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.
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.
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.
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.
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.
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.
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.
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.
News in Brief
A Comprehensive Model of Spine Care; Dr. Christine Goertz Appointed Vice Chair of PCORI Board of Governors.
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?
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.
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.
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 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.
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.
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.
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).
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.
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.
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?
ACA Champions H.R. 7157; ICA Voices Major Concerns
While the American Chiropractic Association recently penned an open letter – signed by not only the ACA, but also the Congress of Chiropractic State Associations, Association of Chiropractic Colleges, Clinical Compass and a number of state associations.
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."
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."
When Computers Cause UCS: Adjusting Strategy
With the widespread use of mobile devices such as smartphones and tablets, the incidence of "text neck" has reached almost epidemic proportions. But there is another challenge to the spinal health and well-being of our technology-driven society.
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.
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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