Archive for the ‘Integrative Care’ Category

Prescription: Puppies

| September 27th, 2012 | No Comments »

I checked out a link on twitter today and loved the article so much I just had to write a bit about it

Written  by an animal loving leukemia patient the article shares her experience of getting ‘prescribed’ a puppy during her recovery.  She focuses on the many benefits she has experienced in her life and I think some of her points are ones that anyone who knows a cancer patient should think about.

 The puppy has provided a positive attention draw, she is no longer identified as the ‘bald-lady with cancer’, she is now ‘the (bald) lady with the sweet puppy’ to the general public and that is freeing, she is more than her diagnosis or disease, she is not just a receiver of care, but a giver of care.  

In her more intimate relationship with her boyfriend this has provided the both of them a focus for their attentions that doesn’t have to do with treatment or symptom management.  

Taking the puppy walking and to obedience classes also get her out into the wider world regularly, providing both stimulation (mental and social) and exercise (an important part of regaining her “normal” life).  

I particularly loved the idea of the comfort and cheer listening to the  puupy’s heartbeat and feeling his warmth bring to her.  I was reminded of new Mom’s being encouraged to hold their children close to their bodies to soothe them with their warmth, scent and the sound of their hearts.  Research has demonstrated that this snuggling lowers babies heart rates, reduces their stress levels and that they fuss less often – perhaps she is enjoying similar benefits.

If you know people going through cancer treatment – especially long and/or high-risk treatments – remember that though you and they need the opportunity to talk about the illness that your relationship goes beyond that and that they may already have had lots of opportunity to talk about their treatment.  Be open to talking about their disease and treatment but remember they are not just a patient, their your friend.

Once upon a time, because of the risk of cross-infection with your pet, or your pet bringing in dirt and contaminants the ill and the elderly were not encouraged to have pets.  In recent years that has been changing.  Cats, and sometimes dogs, can now be found in nursing and retirement facilities as group pets.  These animals provide the residents with company and entertainment.  HIV/AIDS patients, with their lowered immune function, were encouraged to give up pets they had, not  just avoid adding a pet, in earlier days.  Now the emotional and social benefits of having a pet to love and care for and to be cared for by have been show to improve immune function and reduce depression in patients.

 

More reading?…..

pets in elder care

you can even go to school to learn about it…

preterm infants (another immunocompromised bunch) and touch…

 

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August newsletter

| August 20th, 2012 | No Comments »

Modalities Massage Therapy

August Newsletter

 

Dear clients, This Thursday, August 23rd, is the deadline for aromatherapy orders.  Check out the webpage on direct orders for the short list of products and pricing.  Contact me by phone or email to place your order. As always, orders should be in within a week and I will contact you regarding pick-up. Beginning in September there will be some small changes in my work schedule.  I will be teaching infant massage at Mothering Touch again but on Wednesday mornings and I will no longer be working at Achieve Health Monday and Wednesday mornings.  In terms of hours here at Modalities there will be only small changes and a continuation of the ‘temporary’ addition of Tuesday mornings.  New hours as of September 1/2012 will be:

Monday: 10am to 6pm Tuesdays: 10am to 4:30pm; one 7 pm appointment Wednesdays: 12:30pm to 4:30pm Thursdays: 9am to 4:30pm; one 7 pm appointment Friday: 10am to 6pm

I have been doing some blogging lately and wanted to share those thoughts with you. The following links will take you to them: food and drug efficacy and DNR and final wishes.

As we move into the fall I hope that we all have the opportunity to enjoy some more warm weather and sunshine. For those of you coming under the influence of school I hope your return to classes goes smoothly.

Best wishes,

Sheila Hobbs, RMT

250-361-5246

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Food and drug administration…

| August 15th, 2012 | No Comments »

I am not talking about the FDA (Food and Drug Administration – the entity in the US that approves food and drug sales) in this blog, or at least not directly, but the title just called out to me.  What I am talking about is how the food you eat and the drink you drink impact the drugs you might take.  I got inspired by a couple of tweets I checked out and re-tweeted that I found really interesting.

