resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
An Integrated Approach to Chronic Pain
Findings from a unique Medicaid pilot project in Rhode Island involving high-use Medicaid recipients from two health plans were recently presented to the state's Department of Health, demonstrating stellar outcomes with regard to medication use, ER visits, health care costs and patient satisfaction.
Eczema & Acupuncture: A Sound Solution (Part 1)
Eczema affects approximately 3.5 percent of the global population and is one of the most common skin complaints seen by dermatologists.
Balancing Spring Challenges
As the winter months come to a close and warmer spring weather appears, patients may begin to present with new challenging pattern presentations.
Taking the Chiropractic Message to the Press
"There is no better place on earth to have a news event," the National Press Club boasts, and it's easy to understand why: Every year, the 108-year-old Washington, D.C.-based organization hosts countless press conferences on the hottest topics impacting America and often the world.
Bill With Confidence: Learn What to Collect
Q: I am trying to understand what I may collect from my patient when there is insurance. Do I have to accept the amount allowed by the plan or may I collect up to my billed amount? Please note, I am not a member of any insurance plan.
New Relationships, Old Trauma: AOM & Other Healing Strategies
Being in love is one the most beautiful and enjoyable experiences. Most of us are willing to pay almost any price to have that experience, and still often find it elusive or fleeting. Navigating the ups and downs of loving relationships are often challenging — even for the most psychologically balanced among us.
Clearing Blocks: A Way to Improve Cosmetic Acupuncture
As a Five Element acupuncturist who teaches facial acupuncture classes nationally, I was surprised to learn that one of the basic principles I was taught in school is unfamiliar to most acupuncturists.
Is It Time to Rethink Mental Illness? (Pt. 1)
Invariably, patients will ask their chiropractor about depression or various mental illnesses. Some practitioners will reflexively offer a cervical adjustment, suggest St. John's wort or contemplate a referral to a specialist.
A Daily Strategy for Heavy-Metal Detox
In modern society, we are constantly exposed to heavy metals such as cadmium, lead and mercury. These heavy metals have no essential biochemical roles in our body, and conversely, can cause us a great deal of harm if they build up to toxic levels.
The Visual Error Scoring System: A Concussion Tool
Postural stability and oculomotor function are the most easily recognized physical indicators of neurologic motor dysfunction associated with concussions.
News in Brief
ACA Adopts New Governance Model; ACA 2017 Awards; CCA Helps Calif. DCs "Share the Love"; $1 Million to Help Advance the Profession; D'Youville Raises the Bar on Anatomy Education; ErRatum.
An Unexpected Diagnosis: The Result of Lacking Communication
A couple years ago I had a case that showed me the importance of open communication between health practitioners. We need to show up with less fear, and let go of our judgments so we can do better for the patient.
Women's Hormones: A Western & Eastern Perspective
Sometimes it may seem that you require a degree in medicine to understand hormones and how they function.
Raditation & Your Smartphone: Is it Worth the Risk?
If radial arteries could talk (and in my experience they can to some extent), they would say, "Step away from the smartphone." At least that is the message I am receiving loud and clear as I feel the pulses of many patients.
Universal Design: Principles & Practice
In many respects, universal design serves as the core of ergonomics. It's also a good tool to use when designing a return-to-work program for injured and/or ill patients. Let's take a closer look at universal design and why it should matter to you and your patients.
Is the New Medicare Reporting Exemption Right for You?
What you've heard is not a rumor – there will be exemptions for providers of Medicare patients, with no penalties assessed for offices that do not do Quality Payment Program (EHR, PQRS, MACRA and MIPS) reporting.
A Major Role in Back Pain: The Multifidus
Back pain affects roughly 80 percent of the population at one time or another and is one of the leading causes of doctor visits.
Why I Quit Doing House Calls
My father was a chiropractor who did house calls, so when I became a DC, I figured doing house calls was part of the job. My March article recalled my experience as a small boy, accompanying my dad while he went to patients' homes to treat them.
Creating Good Business Buzz
What do patients really think about working with you? Rarely do you hear the whole truth. Those who improve may be candid in their gratitude.
February, 2005, Vol. 05, Issue 02
An Obscure Side-Effect of Obesity
By John Upledger, DO, OMM
The sad passing in December of future NFL hall-of-famer Reggie White illuminates an obscure side-effect of obesity that also gives us some fascinating insight into the human body. White, who died at 43, topped out at weights exceeding 290 in the course of his career.While the results of his death weren't conclusive at the time of this writing, the coroner cited sleep apnea as having played a possible role.
