Forum Replies Created
-
Posts
-
Kelly-
I would not think that lipedema would be contraindicated. Although the mechanism is unknown, I don’t think there is anything about it that would be contraindicated. I would check with the MD to make sure there are no underlying issues and that he/ she is on board with its use.
Hope that helps-
SueHi Robert. I would say i have more questions than answers at this point.
1) Has the patient had these seizures worked up? Is he have breakthrough seizures despite medication? If so, headaches may be symptoms of the neuro imbalance and may be best treated by medication adjustment.
2) How regulated are the seizures?
3) Have you taken advanced course work? If so, have you tried suboccipital and or typical needling from SFDN1? How was that tolerated?
4) There are reported cases of people with seizures having more seizures with needling. The concern here is if they have a seizure with needles in, is there a plan to get them out quickly and safely? Have you thought thought the emergency action plan to have in place in case one occurs while needles are in? I do know of a case that someone had a seizure while on the table, needles were gotten out safely, however the patient fell off the table and sustained a concussion.All of that said, it isn’t that you CANT needle someone with seziures, I would just consider your experience, both clinically and with needles, and take all things into consideration. Not as cut and dry as yes or no. Hope that helps.
SueJessica-
this is not my area of expertise at all so I am going to defer on this answer. Have you done a lit review yet on this? I would proceed with extreme caution, do a lit review, know blood markers and speak to the doc who has way more experience than I. I am sorry I am not of much help here. Hoping on of our colleagues jumps in here who has more experience with this population and diagnosis.
All the best-
SueDeep needling in this population is contraindicated as you don’t know if you will create a bleed, and thus be able to control it.
I personally would not needle to the depth of piriformis. But that doesn’t mean more superficial needle wouldn’t be helpful. I would start with short, 1/2 needles and see how it is tolerated. If they bruise with that, then I would not increase needle depth. I would “maybe” go to 40mm of a 50mm needle, depending on their reaction to shorter needles and use very thin needles (maybe .22). Again, this is a very general answer and you will need to see how they tolerate it, always with compression upon each needle removal.
Hope that is helpful!
SueHi Malcolm!
I am so sorry for the delay here but I am unfortunately not going to be of much help here. I don’t have any experience with this population and needling. Hoping one of our colleagues jumps in with some experience on this.
Hope you are well!
SueHi Craig-
I have Mercer as insurance and the dry needling stuff hasn’t been an issue. More of an issue that I treat pro athletes. But i haven’t found needling to be a barrier. I would suggest calling your liability insurance to make sure dry needling isn’t EXCLUDED in your policy. That is more important than being specifically included, from what I understand. That is not legal advice, but general professional advice. Good luck and let us know if you find out something helpful!
SueHi Gwen! Sorry for the delay here. Based on what you have written, I don’t have any issues inserting needles at the partial tear of the hammy. I would treat as you have outlined! Hope that is helpful!
SueHi there! I have not needled someone this young, but know colleagues who have successfully. If they are willing and able to sit still for you, age (in and of itself) is not a contraindication. Biggest thing is obviously parental consent along with the child understanding what is happening. The neck and upper trap are obviously precarious areas so be sure to take that into account of your decisions and of course…only do techniques you are trained in. Hope that helps!
SueHi Craig-
I checked around on the usage of that code with some clinic owners I know in AZ and CA. While yes you can bill that code, sounds like insurance companies are not really paying it.Not sure about AT services being billed in CA. Haven’t heard anything new there.
Anyone else?
Sue
I had to look that one up, Robert! I love the Arthrex videos! I use them all the time in my surgical class at AT Still.
Anyway, ugh, that is a tough one. I would needle at the AC joint (just 1/2″ needles”) for some pain control and then muscle wise, I would go posterior cuff (infra and supra like we did in class) and the in and out technique at the lat/ teres, as we demonstrated in class. You could always go anterior/ posterior glenohumeral joint as well and attach estim for pain control, if there are no contraindications there. I do that in side lying, with the patients are very supported so it doesn’t fall forward or backward during treatment. You may or my not feel comfortable with that as depending on who you took class with and when, we may not have shown that technique. But it’s a thought.
Hope that helps! Good luck and keep us posted!
SueHi Ashlee-
More follow up here. A couple of instructors weighed in on this and without significant experience treating this population, they were also hesitant. specifically due to the significant anatomy changes that are made with such extensive lymph node removal. Sounds like the overall feeling from the team is great hesitation.All the best-
SueHi Ashlee-
Sorry for the delay here. We were all discussing it and there is not a clear cur answer here. A few things to consider:1) Is the anatomy changed at all from surgery and radiation. If so, you may want to reconsider needling
2) Have you talked with the referring doc? If not, a phone call is in order to see if there are any concerns
3) Have you talked with the patient and they have given informed consent, understanding the risks of infection, altered anatomy, potential uncontrolled or increased edema, etc? If not, I would reconsider needling.
4) Is blood work,including CBC, WBC, etc all normal?Ultimately there are a lot of unknowns here. He has a compromised lymphatic that simply may not be able to handle the stress of needling in the area. A great conversation with the doc and allowing the patient to understand the unknowns are paramount in this situation.
I don’t see this population, therefore personally I would not needle this person, even with my fairly extensive experience needling. I would proceed with extreme caution, and great communication, no matter which way you decide to go as a clinician. I would also do a great lit review and see what the literature is suggesting. Not an area I spend my time reading on, but would be worth a great lit review, no doubt.
I know that is not the “yes or no” answer you were most likely looking for. A lot to consider.
SueHi Dan!
