A Resting of the Soul
In my pursuit of being a skilled health care provider, I focus on reading journals, attending classes, staying current on medicinal research, and choosing the correct billing codes. However, most of us would never have started down this career path if there wasn't something more.
End of Life Treatment
TCM looks death in the face. We do not camouflage it as if it were poisonous. "We must allow our patients to die but we cannot allow them to perish," was my first lesson the day I met my teacher as a teenager.
The Secondary Insurance Plan
I have a patient that has Medicare, but also has a secondary insurance plan that does cover acupuncture. How do I bill Medicare to get a denial so that I may bill this secondary payer?
Blockchain Health Records?
Keeping data secure has become a nightmare for the average consumer. Just consider general user account hacks on Yahoo (3 billion records compromised), eBay (145 million records compromised) and Facebook (87 million records compromised), to health record breaches involving Anthem Blue Cross (78 million records compromised) and TRICARE (almost 5 million records compromised).
Art of the Associateship: It's OK to Trust, But Verify
Trust is a valuable part of any business relationship. It serves as the foundation for all business operations and ultimately long-term success for owners, employees and customers. This is especially true in the world of health care.
Reducing Hip, Knee & Shoulder Replacements (Part 2)
In the first article in this series, "Early Detection Reduces Hip, Knee, & Shoulder Replacements," I described time tested screening procedures and perspectives as indicators of when to encourage your patients to seek further medical evaluation.
Autoimmunity, Gut Health and Diet: Connect the Dots
According to the National Institute of Health (NIH), autoimmune disease is recognized in approximately 24 million individuals in the U.S., consisting of more than 80 various disorders that contribute to the top 10 causes of death in female children and women of all age groups.
Doc, Are You a Social Media Holdout? Your Future Is Now
Whether you like it or not, to compete in any business, even chiropractic, you really should know and consider using social media. It is no longer a small, sleepy, local world we live in; it has become a far-reaching community.
Confessions of a Former Drug Rep: Statins Are Endangering Your Overweight Patients
As I sit at my desk on the sixth anniversary of my successful liver transplant, I can't help but reflect on what caused that life-threatening ordeal. Looking back on my personal situation, I want to offer my insight into what is happening routinely to many patients.
Why Take X-Rays When You Already Have an MRI?
Let's clear up the issue regarding the efficacy of plain-film studies when an MRI study has already been performed. I review imaging studies primarily for chiropractors, and often their patients have been to other health care providers before finding their way to a DC.
#TechPain: Causes, Solutions
For the past several decades, the science of ergonomics has blossomed. The workplace is much safer and life is generally more pleasant thanks to the application of ergonomic principles.
The Certified Practitioner
Certified Chinese herb practitioners often identify themselves with the credentials "LAc" (Licensed acupuncturist).
Help Shape the New Neck Pain Best Practices Guideline
The Clinical Compass (originally the Council on Guidelines and Practice Parameters – CCGPP) has issued a call for interested chiropractic clinicians to help shape a new best practices guideline for chiropractic care of neck pain.
News in Brief
WFC Among Founding Members of Global Rehab Alliance; HealthSource Selects GoChiroTV as Exclusive Digital Signage Partner; Western States' Online Degree Programs Among Best in the Nation; Logan University, University of Missouri-St. Louis Forge Partnership.
Facebook Marketing 101
Many of the health care practitioners we work with have smaller practices. The provider tends to wear many hats – office manager, salesperson and healer.
It's All About That Ki
As an industry are we shifting too much toward a Western mind set? We strive to understand how acupuncture works using imaging and extensive studies. We spend numerous hours of our training learning Western medicine and learning to speak their language. What happened to our core though?
A Bold Strategy to Take Chiropractic to New Heights
Building public awareness of an entire profession requires strategic planning – especially when it pertains to the exploration of ground-breaking marketing tactics that target new audiences with key messaging about the value of chiropractic care.
