resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Essentials of Assessment: The Squat
The squat is a simple, fast and functional tool to evaluate patient symmetry and function. As simple and easy as it is to implement, it can yield considerable amounts of valuable, clinically relevant information.
Recording and Appropriate Billing of Timed Physical Medicine Services
There is a common misunderstanding about timed therapy services and although you do have some knowledge of timed service documentation, based on your comment on the 8-minute rule, your understanding is correct, but incomplete.
The Rest of the Patient Story
I've written previously about allowing a patient to tell you their story – about taking the time to listen and engage all the aspects of their case history, the injury in question, and the related issues.
Transparency is Key at ASA First Annual Meeting
On March 4th and 5th the American Society of Acupuncturists (ASA) held a successful first annual meeting in Albuquerque, New Mexico.
Asking Patients the Right Questions
When was the last time you asked a patient a question? Maybe 30 seconds ago? But, are you asking the right questions to elicit valuable and useful information? As a healthcare provider, you've likely spent hundreds of hours learning to ask the right questions to gather critical health information from your patients.
News in Brief
A Moment of Silence for Dr. Stephen Press; New ACA President Elected; F4CP Offers New MemBership Benefit.
Health and Wellness Partnership
Yo San University of Traditional Chinese Medicine and The Wellness Center at the LAC + USC Historic General Hospital recently joined forces to extend care to the residents of Boyle Heights area of Los Angeles.
How to Find and Fix TL Nerve Impingements
The thoracolumbar junction (TLJ) and the peripheral sensory nerves that exit from it are frequent, important and rarely recognized sources of lower back, pelvic and hip pain. Let's outline a clear exam protocol for diagnosing the problem.
Building Relationships and Referral Networks with Allopathic Practitioners
Dr. Doug, an orthopedist of 20 years, had heard stories from patients who tried acupuncture. While he was able to address many of their complaints effectively, some appeared to gain additional benefit when their care included TCM.
Filling the Gap: The Role of Alternative Practitioners in a Broken Health Care System
I have been asked many times what got me into alternative medicine. My answer is simple: I want to truly help and make a difference in people's health.
Constructing Our Reality: The Primary Channels and Perception, Part 1
My favorite topic of discussion within Chinese medicine is the acupuncture channel systems. First of all, each of us have them. They are part of our bodies; not something external to us. To learn about the acupuncture channels is to learn about ourselves.
An Interview with Amanda Shayle
JW: Can you share with us some of your history and how you became an acupuncturist? What did you do prior to becoming an acupuncturist? Where did you go to school?
The Power of Eccentric Exercise: Hamstring Injury Prevention and Rehab
For almost 20 years, I've worked with professional athletes who make a living by running really fast. It goes without saying that hamstring injury (HSI) prevention and rehabilitation is a big part of what they expect from a sports chiropractor.
The Art of Listening
One of the most important clinical concepts for me was voiced by the legendary physician William Osler. "Listen to your patient, he/she is telling you the diagnosis." After treating literally thousands of patients, it can become almost second nature to quickly discover clues which reveal the underlying diagnosis.
NCCAOM Launches New Membership Organization
The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) recently launched a new national membership organization, the NCCAOM Academy of Diplomates.
Roots in the Community, Branches Far Beyond
The Jung Tao School of Classical Chinese Medicine (JTS) was founded in 1998 by Sean Christian Marshall in Sugar Grove, North Carolina, a small community near Boone in the state's westernmost mountains.
Business Lesson #1: Adapt or Else
My wife and I recently enjoyed an excellent meal at a restaurant recommended by some friends. We often have concerns about restaurant recommendations, as many have been disappointing.
The Value of Melatonin in Breast Cancer Prevention and Adjunctive Treatment
Although melatonin (MLT) is best known for its sleep-aid properties and as a natural remedy to prevent jet lag, extensive experimental studies suggest it possesses anticancer activity through several biological mechanisms.
Energy: For Life and For Death
Energy is a deep topic in Traditional Chinese Medicine. Qi is understood to underlie all of existence, animated or not, and the qi of the living is studied with special attention.
Musculoskeletal Disorders Take Center Stage
Looking for the latest on the musculoskeletal pain epidemic and the increasing premium placed on preventive strategies including chiropractic? Check out The Impact of Musculoskeletal Disorders on Americans – Opportunities for Action.
