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The Heart Protector
On the physical level, the Pericardium is a double-layered sac of fibrous tissue that envelops the Heart. The space between the layers is filled with serous fluid that protects the Heart from external shock or trauma and lubricates to allow for normal Heart movement.
Healing With TCM at San Quentin State Prison
For the prisoners at San Quentin State Prison, life-sentences are the reality of every day life. It is not often that prisoners get the opportunity to use alternative medicine to deal with common ailments they encounter behind bars such as, depression, anxiety and pain.
Jingei Diagnosis: An Effective and Powerful Diagnostic
I graduated from the Kotatama Institute under the direction of Drs. Masahilo and Katsuharu Nakazono in 1984. As a student, I was exposed to the practice of most of the various theories and modalites of Oriental Medicine.
Simple Ways To Find True Happiness
Patients in our clinics are always seeking happiness. As their health advocate, we need to ensure we inform them that in order to find happiness, they have to make sure to identify what makes them happy in the first place.
Managing Today's Fertility Patient
I recently received an email from one of my fertility patients: "Got my lab results back. FSH is 11, AMH is 0.7. My doctor said these numbers aren't good. I guess I'm infertile. Just as a thought. Just set up an appointment to speak with an adoption agency."
Pulse Diagnosis: What We Know
I am still finding pearls of wisdom from the books and papers that I inherited from my pulse diagnosis mentor Jim Ramholz.
The Tao of Gender
If you think gender is as simple as having a new client check off the "male" or "female" box on your intake form, we hope this article will expand your understanding and thus the reach of your health care.
Talking to Patients About Healthy Aging
I've noticed that a particular category of patients seems to make up more and more of my practice – they work out, but still experience lots of degenerative joint disease (DJD) issues.
Help Patients Achieve Optimal Vitamin D Levels
Much research has been done on vitamin D levels and their impact on health; optimal levels have been correlated with a reduced risk of developing numerous conditions.
Transparency and Accountability: Q&A With the CCE
Every profession needs an organization dedicated to upholding the quality and integrity of its degree programs and educational institutions.
AOMA Strengthens Leadership Team
AOMA Graduate School of Integrative Medicine, a leading college of acupuncture & herbal medicine, announced the appointment of Donna LaPoint Hurta, MBA as the new VP of Finance & Operations this Fall.
Lime Jello on Morphine
Taste is in the eyes... actually the mouth... of the beholder. My food preferences have changed, lightening from the food of my youth. My parents loved heavy eastern European cuisine and I loved it as a child. Now I enjoy leaner, healthier whole foods.
To The Finish Line With the Help of TCM
When acupuncturist Eddy De Smedt pursued a career in Traditional Chinese Medicine, he knew he wanted to make a difference.
Understanding and Identifying Pediatric Growth-Plate Fractures
In general, fractures in children heal well with little intervention as long as the alignment is good. Fractures involving the growth plate, however, are a different issue. In fact, growth-plate injuries are the primary reason for the subspecialty of pediatric orthopedics.
The X Factor in Clinical Research: The Patient
It was the great baseball legend, former New York Yankees catcher Yogi Berra – he of countless aphorisms, each with a mind-bending twist – who once declared, "You can observe a lot by watching."
The Wonders of Light Therapy: An Interview with Wes Burwell
I first met Wes Burwell in 2011 when he was teaching a class on light. Since then, every time I hear him speak, his understanding of the benefits, function and capacity of light has evolved.
5 Ways to Occupy Occupational Health
Despite the progress that has been made to better protect workers, occupational health and safety remains a priority area for many national governmental organizations due to the widespread problem of occupationally related morbidity and mortality.
Calcium Helps Prevent Colorectal Cancer
Over the past 25 to 30 years, studies have suggested calcium may confer protection against colorectal cancer.
Managing Patient Expectations About Acupuncture
Last year, I attended the Pacific Symposium in San Diego for the first time in six or seven years. It was the 25th anniversary of this event, and on one evening there was a panel discussion with the title; "What is Qi?."
Blaming the Gluteus Medius, Overlooking the Deltoid
The gluteus medius (Gmed) is commonly written about, strengthened and blamed for many conditions, and rightfully so. After all, the Gmed plays a role in pelvic stability, hip motor control and lower-quarter dynamic movements.
Saying No to Medicine
An interesting article recently appeared in Men's Journal titled "When to Say No to Your Doctor." The article begins with the summary statement above and effectively arms readers with information that will help them "take more responsibility for your own health care, because you can't be sure anyone else is.
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 more information about Rita Woods, LMT.
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