Supplement Safety: Is It Time to Give Big Pharma a Chance?
Why in the world would I, a chiropractor, consider Big Pharma when I make a vitamin / supplement recommendation to a patient? There are several supplement manufacturers at every chiropractic conference, even at some of our schools.
A Little More Chiropractic, A Lot Less Pain
Why should I visit a doctor of chiropractic when I'm not experiencing pain or other symptoms? That's the question many patients still ask themselves, despite the growing body of research supporting the value of chiropractic maintenance care.
The Carcinogen Most Patients Consume
A known carcinogen is being naively consumed by many, if not most of your patients, who have little to no understanding of how dangerous it really is. Depending on the age of the patient, this carcinogen is a leading, if not the leading, risk factor for death and disability.
Renying-Cunkuo Pulse: The Essential Pulse Method of the Ling Shu
The Ling Shu is a Han Dynasty classic book on the practice of Chinese medicine. It presents five main channel systems: Muscle Channels, Chapter 13; Luo Collaterals, Chapter 10 and others; The Main Channels, Chapter 10 and many more; Separate Channels (Divergent Channels) Chapter 11; and the Eight Extraordinary Channels, referenced in chapters throughout the book (there is very little theory).
A Moment of Silence for Dr. Leon Chaitow (1937-2018)
After months of declining health, Dr. Leon Chaitow – clinician, author and teacher – passed away on Sept. 20, 2018 at the age of 80.
How to Address the Question, "Do You Accept Insurance?"
Do you ever dread getting asked the question, do you accept insurance—when you only accept cash, or when you are out-of-network? As part of my daily practice, mentoring acupuncturists to grow their practices faster and more effectively, I talk to a lot of practitioners.
Pregnancy Health: Looking at the Lower Extremities
When patients tell us they are pregnant, many times we focus on the obvious pregnancy signs and symptoms related to their current trimester of pregnancy, and the biomechanical impact on the spine and pelvis.
Procuring a Place for the Future
As the acceptance of acupuncture continues to grow in the U.S. it is important that the profession be licensed in every state, and nationally board certified.
A New NCCIH Director ... One That Backs Acupuncture
The third time is a charm—the National Center for Complementary and Integrative Health (NCCIH), a division of the National Institutes of Health (NIH), announced it's newest director, Dr. Helene Langevin.
Exercise Therapy Following Motor Vehicle Trauma (Pt. 1)
In the absence of acute trauma, a usual strength-building session includes concentric, eccentric and isometric exercises. Popular exercise programs typically include concentric movements as the major muscle contraction and should constitute approximately 70-75 percent of the workout time.
Paradise Lost: AWB Relief in Hawaii
In November, 2014, Acupuncturists Without Borders (AWB) was hosting a training seminar on Oahu. A couple of us from the big island (aka "Hawaii" County) contacted AWB because the big island was in the middle of a crisis.
Manual Muscle Testing for Cervical Radiculopathy (Pt. 2)
Dr. John Bandy developed a protocol that associated specific muscles with myotomal nerve root levels. The deltoid is associated with the C6 nerve root; the triceps with the C7 nerve root; and the finger abductors with the C8 nerve root.
World Acupuncture Day: A Meeting in Paris
World Acupuncture Day is an event organized by the World Acupuncture Day Organization (WADO) in response to the eighth anniversary that UNESCO has included acupuncture and moxibustion on it's Representative List of the Intangible Cultural Heritage of Humanity.
Creatine: Muscle Fuel No Longer Just for Athletes!
Erase that image of the 20-year-old, muscle-bound bodybuilder using creatine. Replace it with the image of a lean, strong, fit 80-year-old hiking up a mountain. Creatine, a staple of athletes for more than 50 years, is now being used by athletes and non-athletes alike to help slow normal age-related muscle loss, improve exercise recovery, increase strength, and live a more active lifestyle.
Travel-to-Treat Coverage Finally Becoming a Reality?
Long-awaited legislation poised to hit the president's desk extends liability insurance coverage from one state to another for DCs and other state-licensed health care professionals who care for athletes / athletic teams that cross state lines.
NBCE Exams: Better, Shorter, More Opportunities
The NBCE's Written Exams department, led by Bruce Shotts, DC, developed a solution to computer-based testing on college campuses. Their work has resulted in 11 exam opportunities per year. CBT exams are on schedule to begin January 2019 as follows:
The Husband/Wife Imbalance
The Husband/Wife Imbalance, like Aggressive Energy, is an energetic block that will result in death, unless cleared, as its presence indicates that nature has given up the fight against the internal or external pathogenic factors that have assaulted the body/mind/spirit of the patient.
