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Multi-Dimensional Acupuncture: 3D, 4D & 5D
Maggie is an intuitive healer and workshop leader who I met on a recent hike. While we were talking she told me how she had to take it easy because of her knees. She said that her doctor told her that she has the early signs of arthritis.
It's Time for a Functional Approach to Chronic Illness
It seems one of the more modern buzzwords is chronic, referring to diseases – that is to say, "ongoing and incurable." However, we can take a different perspective and recognize that, although the body may have been traumatized and injured, healing should always be viewed in the realm of possibility.
Spring Allergies & The Spleen: Looking at Pattern Differentiation
As the season of Spring fades away and we shift into the warm summer months, many patients suffer from chronic allergies. This is by far one of the most common issues I see in the clinic as well as often mistreated and misdiagnosed.
News in Brief
Parker University Launches New Open-Access Research Journal for Chiropractic; Western States, Cleveland-KC Name New Deans of Chiropractic Colleges; Sherman College Goes Tobacco-Free; Life University Wins 11 Awards.
Regenerative Medicine: How to Do It by the Books
The "lay of the land" for regenerative therapies, including but certainly not limited to adult stem-cell treatments, seems to change almost daily.
Cyber Threat Checklist: Defend Your Business With These 10 Steps
Living in an internet connected society brings many conveniences and benefits. The power of the internet to connect us with customers, store data, and find information has opened the door for many small business owners to grow and flourish.
Chiropractic's Next Frontier: Adjusting the Microbiome
Restoring a healthy microbiome to help treat disease may be the next frontier in chiropractic offices around the country.
Acupuncture's Standard of Care
Both a concern and critique of acupuncture, frequently espoused by the bio-medical community is, "there is no standard of care in acupuncture." The following is why I believe this statement is disingenuous at best.
Bastyr University: On the Front Lines of the Pain Epidemic
At University of Washington's Harborview Medical Center, the Seattle region's only Level I Trauma and Burn Center, the demands for in-patient care are dramatically different from a private clinic environment.
Catch the Workplace Wellness Wave
Do you offer workplace wellness services to local businesses? If not, you might want to consider this lucrative channel for expanding your practice. Workplace wellness programs and wellness-related benefits have grown in popularity over the past several decades.
Paving the Way to Integrative Health & Wellness
Jared Polis (D-Colorado) and Mike Coffman (R-Colorado) launched the integrative health and wellness (IHW) caucus in October, 2018.
Prevention: Stop Recurrent Urinary Tract Infections
The recurrent urinary tract infection (UTI) is one of those nuisance conditions that can play havoc with quality of life, and this particular infection is much more common than most people realize.
TCM Codes for the World
I just received an email concerning the ICD-TM11 codes. The World Health Organization (WHO) will be presenting the new ICD-11 codes to World Health Assembly very soon.
Prompting Memory: How to Stimulate Cognition
Recently I gave a talk titled, The Art of Memoir – Tapping the Past to Sharpen the Present at a senior lunch event in Austin, Texas.
Dropping Insurance: 4 Steps
My office manager just got off the phone with the secretary of a long-standing patient. I have treated this woman and 10 members of her family for more than a decade. She has, as have all of my patients, paid my fee at the time of service since I dropped insurance in 1997.
State by State: Chiropractic Leads Changes in Health Care
Monumental legislative bills in support of the chiropractic profession were passed recently in Washington, West Virginia and Oregon. Here is a review of this important legislation, state by state...
First World Spine Care Graduate: Hildah Molate
Hildah Molate, the first World Spine Care (WSC) scholarship student, graduated from Palmer College of Chiropractic earlier this year and is now working at the WSC community spine clinic in Shoshong, Botswana.
Better With Chiropractic
While chiropractic care is receiving high levels of exposure these days, most pain patients who consult with a health provider still do so with their primary-care MD. And of course, that means in most cases, they're receiving standard medical care, not chiropractic.
Missed Causes of LBP: It's the Syndrome, Not the Subluxation
When I read the chart notes of other chiropractors, I am usually disappointed. They list what vertebrae are fixated or misaligned. They may describe the involved fascia and muscles.
Old Trend, New Risks: Heavy Weight Training
With more opportunities to exercise than ever, a greater selection of exercise options, and the subsequent opinions supporting and challenging their merits, it's easy to be confused as to which approach is best.
The Acupuncturist and the Opioid Crisis: Conquering Pain & Addiction in the U.S.
