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:
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.
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.
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.
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.
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.
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?
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.
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.
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.
#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).
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.
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.
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.
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.
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.
The Hidden Hip in LBP: Critical Screening Tests
In 1998, Harvey used this test on 117 elite athletes and found excellent interrater reliability to differentially assess iliopsoas, quadriceps or TFL/ITB tightness.
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).
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?
Does Dairy Cause Dampness?
The topic of dairy consumption was brought up at a scalp acupuncture seminar I recently attended.
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.
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.
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.
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.
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
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.
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.
January, 2003, Vol. 03, Issue 01
Working With Clients Who Have Hyperthyroidism
By Ruth Werner, LMP, NCTMB
In my previous article on thyroidism (October 2002 issue), I discussed how insufficient levels of thyroid hormones circulate in the bloodstream, or receptor cells become resistant to these hormones (or both).Hypothyroidism is a fairly common condition, but getting an accurate diagnosis can be challenging. Its symptoms can overlap with those of fibromyalgia syndrome, candidiasis, chronic fatigue syndrome and other conditions. Furthermore, current measuring standards for "normal" hormone levels are rough at best, which means a person with a borderline case, but significant symptoms, may have difficulty getting a useful diagnosis.
This article focuses on a corollary disorder: hyperthyroidism. Hyperthyroidism and hypothyroidism are closely linked. Both may result in the development of a goiter - a painless enlargement of the thyroid gland. People who begin with hyperthyroidism may end up with hypothyroidism as a result of their treatment. Also, as one reader informed me, a baby born to a mother with hypothyroidism may develop hyperthyroidism as an overcompensation response.
Before we begin this discussion, I'd like to include an excerpt from a correspondence I had with David Ponsonby, a massage therapist from Dallas, Texas, who generously shared his experience with hyperthyroidism:
My mother had the iodine deficiency variety of hypothyroidism, which I believe initially causes the thyroid to enlarge in an attempt to meet demand, then to fail. My mother was the Anglo-Australian equivalent of a "G.I. bride." She went to Western Australia and had two babies. Away from fish and pre-iodized salt, she developed goitre (English spelling). I came across one reference that suggested the fetus will overcompensate for a deficiency and become hyperthyroid - i.e., me. She had two surgeries in the next four years, and a third almost 50 years later that resulted in pneumonia and death. Throughout the 50 years, her breathing, speech and activity level were impaired.
My own hyperthyroidism had some curious "coincidences" at initiation. I developed an apparent cellulitis after being bitten by a mosquito near a city sewer plant. (No association, they tell me?)
My lower right leg swelled up. When the swelling went down, it was very lumpy -- pretibial myxedema. The parathyroid is mixed in, with calcium deposition around the periosteum - like a soccer player's shin. I am a former soccer player, and it was interesting that the site of some of my old injuries seemed to be the focus.
My eyes popped out, I became very hot, my skin was flushed and itchy, my blood pressure went up, my heart pounded in my ears, and I fainted on two occasions -- very scary. I tried to maintain my exercise, although the sweating and fainting made it scary because there was always the possibility that I could collapse while riding my bike, etc.
I tried acupuncture, which seemed to relieve the swelling on one side, under the eye. I tried detoxification, energy therapy, homeopathy, etc. Gradually, most of the symptoms went away. I still have some swelling under one eye.
What Is Hyperthyroidism?
Hyperthyroidism is a condition in which the thyroid gland produces excessive amounts of two forms of thyroid hormone (T3 and T4), resulting in the metabolism of fuel into energy - lots and lots of energy. A person with hyperthyroidism has an engine that runs hot all the time, and never really lets up.
Demographics: Who Gets It?
Hyperthyroidism affects between 1 percent to 2 percent of all people in the United States at some time in their lives. About 500 thousand new cases are diagnosed each year. Women are affected more often than men, by a margin of about 3 or 4 to 1. Most cases are diagnosed between the ages of 20 and 40.
Etiology: What Happens?
Hyperthyroidism is usually caused by one of three things: a thyroid infection; a nodule or group of nodules that become hyperactive for unknown reasons (this is called toxic nodular or multinodular goiter); or an autoimmune attack against the thyroid gland that causes it to secrete excessive amounts of metabolic hormones (also called Grave's disease).