Vitamin D Fails to Help Knee OA? The Proper Perspective
The March 8, 2016 issue of JAMA includes a study about vitamin D supplementation for osteoarthritis of the knee. This is a really weird study.
The IME System: A Current Public Health Risk and Solutions That Are Working
I strongly believe in the independent medical examination (IME) system. There are far too many doctors in every profession who are not following E&M protocols and never claim MMI (maximum medical improvement) has occurred for their patients, which has caused financial stress for many private and public carriers.
April, 2007, Vol. 07, Issue 04
Part I: Chronic Problems Related to Gallbladder Dysfunction/Disease
By Dale G. Alexander, LMT, MA, PhD
The common theme of this three-part series relates to how gallbladder dysfunction and disease progressively place a drag upon general physiology by impeding venous and lymphatic return. First, I will describe the various somatic markers I have experienced with clients associated with the progression of gallbladder dysfunction or disease via the inflammatory process.Next, I will postulate how gallbladder dysfunction might functionally affect the rest of the digestive tract and blood sugar regulation. Further, I will describe how gallbladder difficulties might participate in many hiatal hernia reflux problems, esophageal problems, chronic headache patterns and the existential questions of life.
The purpose of these descriptions is to add to your library one of the more common progressions I have encountered when working with clients who state they have a chronic problem or pain that "just won't go away" even after care from other competent professionals. Typical somatic complaints will include the persistence of one or more of the following: right shoulder and upper back with or without radicular symptoms (pain or numbness into the shoulder, elbow, arm or hand), neck pain and headaches, including migraines, and interestingly, left hip problems.
Additional markers which indicate involvement of the gallbladder include: pain or limited motion of the left side of the neck;1 progressive loss in the range of motion or freezing of the right shoulder; recurrent upper-to-middle right-sided rib subluxations, with accompanying muscle contracture or spasm; reduction in the ease of lateral excursion of the right hemi-diaphragm; hiatal hernia complaints; a marked reduction of ease in spinal flexion and extension during motion testing; and a history of external hemorrhoids. Rarely are all of these reported or identified in an initial interview and session with a client. Yet, over time, they do begin to reveal themselves.
I have selected this progression because it tends to fly under the radar of medical testing, often for years, until its dysfunction becomes acute. I would hasten to add that if one has trouble with their gallbladder, the normal function of their liver is questionable. It is beyond the scope of this article to explore the influence of both organs simultaneously, yet the inflammatory response of the liver produces almost identical somatic profiles.
It has been my consistent clinical experience that gallbladder dysfunction tends to precede the identification of chronic liver dysfunction. Thus, it becomes another example of how the body uses an ailment as the "canary in the coal mine" to signal us that something deeper is amiss. Following the removal of the gallbladder, some clients have received a diagnosis of moderate to severe liver dysfunction, including cirrhosis or non-alcoholic fatty liver disease many years later. This is the nature of progressions.
One of the principles of the Inside-Out Paradigm© is to seek to comprehend how the body is organized to move and recycle its fluids back to the heart and lungs, especially the low pressure systems of lymphatic and venous return. Whatever might impede this flow can progressively create the breeding ground for various pathologies to begin. In the interim, a client's quality of life is insidiously diminished. Our role in therapeutic touch is to enhance their quality of life and to serve as part of their early detection team.
The following description is anecdotal and represents extrapolations of functional physiology (how one thing may relate to another) that are based on my clinical experience. Please do not consider these ideas to be proven fact. I propose that varying degrees of gallbladder dysfunction is an unidentified variable in many somatic profiles because of its "anatomic centrality." In normal anatomic position, which can vary, the gallbladder sits just adjacent to the inferior vena cava, in fascial communication with the portal vein of the liver and just anterior to the transverse colon, in approximation to the abdominal confluence of lymph trunks, often referred to as the cisterna chyli.2
Inflammation of the gallbladder in response to neural excitation or gallstone formation can literally decrease the "rate of flow" of the fluids within the low-pressure venous and lymphatic vessels. When inflamed, the gallbladder swells to occupy more space, thus pushing on these more flexible tubes, creating a "pinched-hose effect." The reduction of the timely return of these fluids back to the heart and lungs places an accretive strain upon the many tasks of maintaining physiologic homeostasis and upon a client's perception of life and themselves.