Case Study: Osteoporosis and the Role of Orthotic Support
The following is the second of three case studies by Dr. Wong on conservative management of lower-extremity complaints. Article #1 (September issue) explored chiropractic management of patellofemoral arthralgia.
Bait & Switch: Are You Guilty?
One of my three sons recently shared a story with me regarding an experience with a chiropractor, which stimulated me to write this ethics article. According to my son, he called a chiropractor's office and asked if his insurance was accepted at the office.
Cyberthreat Checklist: 10 Key Steps to Defend Your Practice
Living in an Internet-connected society brings many conveniences and benefits. The power of the Internet to connect us with customers, store data and find information has opened the door for many small-business owners to grow and flourish.
Vertebral Subluxation: Give Credit Where Credit Is Due
Vertebral subluxation: have any other words caused as much turmoil and controversy in the chiropractic profession? As a chiropractic term, vertebral subluxation did not make its debut until six or seven years after the profession's founding.
Chiropractic Integration a Big Success, Suggests Research
Whether chiropractors should integrate with other health care professionals in medical / multidisciplinary settings remains a contentious issue, depending on whom you ask, but there's no denying two realities.
An Effective Herb for Stress
We all know stress has become a significant factor in the increasing number of reported mental health disabilities and a contributor to various physical health conditions, such as ulcers, high blood pressure, heart disease, and so on.
On Point: Acupuncture Theory & Discussion
Welcome to my new column for Acupuncture Today, which will focus exclusively on the theoretical discussion and clinical application of acupuncture theory and acupuncture points. One of the most common questions I encounter from novice to experienced practitioners is "how do I choose the correct acupuncture point?". I hope this column can help answer some of these questions.
The NCCIH Seeks Participants for Acupuncture RCT
The National Center for Complementary and Integrative Health (NCCIH) is seeking participants for a new Funding Opportunity Announcement (FOA)—a Randomized Control Trial (RCT), which will evaluate the impact of, and strategies to best implement acupuncture treatment of older adults (65 years and older) with chronic low back pain (CLBP).
Checking Your Posture: A Wholistic View From Head to Toe
As you begin reading this article, what position is your body in? Are you sitting down, standing up, lying down, or walking down the street perhaps? Whatever position you are in, stop and observe your posture.
Avoid These New-Patient Turnoffs (Before It's Too Late)
I can't believe this doctor is making me watch this video in a room by myself, your new patient thinks to herself as she texts her best friend.
The Road to TCM, A Talk With Bob Doane
Bob Doane, a veteran acupuncturist, talks about his journey to TCM, the evolution of this medicine, and what he foresees in the future.
Cynicism, Burnout and the Search for the Ideal Patient (Pt. 1)
There is a video on the Internet that has gathered 6 million views as I write this article (so likely millions more by the time you read it). The video is of a doctor in an ER mocking a patient who is extremely weak and distressed.
Placebos, Presence and the Zero Point
We spend a huge amount of time learning the techniques and methods of acupuncture and Chi-nese medicine, and are given professional licenses based on our ability to remember and accu-rately apply them.
A Moment of Silence for Dr. Leon Chaitow (1937 – 2018)
After months of declining health, Dr. Leon Chaitow – clinician, prolific author and teacher – passed away on Sept. 20, 2018 at the age of 80.
News in Brief
The Next Generation of Chiropractic Researchers: Historic NIH Grant; Cleveland University – Kansas City VP Joins CCE Site Accreditation Team; NUHS Opens Second Veterans Clinic; R.I. Chiro. Society Celebrates 100 years.
May, 2008, Vol. 08, Issue 05
A Common Problem, Often Misunderstood
By Ruth Werner, LMP, NCTMB
As promised, this article looks at a surprisingly common problem that is poorly understood. Polymyalgia rheumatica (PMR) is a condition of unknown cause or etiology ("idiopathic") that affects mostly Caucasian women between 50 and 80 years of age. It usually is self-limiting, which means symptoms tend to spontaneously subside within several months or a couple of years following onset. In the meantime, however, PMR can be a severe problem that substantially interferes with a person's quality of life.
Here is a comment that came in from one reader, Karen, about her client with PMR:
The client Karen describes presents a complex picture, because some of her symptoms (especially peripheral neuropathy and hot spots in her distal legs and feet) might be related to her diabetes rather than her PMR. Furthermore, the side effects of PMR treatment can interfere with diabetes management, which complicates things even further!
What Is Polymyalgia Rheumatica?
PMR literally means "many muscle and joint pains," It is a mysterious condition that involves a specific onset of extreme morning stiffness and muscle pain, often concentrated around the neck, trunk, shoulders, upper arms, hips and thighs. One person described it as feeling as if they'd worked hard in the garden or gone on a very demanding hike every single day for about two years.