The question of food and pharmaceuticals, for most, likely brings to mind the little stickers you find on your prescriptions bottles or warnings on the labels of over the counter drugs that mainly circle around whether or not to have with food or alcohol and the safety of heavy machinery operation while using.  I recently was put on doxycycline, a fairly potent antibiotic, and for the first time had a warning about dairy food specifically.  Why do we receive these warnings?  We get instruction of food and drink consumption – both specific types and generally – because of  the risk of over or under-dosing.  Some drugs have greater impact with food, some less; certain minerals can alter how drugs work for all of these reasons we get little stickers and warnings.  This website has very complete information on drug interactions including foods.

How exactly do food and drink influence how drugs are absorbed and broken down in the body?  There are a few answers to that question but one of the main ones is – enzymes.  Enzymes are complex protein molecules that bring about cellular reactions within the body.  Enzymes are how we digest food and are used to speed up, slow down, allow or disallow various chemical reactions to occur.  Enzymes are produced by living cells and found in our bodies and in the things we eat and drink.  Some enzymes also are able to block each other from acting – they shut down other enzymes.  How drugs are processed by the body – especially how long they take to be broken down and absorbed impact how effective they are and how often and how much we need to take.

Alteration in drug processing in the body has profound ripple effects in terms of side-effects, efficacy and costs.  The more of a drug you take the more likely you are to have side effects so if the dose can be lowered you have fewer side effects.  The reason we often have to tolerate side effects is to ensure we receive enough of a drug to actually have it do the job it is supposed to do.  The longer a drug stays at an effective level in our body the more of an impact it can have on our system, slowing down the bodies natural breakdown of a drug into its components can allow a drug to do more.  Cost obviously ends up going down if we use less of a drug making lower doses desirable both medically and fiscally, especially in an era of rising medical budgets.  

The particular article I read was speaking of grapefruit juice and the cancer drug, sirolimus.  When ingested with grapefruit juice a one-third dose of sirolimus had the same effect.  This represents a huge cost savings and a potential reduction in side effects as the lower does was accompanied by fewer side effect.  Here is the interesting bit.  Some dosing is lowered and ordered with a particular accompaniment; in other case, like sirolimus at this time, you take more and are told to avoid the food/beverage that increases the effectiveness of the drug to avoid overdose.  I personally hope that current research will lead to increases the incidence of the former and reduces the latter.

The other interesting point that came up in the article is that not only will what you do or don’t take with drug impact their breakdown and bioavailability to your cells but it can also alter how your cells welcome the drug.  Recent studies have shown that pre-treatment fasting (of 2-3 days) by chemotherapy recipients increases the impact of the treatment on cancer cell, but even more delightfully, it reduces the impact of the same treatments on the healthy cells.  Basically, in healthy cell fasting creates decreased activity, basically the seek to reduce their consumption of fuel, in contrast cancer cells, which are already gluttons become even more ravenous when exposed to fasting causing them to absorb greater quantities of the chemotherapy drugs.

A 2-3 day fast is not a small thing but I suspect this news would be less daunting to the many cancer patients who have appetite loss as part of the symptoms or drug side effects.  The reward of less nausea, headaches, malaise, nerve damage and hair loss – just to name a few – would be a nice reward for a bit of fasting too.  Further, for those cancer patients and their families who face daily struggles to get enough food into themselves or their loved ones a brief respite would not be bad and all the parties could then focus their food efforts on their inter-treatment time.  The volunteers with the trolleys of cookies and juice that wheel through the chemo room though would become a thing of the past.

What I find most interesting about all of these pieces of data is that they can be implemented with minimal hassle, little to no harm and many benefits.  There is no costly drug research, no need for gene therapy the research I am talking about is from human and animal trials and new human trials are moving forward in several places already.  This is exciting as a new drug or therapy can take years and years to even reach human trial stage.  Plus, the cost of all of these options are negligible or well offset by saving.  Not very often is that the case with modern medical innovation.

