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Balancing Spring Challenges
As the winter months come to a close and warmer spring weather appears, patients may begin to present with new challenging pattern presentations.
An Unexpected Diagnosis: The Result of Lacking Communication
A couple years ago I had a case that showed me the importance of open communication between health practitioners. We need to show up with less fear, and let go of our judgments so we can do better for the patient.
New Relationships, Old Trauma: AOM & Other Healing Strategies
Being in love is one the most beautiful and enjoyable experiences. Most of us are willing to pay almost any price to have that experience, and still often find it elusive or fleeting. Navigating the ups and downs of loving relationships are often challenging — even for the most psychologically balanced among us.
An Integrated Approach to Chronic Pain
Findings from a unique Medicaid pilot project in Rhode Island involving high-use Medicaid recipients from two health plans were recently presented to the state's Department of Health, demonstrating stellar outcomes with regard to medication use, ER visits, health care costs and patient satisfaction.
Is the New Medicare Reporting Exemption Right for You?
What you've heard is not a rumor – there will be exemptions for providers of Medicare patients, with no penalties assessed for offices that do not do Quality Payment Program (EHR, PQRS, MACRA and MIPS) reporting.
Universal Design: Principles & Practice
In many respects, universal design serves as the core of ergonomics. It's also a good tool to use when designing a return-to-work program for injured and/or ill patients. Let's take a closer look at universal design and why it should matter to you and your patients.
Creating Good Business Buzz
What do patients really think about working with you? Rarely do you hear the whole truth. Those who improve may be candid in their gratitude.
News in Brief
ACA Adopts New Governance Model; ACA 2017 Awards; CCA Helps Calif. DCs "Share the Love"; $1 Million to Help Advance the Profession; D'Youville Raises the Bar on Anatomy Education; ErRatum.
Why I Quit Doing House Calls
My father was a chiropractor who did house calls, so when I became a DC, I figured doing house calls was part of the job. My March article recalled my experience as a small boy, accompanying my dad while he went to patients' homes to treat them.
Bill With Confidence: Learn What to Collect
Q: I am trying to understand what I may collect from my patient when there is insurance. Do I have to accept the amount allowed by the plan or may I collect up to my billed amount? Please note, I am not a member of any insurance plan.
Taking the Chiropractic Message to the Press
"There is no better place on earth to have a news event," the National Press Club boasts, and it's easy to understand why: Every year, the 108-year-old Washington, D.C.-based organization hosts countless press conferences on the hottest topics impacting America and often the world.
Eczema & Acupuncture: A Sound Solution (Part 1)
Eczema affects approximately 3.5 percent of the global population and is one of the most common skin complaints seen by dermatologists.
Raditation & Your Smartphone: Is it Worth the Risk?
If radial arteries could talk (and in my experience they can to some extent), they would say, "Step away from the smartphone." At least that is the message I am receiving loud and clear as I feel the pulses of many patients.
Is It Time to Rethink Mental Illness? (Pt. 1)
Invariably, patients will ask their chiropractor about depression or various mental illnesses. Some practitioners will reflexively offer a cervical adjustment, suggest St. John's wort or contemplate a referral to a specialist.
A Daily Strategy for Heavy-Metal Detox
In modern society, we are constantly exposed to heavy metals such as cadmium, lead and mercury. These heavy metals have no essential biochemical roles in our body, and conversely, can cause us a great deal of harm if they build up to toxic levels.
A Major Role in Back Pain: The Multifidus
Back pain affects roughly 80 percent of the population at one time or another and is one of the leading causes of doctor visits.
Women's Hormones: A Western & Eastern Perspective
Sometimes it may seem that you require a degree in medicine to understand hormones and how they function.
Clearing Blocks: A Way to Improve Cosmetic Acupuncture
As a Five Element acupuncturist who teaches facial acupuncture classes nationally, I was surprised to learn that one of the basic principles I was taught in school is unfamiliar to most acupuncturists.
Give Yourself the Digital Advantage
When you see this article in the print version of this issue and swear you read it already, don't be alarmed: you probably did. That's because by that time, the May issue will have been available online in digital format for three weeks.
December, 2015, Vol. 15, Issue 12
TDR to Facilitate Venipuncture
By Linda LePelley, RN, NMT
A few years ago, a client who had been receiving intravenous medications regularly complained that she was dreading her next scheduled infusion. She stated that it was bad enough having to sit there for over an hour and a half, but they routinely needed to stick her several times before accessing a vein, and it hurt. It hurt a lot.
Ever believing that massage can alleviate most pain, I offered to work on her antecubital areas, with the hope and expectation that reducing the overall density of the involved tissues could alleviate the pain from multiple sticks. I performed the treatment based on the principles of Tissue Density Restoration (TDR) massage (See "The Seven Principles of TDR Massage," Massage Today, July, 2015.)
Before treatment, the density of the tissues of the antecubital area were elevated, rated at G2 (See "The Tissue Density Grading Scale: A Communication Tool," Massage Today, March, 2014) with slight ridging palpable. After heating the areas and applying the massage, the grade was reduced to G1, with no ridges present. I wasn't disappointed, my client later reported that the entire procedure was painless and I was happily surprised to learn that not only was her nurse able to insert the cannula on the first attempt, but the infusion was completed in 45 minutes.
Since this experience, the occasion to suggest massage to family and clients before routine, expected venipuncture has arisen several times. In each case, whether I administered the treatment or the client did it for themselves, the results have been all positive with no complaints. While these are only a few events, they seem to be repeatable, and are worthy of further investigation. It would not only reduce the pain and anxiety for those being punctured, but if the treatment results in an increase in the rate of infusion, there could also be an increase in the number of patients a facility can treat per day as well. Please note this is not intended for persons who have indwelling ports such as used for dialysis, PICC lines, and the like.
TDR Massage is very effective, but the time required to achieve results can become tedious, so when teaching clients to do this massage for themselves, suggest they do it while watching a show or visiting with a friend, to prevent their becoming bored. Once both ante-cubital areas have been massaged to a tension-free and malleable state, a monthly maintenance routine should be established. Warming the tissues and giving them a brief massage to ascertain that there are no ridges or increase of density will prevent future difficulty with venipuncture.
My Perspective on Pain
TDR Massage is focused entirely on the real and existing state of the tissues that are in pain. In nursing school, I was taught that pain is whatever the one who is experiencing it says it is. At the time, I thought this meant that we should treat everyone's pain, even those who were just imagining it. In the years since then, I have consistently and repeatedly found that tissues which are in a state of pain are associated with a palpable elevation in their density, referred to as Elevated Tissue Density (ETD). I've found and relieved painfully dense tissues in many dozens of people who were thought by other care providers to be imagining or faking their pain. By focusing on restoring the density to a softened and malleable state, the ETD as well as the pain is resolved.
When discussing pain and massage, it is important that the terms being used are understood by all of the communicants involved. When I say that I can feel another person's pain, I am not expressing my emotional or empathetic response to their distress. I am saying that with my hands, I can palpate, measure, document, and treat an actual and real state or condition that exists within the musculoskeletal tissues. Anyone who wishes to do so can also learn to palpate and distinguish tissue that is in pain from that which is not. This kind of "feeling" is in no way an energetic or intuitive sense, it is an actuality. I make no claim of any special gift, only that I pay attention to small details and question everything. Pain is real, and it is palpable, not only by the person who has it, but also by anyone else with an educated touch.
Click here for previous articles by Linda LePelley, RN, NMT.
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