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VOLUME 31, NUMBER 10
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Alternative Health News
A Freebie
Let's face it – patient evaluation takes time. Unless you are really into the diagnostic evaluation game, you probably have found the formal exam protocol tedious if not downright annoying.
Specific Considerations when Massaging Seniors
On January 1, 2011, the first baby boomers turned 65. Every day since then, and for the next 18 years, 10,000 people will turn 65 according to the U.S. Census.
The Relevant Way to Rank Your Massage Practice
Every time Google makes another change (panda, penguin, etc.), it can affect your hard earned time spent ranking your massage practice.

Marketing Your Practice: A Lesson in Press Release Writing 101
There are certain things to bear in mind when creating a press release. At the top left, indicate who is sending out the release; in other words, the name and contact information of the person who will be in charge of receiving any phone calls from inquiring press members.
Peer Points: Stories of Practice Success
When patients go see Arizona-based acupuncturist Jing Liu, it is to get top care from an practitioner well versed in all aspects of Traditional Chinese Medicine.
There Are No Secrets: Treating Complicated Conditions with TCM
Including standardized extra points, there are just over 400 acupuncture points on the body. You get 400 and I get 400 - same. Yet, time and time again treatment protocols are coveted as if they were some secret formula only intended for the right and privileged.
Herbal Medicine: Go Mainstream
When it comes to practicing herbal medicine in a mainstream setting, there are a number of important points to understand when it comes to prescribing formulas. Some important questions to ask are - what method of prescribing and dispensing is most effective in this setting?
The Top 5 Supplements You Need for Self-Care
To propose a mere five supplements for self-care is a presumptuous task. But indeed, those of us in a position to advise others about their health, and offer healing touch, must attend to the proverbial "health thyself," if not heal, at least attend to.
VacuTherapies and Working With the Senior Athlete
There are more than 10,000 men and women between the ages of 50 and 90+ that gather every two years to compete in the National Senior Games. These athletes train year round in their chosen sport and participate in yearly local events in order to improve their skills.
Economics of Complementary/Integrative Care
Although this column doesn't usually feature a book review, we're going outside of our usual public health format to discuss a new book written by Patricia Herman ND, PhD.
You are What You Eat Part II: Integrative Protocols
In the previous installment of this article I discussed important ideas concerning gastrointestinal health and foundational ideas from TCM, which can provide key insights into creating effective protocols for healing the gut.
Technique Synergy: Blending Unique Combinations for Success
Specific techniques and modalities are the key tools of our profession. But as any artisan or craftsmen will tell you, each tool is only as good as the person using it.
Helping Infertility Patients with the Spirit Essence
As many of you know, when it comes to treating infertility, we are dealing with a patient population that is, generally speaking, in emotional turmoil. These patients often experience fear, anxiety, despair, hopelessness, grief and anger.
Soft Tissue Tools Help Post-Natal Calf Pain: A Case Study
Do you use massage tools in your practice? Do you work with post-natal women? If so, this month's Massage Therapy Foundation (MTF) research column features a case study that might interest you.
Temporary Injunction Granted in FL PIP Case
Circuit Judge Terry P. Lewis issued a partial injunction against the Florida Personal Injury Protection law, putting a halt - at least temporarily - to the portion of the law that requires a finding of an emergency medical condition as a prerequisite for payment of PIP benefits and that prohibits payment for services provided by massage therapists, acupuncturists and chiropractors.
The Spirits of the Points: The Gall Bladder Official
The Gall Bladder is known as The Official of Decision Making and Judgment. In any given day, this Official makes countless decisions – conscious and unconscious, which influence every aspect of our being.
Healing Leaders

Energy is a hot commodity. Society pays dearly for it and for the expertise of those who know how to cultivate it.


Helping Patients Through Pregnancy Loss
There is a lot of focus in the acupuncture world on fertility and helping women get pregnant. It's exhilarating to hear the news that a patient is expecting a baby. The other side of that is pregnancy loss. That includes abortion, miscarriage or stillbirth.
Happenings in Our Evolving Profession
Good things seem to be happening for our profession and recent developments show we are all on board. Talking about being on board, this September The Veterans Express-Purple Heart Tour is expected to make its way out of the station.
Pediatric Massage for Healthy Childhood Development
"Mommy, my tummy hurts!" This is commonly heard in many households throughout North America everyday. Childhood abdominal pain has many different characteristics and can be dull, sharp or feel like cramping.
Can There Really Be Too Much of a Good Thing? Never!
Convention and conference season is in full swing! So many incredible events are going on all over the country.
The Journey to Find the Cause of a Pain in the Butt
I hope that title caught your attention because I like to get you questioning and thinking before we begin. I'm going to be talking about a possibly new term I may have just coined: sports butt.
The ABC's of Meeting with Physicians
Have you decided it is time to market your practice to physicians? It is inspiring to know that many physicians see fifteen or more patients a day and some practices have two or more doctors on staff.
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Dynamic Chiropractic – August 9, 1999, Vol. 17, Issue 17
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Reducing Inflammation with Proteolytic Enzymes, Part II: Common Uses, Safety, Weights and Measures, and Dosing

