High Blood Pressure and Tai Chi Therapy

Way back in 2003, the Journal of Alternative and Complimentary Medicine's Oct. 9th issue reported a study finding that Tai Chi "could decrease blood pressure and results in favorable lipid profile changes and improve subjects' anxiety status. Therefore, Tai Chi could be used as an alternative modality in treating patients with mild hypertension, with a promising economic effect." This study laid out a way to save our society, perhaps billions of dollars annually, and possibly save some patients with mild chronic hypertension the potential negative side effects of chronic lifelong medication. However, this largely hasn't occurred.

I caught a glimpse why when I was staying in the beautiful mountain town of Otavala, Ecuador, with a woman known for her knowledge of traditional Indian medicines. A tour of young American medical students stopped here to listen and learn from the Indian woman's tour of her herbal gardens. As I followed them, I asked a group of young bright medical students if they were aware that Tai Chi was found to reduce high blood pressure. One lovely young woman replied, "Oh, yes, I've heard that, but I would never prescribe it."

I asked why, and she responded that she couldn't because she didn't know if it would work. Although Tai Chi studies do show that Tai Chi indeed helps lower high blood pressure, it is true that it does not reduce it in every person. However, it is also true that every drug prescription does not work on every person either. I suggested to the young medical student that she consider that many times I've been to the doctor, and he's pulled out a prescription pad and explained, "Let's give this a try, and see how it works for you, and if it doesn't do the job, we'll try something else." Most of us are familiar with this, and by the confused look on the student's face, I'm assuming her memory banks were bringing up similar images.

So, why are our medical universities giving students the impression that they should not be prescribing Tai Chi, since we know it can help lower high blood pressure for many, who if it is successful with them, can enjoy a lifetime free of chronic and costly medications? And not only do that, but offer a plethora of GOOD SIDE EFFECTS including a stronger immune system and healthier respiratory system. This is a deep and important question we need to be asking as patients and consumers, and health professionals must begin asking this question regularly in order to fulfill the duties of their Hippocratic oath. For, today we have even a much better understanding of Tai Chi's potential than we did a few years ago, so ignorance or inconclusive data is not an acceptable explanation from our medical universities that train our future doctors, without teaching them about Tai Chi research, and what it portends for their future patients.

Today, we are clearer on exactly why Tai Chi is such a powerful therapy for high blood pressure sufferers. In a March 17, 2005, article by the Mayo Clinic staff posted at mayoclinic.com they lay out what a "stress response" is, and the effects it has on the body. This is at the core of high blood pressure problems and the physical changes chronic stress responses illicite that creates or aggravates hypertensive conditions.

In their article, they explain that a stress response, or "fight or flight" reaction involves our pituitary gland releasing adrenocorticotropic hormone (ACTH), which sets a domino effect signaling other glands to produce additional hormones, such as adrenal glands which flood the blood stream with stress hormones, such as "cortisol" and "adrenaline."

When ordinary life's daily frustrations trigger this effect over and over again, the results can be damaging to the mind and body. Many of us experience this domino effect of triggers and hormones daily, which is why about 1/3 of Americans, or over 90 million Americans, suffer from high blood pressure.

Cutting edge scientists like Dr. Herbert Benson, President of the Mind/Body Institute at Beth Israel Deaconess Medical Center in Boston, are discovering a stunning reality through their research. In a wonderful article by Jeanie Lerche Davis at WebMD Medical News entitled The Mysterious 'Medication' of Meditation (http://my.webmd.com/content/article/25/1728_

57992.htm), she writes of how such researchers are discovering that "meditation can indeed be medication - creating long lasting physiciolgical effects that reduce high blood pressure and even help unclog arteries to reverse heart disease."