The most common error a practitioner makes is to predict that emotional factors are the primary source, or that physical factors are the primary source of a chronic problem. In my experience, both represent slices of the pie that might contribute to resolving the chronic problems of clients.
According to Dr. Barral, the developer of visceral manipulation, the gallbladder tends to be the most reactive organ outside of the brain and spinal cord to emotionally charged events. For example, receiving the news that a loved one has died, witnessing an accident, or being unexpectedly fired from one's employment are among many possible triggering events.1
"Sympathetic innervation of the gallbladder is from the celiac ganglion, and innervation from its peritoneal surface from the phrenic nerve. Contraction of smooth muscle within its walls depends on the vagus nerve, i.e., biliary excretion is under parasympathetic control."3 In my articles on the "Phrenic Circuit," I endeavored to set a foundation for how the body distributes these internal tensions through its complex neural net and specifically within the shared cervical portions of the spinal cord which overlap the origins of both the phrenic nerves and the brachial plexuses;4 the latter being the vitalizing source for the shoulders and upper extremities.
It's the presence of chronic inflammation that we need to hold clear in our field of awareness. Its presence is inferred by the persistence of the somatic complaints detailed earlier. I have personally worked with people for many years until the underlying source(s) of their somatic complaints emerged. This is how I may offer a description of this progression to you. Acute inflammation of the gallbladder and/or the passage of a gallstone stuck in the common bile duct usually requires medical attention.
It's prudent for us to refer clients to their physicians when we suspect such a chronic problem and/or when our best efforts fail. Usually, blood tests and an ultrasound scan are ordered to check for the presence of gallstones and any possible infection. Quite often, if there are no stones, the notion that the gallbladder is a relevant variable is dismissed. There is a second test, called the Function Test, to check if the gallbladder is actually working at all. It's important for us to educate our clients that this is an option. The test is not a pleasant experience, as one has to swallow a liquid that places a demand upon the gallbladder while its capacity to function is being monitored. If it no longer is functioning, the possibility of infection or other pathologies increases. In one such instance, the client's gallbladder was diagnosed as precancerous.
Gallstones are made up of calcium bile salts and cholesterol. The actual process of how and why they are formed elicits many possible opinions with few definitive conclusions.
The statistics detailed in Dr. Barral's second book, Visceral Manipulation II, note that within the U.S., 8 percent of men and 20 percent of women over the age of 40 are affected by gallstones and that 2 million surgical procedures are performed every year to remove the gallbladder.3 Not all gallstones produce adverse symptoms paradoxically. Larger gallstones unable to exit the gallbladder might lie dormant for years. However, to my sensibilities, they contribute to the organ's chronic inflammation and do have an effect upon venous and lymphatic drainage.
When initially interviewing a client, take note of whether their parents, grandparents or siblings have had such difficulties. Of all the somatic markers noted earlier, the progressive stiffening of the spine exhibited by a reduction of ease to flexion and extension during motion testing is an indication that the chronic problem is progressively affecting the client. I have seen this repeatedly.
I cited the case study of a client in an earlier article who had experienced the freezing of his right shoulder. All of my attempts to assist its re-mobilization failed. I encouraged him to see his physician and two large gallstones were found. Though encouraged by his physician to have them removed, he declined. Now, many years later, he is struggling with rectal cancer.
The inference here is not to be taken as cause and effect. However, when fluids of the body are unable to find their way to all the cells and/or fluids are impeded from returning to the heart and lungs in a timely manner, it is my postulation that this sets the stage for many possible pathologies to emerge.
The main idea for your consideration is that gallbladder dysfunction and disease may progress in insidious and subtle ways. It's our responsibility to be alert to its possible presence and progression. For all of us, let us be aware that eating large quantities of fried, processed, heavily spiced, or greasy foods may contribute to gallbladder dysfunction.
In the second installment of this article, I will describe what often happens when bile sludge or small gallstones partially or fully occlude the opening through which both bile and pancreatic juices flow into the duodenal portion of the small intestine; the ramifications for digestion and elimination; and the simultaneous role of reducing venous and lymphatic drainage and the timely return to the heart.
Click here for more information about Dale G. Alexander, LMT, MA, PhD.
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