 

 

The tweets I’m talking about:

fasting and cancer treatment

grapefruit juice and drug efficacy

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International Fascia Research Congress 3 – Vancouver, BC, Day 1

| March 28th, 2012 | No Comments »

***Beware – this post is a total fascia geekfest, if you are not prepared to deal with that, read a different post!  Also, any factual errors are my faulty memory, not faulty presentations.***

 

Today I had the absolute pleasure of beginning my time at the 3rd gathering on scientists and clinicians who have an abiding interest in fascia in all its varied and wonderous forms.  I began the day with a flight to Vancouver and a slightly late arrival – but I got before the real geek-out stuff began, so it is all good.  

After some general introductory speeches we dove right into the first keynote speaker.  A anatomist from Temple University, Mary Barbe spoke to us about her research in duplicating repetitive stress injuries (RSI’s) in rats and the tissue changes that occurred in response to various types (high, low and negligable intensities) of work.  How could this possibly relate to massage therapy you ask? Well the road hasn’t fully been built, but knowing that rest doesn’t always fix the problem and that inflammatory processes have likely come and gone prior to anyone presenting at my office (they peak between week 4 and 8 of performing the task) after months or years of a repetitive task, provides me with insight into what interventions and homecare might best benefit my clients.  simply knowing that there are significant connective tissue changes that occur within weeks of undertaking an repetitive task shouts loud and clear about the importance of the fascial work that I am a huge advocate for.

After a quick break we moved our second speaker, Michael Kjaer, whose topic was the impact of exercise on tendon tissues.  We discovered that exercise (and not a lot, 1x creates 72 hours of increased collagen production which is what builds your tendons) increases the density of tendons.  Interestingly, there seems to be little issue with maladaptive changes in the tissue to repetitive exercise as there is to repetitive work activity (there’s a thinker).  More surprisingly, it turns out men exhibit greater tendon density increase than women, and that within the female population women taking oral contraceptive exhibit even lower levels of tendon response than the general population.  Further interest in gender issues came when it was revealed that in post-menopausal women being on hormone replacement heightened tendon response.  Hmmm, that estrogen, funny stuff.  

 

After a break for lunch we broke into three groups for presentations on specific areas of fascial research.  I chose the “biomechanics” room and got to learn about different means of trying to empirically measure different types of mechanical interventions.  From pressure sensitive pads on fingers to rather medieval looking table devices this part of the afternoon was an interesting insight into the various ways we can try to research the interventions we apply with our hands and their outcomes.  I also gained an interesting insight into the world of research.  Failure, or rather, not proving your hypothesis fully or at all.  Even in those cases it was interesting to see how that research could be used to launch into better studies.

Our next keynote speaker, Albert Banes, was a doozy.  I am pretty sure I learned so interesting things, but they went by so fast I think I might be lucky to catch up with them sometime next week – after reading the paper a few times!  He seemed to be summarizing quite an extensive array of studies in the field of fascia research and had some very interesting things to say – and showed us pictures of some lab grow tendons, but it was a lot in just a little time

The final event of the afternoon, academically, was a panel of  four clinicians presenting of “scars and adhesions”.  One of the exciting bits of us BC RMT’s was having one of our own on the panel – Susan Chapelle of Squamish, BC who talked about the benefits of integretive treatment and the need for increased research that included a manual therapy aspect.  She was preceeded by a surgeon, Dr. Michael Diamond, who discussed post-surgical adhesions (things sticking together that shouldn’t after surgery) which I was surprised to find has a 65-100% incidence rate in abdominal surgeries (though they are not limited to those surgeries).  We were then treated to a new movie by Jean Claude Guimberteau, a French physician, who has now produced several in vivo movies of fascia using endoscopic techniques (his first being “Strolling Under the Skin”, presented at the first fascial congress).  We also had a naturopathic doctor, Hal Brown, present some of his case studies of the impact of the injection of aenasthetic under the skin into scars to improve function in both near and far tissues. 

The day finished with a welcome reception that was very well attended that allowed us all to review and discuss our reactions and thoughts regarding the days flood of knowledge.  I can hardly wait for day two….

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m-Medicine – the future of your doctor’s smartphone?

| January 23rd, 2012 | No Comments »

This weekend I was reading an article in the Globe and Mail regarding the impact of technology on health care, specifically mobile technology.  The article referenced several areas in which mobile technologies can improve health care with remote monitoring, to i-tunes credit for diabetic teens who comply with their insulin regimes.  The focus, and one of the most exciting parts, for me was an improvement in post-surgical care monitoring.  