Dr. Benson, who is also associate professor of medicine at Harvard Medical School, sought to prove how this effect could be shown objectively, and had five long-time meditation practitioners take MRI brain scans while meditating. Dr. Benson informed WebMD in the aforementioned article by Davis, "There was a striking quietude across the entire brain which was documented through MRI . . . The areas of the brain that became active from that quietude were those that control metabolism, heart rate, etc., . . . We knew meditation caused a relaxation response, but we couldn't prove it. We knew that if you thought in a certain way, with repetition, that physiologic changes would occur in the body. Here now is proof that mind, in the form of repetition, is affecting the brain, which affects the body . . . "

Stroke Magazine reported on a study funded by the National Institutes of Health, conducted by Dr. Amparo Castillo-Richmond, from the Maharishi University, more specifically on high blood pressure afflicting black people. The meditating group saw a reduction in the thickness of one of the arteries that supplied blood to the brain. Which indicates that blood flow is increasing. The group only using diet and exercise saw their artery walls getting thicker, which indicated that less blood was flowing through to the brain. This finding led Dr. Castillo-Richmond to make the profoundly exciting assertion, "It's possible to reverse heart disease through meditation."

In fact, not only hypertension, but up to 90% of other illnesses sending us to the doctor are being caused by stress, according to Dr. Herbert Benson. Which makes Dr. Benson's and Dr. Castillo-Richmond's findings that meditative techniques can so dramatically alter our stress producing "fight or flight" response in healthy ways even more wonderful.

Dr. Benson explains, that the relaxation response triggered by repetitive forms [like tai chi, yoga, etc.] can result in decreased metabolism, heart rate, breathing rate, blood pressure, and also slower brain waves." Benson asserts that it is the repetitive nature of acts like praying the rosary, yoga, or tai chi's physical repetitive muscular actions that provides the profound hope for reducing anxiety, mild and moderate depression, anger and hostility, hypertension, cardiac irregularities, and all forms of pain, which are made worse by stress.

This concept of Tai Chi being an effective tool for reducing or even avoiding incidence of high blood pressure or other illnesses all together, is echoed elsewhere. Mayoclinic.com also recommends Tai Chi for relaxation training in an article entitled, "Relax: Techniques to help you achieve tranquility" which also explains why relaxation is important and what you might experience by practicing tools that will help you relax.

They detail how you can improve body responses to stress, such as: Slowing your heart rate; Reducing blood pressure; Slowing your breathing rate; Reducing the need for oxygen; Increasing blood flow to the major muscles; Lessening muscle tension.

They go on to explain that practicing relaxation techniques may help you experience: Fewer symptoms of illness, such as headaches, nausea, diarrhea and pain; Few emotional responses such as anger, crying, anxiety, apprehension and frustration; More energy; Improved concentration; Greater ability to handle problems; More efficiency in daily activities.

So, time and time again as we begin to examine one particular benefit of Tai Chi, such as lowering high blood pressure, we see a whole universe of potential opening up before us.

An article from Archives of Internal Medicine, as reported on NBC's local WCAU Health (http://wcau-tvhealth.ip2m.com/index.cfm?pt=itemDetail&Item_ID=112735&Site_Cat_ID=77) explained a Tai Chi research program at Tufts-New England Medical Center in Boston revealed a great deal. The article authors wrote, "Overall, these studies reported that long-term Tai Chi practice had favorable effects on the promotion of balance control, flexibility and cardiovascular fitness and reduced the risk of falls in elders . . . Cardiovascular and respiratory function improvements were noted in healthy people and those who had undergone coronary artery bypass surgery as well as people with heart failure, hypertension, acute myocardial infarction, arthritis and multiple sclerosis . . . Benefit was also found for balance, strength, and flexibility in older subjects; falls in frail elderly subjects; and pain, stress and anxiety in healthy subjects." They add the actual ways that Tai Chi provides these benefits are not well known.

The fact is that less than .5% of the National Institute of Health's budget goes to research alternative therapies, leaving yoga, meditation, tai chi, massage, herbal therapy, aroma therapy, and the entire massive field of alternative health systems to struggle over .5%, or a little over $100 million of the $28 billion (approx.) annual budget. Given the above studies, it boggles the mind that such a small portion of the health research dollars are going to Tai Chi.

