Dr. Saleeby's Blog Part IV

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Therapeutic Massage Articles from Brenda hughey, LMT & Julie Van Tassel, LMT

Massage Therapy for Health Maintenance By Brenda Hughey, LMT When I tell people that I'm a massage therapist, I'm almost always pleased at their response, which is usually something along the lines of "wow that's great, I'd love to have a massage." It's wonderful to know that so many people are interested in massage therapy and know about its benefits. Yet most of these people only rarely "indulge" themselves with a massage. It is unfortunate that massage therapy is still generally viewed as an occasional luxury rather than an important part of a preventive health maintenance program. Massage, simply put, is physical manipulation of soft tissue in the body. There are many different bodywork styles and techniques available to meet individual specific needs. And there's something special about the human touch that a machine can never replace. Massage therapy is probably best known for its ability to relax the body and relieve pain. The basic Swedish style uses long flowing stokes to help get the blood flowing to improve circulation throughout the body and lower blood pressure. This type of massage also helps rid toxins after physical exertion or exercise thus speeding recovery time. Skilled hands, working deeply and specifically in the tissue, can help relieve stiff or painful muscles and joints. Massage can also help heal injuries and limit scar tissue formation. These are just a few of the many benefits. Like regular exercise and good nutrition, receiving frequent massage can promote wellness and improve health. Regular massage keeps muscles supple, can prevent injury and even improve posture. Perhaps more importantly and fundamentally is this RELAXATION aspect. What massage offers is a break from our fast-paced lives and an opportunity to de-stress ourselves. So often we don't really even take the time to notice what's going on in our bodies. And by reducing stress through massage, we're often removing the greatest impediment to healing. Once stress is removed, the body can begin getting well. In the mean time, massage can help alleviate the immediate symptoms of stress like muscle tension, headache, and insomnia. So take time to experience relaxation. Make massage therapy a part of your regular health maintenance program. Brenda Hughey is a graduate of the Florida School of Massage in Gainesville, Florida. She is a graduate of St. Bonaventure University where she obtained a B.A. in Sociology. Brenda also served as a logistics officer in the U.S. Army from 1987 - 1999. She was practicing massage therapy part time at the Saleeby Longevity Institute in Downtown Savannah. Massage for the First Time By Julie Van Tassel, LMT One of the biggest barriers that stop people from ever making their first massage appointment may be the fear of the unknown. The truth is: The thought of venturing into a room with a stranger, not knowing what to expect, would make anyone feel somewhat vulnerable. Take a moment to think back. Can you remember any experiences that were not scary the first time you tried something new? Your first day of kindergarten, or as an adult going back to college for many of us, that was scary! Getting your first massage is just another step along the path to self discovery. When you meet with your massage therapist for the first time, you may be asked to fill out an intake form regarding your health history. Following this, your massage therapist may share with you their education background and talk with you specifically about your needs and expectations to the effect of your treatment. Next, your massage therapist may explain how you should get on the massage table, pointing out where you head should be, and whether you should be face up or face down. During your massage, your massage therapist only exposes those areas that he/she is working on at the moment. This technique is known as draping and this makes you feel comfortable. You may then be asked to undress to the level of your comfort, to lie on the table, and to pull the sheet up over your body while the therapist steps out to wash his/her hands. After the massage therapist has left the room, remember to take your time. He/she knocks before coming in, and usually waits longer than necessary. Your therapist will then make sure you are comfortable, adjust the lights and music. The first moment of contact can tell you a lot about how the rest of the massage is going to feel. When your therapist is attuned to you and your body it becomes a joining together of your consciousness with the consciousness of another, which just doesn't occur often in our modern society. Take advantage of this and pay close attention to what is happening in your own body. This is a great opportunity for you to concentrate on breathing and relaxation. During your massage feel free to give feedback to your massage therapist. If at any point you would like to change what he/she is doing, you have the right to express it. This is your sacred time! Your massage therapist will let you know when your session has come to an end. He/she may ask you to take your time getting off the table and back into your life. Relish these few moments where your cares and concerns seem a million miles away. Some people think of massage as a luxury, and may only use it only in times of dire need. With the pressures in modern society, and particularly the increase of stress-related illnesses, touch therapies should become a part of everyday life. Massage is valuable in preventative health- both for the client and the therapist alike. Massage is truly self-discovery that reveals how it feels to be more relaxed and in tune with ourselves, to experience the pleasure of a body that can breathe, stand, and move freely. Julie Van Tassel is a licensed and nationally certified massage therapist. She completed her requirements for massage & hydrotherapy from the Florida School of Massage in Gainesville, Florida. She previously spent many years as a certified dental assistant. She wa the full time massage therapist and office manager at the Saleeby Longevity Institute. She now practices in NJ.
	© 2003 Saleeby Longevity Institute All Rights Reserved.

