A Simple Miracle: Treatment for Mysterious Foot Pain
Under the old ICD-9 diagnosis codes, there was actually a diagnosis for "adventures in medical mismanagement" to describe patients who had been run down the rabbit hole of poor case management and care. I encountered one of those patients in my office today.
VA Choice Claims Denied? Here's How You Can Get Paid
The VA Choice Program (PC3 as well) indeed pays for chiropractic care including manipulation (CMT 98940-98943) and some physical medicine services.
A Soy Isoflavone That Packs a Punch: Genistein
Soybeans contains unique substances called isoflavones, most notably genistein and daidzein, which have been shown to block the buildup the dangerous type of testosterone in the prostate gland linked to prostate enlargement and prostate cancer.
Malpractice Insurance: Understanding the Cover Letter
Purchasing medical liability insurance is quick, easy and not terribly expensive. The benefits are clearly listed on a certificate—but do you really know what you are getting with that peace of mind?
2018 Gallup-Palmer Report: Key Findings
The fourth annual Gallup – Palmer College report is out; here are some of the key findings excerpted directly from the executive summary regarding Americans' experiences with chiropractic care relative to the management of neck and back pain:
VA Chiropractic Reduces Veterans' Use of Opioids?
Utilization of pain medication – particularly opioids – has been massively high in among veterans for decades, but Veterans Administration guidelines that recommend nonpharmacological first-line treatment options create a greater opportunity than ever for VA chiropractors to make a dent in the opioid and overall pain-management crisis.
A Guide to CBD Dosing: The Correlation Between Dose & Potency
There is an abundance of information available about the daily use of whole plant hemp CBD oil to help maintain and support a healthy lifestyle, however there remains a lack of sound guidance on CBD oil dosing.
Dietary Supplements That Help Restless Leg Syndrome
It is estimated that 7-10 percent (possibly up to 15 percent) of the U.S. population has restless leg syndrome. It is a bit more common in women than men.
Goodbye, Year of the Dog: Two-Thousand-Eighteen Comes to a Close
As Year of the Dog (2018) comes to a close we can look back and see the progress this profession has made. For example, the International Classification of Diseases (ICD) added traditional medicine codes, which were released in June.
The Truth About Malpractice Claims Against DCs (Pt. 1)
Over the past 20 years of active practice, I have seen a number of scary case scenarios regarding signs, symptoms and patient presentations in my office. These presentations scream, This patient is going through an event or This patient does not need chiropractic care, they need emergency care.
Exercise Therapy Following Motor Vehicle Trauma (Pt. 2)
In cases of cervical spine trauma, particularly trauma related to a motor vehicle accident, my plan is to teach the patient one exercise per session and build a progression. This is an effective approach I call an "activation circuit."
Bad for the Back! Exercises That Can Prevent Healing
The questions "Who gets well? Who doesn't? Why?" prompted the following observations based on my close to 40 years of chiropractic practice.
Year in Review: DC's Best of the Best for 2018
As 2018 winds down, let's highlight the most popular articles in Dynamic Chiropractic by month (December – this issue – excluded, of course).
Acupuncture in Hospital Systems: Transitioning From Tolerated to Celebrated
I've had the pleasure of working with Susan Luria, Director of University Hospitals Health Systems Connor Integrative Health Network (CIHN) for the past year on the Integrative Health Policy Consortium (IHPC) Board of Directors and Federal Policy Committee.
Reaching for Our Roots: Healing Digestion With a Simple Traditional Therapy
Are you ignoring a powerful tool in your doctor's bag? Many acupuncturists realize that Spleen Qi deficiency has reached epidemic proportions in the U.S. Yet, we don't prioritize educating our patients about the importance of warm, cooked foods.
Reality Check: Do We Need to Try Harder?
While waiting for a flight to a recent chiropractic event, I overheard the ticket agent at the gate next to mine on his cellphone. His side of the conversation went something like this: "Where are you now? How long before you think you can be at the gate? OK, that will work, see you soon."
A New President for AOMA: A Conversation With Mary Faria
Dr. Faria was formerly a health care executive for over 30 years, the last 17 of those years as vice president and chief operating officer of Seton Southwest Hospital in Austin. She chairs the board of Austin Mayor's Health and Fitness Council.
Knocking Down the Doors: Big Media Success for F4CP
Three articles authored by a DC or a chiropractic organization and promoting the value of chiropractic care – par for the course if you're Dynamic Chiropractic, but if you're Forbes, BOSS Magazine and Becker's Spine Review, three media outlets tailored toward high-level executives and decision-makers, we're talking about an entirely different story.
