Missed Causes of LBP: It's the Syndrome, Not the Subluxation
When I read the chart notes of other chiropractors, I am usually disappointed. They list what vertebrae are fixated or misaligned. They may describe the involved fascia and muscles.
New Opportunities for DCs
For decades, the model chiropractic practice has been the single-doctor practice. Recent surveys have found that approximately two-thirds of U.S. doctors of chiropractic still practice this way, with another 20 percent practicing in multiple-chiropractor practices.
Catch the Workplace Wellness Wave
Do you offer workplace wellness services to local businesses? If not, you might want to consider this lucrative channel for expanding your practice. Workplace wellness programs and wellness-related benefits have grown in popularity over the past several decades.
Practice Pearls: There's More to ROM Than Meets the Eye
As part of my neuromusculoskeletal examination, I perform range-of-motion (ROM) evaluations. I can "eyeball" the range and measure, I can use a goniometer and measure, I can use my phone app and measure, or I can use various other instruments to help determine degrees of motion.
News in Brief
Parker University Launches New Open-Access Research Journal for Chiropractic; Western States, Cleveland-KC Name New Deans of Chiropractic Colleges; Sherman College Goes Tobacco-Free; Life University Wins 11 Awards.
Official NCCAOM Practice Tests
The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) is excited to announce the launch of the new NCCAOM Exam Preparation Center.
Bastyr University: On the Front Lines of the Pain Epidemic
At University of Washington's Harborview Medical Center, the Seattle region's only Level I Trauma and Burn Center, the demands for in-patient care are dramatically different from a private clinic environment.
First World Spine Care Graduate: Hildah Molate
Hildah Molate, the first World Spine Care (WSC) scholarship student, graduated from Palmer College of Chiropractic earlier this year and is now working at the WSC community spine clinic in Shoshong, Botswana.
Multi-Dimensional Acupuncture: 3D, 4D & 5D
Maggie is an intuitive healer and workshop leader who I met on a recent hike. While we were talking she told me how she had to take it easy because of her knees. She said that her doctor told her that she has the early signs of arthritis.
Old Trend, New Risks: Heavy Weight Training
With more opportunities to exercise than ever, a greater selection of exercise options, and the subsequent opinions supporting and challenging their merits, it's easy to be confused as to which approach is best.
A Novel Way to Prevent Elderly Falls: Toe Strength
In any given year, nearly 40 percent of senior citizens ages 70 and older will fall at least once. Each fall significantly increases the risk of not only sprains, strains and contusions, but also fractures.
State by State: Chiropractic Leads Changes in Health Care
Monumental legislative bills in support of the chiropractic profession were passed recently in Washington, West Virginia and Oregon. Here is a review of this important legislation, state by state...
NBCE to Reinstitute Computer-Based Exams
The National Board of Chiropractic Examiners (NBCE) has announced it will reinstate computer-based testing in January 2019 courtesy of a partnership with testing and assessment solutions provider Prometric.
Acupuncture's Standard of Care
Both a concern and critique of acupuncture, frequently espoused by the bio-medical community is, "there is no standard of care in acupuncture." The following is why I believe this statement is disingenuous at best.
Better With Chiropractic
While chiropractic care is receiving high levels of exposure these days, most pain patients who consult with a health provider still do so with their primary-care MD. And of course, that means in most cases, they're receiving standard medical care, not chiropractic.
Chiropractic's Next Frontier: Adjusting the Microbiome
Restoring a healthy microbiome to help treat disease may be the next frontier in chiropractic offices around the country.
Regenerative Medicine: How to Do It by the Books
The "lay of the land" for regenerative therapies, including but certainly not limited to adult stem-cell treatments, seems to change almost daily.
TCM Codes for the World
I just received an email concerning the ICD-TM11 codes. The World Health Organization (WHO) will be presenting the new ICD-11 codes to World Health Assembly very soon.
Dropping Insurance: 4 Steps
My office manager just got off the phone with the secretary of a long-standing patient. I have treated this woman and 10 members of her family for more than a decade. She has, as have all of my patients, paid my fee at the time of service since I dropped insurance in 1997.
