excessive dietary cholesterol was labeled a public health concern. Specifically, it was thought that there was a causal link between consumption of cholesterol-laden foods and increased risk of heart disease.
Treat Every Patient as an Athlete
Frontal-plane movement pattern dysfunction can set the stage for musculoskeletal injury. Frontal-plane stabilization is essential during the normal activities of daily living: think single-leg stance and gait cycle.
Aetna Updates 97140 Policy
In a development the Association of New Jersey Chiropractors is calling "a resounding victory for chiropractors nationwide," Aetna Insurance Company has updated its national reimbursement policy regarding 97140 (manual therapy), reaching an agreement two years after the association filed a declaratory judgment suit in federal court against the insurer.
Data: The New Frontier in Health Care
Your practice is empowered with the data you need to improve patient health, run a more efficient (read: profitable) practice, get paid in timely fashion and help show the efficacy of chiropractic on the national stage in the midst of sweeping changes in health care!
Healing Trauma: Cultivating Resilience and Presence Through Mindfulness, Part 1
All humans, by the very nature of being human, will experience moments of trauma and suffering. What, then, makes the difference in how the individual who experiences trauma, suffering, and spiritual loss reacts to such experiences?
Integrative Sports Medicine
One of the most rewarding and challenging clinical scenarios is the treatment of athletes.
Acupuncture Treatment of Trauma in the Canine
From 1972 until 1976, John Ottaviano and I were treating dogs at five different veterinary clinics in the Los Angeles county area. Usually, we were at a clinic for seven to eight hours.
What to do When Today Sucks
Have you ever had one of those days when nothing went the way it should have? The patient with migraines got worse instead of better from a treatment similar to one you've effectively used on him before.
Fish Oil: A Key Component to Positive Clinical Outcomes
Patients seem to be presenting with more complex problems, and many are responding to care more slowly or have completely unexpected results. Why?
Patient Retention Techniques
When talking about techniques to grow your business, we tend to focus on the "large" aspect of the patient base, that is, on strategies to attract new patients. However, it is important to remember that "loyal" is equally, if not more, important.
A War You Can Help Patients Win
The average American consumes approximately 60 percent of calories from sugar, flour and refined oils. A donut is a good example of a so-called "food" that represents these calorie sources.
Making Public Health a Chiropractic Priority
As highlighted in this edition's News in Brief, Rand Baird, DC, MPH, FICA, FICC, editor and occasional author of our long-running column, "Chiropractic in the American Public Health Association", was recognized by the organization recently for 40 years of membership.
ASA Ready to Impact Profession
The American Society of Acupuncturists (ASA) is a 501(c)6 (pending), not-for-profit collaboration among state based, acupuncturist professional associations.
Preaching to the Choir: How to Extend Our Reach Beyond the CAM Community
Professional conferences offer unique opportunities to network, be exposed to cutting-edge innovators, share your interests and work, and be inspired.
Technology Meets Practice: Chiropractic Every Day
About a year ago, I had an interesting conversation with a DC who made house calls. When I asked why, she was quick to explain she learns much more about her patients when she sees them at home than she could ever observe in the office.
Learning the Transformative Language of the Channel System: The Sinew Channels
The Chinese medical classics describe the energetic terrain of the body in much detail. The acupuncture channel systems, as presented in the Ling Shu illustrate the various expressions our qi energy can take.
It's Time to Wake Up
It is time for this profession to wake up and tell someone about the healing benefits of acupuncture. This is the time for Asian Medicine. Its popularity, growth and unusual acceptance is nothing short of amazing.
ICD-10 Is Not Scary (and Not About Billing)
In my 13 years of consulting with doctors on billing and coding matters, ICD-10 has aroused the biggest combination of misguided fear and ignorance I can remember.
The Ethics of Herbal Prescribing
While teaching ethics classes, I often encounter licensed acupuncturists who are surprised that our use of herbs and supplements has a specific section in the material. It is often an aspect within ethics that clinicians don't think of in practice.
Teaching Qi Gong to Children
Many of us have come to embrace Qi Gong or Tai Chi practice as a regular part of our lives. Qi Gong has been a stabilizing factor in my life for the last twenty years.
News in Brief
Support of F4CP Continues With Latest Donations; Walter Reed Honors Dr. William Morgan; Recognizing 40 Years of Public-Health Activism; Allstate Decision Reversed.
Treating LBP in Golfers: Beyond Basic Assessment
The drive to master the most efficient swing demands a tremendous amount from the lower back. Maintaining stability in a flexed posture, supporting torso rotation and repetitively supporting the golf swing all put the lower back in a vulnerable position.
Lower-Extremity Overuse Injuries: Primer on Causes and Corrections
From ankle sprains to stress fractures, shin splints to plantar fasciitis, the research is clear: These common overuse injuries of the lower extremities – among dozens of others – may be related to abnormal foot function in your patients.