Acupuncture article by Jane Gregorie, DOM, LAc

Acupuncture and Chinese Medicine: Getting to the Point By Jane Gregorie, DOM In July of last year, the Georgia State legislature passed the "Georgia Acupuncture Act," making it possible for national board certified and qualified practitioners of acupuncture to obtain a state license and practice under the regulation of the medical board. Until that time, only medical doctors, required to have far less training in acupuncture than a national board certified acupuncturist does, were licensed to practice acupuncture in the state. Currently acupuncture is regulated by licensure or registration in at least 40 states, and is covered by insurance plans in many of those states. Having recently relocated here from Santa Fe, New Mexico, where acupuncture is widely used and accepted, I have been surprised and refreshed by the questions I have been asked as an acupuncturist about what I do. And I have realized that although acupuncture is literally thousands of years old, here in Georgia it is newer than sliced bread. So let's start with the basics. What is acupuncture good for, anyway? How does it work? How big are the needles? And the most frequent and burning question of them all- Does it hurt? Although many people assume acupuncture is only used for pain relief, acupuncture as a component of TCM (Traditional Chinese Medicine) encompasses a whole system of internal medicine. The modalities of TCM include acupuncture, moxibustion, Oriental bodywork, Chinese Herbology, and nutrition and are useful in treating a wide range of disorders from the common cold to anxiety to the side effects of chemotherapy. The World Health Organization has recognized 43 conditions that are amenable to treatment by acupuncture and Oriental medicine. Over 12 million Americans received acupuncture in 1995, and the numbers are steadily rising. What makes TCM distinct from Western allopathic medicine is its focus on treating not only the symptoms of illness, but also the deeper imbalances that lead to such pathologies. Traditionally, we refer to this as treating the root along with the branch, or treating the underlying disharmony along with its concomitant symptoms. Acupuncture has always embraced the concept that superior medicine is preventative medicine. This is evidenced by the words of the Yellow Emperor to his student in the ancient (written in 200-100 BCE) treatise on Chinese Medicine, the Neijing: In the old days the sages treated disease by preventing an illness before it began, just as a good government or emperor was able to take the necessary steps to avoid war. Treating an illness after it has begun is like suppressing revolt after it has broken out. If someone digs a well when thirsty, or forges weapons after becoming engaged in battle, one cannot help but ask: Are not these actions too late? Treating the root also means that an acupuncturist will not use a set, rigid protocol for any given condition. A patient's treatment plan is entirely dependent on his or her individual presentation. While patient A may be treated a certain way for migraine headaches, patient B may receive an entirely different treatment for migraine headaches, based on the nature of the headache itself, specific organ system imbalances, and constitutional makeup. Chinese medical theory includes a sophisticated system of differentiation that distinguishes syndromes so that the practitioner can pinpoint both the specific qualities of an imbalance and its underlying causes as well. In the case of a migraine for instance, one would treat not only the headache, but also the deficiency or excess or stagnation that caused the pain to arise in the first place. For this reason, one person's migraine may respond to a treatment that is entirely different from a treatment that was effective in treating someone else's migraine. This is what makes acupuncture and Chinese Herbal Medicine so very subtle and powerful. The acupuncturist must act not from rote memory when treating an illness, but must regard every detail of an individual's presentation and history in order to come up with an entirely unique treatment plan that is best suited to the person as a whole. Acupuncture works by using needles to access the Qi (pronounced "chee") or vital energy at acupoints, and manipulating that energy in specific ways. One can either supplement, drain, or move the Qi in order to restore the proper flow of energy through the meridians (pathways for Qi) in the body. Meridians are similar to rivers or little energy highways in the body. They are all interconnected and correspond to specific organ systems and flow in designated directions. Whenever Qi is stuck in a specific area, something happens like a