Acupuncture is a Science-Based Medicine
A longstanding patient of mine came in for a routine treatment after she recently began seeing a chiropractor for neck pain. She saw him a couple of times and wasn't getting the relief she had hoped for, so he recommended she let him do dry needling.
Cynicism and Burnout: It Can Happen to You
Trying to achieve fulfillment as a doctor in today's health care environment is a "rigged game" and physicians are programmed to burn out. At least this is the opinion of Dike Drummond, MD, in his thehappymd.com blog.
The Top 5 Strategies to Manage Your Reputation Online
You don't need an acupuncture website anymore! Okay, maybe that statement is a little over the top. But it's not that far from the truth. A recent study on Google searches revealed that 34 percent of all searches resulted in no clicks at all.
The Raw Food Debate: Practitioners Discuss Nutrition & TCM
Licensed acupuncturist and fellow blogger Elissa Gonda joins this month's column for a conversation about raw food diets. She brings her perspective on the healing potential of a raw primal diet.
Electrotherapy Gives Hope for Patients With Spinal Cord Injury
There has been little optimism for recovery from a spinal cord injury because the central nervous system does not repair itself well. The severity of the injury depends on the affected area.
News in Brief
A Comprehensive Model of Spine Care; Dr. Christine Goertz Appointed Vice Chair of PCORI Board of Governors.
Map It: Understanding the Customer's Journey
One of the biggest marketing mistakes most practice owners or administrators make is not putting themselves in their prospective or current patients' shoes. How do they think and feel about you and your practice? What makes them take action?
October, 2002, Vol. 02, Issue 10
Working with Patients Who Have Hypothyroidism
By Ruth Werner, LMP, NCTMB
In my last article on cerebral palsy, I was happy to find lots of material not only on the condition itself, but on how massage can play a part in the life of a CP patient.I duly related this latter point in my article, expecting little controversy, since this is a well-researched and well-understood condition. Well, duck, because the fallout is still coming down.
I made a few errors in the CP article that I'd like to clear up. First, I misstated the locations in the brain where the damage takes place. Unable to find any specific information on this issue in my pathology resources, I pulled out my anatomy texts and listed the movement centers I know about: the basal ganglia, frontal lobe, and cerebellum.
Gary Bruce, LMT, NCTMB, who works extensively with special needs individuals, corrected me in an e-mail he sent me:
Second, I referred to the tight muscles of a CP patient as a "spasm"- this is quite incorrect: the proper term is spasticity, and the way it responds to massage is quite different. (For more information, please refer to my spinal cord injury article in the May edition of Massage Today.) These are technical errors, and I take full responsibility for not catching them.
At this point I'd like to restate (or state for the first time) what my job is: I am a translator. I read through scads and scads of material: some boring, some fascinating. Then I try to translate that material into accessible terms, so I can share it with anyone who is interested. Sometimes I get lucky and I find people who help me understand a topic, either because they themselves live with it, or they work with people who do. Sometimes, unfortunately, I don't get in contact with a valuable resource until it's too late. Such was the case with the CP article.
I want to voice my appreciation to everyone who wrote me with their own opinions about this issue, which proves that we are people who take our work and the well- being of our clients very seriously. It also proves that what the mainstream medical community promotes is not always the last word. To illustrate this fact, I'd like to quote from another response I got to the CP article, from Mary Green, LMT. Her comment relates to the statement that CP is non-progressive, but nontreatable. (Remember, I just report this stuff, I don't make it up!)
And that's all I'm going to say about CP for the time being.
In my last article, I asked what people would like to read about next, and thyroid disorders won the election in a landslide. I had planned to combine both hyper and hypothyroidism into one article, but it's just too much information, so I decided to limit this discussion to one of the most frustrating and controversial issues in chronic disorders: hypothyroidism.
What Is Hypothyroidism?
Hypothyroidism is a condition in which circulating levels of thyroid hormones are abnormally low, or in which levels of thyroid hormones may be normal, but target cells have become resistant to their action. This interferes with the body's ability to generate energy from fuel.
Demographics: Who Gets It?
Hypothyroidism may be a fairly common condition, affecting about one-tenth of one percent of the population overall. Women are five times more likely to develop hypothyroidism than men. Statistics rise with age; within women over 65 the incidence of this disorder may be as high as 10%. These numbers reflect reported cases; many people may experience hypothyroid symptoms without achieving a diagnosis.
Etiology: What Happens?
Before we get into the specifics of this disorder, we need to discuss some massage school anatomy. You may remember that the thyroid gland, that butterfly-shaped structure that wraps around the trachea, is an endocrine gland that secretes hormones related to metabolism: the use of fuel for energy or growth. It does this under orders from the pituitary gland, which secretes thyroid-stimulating hormone (TSH).