December, 2011, Vol. 11, Issue 12
Osteoporosis: Another Insidiously Silent Progression, Part III
By Dale G. Alexander, LMT, MA, PhD
The premise in writing this series is that many "chronic somatic conditions" include the silent progression of osteoporosis for both genders. If one's bones are insidiously weakening, then how do you imagine the body is going to pick up the slack during the weight bearing activities of standing and movement, let alone the more fun activities of running, twisting, jumping, golfing and dancing?
My postulation is that, as bones weaken, the human body will increase the internal pressure within its cavities promoting the cringing of body sacs and the shortening and narrowing of the tubes within organs and between organs including the arteries throughout the body. Such cringing, shortening and narrowing of the body's core structures stimulates a reflexive tightening of the soft tissues, includingligaments, tendons, muscles and fasciae associated with all of one's joints.1
Also, as one's bones progressively weaken, their myofascial tissues will endeavor to function more like bone. The autonomic nervous system begins to alter the consistency of soft tissues by becoming fibrotic and resetting their length and tone to a calibration of bracing from within and along the body's sleeve to add structural support.2
Consider the association of the silent progression of osteoporosis to the chronic somatic problems clients present to you in your office. Especially those persistent problems that just won't go away. It is one, among many, variables to consider. Yet, one that I believe has long been under-appreciated.
Chronic problems tend to be multi-factorial in their nature. Other physiologic progressions may co-exist simultaneously along with the compensatory/substitution matrix that inevitably emerges as traumatic events and/or illnesses accrete over the course of one's lifetime. Or, as a result of a undiscovered genetic predisposition within an individual of any age.
When I sense osteoporosis might be a variable, I do inquire with a client as to whether they have had a bone density test or DXA scan done and, if not, I encourage them to do so.
DXA is most often performed on the narrow neck of one's femur bone, just below the hip joint and a picture of the lumbar vertebrae is also usually taken. The narrow neck of the femur is a good predictor of one's risk of hip fracture, which is the most serious complication of osteoporosis. Other testing technologies include CT imagery, ultrasound and high-resolution MRI. Some of these are specific to checking the density of the forearm, wrists, fingers, ankle or the heel. The key concept that we all need to anchor in our understanding is that bone loss can accelerate in different parts of the human body at different times and in various places.3 I am clinically suspicious of wrist/hand, ankle/foot or rib fractures that occur with clients in the 45 to 65 age range.
The somatic markers for our consideration as massage therapists is to palpate our clients wrists and ankles with an increased sense of awareness. What do you perceive their density to be? Sounds fantastic yet, by simply attuning yourself, you will be amazed at your ability in a very short period of time to pick up on cues and clues that previously you did not notice before. When the soft tissues of a client's low back continue to splint even after you have done everything you can to assist, this can be a flag that the splinting is being driven by the soft tissues valiantly trying to do the job of the bones.2
Most importantly, mobilize your client's hips in any way you know how. It is the key to how we might assist to slow the progression of osteoporosis in my clinical experience. The father of osteopathic medicine, Andrew Still, had a notion that when the head of the femur bones were squarely in the center of the hip joints, all physiologic processes work better.2 This presumption has borne itself to be accurate in my opinion over 31 years. I evaluate and treat every client's hips, every session. It is core to any clinical orientation to therapeutic massage and bodywork.
The central question to ask a client is whether their mother or grandmother became bent forward as they aged. I ask about fathers and grandfathers too, but the maternal line tends to be more closely correlated. If the answer is yes, then the probabilities of them experiencing some degree of osteoporosis are much higher and preventative steps need to be taken as early as possible.
Let's return to our exploration of osteoporosis so that we cover the main points of this controversial progression. Is the incidence of osteoporosis actually increasing? According to Dr. Alan Gaby M.D., author of Preventing & Reversing Osteoporosis, "more than twice as many osteoporotic fractures occur now, compared with 30 years ago, and this difference cannot be explained by the aging of the population."5 His premise is that the "degenerative diseases of modern civilization are caused in part by chronic nutritional deficiencies, hormonal imbalances and environmental pollution." He strengthens his assertion by citing a forensic study of skeletons recovered from a London church dating from 1729 to 1852. The rate of bone loss in the hip was found to be significantly greater in modern-day women than in the women's skeletons from two centuries ago, both before and after menopause.5
What are the most appropriate sources of calcium and other substances crucial to the health of our bones? Boy, is there a diversity of opinion on this question! If you read the more traditional medical literature on osteoporosis you will find a consensus that calcium from dairy products is not only acceptable but preferred. They don't disregard the importance of dark green leafy vegetables and a balanced diet, however, it seems ironic that they emphasize dairy products in face of the fact that the the top dairy consuming countries report the highest incidence of osteoporosis.6
Dr. Gaby further asserts in his book that magnesium, vitamins D and K, DHEA, the judicious use of progesterone, and a host of micronutrients have shown themselves to be superior to the more traditional emphasis on calcium intake, hormonal therapy and exercise alone.
