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Less Time Than Required
Q: When is it appropriate to use a modifier -52? Can I use it for a timed service when I do less than the time required by the code?
Let's Talk About Biceps Injuries at the Elbow
While most muscles cross over only one joint, the biceps crosses two joints: the elbow and the shoulder. Injuries to the lower biceps cause considerable elbow pain. Here's how to assess and treat an injury to this area conservatively.
Adventures with the Pericardium
My previous column on the San Jiao deserves equal time for SJ's loving partner, the pericardium. I nicknamed SJ the travel meridian – but pericardium can also play a crucial role in air travel.
The National Institutes of Health (NIH) lists more than 80 common autoimmune diseases including asthma, Crohn's disease, Guillain-Barré syndrome, multiple sclerosis, myasthenia gravis, psoriasis, rheumatoid arthritis, and lupus.
Don't Ignore the Lower Half of the Pelvis (Part 1)
When your patient complains of lower back or pelvic pain, but your usual treatments are not getting the job done, what do you examine and treat? You may be missing important structures in the lower half of the pelvis.
Traditional Chinese Herbal Medicine in Taiwan Hospitals
This spring, a team of Western medical doctors and TCM practitioners from Cleveland Clinic traveled to Taiwan to visit Kaiser Pharmaceutical Co. (KP), and China Medical University (CMU), Taiwan's leading integrative medicine hospital.
What are the Meridians?
The meridian and collateral system (jing luo, hereinafter referred to as "Meridians") is comprised of the main meridian channels (jing mai) and the collateral vessels (luo mai). Jing takes from meaning of the Chinese word pathway (also jing) and are the main branches of the system.
Chiropractic in the Eyes of the Public: 2nd Gallup-Palmer Poll
The second Gallup / Palmer College poll has been completed, yielding significant additional data regarding Americans' experiences with and perceptions of chiropractic care.
Are Probiotics Doing More Harm Than Good?
Considerable controversy exists concerning the efficacy of probiotic supplements. Very few human studies show any real positive impact on the microbiome or health. The "promise" of probiotics is based on the few animal studies that suggest a positive effect.
International Congress on Integrative Medicine
"Bridging Research, Clinical Care, Education and Policy" was the theme for the International Congress on Integrative Medicine and Health 2016 (ICIMH).
Lessons from Functional Neurology
Chiropractic neurology, also known as clinical neuroscience or functional neurology, is moving the chiropractic profession forward by leaps and bounds.
A Study of Relationships
Sa-Ahm's five element acupuncture method is known to be one of the most effective acupuncture techniques in Korea because it gives an instant response at the time of treatment and has a high success rate in resolving chronic problems.
Work Stress and Musculoskeletal Health: Do Your Patients Get the Connection?
Most people underestimate the impact their job has on their health, especially if that job isn't particularly physically demanding. Big mistake.
The Professional and Practice Benefits of Political Activism
Welcome to election season, a vital part of our American culture. Every two years, without fail, we are bombarded with TV, print materials and phone messages seeking our vote.
Overuse Injuries in Young Athletes (Part 1)
More than 45 million children ages 6-18 participate in some form of organized athletics, and 75 percent of American families with school-aged children have at least one child participating in organized sports.
Time to Fight for Your Medicare Right
I have heard a lot of noise and a lot of debate about what is going on with Medicare. As an ACA delegate, I often get asked: 'What is the ACA even doing?'
What's New in the NCCIH Strategic Plan
The NIH National Center for Complementary and Integrative Health (NCCIH) released its draft strategic plan 2016-2021 for public comment in early spring of 2016.
Know Your Research: Tips for Evaluating Literature Reviews
Clinical and experimental studies are not the only types of published research we might encounter as we look for evidence to inform our practices. One of the most useful types is the literature review, which summarizes a group of studies.
Code Connection: Guidelines for the Use of Modifier -52
Modifier -52 identifies that a service or procedure has been partially reduced or eliminated at the physician's discretion. This is to indicate the basic service described by the procedure code has been performed, but not all aspects of the service have been performed.
Illuminating the Hidden, Freeing the Source
Amongst the Primary Channels, from a classical point of view, the small intestine is perhaps the most important channel to understand. It is one of the least used acupuncture channels in modern acupuncture, yet it within it can be found a wealth of theories from the Ling Shu.
Analyzing Acupuncture Case Studies
Confirm the answer quickly by the elimination method. Take this case study as an example. After two treatments for back pain, a patient presents for a third session complaining of rapid breathing and wheezing that is made worse during cold weather.
MPA Media Wins More Publishing Awards
The American Society of Business Publication Editors (ASBPE) has honored Dynamic Chiropractic with a national award and two regional awards for editorial excellence, and sister publication DC Practice Insights with two regional awards for graphic design excellence.
November, 2012, Vol. 12, Issue 11
Adding Aromatherapy as Effective Ambience
By Shellie Enteen, RA, BA, LMBT
Whether you add essential oils to a massage blend for their therapeutic benefits or not, aromatherapy can add an attractive and effective dimension to your practice. Doing so makes a visit to your office even more memorable and can add to your income, too.
No matter what kind of method you use with massage, clients love the addition of hot moist towels to their session. It can easily be done without purchasing special hot cabinets if your volume doesn't warrant that. If you have a microwave or a crock pot that is used for hot stones, hot, moist, aromatic towels can easily be added to your sessions. The sprays themselves will not cost much to make but the added pleasure they provide will easily upgrade your client service rating.