Prevention: Stop Recurrent Urinary Tract Infections
The recurrent urinary tract infection (UTI) is one of those nuisance conditions that can play havoc with quality of life, and this particular infection is much more common than most people realize.
Transforming Exam Delivery
The NBCE Board of Directors has never wavered on its promise to deliver an excellent, on-campus computerized testing experience to students. Likewise, there has never been a compromise to the delivery of fair, valid and legally defensible exams.
Is Primary Spine Care the Answer for Chiropractic?
Recently, we sat down with Mark Studin, DC, FASBE(C), DAAPM, DAAMLP, to discuss the state of chiropractic and why primary spine care may hold the key to chiropractic's future. Read what he had to share in this exclusive interview.
Cyber Threat Checklist: Defend Your Business With These 10 Steps
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.
Paving the Way to Integrative Health & Wellness
Jared Polis (D-Colorado) and Mike Coffman (R-Colorado) launched the integrative health and wellness (IHW) caucus in October, 2018.
Prompting Memory: How to Stimulate Cognition
Recently I gave a talk titled, The Art of Memoir – Tapping the Past to Sharpen the Present at a senior lunch event in Austin, Texas.
It's Time for a Functional Approach to Chronic Illness
It seems one of the more modern buzzwords is chronic, referring to diseases – that is to say, "ongoing and incurable." However, we can take a different perspective and recognize that, although the body may have been traumatized and injured, healing should always be viewed in the realm of possibility.
Spring Allergies & The Spleen: Looking at Pattern Differentiation
As the season of Spring fades away and we shift into the warm summer months, many patients suffer from chronic allergies. This is by far one of the most common issues I see in the clinic as well as often mistreated and misdiagnosed.
Diagnosing & Treating Aggressive Energy
Recently, there has been an article, and subsequent discussion, about the subject of Aggressive Energy (AKA "AE"), including ways to detect its presence and an alternative method of treating it.
The Acupuncturist and the Opioid Crisis: Conquering Pain & Addiction in the U.S.
The current opioid epidemic dominates the discussion among national health leaders, recovery advocates and families nationwide. Opioids include heroin as well as prescription pain relievers such as oxycodone, hydrocodone, codeine, morphine, fentanyl, and others.
Reducing Allostatic Load & Stress Through Heightened Awareness
Your contemporary mental health and psychotherapy colleagues may often approach the treatment of allostatic load as a mental health condition and use prescription psycho-pharmaceutical medicine to affect general and specific central nervous system (CNS) pathways and brain neuro-chemistry medicine to alleviate the associated symptoms.
August, 2009, Vol. 9, Issue 08
The Mysteries of Poison Ivy, Oak and Sumac Revealed
By Ruth Werner, LMP, NCTMB
In the summer, many of us enjoy time outdoors in the woods, hiking in the mountains or working with clients who are doing the same. One of the consequences of that pastime is the possibility of a common allergic reaction to a chemical called urushiol. This is the irritant found in the sap of three major plant species that are members of the cashew family: Rhus radicans, Rhus diversiloba or Rhus vernix. In other words, the topic for this column is poison ivy, poison oak, and poison sumac.
A lot of contradictory and flatly incorrect information is circulated about these plants and the rashes they cause, so I decided to take this opportunity to clear up some common misconceptions. This is in attempt to keep massage therapists safe, and to provide information to give useful advice to our clients who are dealing with these allergic reactions.
Poison Ivy, Oak and Sumac: What are they?
Poison ivy, poison oak and poison sumac are plants that are found in various places throughout North America. They favor wooded and watery areas. They have one feature in common: the presence of a chemical called urushiol that is carried in the sap of the leaves. The old rhyme, "leaves of three, let it be" applies to poison ivy and poison oak, as leaflets often appear in groups of three. Poison sumac can have leaflets numbering five, seven or more. One mark that is sometimes observed on these plants is shiny black spots that look like spatters of tar. This is actually the urushiol on the surface of the leaves.