Wading into this same calcium controversy are those who assert that the maintenance of a normal pH within the body's narrow homeostatic range is the crucial tipping point to prevent the slide into osteoporosis. That our culture's high intake of protein actually is one of the major reasons that the body is forced to pull calcium from the skeleton in order to buffer the acidic environment created by a high protein consumption. Amy Joy Lanou, PhD and Michael Castleman have described this process their book entitled, Building Bone Vitality, asserting that calcium, estrogen, and medications are not the answer, again, with compelling discussions of possible alternatives for people to consider.6
Encourage your clients to research this topic for themselves and find a philosophy that fits for them. "Doing nothing", is not a plan.
Dr. Fred Harvey M.D. in Sarasota wrote to me how he approaches caring for his patients with this common sense perspective; "Bone density tests are helpful, but if normal, they do not indicate that the bone will remain healthy. There is a blood or urine test called N-telopeptide (NTx) that assesses the rate of bone loss. It looks at the health of the bone matrix by examining turnover of bone collagen. I use this test as a screening test and between bone density tests to assess progress." He goes on to further describe how he believes this test can in combination with a DXA scan predict future bone health and maybe even more importantly, to track whether a therapeutic regime for a person with identified osteopenia or osteoporosis is actually working or, not.8 I like this style of logic and the fact that there are at least some reliable ways to monitor treatment options.
The NTx-telopeptide test is one of 4 bone marker tests according to the Mayo Clinic that are used to track both bone resorption(breakdown) or bone formation3. It is important for us all to remember that no medical technology is perfect nor can be absolutely comprehensive because as stated in the last article there are many aspects of bone loss that have yet to be clearly understood. Which is all the more reason for us to educate ourselves as professionals.
What additional medically related difficulties promote the escalation of osteoporosis or, may fly undetected under the general diagnosis of osteoporosis? According to the Mayo clinic, there are many secondary causes of osteoporosis progression. These include certain diseases, surgical procedures or medications that accelerate bone loss. These are listed in Table I at the end of the article.3 Read this list carefully, especially if you have an aging parent or work with elderly clients. Encourage them to review their medications with a pharmacist with an emphasis on whether any medication they are taking could accelerate their bone loss.
One physiological progression which I will highlight and sometimes is not considered by competent physicians is the role of the parathyroid hormones. If serum calcium drops, whatever the provocation, it is the job of these hormones to pull calcium from the bones to maintain its appropriate level. It has been my clinical experience that many peri- and post- menopausal women have thyroid and parathyroid difficulties and, occasionally younger women, too. I have had my best success in helping these individuals by encouraging them to seek a thorough evaluation by an endocrinologist, an internist who specializes in dysfunctions of these crucial endocrine glands or, a nutritionist who uses blood and hair analysis in their evaluation. Typical presenting symptoms include a diagnosis of fibromyalgia, sleep disorder, an intolerance to cold, periodic systemic sweating and chronic pain. More sensitive thyroid tests are needed to discover this insidious hormonal slide.
I have come to recognize that my palpation skill sets can help many but not all without the assistance of more sophisticated medical testing. We are a crucial link in the medical health delivery system in our country because we take the time to listen, by recognizing our limitations and by referring clients to their physicians or other alternative health practitioners when our best efforts fail to assist our clients to regain their quality of life.
How effective are the many medicines prescribed for osteoporosis? This answer depends on what your professional experience has validated and whose perspective you tend to believe. My experience professionally suggests that the myriad of medications that retard the resorption of bone have their place as a one to two year regime. But to take them for the rest of one's lifetime defies common sense to me.
One obvious exception are men who are chemically castrated as part of their prostate cancer therapy. There really are no other options at present than for them to rely on the bisphosphonate medications (detailed in the previous article) and, there are many women with complex medical problems for whom this is true as well.
It has been my intention in this article series to delineate many of the categories for your further research. It is my personal intuition that there exists 6 to 7 distinct regimes of diet, exercise, vitamin supplementation, hormonal support and medications that would enhance the bone health for those who are aging in our nation based on familial genetic history, race, blood type, body type, level of exercise and lifestyle choices. I encourage each of you to research the references I have detailed in this series on osteoporosis as each has something to offer. In conclusion, moderate exercise, periodic medical testing, therapeutic massage and bodywork, and an intelligent diet are together the least expensive and most reliable form of maintaining one's healthy bones.
Table I: Secondary Causes of Osteoporosis in Adults
The following medications, diseases, and procedures can accelerate bone loss, increasing your risk of osteoporosis.
Click here for more information about Dale G. Alexander, LMT, MA, PhD.
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