logjam in a river or a traffic jam on a highway, and that part of the body will react, becoming painful or manifesting signs of pathology in an area associated with its correspondent organ system. Similarly, when there is not enough Qi flowing in a certain meridian, symptoms such as weakness and fatigue may occur, signaling that not enough nourishment is being circulated to all or part of the body. Or if the energy goes the wrong way in a meridian, like an errant car traveling the wrong way down a one way street, other types of imbalance will arise. In any of the above cases, the acupuncturist accesses the Qi through the use of tiny, hair-like, sterile, disposable, filiform needles, and restores the proper flow. And no, acupuncture needles do not really hurt. Usually the insertion of the needle is completely painless. Rarely, one experiences minor stinging or pricking upon insertion. But once the Qi is accessed, one feels an interestingly achy, or electric, or distended sensation at the site of the needle. Sometimes this sensation radiates, and sometimes it sends waves of warmth or energy throughout the body. At any rate, acupuncture needle sensation is nothing like a hypodermic needle stick, and actually has been reported to be pleasant by some. While the needles are being retained (20-45 minutes), people often doze off, or find themselves in a deeply relaxed and euphoric state of being. As the Yellow Emperor so eloquently put it, "When the energies are able to circulate smoothly and freely, and the energy of the mind is not scattered, but is focused and concentrated, illness and disease can be avoided." This pithy statement expresses the use of acupuncture at its best. By restoring the smooth and proper flow of energy in the body and inducing a state of mind that is peaceful and composed, acupuncture can be used not only to treat, but to prevent illness as well. Traditional Chinese Medicine is a beautiful, refined system of healthcare that is based on an age-old model of well being and harmony that is still applicable today. The job of the superior acupuncturist is to reunite a person with his or her own natural state of body-mind balance, nurture the roots of vitality, and ultimately enable them to thrive. What are acupuncture points and meridians? Acupuncture points are those areas on the body that have been shown to have an influence on pain or body function when stimulated by a needle, pressure or heat. These points are quite small, and exact location is important for attaining maximum benefit from a given treatment. By inserting needles into points on the meridian pathways, the normal flow of energy may be restored and balanced. The points are organized into twelve classic meridians which are named after the organ systems to which they correspond. There are also eight extra meridians which have distinct functions and address specific conditions. How long does a treatment take? The initial visit usually last one to two hours due to the time required for the extensive intake of questions and examination. Follow-up treatments tend to take only 30 minutes to an hour. To learn more attend one of the upcoming lectures at the SLI. What Can Be Treated By Acupuncture/TCM? Gastrointestinal disorders- food allergies, peptic ulcers, chronic diarrhea, constipation, indigestion, gastrointestinal weakness, anorexia, gastritis Urogenital Disorders- stress incontinence, UTI's, sexual dysfunction OB/GYN- irregular, heavy, painful menstruation, infertility, PMS Respiratory Disorders- emphysema, sinusitis, asthma, allergies, bronchitis Disorders of the bones, muscles, joints, and nervous system- arthritis, migraines, neuralgia, insomnia, dizziness, low back pain, neck and shoulder pain. Circulatory disorders- hypertension, angina pectoris, arteriosclerosis, anemia Emotional & Physical Disorders- depression & anxiety Addiction- alcohol, nicotine, and drugs Ear, Eye, Nose and Throat Disorders Supportive Therapy for other chronic and painful disorders The World Health Organization recognizes acupuncture and traditional Oriental medicine's ability to treat over 43 common disorders including those listed above. US FDA has approved acupuncture for the management of pain. Jane Gregorie is a Nationally and State Licensed Acupuncturist in the states of Georgia and New Mexico. She received her M.S. in Oriental Medicine from Southwest Acupuncture College in New Mexico. She completed her undergraduate degree at The Naropa Institute in Boulder, Colorado. In addition to her formal education, she has spent time in Japan, Nepal, India, and Tibet. She was staff acupuncturist and herbalist at the Saleeby Longevity Institute. Now practices in NM.
	© 2003 Saleeby Longevity Institute All Rights Reserved.