Those of northern European descent have the highest incidence. Women with PMR outnumber men by about 2 to 1. The incidence among people over age 50 is fairly high. It's estimated to affect between 0.5 percent and 0.7 percent of this population. The average age at onset is 72 years, but anyone over age 50 who describes these signs and symptoms should think about getting tested for PMR. It's rare among African-Americans or Asians. This predictable racial distribution points to a genetic component for the disease.
The exact causes or etiology of PMR are unknown, but when people with this condition are compared to people without it, some differences are strongly predictable. Many (but not all) people with PMR are positive for a specific genetic marker called HLA-DR4. Evidence of past infection with several common viruses is typical. Certain kinds of white blood cells are present in the synovial capsules, tenosynovial sheaths and bursae of many people with PMR. Levels of C-reactive protein and the erythrocyte sedimentation rate (ESR or "sed rate") of people with PMR both tend to be higher than that of the general population. These tests are not definitive for PMR specifically, but they do point toward a possibility of inflammation and immune-system hyperactivity.
Signs and Symptoms of PMR
As described above, PMR most often is defined by a specific onset of pain and stiffness focused around the trunk and proximal aspects of the arms and legs. It might start unilaterally, but most people develop bilateral symptoms.
Magnetic resonance and ultrasound imaging of specific soft-tissue structures show that bursae, tenosynovial sheaths and joint capsules in the shoulders and hips may be inflamed with PMR, but no erosion or bony adaptation is present. Many specialists suggest this inflammation contributes to the sensation of stiffness and pain in the muscles that cross these joints.
PMR also might show systemic symptoms including low fever, weight loss, weakness, fatigue and depression. While it's not a dangerous disorder and the life expectancy of a person with PMR is the same as the general population, this condition certainly can interfere with the quality of a person's life. Fortunately, it's self-limiting and symptoms usually subside within two years of onset.
Complications of PMR
PMR by itself doesn't carry a lot of potential complications, but about 15 percent of people with the condition have another immune-system hypersensitivity reaction called temporal arteritis or giant cell arteritis (GCA). This condition does have some serious consequences including a high risk of permanent visual loss and some blood vessel damage. We will look more closely at GCA in the July column.
Treatment for PMR
The good news about PMR is that it's highly treatable. This chronic, low-grade inflammatory condition responds well to steroidal anti-inflammatories and most people report a significant reduction in symptoms within a few days of initiating treatment.
The bad news, of course, is that steroidal anti-inflammatories carry a long list of serious side effects including bone thinning (patients are counseled to supplement vitamin D and calcium), insulin disruption (this has implications for patients such as Karen's client, who uses insulin to control her diabetes), edema, liver and kidney problems, and other risks. Patients who take steroids must aim for the lowest possible dose for the shortest possible period of time, and they must be vigilant about scanning for side effects that can be prevented or treated.
PMR Versus FMS
Careful readers may now be wondering about differentiating between PMR and another common, poorly understood condition, fibromyalgia syndrome (FMS). Because they are both more common in women than in men, and both involve non-injury related muscle tenderness and debilitating fatigue, the potential for confusion is large. A few delineations can help sort out these conditions:
None of those things is true for fibromyalgia syndrome. If a mature Caucasian female client reports a new onset of morning stiffness and muscle pain, it's very much worth their time to get tested for PMR, which has a different treatment protocol than fibromyalgia syndrome.
Massage for PMR
As always, judgments about massage and bodywork for clients with PMR boil down to potential risks and benefits. The risks of working with a client who has PMR include the fact that this is a demonstrably inflammatory condition, and some types of massage promote inflammation: We don't want to attract new fluid to areas like shoulders or hips that are already packed and busy. Other risks center around treatment: Does the client have any side effects related to steroid use that might interfere with the ability to deliver massage safely? These can include bone thinning, diabetes-management challenges and other complications. Remember, too, that anti-inflammatories quell pain symptoms, which makes clients easier to overtreat.
Benefits of massage and bodywork for clients with PMR can be significant if we are careful. If we can reduce muscle stiffness and fatigue without exacerbating local inflammation, what a gift for a person who always feels sore! Massage is unlikely to undo the immune system hyperactivity we observe with this condition, but it certainly can contribute to the coping skills of the client waiting for the problem to resolve.
In my next column, I will discuss the companion to PMR, giant cell arteritis (GCA). In the meantime, I'd love to hear from some of you who work with clients who have PMR, GCA or both. What's the best outcome you've seen? What will you do differently next time? This column is a place for you to share with your colleagues: What's on Your Table?
Click here for previous articles by Ruth Werner, LMP, NCTMB.
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