The leaves of these plants are incredibly delicate, and even very gently brushing against them can allow the transfer of a tiny amount of urushiol, which then binds to cells deep in the epidermis. Symptoms, which include an itchy rash with fluid-filled blisters, typically develop 12-72 hours after contact with the oil. Some areas of the skin appear to react more quickly than others, so the rash may continue to develop over a few days. Further, the person may inadvertently spread the irritant on him or herself before bathing. This can make it appear that the rash is spreading spontaneously from the original site of exposure.
About 85 percent of the population is allergic to urushiol, although some people are more sensitive than others. It may take several exposures to launch an immune system reaction. Some people also find that their sensitivity declines with age: older people appear to be somewhat more tolerant of urushiol exposure.
Interestingly, humans and some other primates appear to be the only species sensitive to urushiol. Birds consume the berries of these plants with great enthusiasm. This is why they are often found growing near trees and fences: the seeds are spread by birds. Deer eat these plants with no apparent ill effects. And dogs don't appear to develop a rash, although they can effectively and enthusiastically share the urushiol that is on their fur.
Is it contagious?
Poison ivy and its partners are contagious from person-to-person only between when a person is exposed to the sap, and the next time that person bathes. This means that if a client arrives for a massage just after a pleasant walk in the woods, she or he may have had some exposure but has not yet developed symptoms. Receiving a massage at this point could put both the client and the therapist at risk for a much more extensive exposure to urushiol than anyone expects.
One example I witnessed along this theme was at a hot spring resort. An enthusiastic hiker joyfully made use of a public hot tub, not realizing that she had been exposed to poison oak during her morning walk. The oily sap spread on the water, affecting other bathers, and one of them had a very extreme reaction that bordered on anaphylaxis.
A poison ivy rash may involve fluid-filled blisters, but the fluid does not spread the rash. Scratching or popping the blisters, however, may introduce the risk of a secondary bacterial infection: definitely not a benefit.
It is important to understand that the cause of the rash seen with exposure to these plants is the sap, and only the sap. If the urushiol has been removed, even if the rash persists, the risk of the affected person spreading or sharing the rash is likewise gone. However, the oil in urushiol is amazingly stable and can retain its potency for months or longer. Dead plants can carry active urushiol for up to five years. It can also cling to fabric or metal, including the lawn mower or weed whacker that was used last season, the work boots that have been in the shed all winter, and the gardening gloves that are still on the tool bench. Another indirect way to contact this allergen is when it is vaporized in the atmosphere. For this reason, it is important never to burn clippings of poison ivy or its cousins.
What to do?
How do we limit the effects of urushiol? This is the million-dollar question, and it yields a surprising variety of answers. The one thing that seems consistently clear in the literature is that no single intervention appears to work on every person.
Experts agree that when exposure to urushiol is suspected, the area should be cleaned as quickly as possible. If the oil can be dislodged within 30 minutes the rash appears to be less extreme. The open question is how that removal should take place. Some people recommend treating the area with a skin-friendly solvent like rubbing alcohol or witch hazel first (the very scent of witch hazel takes me back to my poison ivy-filled youth!), rinsing with cool water, and then bathing with warm water and soap. Others suggest rinsing with warm soapy water right away. Some products have been developed that claim to be specifically targeted to shield the skin from urushiol, or to be especially effective at dislodging the molecules from skin cells, but the research on their efficacy is inconsistent at best.
Once the rash has emerged, a variety of topical applications are soothing and effective at managing the itching and swelling: calamine lotion (another evocative scent and color!), oatmeal baths and cortisone creams are all well-accepted.
Obviously an active urushiol-caused rash is at least a local contraindication for massage, but not because the rash is contagious or will spread; simply because any compromised skin is a possible invitation for secondary infection, and who needs to bring more circulation to an itchy area anyway?
Clients who have been spending time in areas that put them at risk are well advised to bathe before receiving massage. Massage therapists can give good advice about how to avoid contact with these plants and how to minimize their irritating effects. It's almost enough to make you look forward to autumn, isn't it?
For next time: The floor is open, and I am waiting for suggestions. This is your column, so 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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