To recap, about 1/3 of the American population suffers high blood pressure. Tai Chi is proven to be a beneficial therapy that not only has no bad side effects, but dramatically improves immune function, respiratory function, lowers the incidence of anxiety and depression, and profoundly improves the balance of practitioners. Tai Chi does more, but for our purposes here these profound realities are enough to show exactly why it is truly unbelievable that Tai Chi is getting so little scrutiny in medical research dollars, when it can save so many from chronic suffering and perhaps some from a lifetime of chronic costly medications.

It is time we all began to ask the question that all good consumers should ask, "What is the best way/product for my health?" If Tai Chi is that product, the next question is, "Why isn't every physician offering it as an option to their patients with hypertension, as a prescription?" "Why aren't all insurance policies covering such prescriptions for Tai Chi?" Ask and ye shall receive. We must become informed and demanding health consumers, in order to get the best health options available.

This article does not advocate self-treatment, and encourages all to make health choices in conjunction with their physician. However, if your physician is close-minded to anything but a certain group of health options, even when research indicates your choices may be wider, than it is time to have a good talk with your physician about possibly widening your options.

Copyright 2005 Bill Douglas

Bill Douglas is the Tai Chi Expert at DrWeil.com, Founder of World T'ai Chi & Qigong Day (held in 50 nations each year), and has authored and co-authored several books including a #1 best selling Tai Chi book ?The Complete Idiot?s Guide to T?ai Chi & Qigong.? Bill?s been a Tai Chi source for The Wall Street Journal, New York Times, etc. You can learn more about Tai Chi & Qigong, and also contact Bill Douglas at http://www.worldtaichiday.org

Physical Therapy And Reimbursement - Where Are We Heading?

The professions of Physical Therapy and Rehabilitation have always been professions of healing, caring and educating. In the past 10 years, we have had to adapt and advance our professional therapeutic skills to include a dual specialty of therapist and reimbursement coordinator and manager. We enter the profession of therapeutic rehabilitation to heal our clients and provide education. We are now experiencing an ever-increasing demand on our time to complete extensive documentation required by multiple insurance companies.

The amount of reimbursement received for Physical Therapy services has remained largely flat over the past several years. In the same amount of time, the amount of required documentation has exponentially increased in volume as well as in complexity. The increase in documentation requirements, with a relatively flat level of reimbursement, does not keep pace with inflation. This effectively lowers the cost of reimbursement even further. These factors combine to produce lower levels of professional productivity due to extensive documentation time, and increased cost for additional office staff to support claims processing. The end result is working harder for less profit.

The National APTA Medicare Fee Schedule Calculator provides average reimbursements for CPT codes from 2000 to present. For a PT evaluation (97001) in upstate New York reimbursement rates have ranged from a low of $60.79 in 2000 to a high of $73.19 in 2005 and have continued to fall since that time. With reimbursement rates decreasing, paperwork increasing and increasing costs of malpractice, unemployment, disability, and workers compensation insurance for private practices, where do we go to improve the efficiency of our practices and get back to what we were trained to do? Treat patients!

Many organizations and data management companies have designed software programs for the end user offering electronic medical records and scheduling. Others offer evaluation forms and Billing/Claims/Account management systems. What becomes evident while researching these software systems is two things:

a. Software packages are aimed at improving the workflow within an office or office system that must then be managed by the provider. The full responsibility of the success of the system is placed back on the Physical Therapy Practice owner and/or the office staff, which must be hired to manage, support and facilitate the system.

b. Each software system is only as up to date as the date it was published or downloaded. With insurance regulations changing on a regular basis, the practice owner must again manage processes to update EOB's, CCI edits and new memorandums released by multiple insurance companies to assure complete and timely payments.

