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.
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.
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?
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).
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.
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.
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.
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.
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.
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.
#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).
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.
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.
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.
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?
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.
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.
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:
"Community Care" for Vets: It's Really a Big Deal!
As a preamble, while I regrettably never served in the military, I have the highest respect for those who did and those who currently serve.
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.
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.
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.
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.
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.
Does Dairy Cause Dampness?
The topic of dairy consumption was brought up at a scalp acupuncture seminar I recently attended.
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.
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
November, 2015, Vol. 15, Issue 11
Massage Therapy Reduces Suffering for Patients With Advanced Illness
By Massage Therapy Foundation Contributor
Contributed by Jolie Haun PhD EdS LMT; MK Brennan MS, RN, LMBT; Renee Stenbjorn MPA, LMT
Patients suffering with advanced cancer or other life-limiting illnesses often experience chronic pain, anxiety, and decreased quality of life.Medications for symptom relief are often inadequate and can result in numerous side effects. Previous studies evaluating massage have reported decreases in pain in individuals with advanced illness, such as cancer, but these studies have been limited by small sample size, lack of a control group, or randomization. This month's Massage Therapy Foundation research review focuses on recent study findings on the integration of massage therapy into a palliative care service. In this published research, Mitchinson and colleagues report on the outcomes of massage for patients with advanced illnesses.
The Study Design
Patients receiving palliative care for advanced illnesses, such as cancer, received massage at a Veterans Affairs Medical Center in Ann Arbor, Michigan. Massage therapists collected data pre and post massage to examine outcomes associated with pain, anxiety, dyspnea, relaxation, and inner peace. A retrospective chart review was conducted to collect all the data related to the patient and the massage sessions. The statistical method, analysis of covariance was used to examine changes over time.
Massage treatments were provided by a nationally certified massage therapist. Massage sessions averaged 20 minutes for inpatients and 22 minutes for outpatients and primarily consisted of effleurage with limited trigger point therapy for those patients who could tolerate the therapy. The pressure was light to moderate depending on the patient's health condition. Wounds were avoided. Patients with bony metastases often received massage to uninvolved areas. Patients who were actively dying usually received foot massage.
Of the 153 patients who received massage, 115 were able to provide data for analysis. Patients unable to do so included those who fell asleep, were delirious or confused, were very near the end of life, or who refused to answer. In total, 52% of the patients received massages in an inpatient setting; 37% received massages as outpatients and others received massages in both the inpatient and outpatient settings. In addition to their life-threatening diagnosis, 70% of patients had preexisting chronic pain. Of this sample, 69% had a primary diagnosis of cancer; the other patients were referred for non-cancer diagnoses. As is common among Veteran populations, this sample was primarily older white males.
For the sample, all short-term changes in symptoms showed improvement and all were statistically significant. Pain intensity decreased by 1.65 (0-10 scale, P < .001), anxiety decreased by 1.52 (0-10 scale, P < .001), patients' sense of relaxation increased by 2.92 (0-10 scale, P < .001), and inner peace improved by 1.80 (0-10 scale, P < .001). Unique to this study, the authors also provided individual cases to demonstrate the suffering associated with advanced illness and the impact of massage therapy (excerpts from cases).
A 55-year-old veteran with bipolar illness, a personality disorder, chronic back pain, low social support, and a history of heroin and alcohol abuse was admitted with a new diagnosis of advanced non–small-cell lung carcinoma metastatic to liver and spine. Psychiatry was consulted to help address agitation, irritability, and pacing behavior. He primarily complained of neck and shoulder pain. After the first massage, his pain intensity dropped from 10 of 10 to 8 of 10. He was initially reluctant to admit how much massage had helped relieve his pain because he feared no longer receiving opioids. Initially, he rated his sense of relaxation and inner peace as 0 of 10 prior to massage and 3 of 10 afterward. When asked about his anxiety after the second massage he commented, "I feel better than I have in a long time; that was beautiful." Later during his illness, he commented that the massages were very helpful and said, "I'm in heaven. No offense to God, but this is the only time I'm in heaven."
An 81-year-old World War II veteran with end-stage congestive heart failure and chronic back pain was followed in the clinic. He received 8 massages over an 18-month period. At his first visit, he was complaining about not being able to get his "happy breath." Prior to the massage, he rated his anxiety a 6 out of 10 and his shortness of breath 8 out of 10. He enjoyed the massage and reported a decrease in his anxiety (0 of 10) and shortness of breath (6 of 10). He commented that he felt "a little happier" because he could breathe more easily. On another occasion, he described the massage as "a little better than a piece of warm apple pie and a cup of coffee" and admitted, "I'd be lying if I said I didn't like it."
These case histories provide compelling evidence for the relief of massage experienced by patients suffering with advanced illness.
Implications for the Field of Massage
Mitchinson and colleagues conclude that "massage is a useful tool for improving symptom management and reducing suffering in palliative care patients." The most impressive aspects of this study are the sample size, the implementation of the massage program in palliative care, and the qualitative case histories exemplifying the participants' experiences with massage.
The authors' noted in their discussion that the massage program has been well accepted by professionals within the medical facility and there have been no reports of adverse events related to massage. They reported the biggest challenge was prioritizing patients by need, not having time to keep up with the requests for massage, allocating time between inpatients and outpatients, and getting access to inpatients with competing demands for the patients' time.
The authors also reported study limitations; this study used an observational method with no control group, and the sample had limited diversity. Future studies will benefit from collecting data from a diverse sample including a range of ages and ethnicities from both genders. Finally, data were self-reported and collected by the therapist, so it is possible there was reporting bias to please the therapist. Future research would benefit from data collection from someone other than the therapist; and of greater value would be to complement self-report data with objective data such as biomarkers, to support a rigorous data collection process. The use of qualitative case histories, as used in this study, provide rich data from the perspective of the participants and clearly illustrates their personal experience with massage therapy. Though the authors did not mention it as a limitation, the massage therapy protocol provided in the article was vague and would thus be difficult to replicate. The practical nature of implementing palliative care programs within a medical setting may warrant the use of a wide range of individualized massage protocols.
Practitioners, particularly those working in medical facilities now have information to support the recommendation of massage therapy within palliative care programs. As for the field of massage, this study supports the ever-expanding scope of populations and conditions for which massage therapy can be delivered as an effective treatment to alleviate pain and suffering.
Are you interested in learning more about the uses of massage therapy to alleviate pain and promote quality of life for patients with advanced illness? To learn more about the effects of massage therapy, to learn more about the effects of massage therapy, you can review the Massage Therapy Foundation review article archives, read accepted MTF Research Grant abstracts, or search PubMed for massage therapy studies.
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