Grave's disease is by far the most common variety of this disorder, accounting for 70 percent to 80 percent of all cases. In this situation, antibodies called thyroid-stimulating immunoglobins (TSI) mistakenly attack the thyroid gland, causing it to grow to huge dimensions (this is called a goiter) and so to secrete excessive levels of both forms of thyroxine.
Under normal circumstances, pituitary secretions of thyroid-stimulating hormone (TSH) tell the thyroid when and how much to metabolize fuel into energy. When Grave's disease is well-established, the thyroid produces its own TSH for local action, so circulating levels of this hormone drop significantly. At the same time, levels of TSI, the antibodies that attack the thyroid, increase systemically throughout the circulatory system. The result is that the conversion of fuel into energy increases by 60 percent to 100 percent.
While genetics clearly play a major part of developing Grave's disease, its onset often seems to be connected to a stressful situation like a death in the family or a job change. Other risk factors for developing this disorder include exposure of the thyroid to X-rays, or previous use of antiviral medications such as interferon or interleukin.
Signs and Symptoms
The primary symptom of Grave's disease is the development of a goiter: the thyroid becomes enlarged enough to create a visible, painless swelling in the neck. Other signs and symptoms are mostly related to the emphasis on metabolizing fuel for energy, rather than growth or storage.
Grave's disease patients may show anxiety, irritability, insomnia, rapid heartbeat, tremor, increased perspiration, sensitivity to heat, and unintentional weight loss. Skeletal muscles, especially in the arms, often become weak. Other symptoms may include a lighter flow during menstrual periods, dry skin and brittle nails. Grave's disease can also affect the muscles that lift the eyelids. When the eyes seem to protrude, this is called exophthalmos. (Think of Marty Feldman in Young Frankenstein - he was a famous hyperthyroidism patient.) Grave's ophthalmopathy is a rarer disorder that causes the eyeball to protrude beyond its protective orbit because tissues and muscles behind it swell. The front surface of the eye can dry out, causing light sensitivity, double vision, decreased freedom of movement within the orbit, pain, and excessive tearing.
Some Grave's disease patients develop red raised patches of skin on their shins and feet. These rashes are called pretibial myxedema, and they are generally not painful or dangerous.
One of the most serious complications of Grave's disease is the risk of episodes of dangerously accelerated metabolism called thyroid storms. In these episodes symptoms may include rapid heartbeat, fever without infection, intolerance to heat, confusion, agitation, and finally fainting or shock. Thyroid storms can be medical emergencies and require immediate intervention to slow the heart and bring down the fever.
Grave's disease is usually diagnosed through a physical exam, a blood test, and an examination of how the thyroid takes up radioactive iodine. The physical exam concentrates on issues like goiter, temperature, heart rate, muscle weakness, and tremor. Blood tests will look for low levels of TSH combined with high levels of TSI, along with abnormally high levels of thyroxine. The ingestion of radioactive iodine shows how quickly the thyroid absorbs iodine (a primary component of thyroxine), along with which parts of the thyroid appear to be hyperactive. This test helps to delineate between Grave's disease and nodular hyperthyroidism.
Hyperthyroidism can be treated in a number of ways, depending on the underlying causes and the severity of the symptoms.
Alternative therapies for hyperthyroidism focus on the use of certain foods and/or vitamins that inhibit thyroid activity, but I couldn't find any information on modalities that can actually interrupt the immune system attacks on the thyroid gland.
What About Massage?
As long as the skin is healthy and intact, and the cardiovascular system can adjust to the changes we bring about, massage of all types may be beneficial to clients with hyperactive thyroid glands. The calm, relaxed response bodywork creates may provide a welcome change to the sympathetic-like symptoms of hyperthyroidism.
In my next article, I will discuss reflex sympathetic dystrophy syndrome (RSDS). Also referred to as causalgia, sympathetic maintained pain syndrome, or complex regional pain syndrome, this chronic pain syndrome presents special challenges for massage therapists. If any of you live with this, or have clients who do, I'd love to hear from you.
Until then, many thanks, and good health and happiness.
Click here for previous articles by Ruth Werner, LMP, NCTMB.
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