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.
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?
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."
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.
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?
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.
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.
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).
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 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.
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.
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.
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."
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.
When Computers Cause UCS: Adjusting Strategy
With the widespread use of mobile devices such as smartphones and tablets, the incidence of "text neck" has reached almost epidemic proportions. But there is another challenge to the spinal health and well-being of our technology-driven society.
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.
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.
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.
News in Brief
A Comprehensive Model of Spine Care; Dr. Christine Goertz Appointed Vice Chair of PCORI Board of Governors.
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.
ACA Champions H.R. 7157; ICA Voices Major Concerns
While the American Chiropractic Association recently penned an open letter – signed by not only the ACA, but also the Congress of Chiropractic State Associations, Association of Chiropractic Colleges, Clinical Compass and a number of state associations.
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.
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.
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.
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.
September, 2014, Vol. 14, Issue 09
In Oncology Massage, Positioning Matters
By Tracy Walton, LMT, MS
A client with advanced cancer was looking forward to the massage session in his home. There had been so many medical appointments lately. So many scans and procedures and hard conversations.This soothing, gentle massage was exactly what he needed — touch without a medical procedure attached it and he couldn't wait to escape it all for an hour.
But there was a challenge ahead. Before the therapist even laid a hand on him, she was concerned that she couldn't get him comfortable on the massage table or even on the client's bed. Cancer had spread to his liver, causing his abdomen to become distended, a condition known as ascites. The added volume in his abdomen, plus this new challenge to his breathing, made the prone position impossible. Even lying supine would most likely cause shortness of breath.
A less-than-comfortable position detracts from the experience of the massage, no matter how lovely and skilled a therapist's hands may be. If someone is lying in discomfort, even minor, annoying discomfort, it may interfere with the potential benefits of the massage session, especially the ability to relax.
Now, imagine lying on the table in not just minor discomfort, but something decidedly more like pain. Pressure in the wrong areas, leads to guarding and tensing up. Compromised breathing leads to sudden changes in position in the search for air. Now, lying down has become work. This is where a skilled therapist can come in to save the session with some mindfulness, creativity and patience.
Most massage therapists are familiar with the two most popular positioning options: supine with a bolster or pillow under the knees and perhaps the head, and prone with a bolster or small pillow underneath the ankles, and sometimes, this is all we may need. But there are many less obvious choices, individualized ones tailored to each client's needs based on their responses to our intake interview questions and how things look on the table during the session.
In oncology massage, there are many reasons for possible position modifications. Anything going on in the abdomen, be it something as serious as liver swelling or abdominal masses to something like GERD, can make prone or supine positioning uncomfortable. In these cases, other options can ease breathing or alleviate pressure. Among these options are:
More Than Uncomfortable
There are cases where the wrong positioning can set the client up for risk. If a client has a history or risk of lymphedema, a chronic condition whereby an extremity or other area of the body fills up with protein-rich fluid, their arms should not hang off of the side of the massage table, as this can put pressure on axillary lymphatic structures and potentially cause damage or trigger an episode of swelling. Scrolls and wells made with rolled-up towels can gently support and tuck in extremities so that they stay safely on the table. Elevating an extremity with pillows or towels can help to ease that feeling of heaviness or fullness, even if only for a little while.
Clients undergoing cancer treatment may have a chemotherapy port in place. It can be positioned below their collarbone or on their abdomen, or sometimes in other areas of the body. For those clients who have a port placed in their chest, for example, and who really want to incorporate comfortable and safe back massage into their session, they can sometimes lie prone comfortably with the help of a "nest" made with a small hand towel that creates a soft, little depression that the port can fit into so that there isn't pressure being put on a sensitive area.
Good Positioning Supports Sleep
A good night's sleep is good for anyone. But for someone experiencing the symptoms of cancer and side effects of treatment, good sleep is essential. Properly bolstering and positioning someone who needs extra, individualized support may help clients relax more deeply during the massage itself. In addition, the work that you do as a therapist with lovingly supporting an arm, placing a pillow between the knees, or creating a "nest" around a sore spot can be carried into the client's daily life. They can use some of those positioning and bolstering strategies for themselves at home, to help get them more comfortable in bed when they are sleeping.
Perhaps these strategies can be passed along to the client's caregivers, who then get a chance to help by offering a well-placed pillow or towel at home. Good support with towels and pillows can help create a neutral spine for the client when they are on the table, and this position can help minimize pain in cases of bone involvement. Limbs can be gently supported, torsion on the spine can be eased and the neck can be cradled by rolls of soft towels. There is so much versatility and value available with such simple materials, aided by the creativity and caring intent of the therapist.
As hard as it may be, think of client positioning at a vital part of the massage session, not something to be hastily fussed with and glossed over in an effort to get to the "real" massage. Even though it can take longer with a client with a complicated medical history, it is worth the effort. Take time to communicate about it, so the client doesn't worry or feel pressured to rush the process.
"We're going to spend a few minutes of your session positioning you so you're comfortable. I'll ask you several different times about your comfort. Imagine the eye doctor asking, 'is this better, or worse?' In my experience, this time is well-spent. Once we've settled you into a well-supported position, you'll likely relax better during the massage."
When we take the time to make sure a client is positioned in the best way, when we take those moments to create a soft nest from a towel or to gently add another pillow under the head, and when we do so with 100% presence, our clients often express appreciation. More benefit is possible when the position is comfortable.
Worth the Effort
In the end, the massage therapist worked with the client with ascites in the semi-reclining and then sidelying positions, with five pillows and a few rolled-up towels that she was able to find in his home. The whole process took about 10 to 15 minutes, to get him lying comfortably and supported and bolstered well in each of several positions. Throughout, she worked in a mindful, caring way. She checked to make sure each area was well supported, sliding her hand underneath the support to check for space, then using more towels if the support was not bearing weight.
It didn't leave as much time for the hands-on work as the therapist was hoping for, but she knew her time was worth it when she heard him sigh happily and say, "It doesn't hurt anymore to lie this way. Thank you."
Click here for more information about Tracy Walton, LMT, MS.
Join the conversation
Comments are encouraged, but you must follow our User Agreementcomments powered by Disqus
Keep it civil and stay on topic. No profanity, vulgar, racist or hateful comments or personal attacks. Anyone who chooses to exercise poor judgement will be blocked. By posting your comment, you agree to allow MPA Media the right to republish your name and comment in additional MPA Media publications without any notification or payment.