The primary hormone associated with the thyroid gland is called thyroxine. When thyroxine levels are high, metabolism is fast - hyperthyroid symptoms include weight loss, heart palpitations, minimal menstrual periods, and bulging eyes. When thyroxine levels are low, metabolism is slow. Weight gain, low energy, and hypersensitivity to cold may ensue. As with most things concerning hormones, this description is an oversimplification.
The thyroid actually secretes several different substances, including T4 (also called thyroxine, this is a molecule with four iodine atoms) and T3 (a molecule with three iodine atoms). T4 is generally secreted in greater amounts than T3, but T3 is more potent. Enzymes elsewhere in the body may help to convert T3 to T4, or vice-versa. In the etiology of hypothyroidism, it is the presence of T4 that is usually tested and treated with a synthetic version of thyroxine (Synthroid).
Beyond simple low levels of circulating hormones or cellular resistance, several other contributing factors to hypothyroidism have been identified:
Signs and Symptoms
Signs and symptoms of hypothyroidism are often subtle but steadily progressive. A person may not realize the extent of the problem until someone points it out. The result of not being able to convert fuel into energy means that a person gains weight, feels fatigued and depressed, and has a sluggish digestive system with chronic constipation. The person will have poor tolerance of cold, and the skin will be puffy, but dry. Hair will be flat and brittle, and may even fall out. In women, menstrual periods tend to be heavy and long-lasting. Some hypothyroidism patients will develop goiter: a painless enlargement of the thyroid.
It is common for hypothyroid patients to develop atherosclerosis, as liver function to produce the chemicals that expel cholesterol from the body is sluggish. High cholesterol levels from hypothyroidism do not respond to cholesterol-lowering medications. Fluid retention in the arms and wrists raises the risk of carpal tunnel syndrome; fluid retention in the neck along with goiter may cause chronic hoarseness. Very severe cases may cause patients to become so cold and drowsy that they becomes unconscious. This is called myxedema coma, and it is a significant cause of death among elderly hypothyroidism patients.
Many people who fit the profile for hypothyroidism also have symptoms of fibromyalgia syndrome, depression, candidiasis, or chronic fatigue syndrome. It can be a daunting and frustrating process to sort out which is which, since none of these conditions is well-understood or easy to treat.
Physical exams for hypothyroidism look for goiter, along with a significantly slowed heart rate. Reflexes are often slow in hypothyroid patients.
Blood tests may be conducted to look for elevated levels of antithyroid antibodies, which would point to a diagnosis of Hashimoto's disease. Levels of thyroid stimulating hormone (TSH) might also be evaluated. If the thyroid is underactive, the pituitary usually will pour more of this chemical into the bloodstream.
It is especially important for pregnant women to be tested for thyroid function. Pregnancy can hide some symptoms of hypothyroidism, which can create serious repercussions for the unborn child. Most newborns are tested for thyroid function as a matter of course; early intervention in the rare cases when thyroid function is subnormal can prevent stunted growth and mental retardation.
The most common treatment for hypothyroidism is to supplement thyroid hormone. In the early days of understanding this disease, desiccated thyroid glands of a variety of animals were prescribed to treat hypothyroidism. The doses were difficult to regulate, since potency could vary widely. Today, thyroxine is replaced with a synthetic version of the hormone, called Synthroid.
Some researchers, however, suggest that the symptoms of hypothyroidism may be related to other factors: general toxicity, for instance, or cellular resistance to thyroid hormones, or a need to supplement T3 instead of or in addition to T4. And of course the added challenge for treatment lies in the possibility of fibromyalgia syndrome, chronic fatigue syndrome, candidiasis, and any number of other chronic disorders that may mimic or accompany hypothyroidism. These factors, which are often neglected by some "mainstream" medical professionals, may account for why many people who have hypothyroid symptoms do not feel that taking synthetic thyroxine successfully treats their disorder.
Can Massage Help?
Outside of the risk of atherosclerosis (which is a risk for many mature clients regardless of thyroid function), massage is a perfectly appropriate choice for hypothyroidism clients. Although it is unlikely to restore the normal production of thyroid hormones or cellular sensitivity to them, massage can certainly improve the quality of life of people who feel chronically drained and lethargic.
In my next column, I'll examine hyperthyroidism. I'd love to hear from any readers who live with this disorder, or whose clients do. How has it impacted the quality of your life? What have you done, or what are you doing to treat it? What kind of impact has massage had on your situation? Share your experiences and wisdom - pathology readers want to know!
Ruth Werner, LMT, NCTMB
Click here for previous articles by Ruth Werner, LMP, NCTMB.
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