Celiac Disease (Gluten Intolerance)

Celiac Disease

by JP Saleeby, MD

The genetic malabsorptive disorder Celiac Disease (or celiac sprue) a condition where the body has an immunologic reaction to gluten may be more widespread than previously thought. It is estimated that one in 300 Americans have celiac disease. Since this condition can manifest itself from infancy to old age it is sometime overlooked or undiagnosed mainly due to low suspicion and its protean presentation. Symptoms may fall on a continuum from mild to severe, but there are certain key symptoms and signs that should trigger a complete work up for this disorder.

Celiac disease is an inherited disorder and results when gluten proteins from many of the grains we eat spark an immune reaction resulting in a malabsorptive digestive disorder. Rye, wheat and barley are some major offenders, but gluten hides in many prepared foods such as hotdogs. Think of it as an intestinal allergy to gluten and the consequences can be grave. It is important for an individual who is diagnosed with celiac disease to refrain from eating gluten containing foods, as this is the treatment of choice.

Celiac disease often causes diarrhea, fatigue, borborygmus (rumbling stomach), abdominal pain, weight loss, distention of the abdomen, flatulence and iron deficiency anemia. Additionally, signs that present on examination of a patient are a skin disorder called dermatitis herpetiformis, aphthous ulcers (canker sores), low blood counts (anemia), with Diabetes mellitus (Type I) and autoimmune Thyroid disease as associated illnesses. The skin eruptions know as dermatitis herpetiformis is almost pathognomonic for celiac disease as those who present with it should be screened for it is found in up to 20% of patients with celiac disease. Under or misdiagnosis is certainly a problem. According to one study up to 36% of celiac patients were misdiagnosed as having irritable bowel syndrome until the true diagnosis was realized. Left untreated celiac disease can ultimately lead to osteoporosis and intestinal lymphoma.

When it is suspected there are serum (blood) tests that should be ordered first and they include immunoglobulin A (IgA) tissue transglutaminase antibodies (tTG) and anti-endomysial antibody (IgA) analysis. For confirmation a small intestine biopsy can be performed under endoscopy. The Anti-gliadin test has fallen out of favor in recent years due to its lack of specificity and low sensitivity. Additionally, genetic markers such as the HLA phenotypes DQ2 and DQ8 may be helpful as they are found in 99% of people with celiac disease.

Those with celiac disease have a higher mortality due to a risk three to six times higher for developing gastrointestinal cancers and in particular a non-Hodgkin’s lymphoma. Patients with celiac disease need close and routine follow up care. Cancer screening along with routine testing for diabetes, thyroid disease, vitamin deficiencies, anemia and osteoporosis should be performed by their family doctor.

Along with stick avoidance of gluten containing foods, replacement of key nutrients is essential. Those who suffer from celiac disease are prone to deficiencies of iron, calcium, folic acid, vitamin B12 and some fat-soluble vitamins (notably Vitamin D). Therefore, it is good practice to supplement with these vitamins and minerals. There are alternatives to wheat, rye and barley that provide a good balance of fiber and a health supply of vitamins usually associated with the offending grains. While corn, potato, and rice make up the mainstay of starches for celiacs, soybeans, tapioca, arrowroot, carob, buckwheat, millet, amaranth and quinoa are allowable and suitable additions.

A good adjunct to a gluten free diet is a new product on the market offered by BeachBody. This product launched in March 2009 was directed to the health and fitness market as a meal replacement dietary supplement for attaining health weight goals. However, this product is guaranteed gluten free and caries many additional nutrients someone with celiac disease would benefit. Shakeology (www.shakeology.com) has benefits for keeping a celiac patient out of a malnutrition state as it has a health helping of protein (from whey), a well balanced supply of multivitamins and minerals, pre and probiotics, digestive enzymes, fiber and adaptogen herbs. It could conceivably be the healthiest meal of the day for any person suffering from celiac disease.

More information is available about this disease, diagnosis and treatments (including a list of gluten free foods) at the Celiac Disease Foundation web site: www.celiac.org.

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JP Saleeby, MD is an integrative medicine physician and emergency room doctor with years experience in nutritional medicine and a formulator of several dietary supplements on the market. He authored a book on adaptogen herbs entitled Wonder Herbs: A guide to Three Adaptogens (Xlibris) in 2006. He recently reviewed the research study supporting the new meal replacement shake Shakeology for Product Partners. He can be reached for comment at jpsaleeby@aol.com.

