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.
February, 2015, Vol. 15, Issue 02
When Cancer Involves the Liver
By Tracy Walton, LMT, MS
It was a home visit and my client had advanced pancreatic cancer, metastasized to the liver. He was struggling with pain and breathing. Liver involvement had given him ascites, an accumulation of fluid in the abdomen. He also had leg swelling and difficulty breathing.
Sometimes, the goal of a session is comfort, rather than making much change. Advanced cancer and significant liver involvement meant that his body was doing all it could to cope and it wasn't for me to tip the balance. The swelling wasn't something I could alleviate, and had I done so, it might have been too much for him. I positioned him thoughtfully to ease his breathing and pain, offered some simple classical massage on his back, neck, arms and feet, and simply held his legs.
Both he and his spouse were grateful as I left and we all agreed on another session. A second session wasn't to be, as his condition worsened considerably in the following days. I read his obituary in the newspaper only a week or so later. I had looked forward to seeing him again. I was saddened at his death and especially at how bereft so many others were at losing him. At the same time, I was satisfied that I had done what I could and hopeful that I had eased the hard path for both of them, if even a little bit.
The liver is a common site of the growth of a secondary cancer. This means that cancer cells have spread or metastasized from another primary site such as the breast, GI tract, lung or ovary, or from the pancreas, as in my client's case. The tumor growth is made of the primary cancer cells, not liver cells. So for example, primary lung cancer that has spread to the liver would be considered "lung cancer with liver metastases," or more commonly, "with liver mets." This is called metastatic cancer. This was true in this client's case.
The liver can also be a site of for primary cancer, meaning it is where the cancer growth originated. Most primary liver cancers are called hepatocellular carcinoma or hepatoma. Primary liver cancer may follow cirrhosis and liver failure, which usually arising from conditions such as chronic hepatitis B or C, excessive alcohol use or other inflammatory diseases of the liver.
Regardless of whether a tumor is primary or secondary, liver function may be affected by cancer. When such a generous organ is affected, with hundreds of different jobs, cancer organ failure can be difficult and frightening. The liver metabolizes and stores nutrients, produces bile to aid with digestion and is an organ of detoxification, taking toxic substances and either converting them into something harmless or ensuring their release from the body. It is such a vital organ that we would only survive one or two days if the liver stopped functioning entirely.
Signs and Symptoms
Liver involvement can present as loss of appetite, abdominal pain, pain in the right shoulder, fever, fatigue and enlargement of the liver with possible palpable masses. The spleen may also become enlarged with liver cancer. However, these signs and symptoms may not always point to cancer and often may lead to diagnosis of other, less harmful conditions. Early diagnosis results in a better prognosis, but diagnosis can be delayed because the initial symptoms may mimic other conditions. This often leads to a poor prognosis. The five-year survival rate for a person with primary liver cancer is less than 20 percent. Complications that may present in later stages can include the ascites, as my client had, as well as esophageal varices and profound weight loss.
If the liver is the primary site of cancer, metastases to other sites most often include the lungs, the abdominal lymph nodes and bone. Because of this, some clients may present with shortness of breath or bone pain, which are signs that the liver cancer has spread.
Liver Cancer And Massage
Working with any cancer or cancer history requires a set of skills including interviewing, clinical reasoning and modifications of pressure, joint movement and other massage elements. If these and other skills were not covered in basic massage therapy training, some MTs can teach themselves the information needed, most require comprehensive training in oncology massage to do the work safely and effectively. No matter how the skills and information are gained, one responsibility we take on is to read everything we can about cancer and massage therapy, including many books and articles on the topic.
With liver involvement affecting function of the organ, massage therapy involves adjustments that address both the cancer and liver failure. Here are some of the questions we ask a client with liver involvement:
No Sound Bites
Cancer is an individual experience for each client and this experience will likely change from session to session. Although the guidelines can't be reduced to a sound bite or a short list, here is a list of a few massage adjustments.
Careful supports and joint movement: By learning how the cancer affects each client, we can customize the session in terms of bolstering and joint movement. Significant weight loss calls for gentle joint movement (loss of muscle mass can make joints unstable) and special attention to bolstering and positioning to ease any discomfort of protruding bony landmarks. Pain in the shoulder or in the abdomen can be tended to with careful positioning, such as having the client side-lying on the table, with folded towels and pillows as needed to support the abdomen or the shoulder joint.
Caution and careful interviewing about pain: If there is any possible bone involvement or any bone pain present, use gentle movement and pressure to avoid the risk of pathologic fracture. Even if the source of the pain is undetermined, the therapist should treat any new and unfamiliar pain as possible bone involvement and therefore possible instability of the bone tissue. Any time pain is new, unfamiliar or has not yet been reported to the client's doctor, the massage therapist should refer the client to their physician for support.
Easing the pressure, and a gentle approach overall: As in any medical condition causing fatigue, our approach would be gentle overall, not too taxing to the body. A typical session would include:
As it is for any client with cancer, massage therapists avoid pressure at any and all accessible areas of cancer, whether it is primary or secondary. For a client with liver cancer, it means avoiding pressure over the area of the liver that is accessible just under the ribs, but the massage therapist should consider other sites as well, such as the abdomen, if tissues there are or might also be involved. Also, if liver function is impaired, there may be bruising and bleeding, calling for gentle pressure everywhere.
Some types of treatment for liver involvement include cryosurgery, where surgeons use metal probes to freeze tumors while the patient is under general anesthesia. Sometimes ethanol is injected directly into tumor sites, with the intention of dehydrating and destroying the tumors. These types of treatments generally produce few side effects afterward, other than at the incision or injection sites.
However, chemoembolization is a more intensive therapy, where the blood supply to the liver tumor is blocked and medication is delivered directly into the artery that supplies the area of the tumor. This procedure can cause pain, nausea, vomiting, fever and fatigue, and these side effects can linger even after the therapy is completed.
Easing The Way
Massage may support someone with liver involvement by providing positive, safe and comforting touch. Cancer is often far along once signs and symptoms appear and a diagnosis is made. This means the initial news, prognosis and consequent path of treatment can be a shock. Such an aggressive cancer and corresponding treatments can be very hard on the body, and things may happen quickly, as they did with my client. His death followed his diagnosis by only a few short months.
Armed with the right skills, questions and hands-on sensitivity, massage may help to "even things out" and ease the way along a tough road.
Click here for more information about Tracy Walton, LMT, MS.
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