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?
July, 2006, Vol. 06, Issue 07
Methicillin-Resistant Staphylococcus Aureus: A Moving Target
By Ruth Werner, LMP, NCTMB
Last time, I promised to look at an emerging condition: MRSA, or methicillin-resistant staphylococcus aureus. This is based on several communications, including this one from a massage therapist in the Northeast:
Anyone who works in a hospital setting probably is already familiar with methicillin-resistant staphylococcus aureus, or MRSA, but this pathogen is now being found in community settings. Since we work so closely with people, it's in our best interest to be well-educated about this bug.
What Is MRSA?
Staphylococcus Aureus (named staphyle, Greek for grapes, and aureus for its yellow color under a microscope) is a group of bacteria known for colonizing human skin and nasal passages. Staph has two mechanisms to cause damage to humans: active tissue invasion through the building of abscesses, and the release of corrosive toxins that can kill cells. MRSA is an antibiotic-resistant form of staph that usually colonizes the skin, respiratory tract, or urinary tract. It's estimated that about 1 percent of the population carries MRSA.
We all know that bacteria can be transmitted from one person to another, but they also can be transmitted from one area to another within the same person. In other words, if a child wipes his nose and then scratches his scabbed knee, it's possible his knee injury could develop a staphylococcus infection. Further, once such an infection is established, it's possible for the staph bacteria to travel through the bloodstream to set up infections elsewhere. Pneumonia, bone and joint infections, heart valve damage and varieties of toxic shock syndrome are all possible complications of superficial staph infections. These are particular risks for people who already are immune-compromised.
MRSA has been a relatively common nocosomial (hospital-based) infection since the 1950s, but in the past several years it has been identified in nursing homes, outpatient treatment centers, prisons, athletic facilities, and others; these outbreaks are called community-acquired infections. MRSA is considered an emerging disease because it's easily communicated from one person to another, and its incidence is rising quickly. It has been identified in about 12 percent of all cultured boils outside of hospital settings.
Signs and Symptoms: Community-acquired MRSA infections usually are picked up through skin-to-skin contact, cuts and abrasions or contaminated surfaces. They often look like a boil or spider bite: a single pustule that is large, red and might be mildly to extremely painful. Fever and fatigue might accompany the lesion, which gets progressively worse. It does not respond to topical or oral applications of methicillin, penicillin, oxacillin or amoxicillin.
Treatment Options: Treatment for MRSA requires long doses of antibiotics that are not in the penicillin family. Infections can recur if antibiotic treatment is not completed. MRSA currently is sensitive to vancomysin, but vancomysin-resistant bacteria have already been observed in some settings, and the crossover from MRSA to vancomysin-resistant staph is a distinct possibility. In addition to antibiotic prescriptions, MRSA infections might be lanced and drained. Pain usually is managed with NSAIDs.
The continuing evolution of this and other pathogens makes prevention of infection vitally important for any person who comes in close contact with other people. Preventive measures include washing and carefully covering all open sores, avoiding picking at or touching open sores, not sharing any personal items like towels or razors, and disinfecting all surfaces touched by many people.
The recommended protocols to prevent the spread of MRSA are the same as those to prevent the spread of any contagious condition: observe standard precautions by covering any skin lesions, and cleaning all surfaces and fabrics that clients contact.
Any client with an undiagnosed skin lesion, especially if it's inflamed, painful and showing signs of infection (i.e., pus), should consult his or her primary care physician before getting massage. Certainly, if a boil-like lesion is accompanied by fever and malaise, the massage needs to be rescheduled and the client should be counseled to see a doctor. MRSA is a contagious and potentially dangerous bacterial infection that must be cleared before any modality that moves lymph or blood increases the risk of spreading infection.
Massage therapists who develop boils themselves and worry about whether they've been exposed to MRSA would be well-advised to consult their doctors, too. As long as the therapist is treating his or her diagnosed infection appropriately (this means taking the correct antibiotics exactly as prescribed), and as long as any lesions are carefully covered and not in an area that comes in contact with clients, giving massage is safe.
One resource available to people with concerns about contagious diseases is your local hospital. If you call and ask for the infection control department, they will connect you with a person whose job is to answer exactly these kinds of questions. Whenever I have done this I have left messages and received a call back within a day. This is a wonderful community resource and I encourage everyone to use it!
For Next Time
I've been on a communicable disease track for a while. In the past several issues, I have written about avian flu, whooping cough, and now MRSA. I am content to stay here: I could do a piece on meningitis, or mononucleosis ("kissing disease"). Or, we could pick up a new thread with a common, stubborn chronic skin condition: psoriasis. It's up to you - let me know, what's on your table?
Many thanks and many blessings.
Click here for previous articles by Ruth Werner, LMP, NCTMB.
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