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.
May, 2015, Vol. 15, Issue 05
Compassion and Compassion Fatigue: Balancing Your Emotions in the Treatment Room
By Tracy Walton, LMT, MS
I entered massage therapy to serve others, and oncology massage therapy because of how deeply that service affected me. In general, massage therapists enter the profession because we care: about people as a whole and in particular about their health and well-being.
But, could caring end up hurting or draining us?
Those of us helping professions — nurses, doctors, social workers, chaplains, massage therapists, and more — can be strongly affected by working with clients experiencing trauma in the form of a health crisis. This strain can happen as a result of working with one particular client, or it can be a cumulative pile-on of a number of different emotionally difficult cases.
There is a lot of discussion and not much agreement out there about the exact meaning of the terms "compassion," "empathy," "compassion fatigue," and "burnout." We'll lump them together under "being deeply affected by a client's experience."
Deeply Affected by a Client's Experience
Whatever we call it, it's important to look at any hard-hitting emotional toll on ourselves when we care for people experiencing pain, trauma, mortality, and suffering. Imagine you are seeing a particular client diagnosed with advanced cancer, and she shares with you how hard and emotional her treatment is, how she is too fatigued to play with her children, and how, most of all, she is terrified of dying before she gets to see them grow up.
That's all just from what your conversations. During the hands-on session, you learn about the physical pain in her hands and feet, the restricted movement from past surgery or radiation, and the ongoing wear of chemotherapy on her hair and skin. You know these things intimately as your hands touch her body in a full hour of time. This intimacy can challenge the separation we need — or think we need — between ourselves and our own fears of cancer, mortality, pain, and suffering.
So our knee-jerk reaction to this might be, "How can I protect myself? How can I establish good boundaries like we were taught to do in massage school?" We don't want to feel our clients' emotional pain and distress, so we might rush to put up strong dividers between "us" and "them."
When our clients represent our worst fears, and we spend a huge amount of effort to protect ourselves from those fears, our lives and our work can suffer. Here, the discussion typically turns to the boundaries we must have for this protection. Healthy boundaries can help us manage our own emotional well-being, but it's worth discussing what those boundaries should look like. The boundaries in my own work that have been most important are regarding self-care, rather than separation or protection from clients' experiences.
Taking on My Own Suffering, Not Others
My first lesson in this came from Irene Smith, more than twenty years ago. Irene is a longtime massage therapist, educator, and author. She founded Service Through Touch, serving people with HIV in the San Francisco Bay area in the 1980's. She has gone on to teach us much about massage in illness and at end of life, and maintains her blog and schedule at www.everflowing.org.
Irene said, "I don't believe that we take on another human being's suffering. I believe that what happens is that we find ourselves in an experience that simply opens us up to our suffering."
With her words and instruction, Irene taught me that, while I might think I am absorbing my client's expressed or unexpressed pain, in reality, the situation is provoking my own pain. If I follow her guidance, I can learn much about my old losses, current fears, and the human condition in general. As I've learned about myself, I've become more present with others.
With this lesson, my relationship to compassion began evolving. I have learned important lessons from several teachers about joining with people and separating from people during hard experiences.
Many Teachers on Compassion
Lauren Muser Cates, an oncology massage therapist and educator, has some more passionate wisdom for us in her blog post, "Boundaries, Schmoundaries." She suggests that instead of putting up walls to try to keep ourselves "safe" and "protected," which can leave us feeling empty, we should work with staying open to others' experiences and ourselves. Lauren tells us that boundaries have their place in the practicalities of massage therapy — scope of practice, payment, set hours, and so on — but "When it comes to emotion and our essential humanness, boundaries, as they've been taught to us, are a myth."
Additional teachers came to me a couple of years ago, when I put together a series of webinars on hospital-based massage therapy (HBMT). I sought out several people who had HBMT programs in place for years, looking for their wisdom on program development, longevity, and the practicalities of making massage work in the hospital. In the process, I interviewed and recorded people from five HBMT programs: Paula Gardiner, MD; SatSiri Sumler, LMT; Carolyn Tague, LMT; Briane Pinkson, LMT; and Karen Armstrong, LMT, about their HBMT work.
When participants in the conference asked these people about the emotional impact of their work, a common theme emerged. The panelists spoke to the importance of some sort of contemplative practice — often yoga or meditation — in maintaining balance and resilience. Self-care was mentioned, of course, but with a particular emphasis on reflection and stillness. I heard their message loud and clear.
More recently, I have come to know the work of Joan Halifax, PhD, founder of the Upaya Institute and Zen Center in Santa Fe. She has worked and been present in end of life care for decades. She has shared important wisdom about compassion through her writing, speaking, and teaching.
In particular, I remember her stating once that true compassion can be enlivening, not draining. She, too, underscores the need for a contemplative practice, so that the mind can be resilient when challenged by pain and suffering. For those of us looking for "everyday compassion for everyday use," she has developed the "G.R.A.C.E." method of cultivating compassion.
These are some of the teachers I have encountered along the way of my own calling in oncology massage, but one more is worth mentioning: myself. I am glad to be able to count myself on my list of teachers. From meeting myself and listening closely, I become better able to be with my own feelings and vulnerability. Lived in more presence, my life is teaching me to feel whole in my own pain and suffering, and to be more present with the pain, suffering, and wholeness of others.
It's also teaching me how that wholeness looks in practice. In fact, in this very column, years ago, I shared my own list of self-care measures. Little has changed over the years on that practical little list. If you read that column and substitute "hula-hooping" for "skating" as my preferred physical outlet, plus add "meditation," the column will be entirely up-to-date for 2015.
Test Your Compassion Fatigue
Because wholeness comes with awareness, I am a fan of most anything that helps us ask the right questions. Once can test one's own compassion satisfaction, compassion fatigue, and burnout levels at many different websites, but one of my favorites is the Professional Quality of Life Scale at the Compassion Fatigue Awareness Project.
The inherent emotional aspects of our profession, those same aspects that may have drawn us toward populations such as oncology massage, hospice and palliative work, can make things like boundaries, presence, and compassion a messy affair. There is rich wisdom to be learned in this messiness, if we choose to pay attention.
Click here for more information about Tracy Walton, LMT, MS.
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