NCCAOM: A Route to National Certification
The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) is offering a route to achieve national certification—without having to take any of the NCCAOM exams. This is specifically for California licensed acupuncturists that meet the eligibility requirements.
Trending: CBD / Hemp Oil
A recent survey of DCs regarding cannabidiol (CBD) / hemp oil provides food for thought as to the viability of CBD-based products as a component of chiropractic patient care. Here are some observations from the executive summary of the survey:
"Community Care" for Vets: It's Really a Big Deal!
As a preamble, while I regrettably never served in the military, I have the highest respect for those who did and those who currently serve.
Why the Automatic Denials for Modifiers 25 and 59?
Your experience is one shared by many chiropractic providers who bill through those plans. It appears to be the national trend, but by far is more prominent in Texas and Illinois.
The Classical Texts & Integrative Medicine
The acupuncture profession has been undergoing many changes in the past years. There has been a shift towards a more integrative approach to medicine as more hospitals include integrative departments.
UnitedHealthcare Can't Seem to Keep Chiropractic Down
AA decade ago, UnitedHealthcare announced changes to its chiropractic services policy that declared manipulative therapy for headache unproven.
Vaccines & Autism (Part 1)
It turns out chronic inflammation is the driver of autism expression. Unfortunately, those who emotionally embrace the vaccine issue rarely, if ever, consider this relationship, which hinders a rational view of the vaccine issue.
Treating Pain With Nutrition
Back in 1910, when D.D. Palmer published The Chiropractor's Adjuster and introduced the world to what he called the "triad of health" – thoughts, trauma and toxins – he explained that the body can only be made optimally healthy if all three aspects of health are addressed.
Does Dairy Cause Dampness?
The topic of dairy consumption was brought up at a scalp acupuncture seminar I recently attended.
CBD for Athletes: The Advantages of Cannibidiol
For athletes, pain is often part of their sport or activity. And to a certain extent, it is to be expected. However, after pushing themselves to the limit, soreness and fatigue set in, hampering their ability to perform and recover.
Valuable Adjunctive Therapies
Based on the latest CDC statistics, more than 795,000 Americans have strokes per year, 140,000 of which are lethal. Approximately 87 percent of all strokes are ischemic with an estimated health care and missed work cost of $34 billion annually.1
March, 2002, Vol. 02, Issue 03
Working with Multiple Sclerosis Patients
By Ruth Werner, LMP, NCTMB
You've done it again: I put out a request for input, and you came through in a big way. December's article on central nervous system dysfunction seemed to hit a cord with many therapists, so for the next couple of columns I will respond as best I can.(Editor's note: Ruth's December 2001 article is available on line at www.massagetoday.com/archives/2001/12/16.html.)
Although I had feedback on several issues related to central nervous system disorders, the majority of respondents requested information on multiple sclerosis (MS). This is a mysterious disorder; its population distribution is unusual, its progression is unpredictable, and its diagnosis is often a particular challenge. Patients with MS can benefit greatly from carefully managed massage, however, and most therapists probably have some clients who live with this disease.
This article will provide some brief information about how this disease develops and whom it affects, followed by a discussion of how various types of bodywork might and might not fit into the picture.
MS: who gets it? The highest incidence of MS is among Caucasian people who live in Northern or extreme Southern latitudes, or who lived there for the first 15 years of life. It is generally diagnosed in patients somewhere between 20 and 40 years old. Women are diagnosed with the disease approximately twice as frequently as men. It affects about 300 thousand Americans, with about nine thousand new diagnoses each year.
MS: what happens in the body? MS often works in cycles of inflammatory "flares" followed by periods of remission. During flares the myelin is damaged, probably by specific types of white blood cells, and is replaced by scar tissue. MS usually affects the optic nerve, brain stem, cerebellum, and spinal cord. During remission, inflammation subsides, and some regeneration of myelin may occur. In this way, MS patients may lose some neurological function during flares, but regain some or all of it during remission. The cause or causes of MS remain a mystery. Leading theories suggest that a combination of factors is at work: exposure to some pathogen that stimulates an ongoing immune system attack, environmental factors, and genetic predisposition may all be part of the picture. At this point no specific genetic, environmental, or pathogenic factors can reliably predict the incidence of multiple sclerosis.
