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Our Medicare Challenges Aren't an Education Issue; Passion to Succeed: More Pivotal Than GPA?
Patience vs. Patients
How long have you been in practice? I began my journey more than 20 years ago and opened my first acupuncture clinic in 2008. Just like you, I've learned a lot over the years. Recently, I sat in an interview and was asked what made me successful.
Physical Examination in an Evidence-Based World
I have always had a fascination with physical examination procedures, particularly orthopedic tests. The origin of my fascination began just after graduation when I began the chiropractic orthopedics program.
Dealing with a Pain in the Butt
The patient came into my office with the classic antalgic stoop. She was bent over almost to ninety degrees, leaning on her husband for support and staggering to walk. She had been under supportive care for a long time, but this new pain scared her.
News in Brief
F4CP MEmbership Milestone Reached; ICA Challenging New California Vaccine Law; TCC Names New President; New Provost at UWS.
Concerns Regarding CDC Guidelines for Pain Management
In response to the epidemic rates of opioid and heroin addiction, the Centers for Disease Control and Prevention (CDC) set new guidelines for physicians regarding treatment for pain.
Forward Head Carriage and the Feet: What's the Connection? (Pt. 2)
Clinical evaluation of standing posture using relatively low-tech tools has been confirmed as valid and reliable by several studies. The original device used to evaluate posture was the plumb line, which served as a reference line for the effects of gravity on body alignment.
The Most Important Vitamin You've Never Heard Of: K2
Imagine if one in every three patients who walked through your door was afflicted with a debilitating, yet completely preventable and treatable disease.
Infertility: Managing Irregular Menses
Infertility is an area where Chinese medicine is particularly helpful. In the main, in women below the age of 38 without organic disturbance, the success rate using TCM (Traditional Chinese Medicine) should exceed 85%.
Letter to the Editor
On December 7, 1999, the U.S. FDA reclassified the status of acupuncture needles from class III (investigative devices subject to investigative device exemptions...) to class II (special controls).
CE Regulations Are Hurting Chiropractic
During my 35 years in the chiropractic profession, I have been forced to attend available continuing-education programs that were occasionally incredibly beneficial, but frequently not worth my time.
Acupuncture Earns BLS Unique Code
The United States Bureau of Labor Statistics recently announced that acupuncturists will have their own unique occupational code in the 2018 BLS Handbook. The new Standard Occupational Code (SOC) is 29-1291, will be included in the next edition of the BLS Occupational Handbook, which will be published in 2018.
The Drug Epidemic: Are You Guilty, Too?
Attention-deficit / hyperactivity disorder (ADHD) has become epidemic among children in the United States. According to the Centers for Disease Control and Prevention (CDC), the percentage of school-aged children diagnosed with ADHD has grown from 7.8 percent in 2003 to 11.0 percent in 2011.
Sacroiliac Joint Fusion: Where's the Wisdom?
We should be very skeptical of the purportedly less invasive version of the already defrocked sacroiliac fusion surgery, "minimally invasive" sacroiliac joint fusion; and concerned this procedure simply represents the device manufacturer's attempt to find yet another new market.
HVLA Technique: Addressing Myths
In the annals of chiropractic history and literature, and in the imagination of the public, there is one manual adjusting technique that can produce a wide range of responses, both from patients and casual observers.
Case Study: 2-Year-Old Suffering From Urinary Reflux
A19-month-old female child presented to my office for treatment. Her mother reported the child had been diagnosed with urinary reflux and associated urinary tract infections, recurrent bouts of otitis media and inability to sleep.
Putting POLITE Into Practice
First came the acronym RICE (Rest, Ice, Compression, Elevation), which eventually became PRICE (Protect, Rest, Ice, Compression, Elevation). Then in 2015, we started hearing POLICE (Protect, Optimal Loading, Ice, Compression, Elevation).
NBCE Fumbles Computerized Testing Process
Imagine being a student again, about to take one of the four tests required to become a doctor of chiropractic. You've studied almost nonstop for the past few weeks. You can feel your anxiety level rise as you sit down in front of the computer screen.
The Lung Official
The Lung is known as the "Official Who Receives the Pure Chi From the Heavens." The act of breathing in, known as inspiration, brings oxygen into the body from the atmosphere. Each exhalation or expiration removes and releases carbon dioxide, a waste product of the body, into the atmosphere.
Acupuncture's Essential Role
Acupuncture should play a more prominent role in U.S. healthcare during and after this post-Affordable Care Act era when chronic care and population health management are key concerns for all healthcare providers.
University of Bridgeport Acupuncture Students Make Rounds at Sisters of Notre Dame
Nuns are not stereotypical acupuncture patients, Dr. Jennifer Brett acknowledges with a laugh. But then again, acupuncture has gone mainstream, just like cappuccinos and recycling. "It's changed a lot from the '70s and '80s," said Brett.
Why We Need to Fix the Mechanoreceptors (Part 2)
The muscle spindle, a particular type of mechanoreceptor, is located deep within the muscle belly, encapsulated in fascia made up of intrafusal fibers, all within the extrafusal muscle fibers.
