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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.
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.
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.
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?
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.
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.
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.
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.
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.
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?'
Lessons from Functional Neurology
Chiropractic neurology, also known as clinical neuroscience or functional neurology, is moving the chiropractic profession forward by leaps and bounds.
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.
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.
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.
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).
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.
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.
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.
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.
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.
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.
December, 2013, Vol. 13, Issue 12
Know What You Are Dealing With: Radiation Therapy and Massage
By Tracy Walton, LMT, MS
Radiation therapy, often abbreviated as XRT for "X-Ray Therapy," is sometimes brushed aside as having fewer side effects than other cancer treatments. But radiation therapy can have strong effects on the body and some require significant adjustments in the massage session.
Myths and misinformation about massage and cancer treatment prevent patients from receiving good, supportive massage therapy care.
Radiation therapy is roughly classified as external beam radiation therapy (EBRT or EBT) and internal radiation therapy. External radiation is the more common of the two, where the patient lies on a surface and a machine, called a linear accelerator, delivers a beam of radiation to the tumor.
It can be used to shrink a tumor before surgery, prevent recurrence after surgery, or it can be used as palliative care when lesions cause pain.
Two Types of Radiation Therapy
External radiation treatments are usually only a few minutes long — most of the patient's session is spent making sure they are properly lined up on the treatment table.
A radiation oncologist typically maps out a specific field of treatment to treat the tumor from a number of angles. This is done to best target the tumor and spare the healthy tissue surrounding it. The sessions themselves are also usually painless.
Internal radiation often involves the placement of small radioactive implants inside the body near the tumor cells. This internal application, also called brachy therapy, allows for a higher dose of radiation and a more focused approach without the risk of damaging too much neighboring tissue.
Internal radiation seeds can be implanted and left in the body (such as with prostate cancer), a wand can be placed and removed (such as with gynecologic cancer), or a radioactive iodine solution can be ingested (as with thyroid cancer).
Touch and Radiation Therapy
Education about massage and cancer is limited in most basic training programs. As a result, a common misconception among massage therapists is that any client going through radiation therapy is "hot" and "radioactive" and either the practitioner should only touch them while wearing gloves, or the client should not be touched at all.
But the truth is that, in the case of EBRT, the radiation source is the linear accelerator which stays in the room. The client is not "contaminated" and the therapist should make appropriate massage adjustments for other factors in cancer treatment. It is safe for a massage therapist to touch the client.
In the case of internal radiation therapy, clients are considered "hot" if the implants are still in and if they are still radioactive (and not expired seeds, as in the case of prostate cancer). You should ask the client ahead of the session.
Ask where and when the internal radiation was implanted, and if there are any contact precautions in place. Most people are already following these precautions and clients are unlikely to seek out massage unless they are cleared for contact.
Radiation is aimed at the cancer cells, but nearby tissues in the path of the beam may be affected as well. Clients can experience swelling, reddening or change in pigmentation and dry and/or itchy skin. They may lose hair in the radiation field.
Another common side effect is overall fatigue. It often starts up a few weeks after treatment begins and can linger for weeks or even months after treatment is complete.
Some side effects depend on where the radiation field is located. Here are some examples:
One complication of XRT is of particular note for massage therapists: Radiation treatment can injure lymph nodes, and lymph nodes in the neck, axilla or groin are often included in the field. This can put a client at lifelong risk for lymphedema, a disfiguring, debilitating and often painful condition that can cause a host of complications.
There is little specific research on massage for clients in XRT, but our clients tell us that the contact of skilled touch can be healing. Relaxation during a stressful time and relief from side effects such as nausea, fatigue and pain provide welcome possibilities for clients.
The key is making sure we apply this touch safely. Finding out how to best serve our clients going through radiation therapy, or who have recently completed therapy, starts with asking the right questions in the intake interview. Here is a "starter list" of questions for these clients:
Therapists will find many massage adjustments for radiation treatment echo common sense: On a current or recent radiation field, we use no friction, pressure, no heat, hot stones or cold therapy, nothing besides hospital-approved lubricants (metals are contraindicated and fragrances can be irritating) and generally no direct contact if it's a current field.
A simple hold through the drape may be possible over a dry radiation field, and the hands-on contact may be soothing. Any other sort of technique brings with it the risk of disturbing healing skin and other tissues, or further exacerbation of skin changes such as flaking, itching, blistering or weeping.
Because the risk of lymphedema is very real in many clients after XRT therapy, it is important to fully understand the condition before attempting to work with clients with histories of cancer treatment. Lymphedema risk is an example of a "hidden contraindication." The adjustments are not intuitively obvious and working safely requires good interviewing and hands-on skills.
If key lymph nodes were in the radiation field, there are strict massage adjustments in pressure, stroke direction, joint movement and position.
It is essential to avoid anything that would redden the skin or injure the intact lymphatic structures. "Just working lightly" is not a complete guideline here and the wrong pressure, thermal application, joint movement or stroke direction could trigger irreversible, chronic lymphedema.
For specifics, refer to Gayle MacDonald's Medicine Hands: Massage Therapy for People with Cancer.
Language is Important
When speaking with a client, we do not ask about "radiation burns" or refer to any areas as "burned." Although we essentially treat these areas as if burned, in cancer care these areas are referred to by more neutral terms: "skin changes" or "skin effects."
For complete massage therapy guidelines, therapists are referred to the Society for Oncology Massage, to the literature on oncology massage and to the growing availability of specialized training.
Because radiation treatment can place a significant demand on the body and effects are often cumulative, oncology massage therapy is careful and does not introduce any more stressors.
Click here for more information about Tracy Walton, LMT, MS.
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