The current opioid epidemic dominates the discussion among national health leaders, recovery advocates and families nationwide. Opioids include heroin as well as prescription pain relievers such as oxycodone, hydrocodone, codeine, morphine, fentanyl, and others.
NBCE to Reinstitute Computer-Based Exams
The National Board of Chiropractic Examiners (NBCE) has announced it will reinstate computer-based testing in January 2019 courtesy of a partnership with testing and assessment solutions provider Prometric.
Practice Pearls: There's More to ROM Than Meets the Eye
As part of my neuromusculoskeletal examination, I perform range-of-motion (ROM) evaluations. I can "eyeball" the range and measure, I can use a goniometer and measure, I can use my phone app and measure, or I can use various other instruments to help determine degrees of motion.
A Novel Way to Prevent Elderly Falls: Toe Strength
In any given year, nearly 40 percent of senior citizens ages 70 and older will fall at least once. Each fall significantly increases the risk of not only sprains, strains and contusions, but also fractures.
Official NCCAOM Practice Tests
The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) is excited to announce the launch of the new NCCAOM Exam Preparation Center.
Is Primary Spine Care the Answer for Chiropractic?
Recently, we sat down with Mark Studin, DC, FASBE(C), DAAPM, DAAMLP, to discuss the state of chiropractic and why primary spine care may hold the key to chiropractic's future. Read what he had to share in this exclusive interview.
Reducing Allostatic Load & Stress Through Heightened Awareness
Your contemporary mental health and psychotherapy colleagues may often approach the treatment of allostatic load as a mental health condition and use prescription psycho-pharmaceutical medicine to affect general and specific central nervous system (CNS) pathways and brain neuro-chemistry medicine to alleviate the associated symptoms.
Diagnosing & Treating Aggressive Energy
Recently, there has been an article, and subsequent discussion, about the subject of Aggressive Energy (AKA "AE"), including ways to detect its presence and an alternative method of treating it.
Transforming Exam Delivery
The NBCE Board of Directors has never wavered on its promise to deliver an excellent, on-campus computerized testing experience to students. Likewise, there has never been a compromise to the delivery of fair, valid and legally defensible exams.
June, 2012, Vol. 12, Issue 06
What You Should Know About Corticosteroids
By Rita Woods, LMT
Corticosteroids are steroid hormones made naturally by the body and are classified as either mineral corticoids or glucocorticoids. Artificial corticosteroids are used as medications. You might be familiar with the most commonly prescribed synthetic steroids which are triamcinolone, cortisone, prednisone, dexamethasone and methylprednisolone.Many of our clients may be undergoing some treatment which includes the use of steroids. (The common term 'steroids' used here should not be confused with the male hormone related steroid compounds that are used predominantly to build muscle mass.)
It is very important to do a thorough medication/medical intake evaluation. It is also important for you to be proactive in reading about and researching your client's conditions and medications so that you can customize the massage sessions appropriately. An excellent website for researching medications is www.drugs.com. Other websites that provide easy to understand information and offer insight are the Cleveland Clinic at my.clevelandclinic.org and the Mayo Clinic at www.mayoclinic.com and www.webmd.com. These are excellent sites to recommend to your clients to research their own conditions and medications. You can also find some great complimentary sites that are packed with helpful knowledge. In my practice, I have found that the more familiar a client is with their condition and medications, the more effectively they communicate with their healthcare providers.
Steroids are used to treat a variety of conditions and manage pain. Steroids work by decreasing inflammation and reducing the activity of the immune system. More specifically, steroids reduce the production of inflammatory chemicals in order to minimize tissue damage. Steroids also reduce the activity of the immune system by affecting the function of white blood cells. Another common use of steroids is in conjunction with chemotherapy. The primary benefits when used in cancer treatment include: reduced nausea associated with chemotherapy and radiation, kills some cancer cells and shrinks tumors as part of chemotherapy, and decreases swelling and reduces allergic reactions (before transfusions, for example). And since one of the side effects of steroid use is increased appetite and weight gain, this can also benefit the client undergoing traditional treatment for cancer. Additionally, they can excite the system so they can be effective fatigue fighters.