Comparing Costs of Care: DCs, MDs or PTs - Who Costs More?
In a health care era where evidence is increasingly the benchmark for insurance coverage, patient care and even cultural authority, we get plenty of it courtesy of a retrospective cost analysis spanning 10 years, more than 660,000 "covered lives" and nearly 7.5 million claims from Blue Cross Blue Shield of North Carolina.
Perpetuates anxiety, panic attacks and chronic pain.
"If burnout is civilization's disease, sleep deprivation is one of its chief symptoms."1 To sleep soundly and awake feeling rested is one of life's true pleasures and blessings of experiencing our innate human capacity to restore and heal. Sadly, this nightly restoration eludes so many of our clients. And tragically, it is "under-appreciated" as a significant variable among those who suffer with chronic pain, anxiety, and panic attacks. Varying levels of insomnia and other sleep disorders, which create sleep deprivation, effect all ages for many reasons. So, the first encouragement of this article is for you as a practitioner to ask of each of your clients one simple and very important question: "How well do you sleep?"
Over my 36 years of clinical practice, I have come to the understand that sleep deprivation related to sleep disorders and insomnia are associated with most chronic problems that clients have presented to me, and particularly for those who experience chronic anxiety and panic attacks - the correlation of those with sleep difficulties is almost 100%.
During the past three decades, I have seen many teenagers and adults who presented with bizarre patterns of behavior who have been medically diagnosed with anxiety disorders and panic attacks and whose condition consistently has distilled into one common problem: "not enough sleep" or "sleep deprivation," as the more formal term. This is after they had sought treatment from many other health professionals whose diagnoses had traversed the gamut of possibilities; yet, had missed this most common sense source of their many psychological and physical problems.
Please consider that within your first three questions when interviewing any client with chronic somatic difficulties, or anxiety and/or panic attacks for the first time that you ask the paired questions, "How well do you sleep?" and, "Do you awake feeling rested?"
Not all will tell the truth. Yet, the questions open the door to consider how the lack of good quality sleep is related to whatever problem has brought them to see you. Many live with sleep deprivation and do not recognize it as a problem. When was the last time your doctor asked you, "How well do you sleep ?" Of course, we all have a restless night from time to time with concerns over loved ones or in response to the state of our world in its tumultuous transition at seemingly every level presently. There is much to realistically kvetch about.
I am strongly suggesting that highlighting and emphasizing the importance of sleep is crucial to assisting your clients. Most often relating your own bouts with sleep difficulties is more influential than any statistical factoid. Encouraging them to drink more water and ingest natural sources of electrolytes regularly helps as well. Client education via our embodied presence as real people (which means encouraging them to see that we are human, too) is what influences and motivates our clients most effectively.
The behavioral patterns associated with sleep deprivation in people suffering from chronic conditions are usually ingrained and subconscious. Sometimes they exclaim, "I've slept badly for as long as I can remember." In response, I have discovered that compassionate and persistent persuasion is required for them to realize its integral relationship to their presenting dilemma. The most consistent symptoms related to chronic problems and anxiety disorders include, "I hurt." "I have no or little energy." And, "I can't move as I need or want to."
For most, three to five nights of quality sleep produces results in all three of these categories that they notice and like. And, if their improved sleep pattern and our bodywork together doesn't bridge the gap, I frequently encourage clients to see their physician.
Clients often experience difficulty in falling to sleep or experience waking up periodically throughout the night. These are the bookends of sleep deprivation. Many individual scenarios exist and vary between these two reference points. Whatever is required, whatever is effective; that is the place to start - whether it is a change in habit or a physician's prescription. Medications can have an effective, rightful place within a preferred trend toward returning to more natural and nutritionally based support for normal behavioral and physiological function.
Research associated with fibromyalgia, one of the well-known chronic conditions I often see, has highlighted the importance of adequate sleep and rest.2 It has been known for a long time that at least four hours of sleep is required for muscle/connective tissue repair on a daily basis.3,4 I do use this standard as a foundation from which to help clients to set a goal of sleeping longer regularly. And if a high frequency of nocturnal urination is a sleep disruption factor, consider it a flag for a referral to a urologist.
What might we do as massage therapists beyond raising our client's consciousness about their body and its functioning, encouraging them to further educate themselves, or suggesting they see their physician? Understanding and appreciating the central influence of the reticular activating system (RAS) is the cornerstone to comprehending sleep difficulties. The RAS, "is a set of nuclei in the brain of vertebrates that is responsible for regulating wakefulness and sleep-wake transitions." It extends from the brain stem into the midbrain (including the thalamus and hypothalamus).5,6 However, most of the research and reference information about the RAS focuses on how these nuclei respond to chemical mediators which modulate the electrical activity of its functioning.
Very little attention has been given to how influencing increased blood and neural flow to, from, and between these structures may assist, or not. This is where our touch skills can assist. Toward this therapeutic intention, creating space is the theme, space between the interface of the cranium and upper cervical spine, and space within the cranial vault and within its relationships to the face, throat, and especially space for the better functioning of the TMJ.
