resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
"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."
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.
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.
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).
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.
The Importance of Knowing Mainstream Lingo
There is a secret lingo within mainstream medicine of which the vast majority of acupuncturists and Chinese medical professionals are unaware.
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?
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."
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.
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."
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.
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.
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:
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.
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."
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.
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.
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
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.
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.
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.
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.
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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