Let's take a look at some of the side effects and see how they might impact your massage session. Keep in mind that not all patients will develop side effects and the side effects will be different for each individual. The occurrence of side effects depends on the dose, the type of steroid given and the length of treatment. The following list includes the more common side effects of systemic steroid use given either through pill form or IV administration. These circulate through the blood stream. This is only a partial list. As already mentioned, the client may be experiencing wakefulness or agitation, nervousness or restlessness and increased appetite and weight gain. They may bruise easily, the skin may become thin, and they may develop streaks or red spots. They may experience changes in body fat distribution, water retention and swelling. Steroid use can also cause or worsen diabetes, increased blood pressure, cause cataracts or glaucoma, and blurred vision. Of particular interest to massage is possible muscle weakness, corticosteroid induced myopathy, and osteoporosis/osteonecrosis. We'll look at bone loss and muscle weakness in a minute.
Steroids can be administered locally in a variety of ways. Inhaled corticosteroids are often prescribed for asthma. They are used in lower doses to reduce inflammation in the airways. Corticosteroid nasal sprays are sometimes used to relieve allergy symptoms. Topical corticosteroids are rubbed on the skin, where they help relieve the itch and redness of inflammatory skin conditions such as eczema. Injected corticosteroids can be given to reduce or relieve the symptoms of rheumatoid arthritis, joint pain, plantar fasciitis and such. Typically, these cause fewer side effects than oral corticosteroids. When reviewing your client's list of medications, keep this in mind and think through the process. So, let's go back and look at some specific musculoskeletal issues that you need to be aware of.
"High-dose cortisone is the second most common cause of osteoporosis, and we currently have no real treatment for this serious side effect," says senior author Steven L. Teitelbaum, MD, Messing Professor of Pathology and Immunology. "Given how frequently these drugs are used to treat many different conditions, that's a major clinical problem." The femoral head is the most commonly affected area. Common sense tells you that if your client fits into this category, you must never use the deep pressure during the massage. One study, published in The Lancet medical journal in 2000, stated that high doses of inhaled steroids used by asthma patients caused significant loss in bone density. The key here is high dose versus low dose and the length of treatment. The study used patients on high doses for at least six years. Think it through. Look it up. Talk to your client.
Corticosteroids inhibit intestinal calcium absorption and increase urinary calcium excretion leading to bone resorption and bone loss. People taking oral steroids also double their risk for severe vitamin D deficiency, which can lead to further bone disease or muscle weakness. Researchers at Albert Einstein College of Medicine of Yeshiva University, in New York City, said in September 2011, steroids might increase levels of an enzyme that inactivates the vitamin, resulting in osteomalacia (softening of the bones), rickets (softening of bones in children) or clinical myopathy (muscle weakness). They recommended that physicians monitor vitamin D levels of patients being treated with oral steroids.
Corticosteroid induced myopathy is damage to the muscle fibers caused by treatment with corticosteroids, such as prednisone, cortisone, dexamethasone and fludrocortisone or overproduction of steroids associated with Cushing's disease. Myopathy causes changes in muscle fibers, including atrophy (shrinkage), lipid (fatty) deposits, necrotic (dead) areas and increased interstitial (connective) tissue between fibers. You may have severe damage to the muscles while the muscles appear normal in size. This happens because the connective tissue increases in the space surrounding the muscle fibers so no noticeable difference in the anatomy is obvious. Everything "looks" normal. However, these clients will experience increasing intolerance to exercise because the muscles start to weaken with use and pain increases. The muscles most affected are those in the arms and legs and the pelvis (hips). Weakness usually starts in the proximal (upper) portion of the muscle and progresses to the distal (bottom) portion. You may have increased difficulty standing, walking up stairs and reaching upward.
The potential impact on bone, muscle and skin with high dose steroid use should send up a red flag in your massage therapy brain. Additionally, because of the possible fluid changes in the body, the circulatory system could be overloaded so try to minimize the movement of fluids with gentle work unless you are trained to specifically work with this. Refer them to a massage specialist or get permission (in writing) from their doctor.
In summary, I think it's safe to say that gentle work is the best way to go with clients on steroids. The exception to this may be in working on the feet. The feet are made to take a pounding like nothing else in the body. The small muscles in a tendon rich environment are designed to withstand pressure that our larger muscles are not designed to do. So, even if your client is undergoing chemotherapy and suffering with chemotherapy induced peripheral neuropathy, the deeper work on the feet to address this issue is generally acceptable. Another (and additional) option for these clients might be stretching. One therapist I spoke with suggests beginning Tai Chi to all of her oncology clients. I think that's a great suggestion. Keep up the good work!
Click here for previous articles by Rita Woods, LMT.
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