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.
November, 2004, Vol. 04, Issue 11
Herpes Simplex Demystified
By Ruth Werner, LMP, NCTMB
Author's note: I would like to thank Lippincott, Williams & Wilkins for the use of the pictures in this article. These photographs appear in A Massage Therapist's Guide to Pathology, 2nd ed., Ruth Werner, Lippincott, Williams & Wilkins, 2002.
The original citations for these photos are: 1) Herpes [reprinted with permission from Rassner G.Atlas of Dermatology, 3rd ed. Philadelphia, PA: Lea & Febiger: 1994:42.] 2) Herpes Whitlow [reprinted with permission from Goodheart HP. A Photoguide of Common Skin Disorders: Diagnosis and Management. Baltimore, MD: Williams & Wilkins; 1999:90.
As a person who has been involved in massage education for 20 years, I know that one of the things students and therapists fear most is the threat of contagious skin diseases; however, as with all things fearful, the best defense is knowledge. In that spirit, I offer this month's topic: herpes simplex. The good news about herpes is you probably already have it; the bad news is it's possible to get it in new places. My hope is that by reading this material you will feel better prepared to protect yourself and your clients from this tough, sturdy virus.
Definition of Herpes Simplex - The word herpes comes from the Greek root herpein, meaning "creeping thing," or serpent. It is an interesting description for this family of viruses that, once introduced into the body, are never fully expelled. They can become inactive, but infections may recur at any time, often when the immune system is sluggish or overtaxed. Herpes viruses include: herpes simplex, Epstein-Barr virus (associated with mononucleosis), varicella zoster (chickenpox and shingles), cytomegalovirus, which typically becomes active when people are immune-suppressed, and others.
Herpes simplex is occasionally discussed as Type I and Type II viruses: Type I has traditionally been associated with oral lesions (the euphemisms for these are "cold sores" or "fever blisters," probably because they tend to occur when the immune system is overtaxed), while Type II virus has been associated with genital herpes.
Examinations of oral and genital lesions show significant crossover between Type I and Type II virus; both have the same treatment options, so the delineation between them has little significance.
Etiology - Herpes simplex is spread through mucous secretions. A person's first outbreak, which usually occurs two to 20 days after exposure, is called primary herpes. All subsequent outbreaks are called recurrent herpes. Recurrent herpes usually occurs in the same place as the primary lesion, because the virus has taken up residence in the affected nerve root. A primary herpes outbreak is often unnoticed.
Most cases of oral herpes are picked up during infancy or early childhood, and the new carrier may never be aware of his or her infection. In rare cases, however, the primary infection may be very extreme, accompanied by fever, swollen glands and many painful sores that may last from two to six weeks.
Signs and Symptoms - Herpes simplex has a fairly predictable presentation: the affected area may experience some pain or tingling a few days before an outbreak (the "prodromic" stage), then a blister or cluster of blisters appears on a red base. The painful, itchy blisters erupt and ooze virus-rich liquid all around the area. The blisters scab over after a week or 10 days, ending the most contagious phase of the disease. Altogether the outbreak lasts about two to three weeks.
Many of us are familiar with oral herpes; these lesions are typically on the lips, but may be elsewhere on the face or even inside the mouth. (Most sores that occur inside the mouth are not herpes, however.)
Genital herpes is not limited to appearing only on the genitals; these lesions may appear virtually anywhere between the knees and the waist, affecting the sacrum, the buttocks and the thighs - all places massage therapists may work.
Two other herpes simplex patterns are worth noting: herpes Whitlow and herpes gladitorium. Herpes Whitlow appears on the hands, especially the nail beds. Herpes gladitorium is named for its habit of appearing virtually anywhere on the bodies of wrestlers: friction burns and contaminated wrestling mats are probably the mode of transmission for this group.
Communicability - The herpes virus is famous for its communicability. Unlike many pathogens, it can remain dormant and healthy outside of a host body for hours at a time. Exactly how long is a matter of some debate. This means that the face pad that an infected client used may now pass the virus to another client. Used face cloths and towels may also harbor the virus. Even leaving aside the possibility of infecting other people, herpes is notorious for spreading to other parts of the body.
While it doesn't happen often, touching a cold sore and then touching the eye can result in a painful and dangerous herpetic infection of the cornea (herpes keratitis). One of the most dangerous aspects of a herpes infection is that a patient could be shedding the virus during the prodromic stage, with no visible lesion. This means that all it takes to catch herpes from another person is skin-to-skin contact with live virus. No sore or break in the skin is necessary.
While exposure to herpes is almost a given for adults in this country, herpes antibodies provide only limited protection against the establishment of new sites of infection. This is why massage therapists, even those who know they have been exposed, must work to prevent contracting herpes simplex at a new portal of entry.
Treatment - Herpes is a viral infection, which means there's little to do for it but wait for it to be over. Antiviral drugs may shorten the duration of an infection, but they don't prevent future outbreaks. Prevention is the main thrust for treatment of this condition; this means isolating towels, bedding and clothing, and avoiding sexual contact while lesions are present. Keeping as healthy as possible between outbreaks is an important way to reduce the frequency and severity of herpes episodes.
The good news about herpes is that the social stigma that used to be attached to this infection has been largely lifted. Many people no longer feel a need to hide this part of their medical history. If a client has a history of herpes, it's important to explain why it's a bad idea to receive a massage during an outbreak, and to request that he or she reschedule if prodromic symptoms or blisters are present. Even after a lesion has scabbed over, herpes is at very least a local contraindication. Because this virus can survive outside of a host, consider the sheets of any client with herpes as "hot": isolate them in a closed container and either have them professionally laundered or add extra bleach to their wash cycle.
Sometimes it is impossible to avoid working with a client who has an active cold sore. This might be a good time, however, to avoid not only this person's face, but also his or her hands. Those of us who get occasional outbreaks of herpes know how hard it is not to touch the blisters, even when we try to be conscientious about good hygiene.
For next time: What's it to be, readers? Right now warts are at the top of my list, but flu season is upon us, and last year's outbreak of avian flu around the globe may create an interesting season. Or do you have something else you want to find out about? Let me know: What's on your table?
Ruth Werner, LMP, NCTMB
Click here for previous articles by Ruth Werner, LMP, NCTMB.
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