Reference:

Presutti, R.J., et al, Celiac Disease, Am Fam Physician 2007; 76:1795-1802.

Pruessner, H., Detecting Celiac Disease in your Patient, Am Fam Physician 1998; 57;1023-1039

© 2009

Problems with Evidence Based Medicine

There is a BIG problem with Evidence Based Medicine that no one really wants to admit. That is the practice of current up to date medical diagnostics and therapeutics but with WHOS evidence.

EBM changes with the seasons, depending on the latest and greatest medical researched published in the top peer-reviewed journals (Lancet, JAMA, NEJM, etc.) But with recommendations changing so often it is confusing to both clinician and patient.

Example, the core-measures treatment of AMI with beta-blockers... considered STANDARD of care for a few years until more current research determined it to be "bad" for patients. So Practice with Caution and don't be too smitten by all that appears between the pages of medical journals. The Art of Medicine still survives.

The recent contribution in this years JAMA illustrates this point:


Scientific Evidence Underlying the ACC/AHA Clinical Practice Guidelines

Pierluigi Tricoci, MD, MHS, PhD; Joseph M. Allen, MA; Judith M. Kramer, MD, MS; Robert M. Califf, MD; Sidney C. Smith Jr, MD

JAMA. 2009;301(8):831-841. (Feb. 25, 2009)

Context The joint cardiovascular practice guidelines of the American College of Cardiology (ACC) and the American Heart Association (AHA) have become important documents for guiding cardiology practice and establishing benchmarks for quality of care.

Objective To describe the evolution of recommendations in ACC/AHA cardiovascular guidelines and the distribution of recommendations across classes of recommendations and levels of evidence.

Data Sources and Study Selection Data from all ACC/AHA practice guidelines issued from 1984 to September 2008 were abstracted by personnel in the ACC Science and Quality Division. Fifty-three guidelines on 22 topics, including a total of 7196 recommendations, were abstracted.

Data Extraction The number of recommendations and the distribution of classes of recommendation (I, II, and III) and levels of evidence (A, B, and C) were determined. The subset of guidelines that were current as of September 2008 was evaluated to describe changes in recommendations between the first and current versions as well as patterns in levels of evidence used in the current versions.

Results Among guidelines with at least 1 revision or update by September 2008, the number of recommendations increased from 1330 to 1973 (+48%) from the first to the current version, with the largest increase observed in use of class II recommendations. Considering the 16 current guidelines reporting levels of evidence, only 314 recommendations of 2711 total are classified as level of evidence A (median, 11%), whereas 1246 (median, 48%) are level of evidence C. Level of evidence significantly varies across categories of guidelines (disease, intervention, or diagnostic) and across individual guidelines. Recommendations with level of evidence A are mostly concentrated in class I, but only 245 of 1305 class I recommendations have level of evidence A (median, 19%).

Conclusions Recommendations issued in current ACC/AHA clinical practice guidelines are largely developed from lower levels of evidence or expert opinion. The proportion of recommendations for which there is no conclusive evidence is also growing. These findings highlight the need to improve the process of writing guidelines and to expand the evidence base from which clinical practice guidelines are derived.

Author Affiliations: Division of Cardiology and Duke Clinical Research Institute (Dr Tricoci), Division of General Internal Medicine and Duke Center for Education and Research on Therapeutics (Dr Kramer), and Division of Cardiology and Duke Translational Medicine Institute (Dr Califf), Duke University, Durham, North Carolina; American College of Cardiology Science and Quality Division, Washington, DC (Mr Allen); and Center for Cardiovascular Science and Medicine, University of North Carolina, Chapel Hill (Dr Smith).

Morphine vs Fentanyl in EMS (MCRS lecture)

Shakeology Launch at Beach Body Summit '09

Speaking before a crowd of 700+ coaches ....

California (March 14th, 2009). Shakeology the new meal replacement by BeachBody is launched in Hollywood California at the 2009 Coaches Summit. On hand to speak about the science and research behind this amazing new dietary supplement is..........me. I share the podium with Carl Daikeler (CEO of Beachbody) to launch this product. For video click on this link and visit Day 2 of Summit. http://www.beachbody.com/category/video.do?bclid=6615764001