An internet based system with real time integrated billing management, claims processing, automated coding and reimbursement regulations is a necessary tool in getting the therapist back in the clinic and getting paid in a timely, efficient and effective manner. This process must be a shared, long-term relationship allowing the therapist to do what we are trained to do; treat patients and let the practice management solution do what it is designed to do:

o process claims faster than the national average

o provide quick access to AR and claims processing and management

o facilitate documentation to assure clean claims processing

o reduce the risk of audits with streamlined documentation

As Physical Therapists we must seek practice management systems which provide expert web based billing, coding and reimbursement solutions with an electronic medical record and scheduling capabilities. As Practice owners this will allow us to focus our efforts and expertise on improved professional staff productivity, decreased documentation time, reduced complexity and ambiguity which has existed in the PT billing and reimbursement process for years, and get back to doing what we do as Physical Therapists...client care and rehabilitation.

Gerilyn M. Gault, BSPT, is co-owner of the rehabilitation company http://www.gandetherapies.com and Account Specialist for Billing Dynamix. Gerilyn is an advanced neurological clinician with years of experience in professional staffing, contract and fiscal management. She invites you to visit http://www.billingdynamix.com/ Service and Practice Management Software for Physical Therapy and Rehab Offices to learn more about responsible billing and reimbursement practices.

Hormone Therapy Plus Radiation Therapy Produce Better Survival Outcomes

Recently, there has been numerous study reports published that address the benefits of Hormone therapy combined with Radiation therapy in treating prostate cancer. This article wishes to provide readers some helpful updates with regards to the new standard treatment for prostate cancer.

In 1995 to 2005, a randomized study was jointly conducted by the National Cancer Institute of Canada, the United Kingdom Medical Research Council and the Southwest Oncology Group in the United States. 1,205 men with high risk prostate cancer in the United States, Canada and in United Kingdom were part of the study. These men were assigned with either receiving hormone therapy alone or a combined hormone therapy (with external beam radiation treatment). Follow ups were made among patients for an average of at least 6 years and findings from this study presents that adding radiation therapy significantly reduced the risk of death among the study group given with the combined therapy.

In another study report published by Bolla et al from an EORTC study in 1997 showed an increase in the probability of a progression-free and overall survival of European patients diagnosed with a locally advance prostate cancer high risk (T1-2 and T3-4NO-1MO) tumors. Patients who were given external beam radiation therapy plus an adjuvant hormonal therapy for three years showed an increase in survival rates compared to the patients who received external beam radiation therapy alone. Additional data from the American studies show similar results. According to this study, two to three years of hormone therapy combined with radiotherapy improves survival among patients but is accompanied by a number of adverse effects such as impotence, hot flashes and risk of acquiring heart attacks.

Horwitz et al reported a US study (RTOG 92-02) in 2008 that radiotherapy plus extended adjuvant hormone therapy for 28 months increased the probability of the disease-free survival and disease-specific survival rates among its study group. The group who received a combined therapy obtained a lower probability of a local progression of the prostate tumor and biochemical failure rates were also lowered. The combined therapy prevented further metastasis (spread) among its study group compared to the radiation therapy group. Overall the survival rates in this study showed an increase rates among patients with a pre-treatment Gleason score of 8-10 with no metastasis to the lymph node or the pelvis with a PSA level of 150 ng/ml and below.

Prostate cancer is believed to be caused by an exposure to the male hormones testosterone. An increase in the testosterone levels in the body stimulates prostate cancer cells to grow. Hormone therapy is given to patients diagnosed with prostate cancer as a means to decease the testosterone levels in the body, it is also referred as the Androgen Deprivation Therapy (in which production of male hormones are prevented). Radiation therapy is given to directly kill and destroy the cancer cells by using external beam radiation.

Numerous studies conclude that combination of hormone therapy plus radiation therapy promotes good survival rates. Hormone therapy helps by reducing tumor growth. It also potentiates killing of the cancer cells when combined with radiotherapy.

Urieashashlu Ul is an experienced prostate cancer health expert who has been helping people with prostate cancer. You can visit his site to learn more about the prostate cancer treatments.