I use DN for recovery all the time, in and out of a team setting (I haven’t been in season with a team for about 2 years but did all the time when I was).We go over this protocol specifically in SFDN2 as well as we just released a DN for Recovery and Regeneration on our new online platform!
https://structureandfunction.net/info/online-education/dry-needling-for-recovery-and-regeneration/
Hope that helps!
SueHi Kristen!
I would be careful with compartment syndrome. the only things Brian and I have found are these studies that showed adverse events and safety issues, and causing compartment syndrome in diabetic and blood thinner patients.I think needling musculature would be fine but not deep needling into the compartments. Hope that helps!
SueSmith, D L, M H Walczyk, and S Campbell. “Acupuncture-Needle-Induced Compartment Syndrome.” Western Journal of Medicine 144, no. 4 (April 1986): 478–79.
Shah, Nasir, Caroline Hing, Keith Tucker, and Robert Crawford. “Infected Compartment Syndrome after Acupuncture.” Acupuncture in Medicine 20, no. 2–3 (August 1, 2002): 105–6. https://doi.org/10.1136/aim.20.2-3.105.
Bergqvist, D. “Vascular Injuries Caused by Acupuncture.” European Journal of Vascular and Endovascular Surgery 36, no. 2 (August 2008): 160–63. https://doi.org/10.1016/j.ejvs.2008.04.004.
Hey Rachel-
Given that she had one infection 10 years ago and no other complications/ issues or anything since, I would have no more concerns for this person than any of my other patients. Clean field, clean hands, gloves, sterile needles, etc.Hope that is helpful!
SueHi Adrienne-
I am so sorry but I do not have any experience with this diagnosis. I looked at the pathophysiology quickly but would need to do more reading. Have you done a lit review with this diagnosis and DN or acupuncture? Might be something in the acupuncture literature to help direct you. What does the physician think? I would definitely have a discussion there to get their thoughts, as I just don’t understand the disease process well enough to offer you insight and guidance. I am sorry I am not of much help here. Hoping one of your colleagues has some experience here they can share.
Keep us posted if you find anything out.
All the best-
SueHi Taryn!
We don’t have a video ready for you but we are working on getting videos uploaded into some type of usable format/ app/ backend thing. Things we are working on for 2020!In the mean time, be sure to check the power point and let me know if you have any specific questions. Biggest thing is identifying the femoral artery (and avoiding it). Stay below inguinal ligament and find the boarders of the adductor longus and sartorius to orient yourself to where you are. Let me know what specific questions you have.
Sue
Hi Robert!
Sorry I was having some technical difficulties! I touched base with our resident LPH instructor, Tonya. Her response is below. We go over stuff like this in the LPH course. Not to offer a shameless plug for that class but it is coming up at the end of Sept in PHX! Most of her suggestions are advanced techniques with a decent risk of injury if not trained in how to perform them, so I would not attempt to do anything you have not been trained in.
Sue“So very unlikely that it is a lateral femoral cutaneous nerve injury. Usually I see genitofemoral or obturator nerve with this surgery and his is right it is usually due to positioning. I would check the cremaster reflex for genitofemoral and find out if there is any testicular discomfort, possibly femoral branch but atypical. I don’t think needling around the spine will help but he could try anterior hip, and lesser trochanter. Needling Obturator foramen will have the best outcome (we go over this in LPH).”
Hi Christine!
Interesting case for sure. Have you tried needling the quads? Maybe L3/ L4 spinal segment? Primary passive trigger points for the LE for sure (not sure if you know those from Foundations? But the IT band, common peroneal, deep peroneal, saphonous, tibial.
Check out the Dunning paper from 2018. Even though he is not an OA patient, may give you an idea. I would try this and see if it is helpful from a pain standpoint.
Just some thoughts. Keep me posted!
Hey Shelly!
What part of the US are you and your patient in? If we have someone local or close, we can refer her there. If not, we can loop in Tonya Bunner, who teaches this class and content and see if she is accepting new patients in Tucson, AZ.
Let us know!
SueHey Robert-
Any time there is a joint replacement, I would be very cautious with needling the actual joint. I would make sure the MD is on board, patient understands the risk (a few case reports of infection and needed revisions in hip patients. These are usually case studies but there is still some evidence.).
If the doc feels like it is helpful, patient is willing to accept the risk and you decide to proceed, I would take extra caution for clean technique, including cleaning the skin and possible use of sterile gloves.
Risk is lowered if you stay away from the joint and focus on surrounding musculature which may be helpful as well, while lowering your overall risk.
Hope that is helpful! Sorry for the delay here! Some back end computer issues so just seeing this!
All the best-
SueHere you go! The lift technique is for if you want to do it prone but I tend to do this technique more often and it is in side lying with the affected side down. Wing the scap out. And head towards the medial boarder of the winged scap. Drop the needle handle to the thorax so needle tip is away from the thorax.
**disclaimer…if you have not taken SFDN2 PLEASE do NOT attempt this technique. It is an advanced technique and needs proper instruction to perform safely. There is a high risk of a pneumothorax if performed incorrectly. video is for SFDN2 participants only!! **
Hey Luke!
I would needle anything related to the cervicogenic component portion of the concussion. So from the Foundations course stand point: cervical paraspinals and fascial points on the skull, upper trap. Potentially the temporalis and frontalis as well.
We teach other things in the advanced class, like scalenes, suboccipitals, levator and will teach those things in the soon to be announced cervical thoracic class as well.
But with SFDN1 you shoul dbe able to needle cervical paraspinals, fasdcial points in the head, some face and upper trap and if those are involved, will help for sure.
Hope that helps!
Sue
