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?
September, 2006, Vol. 06, Issue 09
Dealing With Psoriasis
By Ruth Werner, LMP, NCTMB
I was surprised to hear so little in response to my last piece on MRSA (methicillin resistant staphylococcus aureus); I had fully anticipated a lively discussion of this health threat to follow my article.Instead, the silence was deafening. I didn't get any suggestions for a topic for this article either, so I made an executive decision to pick up a topic of interest, at least to me: psoriasis.
What Is It?
The word psoriasis comes from the Greek root psora, which means "the itch." It's mainly a skin condition, although in some circumstances other systems can be involved as well. Psoriasis is quite common in this country, affecting 6 to 7 million Americans. It's most common in Caucasians. About 150,000 new cases are diagnosed every year.
How Does It Work?
Under normal circumstances, superficial skin cells are replaced roughly every 28 to 32 days. (Hmmm, a 28- to 32- day cycle. What does that make you think of?) What we see with psoriasis is that, in certain areas, skin cells replicate at a vastly accelerated rate: instead of a month-long turnover cycle, they are replaced every 4 to 6 days. The consequence is a patchy pile-up of keratinized epithelial cells, often with a silvery scale: these are the plaques of the most common form of psoriasis.
What we don't understand is why this happens. A genetic link might seem to be part of the picture, because the incidence of psoriasis is higher within families. Immune system anomalies are clear as well, and some experts classify psoriasis as an autoimmune disease - a situation in which immune system mechanisms are directed against healthy tissue by mistake. Psoriasis frequently appears with some other autoimmune disorders (ankylosing spondylitis, for instance), and it runs in cycles of flare and remission; both of these characteristics are common in autoimmune disorders.
Types of Psoriasis
Plaque psoriasis (Fig. 1) is the most common form of this disorder. It frequently appears over joints: knees and elbows are common. Some people have one small lesion that appears in the same place for a few weeks every year or so; others have huge lesions that might cover their back or trunk, scalp, hands or feet. Even when the condition goes into remission, the skin might sustain enough damage to appear permanently discolored and scarred. Other forms of psoriasis are less common, but good to know about:
Psoriasis doesn't usually involve dangerous complications, unless the lesions bleed and get infected, or unless a person with erythrodermic psoriasis has a fluid-loss crisis. However, about 10 percent of the people with psoriasis are at risk for a painful and possibly extreme form of arthritis, called psoriatic arthritis. If a client has psoriatic arthritis, treat it in the same way you would treat rheumatoid arthritis: avoid it when it's hot and inflamed and work for joint mobility and pain reduction when the joint is not actively inflamed.
We understand a lot about the process of how psoriasis develops, but this still is a basically idiopathic (of unknown origin) disease. Consequently, the treatment options for psoriasis are largely hit-and-miss efforts to control symptoms. Many people with psoriasis develop tolerance for medical interventions, and so, must constantly be looking for the next option.
Allopathic interventions include topical skin creams to reduce itching and help clear up plaques. Oral medication can work with controlled exposure to UV radiation to help this process. In very extreme cases, patients might be prescribed chemotherapeutic drugs to limit skin cell replication. All of these can help to control the frequency and severity of psoriasis outbreaks, but none of them are a permanent cure for the disease.
The newest strategy involves a group of drugs called TNF Blockers. TNF (tumor necrosis factor) is an immune system mediator associated with inflammation. Blocking its activity keeps the inflammatory process (and accompanying proliferation of extra skin cells) under control.
Alternative psoriasis treatments also vary widely. A search for "psoriasis cure" brings up dozens of products claiming to heal this disease. They range from herbal clay applications, to aromatherapy, to visiting the Red Sea so that a species of fish can nibble at the lesions (I am not making this up!).
Personally, I am open-minded to seeing dietary adjustments and herbal or homeopathic applications for psoriasis management, but I retain a healthy skepticism of any product that claims to "permanently cure" this condition.
In the olden days (as in, the days of Hippocrates), doctors were instructed to rub olive oil into psoriasis lesions. We know now that when psoriasis is acute, these are areas where cells already are hyperactive. Increasing energy or circulation to these sites might not be the best plan. However, it's important to point out that psoriasis is not contagious! Clients with psoriasis can benefit from bodywork that includes the whole body, as long as the stimulus doesn't increase itching or irritation. Herbal or aromatherapeutic agents could be useful in this context as well. If you have found an application you have seen to improve psoriasis symptoms, please share it with me and other Massage Today readers.
For Next Time
Gentle readers, let me remind you that this is your column! I am at your disposal to gather information on the pathology topics you want to read about. Please go through your client history notes and find one that makes you curious - and let us all know: what's on your table?
Click here for previous articles by Ruth Werner, LMP, NCTMB.
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