By G. Douglas Andersen, DC, DACBSP, CCN

Last month, in the first part of "Reducing Inflammation with Proteolytic Enzymes," we reviewed issues on absorption and the substances that proteolytic substances are derived from. This month,we will begin our discussion of proteolytic enzymes with a list of conditions commonly encountered in the chiropractic practice where proteolytic enzyme supplementation may be of benefit:

Abrasions
Bruises
Contusions
Ecchymosis
Hematomas
Lacerations
Sprains
Strains
Fractures
Surgeries1

Safety

After reviewing over 30 studies, Bucci stated that there were "more frequent side effects from placebos than from proteases."1 The most common negative side effects of proteolytic enzymes are gastrointestinal.

A few people will complain of upset stomach or nausea when taking enzyme preparations. If this occurs: (1) ask the patient if they have a sensitivity to the source of the enzyme, for example, beef, pork, papaya, and pineapple; and (2) change formulas/brands.1

Weights and Measures

Weights and measures have been one of the biggest problems with the use of proteolytic enzymes. There are no uniform measurements of activity; thus, it is not possible to compare the strengths of different preparations or different types of enzymes. Common measurements used include United States Pharmacopeia (USP); Armour units, Rohrer units; milk clotting units (MCU); gelatin-dissolving units (GDU); and national formulary units (NF). There is no conversion equation to determine if 100 mg of brand A that has 500 MCU of potency is stronger or weaker that 50 mg of brand B that guarantees 1,000 USP of activity. To make matters worse, many brands are sold by their weight, which has nothing to do with how active the product is.

Dosing

  1. Start ingesting enzymes as soon as possible after the injury.

     

  2. Take enzymes on an empty stomach. Any time food is present in the stomach or small intestine, serum uptake is reduced.

     

  3. Enzymes must be taken throughout the day to maintain peak serum levels; therefore, they should be taken a minimum of three times per day. Most manufacturers recommend dosing five or six times for maximum effectiveness.

     

  4. Enterically coated preparations are much preferred, although not mandatory with bromelain.

     

  5. Multiple types of enzymes increase the chances of disrupting the inflammatory cascade by increasing the range of peptide bonds that can be attacked.

     

  6. Enzymes should be used for one week or until signs and symptoms improve.

     

  7. Tissue saturation is imperative for enzymes to be effective. Tissue saturation is achieved with a patient's complaints of loose stools.

     

  8. When stools loosen, reduce the dose slightly and maintain at that level.

     

  9. Because of the problems with weights and measures, it is strongly advised that along with whatever product you use, you also contact the company to obtain a realistic amount required to reduce inflammation. Most companies label their products in a very conservative manner, and if patients simply follow the label, they will not be pleased with their investment.

     

  10. Unlike many nutritional supplements, proteolytic enzymes have a relatively short shelf life (one year). Therefore, if you do carry proteolytic enzymes in your office, purchase them in amounts that will turn over rapidly. This will increase the chances that what you recommend is fresh and active.

     

  11. When you find a formula that works for you and your patients, stay with it.

Until manufacturers can come up with uniform standards for clinicians to compare and recommend these products in a rational manner, utilization of enzymes will be continue to be less than it should be. I know of no other vitamin, mineral, herb or nutraceutical substance which the experts recommend to "take a bunch of pills four or five times a day."
If you can get by the frustrating weight and measure issue, you will find that proteolytic enzymes can be a useful tool in your practice.

Reference

1. Bucci L. Nutrition Applied to Injury Rehabilitation and Sports Medicine. Boca Raton, FL: CRC Press, 1995.

Click here for more information about G. Douglas Andersen, DC, DACBSP, CCN.

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Dynamic Chiropractic
What concerns you most about physical therapists performing spinal manipulation?
Aren't adequately trained to do so
Reduces our potential patient base
Affects our standing with insurers
Reduces referrals from MDs
Compromises our "uniqueness"
Other
It doesn't concern me at all
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