One original technique that spontaneously guided my hands many years ago which can significantly decompress the TMJ involves placing your gloved and kleenex-wrapped forefinger in the client's mouth back to their first molar tooth while contacting the lateral side of their mastoid process of the temporal bone on the same side with your other hand's thumb and forefinger. Asking the client to watch your eyes in order to clearly communicate any signs of distress, request that they slowly begin to add pressure to your finger from both sides as you softly guide the temporal bone medially. Very quickly, in most instances, you will feel a giving of the TMJ surfaces and a release of the pressure within this crucial joint.
This manipulation is what Osteopath's call a shotgun technique, and its effect is often immediate and positive in that it creates the sensory experience of space within the joint and throughout that side of the face. Sometime clients report that they can breathe easier through their nose and open their mouth more easily and with greater range of motion.
I propose that reducing compression and congestion throughout the head, neck, and face allows an easing and improvement of blood and neural flow. As congestion within these areas is reduced, then a re-coordination of autonomic neural activity becomes more possible.7 This is the essence of what my clinical experience has shown to be effective for clients.
In a future article, I will outline more of the anatomical structures that I have discovered are most directly related to regaining a normal sleep pattern and restoring balance between the two divisions of the autonomic nervous system. Many will relate to the cranial vault, face, jaw, throat, and upper cervical vertebrae.
The two goals of rebalancing the TMJ and of restoring ANS coordinated functioning are inextricably woven together in the quest to normalize the function of the RAS. Without a more normal sleep pattern, chronic dysfunction, pain, anxiety, and panic attacks often function like a roving brown-out as when the capacity of a community's electrical distribution system is impaired. All customers get some electrical service, but not enough for full and normal activity. And so it is with the human body when a "neurovascular brown-out" occurs. One's quality of life diminishes quickly without adequate sleep.
Recently, Dr. David Brownstein, MD, included a natural protocol for addressing sleep disorders and insomnia in his April 2016 Natural Way to Health newsletter. He recommends the use of melatonin, beginning with a low dose of 0.5 mg that can be raised gradually to 3 mg. He also recommends the amino acid 5HTP at 200 mg, noting that it can be converted into natural forms of serotonin and L-tryptophan. The last of his natural triad involves the use of GABA (gamma amino-butyric acid) at a dose of 1000 mg to assist in calming the brain. All of these to be taken at bedtime.8
Our license as massage therapists does not allow us to recommend such regimes, per se; however, we can speak to our own personal experience, the successful experience of other clients, or to point our clients toward articles such as this one summarized here. Two additional links are included that suggest some precautions regarding the use of GABA.9
Calming the brain appears to be the most crucial element to breaking the insidious cycle of insomnia and sleep disorders that lead to sleep deprivation. Behaviorally, sleep research advocates suggest that creating a "routine of behaviors" that calm one's body and mind is most often successful in one's attempt to normalize their sleep pattern. Turning off all electronic devices and TV is considered an essential step to increasing the success of such a routine.
There are many websites that offer tips for achieving better sleep. One idea I plan to implement is to create a printed page listing the ones containing information that make the most sense to me and give it to clients when appropriate. Included in these recommendations will be an encouragement to see their physician. Anything that expands our client's informational perspective and is tangible adds to our credibility and effectiveness as educators, as well as practitioners. Please consider doing this for your clients.
During my research for this article, three novel recommendations enlightened me. These included the ideas of lowering the temperature of one's bedroom to 65-67 degrees F, creating one's "to do list" for the next day "an hour before bedtime," and going to bed and awaking at the same time each day. Although, living in the Florida Keys as I do, 65-67 degrees seems too cool, it is a concept that instinctively makes sense to me, as did the other two suggestions.10
The first recommendation is based on a study that asserts that regulation of body temperature and sleep are two physiological mechanisms that are vital for our survival. Interestingly, the neural structures implicated in both these functions are common.11
Another recommendation I often suggest that was found in only a few of these many websites is to encourage clients to consider purchasing a new bed if theirs is more than years old. Once I actually discovered that my box spring was broken directly beneath a shoulder that had been bothering me for many months. If you don't look, you won't know. And, regardless of the material construction of a bed, it will eventually break down, offering your body less balanced support.
An additional learning was that our circadian rhythm is principally triggered by light intensity, hence the common advice to keep one's sleeping quarters dark, and if reading is part of your bedtime routine, to use a low intensity source of illumination.12
In summary, the listing of the types and possible causes of insomnia and sleep disorders that produce sleep deprivation is far beyond a single article. Yet, each of us can make a difference as massage therapists by asking two simple questions of our clients, "How well do you sleep?" and, "Do you feel rested when you awake?" Heart-felt, common sense encouragements do influence our clients as does adding to their scope of understanding of the variables both anatomical and behaviorally. We are educators as well as practitioners. Encouraging our clients to seek medical advice and monitoring is a practical service to all clients.
Seek to comprehend the anatomy and physiology of the reticular activating system and its interface with the coordinated functioning of the autonomic nervous system, and learn techniques that may serve to synchronize their harmonious functioning. We can offer much more than we realize as a competent face and voice within the health care delivery system.