Dr. Semple, the surgeon-in-chief of Women’s College Hospital in Toronto, is running a pilot project to monitor the ambulatory surgery (in hospital less than 23 hours) patients under his care.  Dr. Semple and his research team have developed an app that allows patients with a smart phone or tablet to be in regular touch with him post-operatively.  This app allows patients to photograph their surgical incisions and send them to Dr. Semple along with text regarding how they are feeling.  From this information Dr. Semple can very accurately assess the progress of their recovery and make decisions regarding any need they may have to return to the hospital for follow-up care prior to their scheduled appointment.  

This seems simple, wouldn’t a phone call do the same?  I see this new evolution addressing several weaknesses in the call-in follow-up.  One, for time pressed surgeons – and patients – there is no need to mesh schedules.  Patients send in their information when they can and the doctor can pick up the information whenever he chooses.  Yes, this sounds a bit like answering machine tag, but there are other factors.  When the doctor picks up that message he is not just listening to a voice trying to squeeze their information into a brief window before the beep – he is reading a summary that the patient has been able to compile at their leisure.  He is also able to pick up that piece of information anywhere.  The other highly valuable piece of information he is getting is the visual.  They say a picture is worth a thousand words, and with this technology it may very well be so,  it may even be worth a life.  The article talks about a scenario where Dr. Semple is able to save himself, his patient and the system, time and money by preventing an unneeded hospital visit from the other side of the globe, but lets look at the other possibility.  What if his patient’s bruising wasn’t benign?

Using the app the doctor could have gotten that patient into the hospital as soon as he saw cause for concern.  Post-surgical care costs can escalate through to means – unneeded return, and delay of needed return.  The later being more costly in the end for all concerned as it would be associated with re-hospitalization, care for the complication that would be more extensive than a promptly dealt with one, and, perhaps, long term health issues or death if an infection was not dealt with for a prolonged period.  Close monitoring has always had benefits in terms of preventing complication but earlier discharge offers huge savings, higher numbers of patients processed and, frankly, more comfort for the patient.  Anyone who has spent time in hospital knows it is not very restful or healing.  The food is awful, it is noisy and people are disturbing you at all hours to check your temperature.  Who wouldn’t prefer the privacy of their own room, in their own home with undisturbed nights?  When those things can be accompanied by closer monitoring we have a winning solution both for the patient, for their health and for the system.

This week there is a conference in Toronto that offers doctor’s the opportunity to explore the options of mobile health technologies and hear from leaders in the field.  I hope my doctor is on her way there! 

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Integration, hooray!

| November 23rd, 2011 | No Comments »

Yesterday I got an email from one of my clients asking if  “I would be open to communicating” with her chiropractor.  I almost swooned with joy – okay, not really, I’m not much for swooning, but I was really excited.  This type of request doesn’t come very often but I am always happy to receive them.  

Most often we allied health professionals work in a bit of a vacuum.  We have only our clients recollections to inform us of what other treatments they are receiving.  Client feedback is helpful for understanding their feelings regarding progress and how their bodies experience and respond, but not so helpful in determining what another practitioner actually did, nor what they intended by doing it.

By habit. I always ask about other practitioners my client’s are seeing.  When they are receiving concurrent treatment I will often ask when they last saw that practitioner and what they work they did.  I have often determined my approach based on this feedback.  If I know their chiropractor has gotten a good re-alignment I won’t focus on my own tools for structural alignment, I will focus on soft tissue support.  If their physiotherapist has been working on nerve mobilization in the neck and shoulder I may choose supportive back work and joint mobilization to complement.  The problem is that some clients recollections don’t provide me with those insights – or I fail to inquire – and a chance to improve the quality of care I give my clients is lost.  Even worse, we practitioners may overwork an area by compounding treatments, which is as detrimental as not working the area at all.

I believe strongly in the need for increased communication between practitioners to improve the impact of all of our work and ensure that patients receive the most efficient and effective care.  Thanks to that client and I look forward to the collaboration.  I will use this reminder to increase my initiative in communication, so that I am walking my walk, not just talking my talk.

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