Thinking ahead, it's best not to put hot moist towels on the table without a way to keep moisture from penetrating table linens and causing underlying padding or the table itself to retain moisture. This is especially true when you have back to back clients. Your next client certainly won't enjoy lying down on a damp area.
A quick trip to the infant needs section of a local store should produce the perfect thing: diaper changing pads. These can be cut to fit specific areas: under the head and neck and under the feet. They can be put under the bottom sheet for neck towel placement or foot wraps, draped over a pillow or bolster and covered with a towel for elevated foot massage like reflexology.
The best way to prepare the towel itself is to get it wet and then roll and wring out excess moisture. Roll so that the cotton tab is sticking out and can be easily grabbed. Place the number of towels needed, tab side up, into the hot cabinet or crock pot and allow them to heat up in advance. Microwave towels will take about a minute but can be done while your client is relaxing -- either after they roll over to the supine position or before you come into the room if you start your client in the supine position.
The tab does not retain heat and this lets you lift the towel without burning your own hands. You can use the tab to hold the towel up and wave it for a second or two to allow extreme heat to dissipate before rolling it again for placement. After you have rolled the towel again, apply the mister spray blend before placing. Heat accelerates the vaporization of the essential oil to enhance inhalation and that will deliver therapeutic effects along with a pleasant aroma.
A mister spray is made by placing a small amount of food grade alcohol in the bottom of a 1 oz mister spray bottle. Add up to 12 to 16 drops of essential oils, shake well and then fill the bottle with distilled water. As always, choose essential oils and blends based on the client preference and needs. Keep in mind that these oils and blends, though diluted in alcohol and water, will be placed against the skin where moist heat increases penetration, and avoid using the essences known to irritate the skin. Those include spices like cinnamon (Cinnamomum zeylanicum), thyme (Thymus vulgaris), basil (Ocimum basilicum).
For an under the neck roll, consider using the following in alcohol in a 1 oz mister:
Stress relief, muscle tension and pain:
Shake the bottle well and apply 2 to 3 sprays onto the side of the towel that will face up against the client's skin. Place under the neck after your head, face and neck work and continue your massage. Or, place it under the neck and begin your massage if you begin on the legs, removing it before you begin neck work.
For mister blends, essences known to aid anxiety relief, such as geranium (Pelargonium graveolens), orange (Citrus sinensis) or Roman chamomile (Anthemus nobilis), would be appropriate and will add to the client's general relaxation.
The moist aromatic neck roll is also helpful to decongest the client who has been lying prone for the first half of the massage. If your client begins supine and will be prone for the second part of the massage, you can also spray your hands with Peppermint or Eucalyptus and hold them under the nose area, telling the client to inhale deeply, before you leave the room.
A hot moist aromatic towel can also be placed in a loose drape over the client's face, excluding the nostrils, before doing face massage.
For feet, hold the hot towel by the tab and apply 2 to 3 sprays, then wrap the towel around the feet. Repeat for the second foot. Remove the towel from the first foot and wrap cover the foot with your drape, then repeat with the second foot. You can also use the moist aromatic towel to clean off feet in an unobtrusive way.
For foot towels, consider using the following in alcohol in a 1 oz mister:
General foot massage or foot pain:
The waiting room and bathroom are other places to create a pleasant ambience with aromatherapy. Instead of using synthetic fragrances in candles, soaps and hand lotion, consider other easy ways to make the experience more therapeutic and toxin-free.
There are small electric nebulizers that are inexpensive, very easy to use and perfect for a waiting room area. You might find them online or in your health food store. You just have to fill with tap water, add a small amount of essential oils and plug it in. Clean up involves emptying leftover water and wiping the chamber with a paper towel.
However, if you are adding aroma to this area, make sure it is an aroma blend of common fragrances that clients would encounter frequently. These would include woods, like cedar, pine and juniper, citrus oils like lemon, grapefruit, lime, orange and spices like cinnamon, clove and ginger. These essences will be less objectionable for clients who might not like flowery aromas and won't have a big effect on any other treatment blend you plan to use. They also won't build up to a level that can cause drowsiness (a reason not to diffuse lavender in common areas).
A sample diffusion waiting room blend might be:
Use up to 5 drops of this blend in the nebulizer and allow it to run for two hours and then take a break of several hours before diffusing again. Molecules will build up and be noticeable to people coming in even after you have stopped being aware of the aroma.
Make your own soap and hand lotion. It's very easy to do and you can enjoy making blends that appeal to you and even create a 'signature blend' for your office. For soap, buy a gallon of Dr. Bronner's pure organic unscented castile soap. Add a small amount of water to the soap to thin it a bit. Search bottle companies for pump dispensers. The best type of pump for pure castile is the foaming type as this soap can solidify and clog other pump and flip top styles. For hand lotion, find an unscented brand, free of the most undesirable ingredients. Search online or in the health food store. Put this into a dispenser bottle and add essential oils.
A protective, antibacterial soap blend might be:
A pleasant skin lotion blend might be:
If you have a retail license, you can sell your soap, lotion, room diffusion and mister blends. Be sure to use proper guidelines on the label. This includes safety directions like: 'For external use only', and directions for use, i.e., 'Apply to wet hands, wash and rinse'. You must also list all ingredients. Full label requirements can be found at www.fda.gov/Cosmetics/CosmeticLabelingLabelClaims.
Click here for previous articles by Shellie Enteen, RA, BA, LMBT.
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