MS: what does it look like? This disease is sometimes called The Great Imitator because its initial symptoms can look like a variety of other diseases, depending on what area of nerve tissue has been affected. The order with which symptoms appear also varies greatly from one person to the next. Some of the most dependable signs and symptoms include:
MS: how does it progress? The progression of MS is highly unpredictable. It has a few characteristic patterns, but some patients move from one pattern type to others within their disease process. Some of the basic patterns are as follows:
MS may also present as a combination of the R/R and P/P varieties.
MS is not a terminal disease in and of itself. MS sufferers generally have a lifespan about six years shorter than the average, although that statistic may improve as new medications prolong the time between flares and limit central nervous system damage. People who die prematurely from MS are usually immobile, and they fall prey to an opportunistic disease such as a kidney infection, urinary tract infection or pneumonia.
MS: what about massage? This is where it gets interesting. I've received letters from some people asking, "what do I do for this type or that...?" and letters from others saying, "I've had success with this approach..." I couldn't be happier to put all of this information together here in this article.
First of all, let me offer some words of warning. In its acute, or "flare" stage, MS is an inflammatory condition. True, the inflammation is happening in the CNS where we don't have access, but the general rule for massage and acute inflammation is to let it pass.
During an MS exacerbation, the body has a lot of activity to process. In my opinion (and absolutely anyone is invited to disagree), I think it's a better idea to let the dust settle before adding any more input in the form of massage. Some varieties of energetic work may be appropriate during MS flares, as long as the process is respected and the client is not overwhelmed or overchallenged by the stimulus being supplied.
During remission, however, we have a different story. The level of function a person achieves during remission depends on the severity of the flare, and how deeply the myelin was affected. If it was only a superficial attack, the damaged myelin may grow back and no permanent changes may occur. If it was a more intrusive flare, however, some amount of permanent damage may accrue to the nerve tissue, resulting in muscle weakness, sensory changes including parasthesia ("pins and needles"), or even complete numbness. This is where massage (as well as other therapeutic modalities) may have a profoundly positive impact. While we generally say, "if a client can't feel it, we shouldn't try to change it," some massage therapists have found that working deeply and specifically on the antagonistic muscle groups of isolated numb or weak muscles of MS clients yields exciting results.
Here is what one therapist (Jim McFarland of Virginia) has found:
Another reader, Michael Eisenberg of Washington State shared with me that Thai massage, which he describes as being just as beneficial to give as it is to receive, has helped him to manage his own MS:
And yet another reader has a client with very advanced MS who has lost most of the function in his legs. This is what she has to say:
All of these wonderful stories point in the same direction: massage has a lot to offer clients who live with MS, as long as some basic principles are kept in mind: avoid mechanical or manipulative work during periods of flare; respect numbness; only work deeply where the client has sensation; and monitor your results carefully so that you can continue to make positive choices for your client's needs.
Readers who are interested in learning more about MS, either for themselves or for their clients, would do well to visit this website: www.mic.ki.se/Diseases/. This site has an extensive list of recent articles on just about any disease you could think of. MS is listed under Neurological Diseases as a demyelinating disease.
In next month's article, I plan to discuss another aspect of CNS dysfunction: working with spinal cord injury survivors. I've had several questions from readers about "do's" and "don'ts" for these clients; what advice do you have for massage therapists?
Ruth Werner, LMT, NCTMB
Click here for previous articles by Ruth Werner, LMP, NCTMB.
Join the conversation
Comments are encouraged, but you must follow our User Agreementcomments powered by Disqus
Keep it civil and stay on topic. No profanity, vulgar, racist or hateful comments or personal attacks. Anyone who chooses to exercise poor judgement will be blocked. By posting your comment, you agree to allow MPA Media the right to republish your name and comment in additional MPA Media publications without any notification or payment.