Not to be confused with central sleep apnea secondary to brain dysfunction, White's type of sleep apnea is most common among men of large body mass. Like snoring, this sleep apnea is often secondary to the fatty enlargement of tissues in the nasal air passages at the back and upper areas of the throat. These patterns are generally characterized by gasping inhalations followed by long pauses during which there is little or no exchange of air via the airways into the bronchi and lungs.
Let's dig into the subject a little deeper and see what's behind all this. Involuntary respiration is controlled by nerve cells/neurons in the medulla oblongata located in the skull just above the upper end of the spinal cord. These nerve cells get their instructions from the pons, which is higher in the brain. The pons gets its information from several other brain centers then sorts out all the little details to develop regulations for breathing. I suspect some of the pons' incoming messages originate in the fat-enlarged tissues of the nose and mouth airways. These messages may then cause the pons to periodically hold back normal rhythmical inhalations.
Taken to the extreme, respiratory arrhythmias secondary to abnormally fatty tissues can take sleep apnea to the point that increased back pressure in the lungs can produce some degree of right-sided heart failure. The result is cyanosis, a bluish discoloration of the skin and mucous membranes that first appears in nail beds and lips. The discoloration comes from a reduced level of oxygen in the blood secondary to the compromised breathing that began with snoring and sleep apnea.
Now let's look at a molecule called "nitric oxide" (NO). This gaseous substance is attracted to lipid (fat) molecules. It is moderately reactive compared to inert gases such as helium, neon and argon, which do not react with other atoms, ions or molecules. What nitric oxide does within our bodies is remarkable. It has a great deal to do with the flow of blood through our vascular systems. With every heartbeat, a puff of nitric oxide gas is released from the endothelial cells where a great deal of it is stored. Endothelial cells line all our blood vessels, including arteries, veins, arterioles, venules and capillaries. So nitric oxide is released in some amount in every blood vessel.
The process by which nitric oxide causes blood vessel relaxation and dilation is somewhat complicated. It goes something like this: The puff of nitric oxide that's released from the endothelial cells of the blood vessels goes directly to the red blood cells (RBCs) where the nitric oxide molecules become attached to hemoglobin (Hb). The nitric oxide remains attached to the hemoglobin as assessments are made regarding how much oxygen is available to the body for its cellular needs.
Low oxygen levels cause more nitric oxide to be released from the hemoglobin. Higher oxygen levels cause hemoglobin to retain a higher percentage of nitric oxide. That makes good sense. When oxygen is low, nitric oxide causes blood vessels to dilate and deliver more blood to the tissues to increase the amount of oxygen getting to the cells. Incidentally, as cells take in available oxygen, most of it goes to intracellular mitochondria. There are thousands of mitochondrial organelles in the cytoplasm of each cell. The mitochondria make the energy that's required by every cell.
Back to our nitric oxide molecule travels. As nitric oxide is released by the hemoglobin, it emerges from the RBC after combining with the amino acid "cysteine" to form S-nitrosothial. In this form, nitric oxide will not be reattached by the hemoglobin as it travels through RBC cytoplasm. The nitric oxide is ushered out of the cell by specific proteins attached to the RBC membrane. It then enters the blood serum and the endothelial cells where the molecules are stored as nitric oxide. When it's time for the blood vessel to dilate, the nitric oxide goes to the smooth muscles in the blood vessel walls and causes the muscles to relax. This relaxation allows the blood vessels to dilate and pass more blood at a lowered blood pressure.
What does all this have to do with obesity? It was recently discovered that our paranasal sinuses produce a lot of nitric oxide. When nitric oxide is inhaled through the nasal airway, it gets into the lungs and increases the amount of oxygen that gets into the blood that is circulating through the lungs. The clearer the nasal passages, the more nitric oxide will be inhaled into the lung tissue. Hence, the more efficiently the oxygen will be absorbed via the lungs into the body vasculature, which then delivers the oxygen to all body cells.
Obesity often causes sleep apnea and snoring, which indicates a blockage of nasal airways. The nitric oxide delivery to the lungs then is reduced, as is oxygen absorbed through the lungs. Lowered oxygen levels in the body signal that the tissues need more blood to supply the oxygen. The physiological response is to raise the blood pressure to increase blood flow and improve oxygen supplies to tissues. Hence, high blood pressure occurs because nitric oxide isn't getting into the lungs effectively.
Hopefully, the passing of Reggie White will wake others up to a lesser-known but potentially deadly side effect of obesity.
Click here for previous articles by John Upledger, DO, OMM.
Join the conversation
Comments are encouraged, but you must follow our User Agreementcomments powered by Disqus
Keep it civil and stay on topic. No profanity, vulgar, racist or hateful comments or personal attacks. Anyone who chooses to exercise poor judgement will be blocked. By posting your comment, you agree to allow MPA Media the right to republish your name and comment in additional MPA Media publications without any notification or payment.