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.
February, 2009, Vol. 09, Issue 02
By Ruth Werner, LMP, NCTMB
In the absence of any feedback or requests relating to my previous article, "Body Art: Tattoos and Piercings" (MT December 2008), I have decided to discuss an entirely different topic: bariatric surgery, sometimes known as "gastric bypass." This comes about because of an interaction with a particularly generous individual who willingly shared her experiences with me during a workshop. Since some of us are probably still recovering from holiday-related overeating, and since about 120,000 people will undergo some related procedure in the country this year, it seems timely and appropriate to take a closer look at how we can serve clients who have had bariatric surgery.
What Is It?
Bariatric surgery is a collective term for several different surgical options, all of which are designed to interfere with the uptake of nutrients in the gastrointestinal tract. Drastically limiting the capacity of the stomach reduces not only the amount of food a person eats, but also their capacity to digest what they take in. The result is typically massive weight loss.
In the United States, more than 60 percent of all adults are functionally overweight, and about 12 million people have a BMI of 40 or above; this is at least 100 pounds overweight for men and 80 pounds or more for women. When people experience this level of obesity their ability to reverse their situation becomes progressively more limited: knee and hip arthritis make exercise impossible, diabetes becomes resistant to treatment and fatty liver disease interrupts liver function. Patients become more vulnerable to secondary infections, certain kinds of cancer and early mortality.
At some point in this cycle, the safest, most effective intervention becomes surgically interfering with the volume of food that is eaten or the absorption of nutrients: bariatric surgery. When this is accompanied by improved eating habits and exercise, many of the illnesses associated with extreme obesity can be more manageable or even reversed.
Types of Surgery
Most types of bariatric surgery can be conducted laparoscopically, unless the patient has some specific limitations. This reduces the risk of secondary infection, and usually shortens recovery time.
Adjustable gastric band. This procedure places an adjustable band around the stomach. The size of the outlet can be controlled with a small balloon inside the band.
Roux-en-Y gastric bypass. In this procedure, food absorption is decreased by stapling the stomach to be about the size of a walnut and directly connecting it to the distal end of the small intestine.
Gastric sleeve. This surgery is often the first stage of another procedure called biliopancreatic bypass. This procedure removes much of the stomach, but leaves the intestines intact.
Biliopancreatic bypass with a duodenal switch. This surgery removes the lower portion (about 80 percent) of the stomach and connects the rest to the lower parts of the small intestine. It is extremely effective, but has a higher risk of complications than other surgeries.
If a bariatric surgery is successful, a patient can expect to lose 50-60 percent of their excess weight within the first year after surgery. This weight loss can continue and stabilize if the patient is careful about diet and exercise. In addition, many of the disorders associated with obesity can be averted. The severity of osteoarthritis, type 2 diabetes, high cholesterol, high blood pressure, sleep apnea, and GERD (gastroesophageal reflux disease), which is linked to esophageal cancer, may all be reduced. Some research also indicates that bariatric surgery may reduce the risk of colorectal, breast and several other types of cancer for obese patients.
Bariatric surgeries are obviously not risk-free. Short-term problems include bleeding, leaking if intestinal sutures fail, infection, perforation of part of the gastrointestinal tract, and post-surgical blood clots that may cause pulmonary emboli. "Dumping syndrome" describes what happens when stomach contents move into the small intestine too quickly; this leads to nausea, vomiting, dizziness and sweating.
Longer-term issues include malnutrition and vitamin deficiencies, strictures (scarring in the GI tract), kidney stones, gallstones, and hernias: bulges that press through the surgical scar or through the mesentery - the fascia that suspends the intestines from the abdominal wall. Annoying but less threatening complications include hair thinning, feeling cold all the time, and dry skin. Finally, it is important to point out that about 10 percent of all bariatric surgeries are unsuccessful. In other words, patients do not experience adequate weight loss, or their weight loss is only temporary.
Massage and Bariatric Surgery
This article came about because I was involved in a class discussion on the benefits of abdominal massage even - or especially - for people who struggle with issues of body image and weight control. It was not surprising that most of the therapists in the class didn't make a habit of including abdominal massage. "Most people would rather just have extra time on their backs or legs" was a common comment. Nanette, one of the class participants, spoke up about her experiences receiving abdominal work in massage school several months after her roux-en-Y surgery:
"I felt horrible. It was unnatural, foreign. I felt anxious, nervous. Clockwise strokes on my abdomen made me feel sick. I wondered if somehow they had rearranged my insides with the surgery. I didn't feel safe. It spooked me."
Part of our job as massage therapists is to "in-corpor-ate" - literally help to weave together - our clients' bodies. For someone who doesn't feel connected to their belly, the experience (even if all it entails is a few unhurried breaths with warm hands on top of the sheet on the abdomen) can be an unusually powerful chance to experience that part of her body as positive, included, woven in. The students in Nanette's massage school were unable to help her do that, and after her initial experiences, she was unwilling to pursue it further.
Granted, Nanette's experience also included significant and painful post-operative complications, and although she lost more than 100 pounds, her general experience with the surgery was frustrating. Students (some of whom probably struggle with their own body image issues!) were not her best resource for abdominal work. But it is still an important goal for us to help our clients feel supported as full and beautiful whole beings, not as disintegrated, disconnected parts.
Massage is finding a place in many traditionally medical niches, including in the context of surgery. It is not unusual now to find therapists delivering pre-surgical massages for stress reduction, and post-surgical sessions for pain, improved sleep and general discomfort. Obviously modalities must be adapted to meet the resilience of the patients.
For clients who have had bariatric surgery, abdominal work clearly must be done with extra care. Nanette obviously needs a therapist with patience and expertise if she is ever to be comfortable with receiving even non-moving touch on her abdomen. Other clients will also appreciate the value of confident, sensitive, gentle strokes on their bellies.
Our unique ability to offer positive, therapeutic, nonjudgmental touch to our clients who do not fit our culture's expectations for normal size or appearance is an incomparable gift. Whether our clients consider bariatric surgery or not, we can provide a welcoming, accepting environment that will be much appreciated.
For next time: The floor is open, readers! Let me know, what's on your table? Until then, many thanks and many blessings.
Click here for previous articles by Ruth Werner, LMP, NCTMB.
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