resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
A House Divided?
The American Chiropractic Association's House of Delegates voted on 30 resolutions at its annual business meeting in Washington D.C., but two in particular took immediate center stage due to their controversial nature.
5 Tips for Using Pinterest to Market Your Practice
Pinterest is a very popular, but often under-utilized, social media platform where people can bookmark, or "pin," fun and interesting things from all across the internet.
Functional Hip Impingement (Part 1)
Every time I sit down to write an article, I realize how much more there is to know about musculoskeletal pain. I also learn something new every time. (I want to give special thanks to Lucy Whyte Ferguson for assisting with this article.)
How Much Do You Know About the Benefits of Birds Nest?
Edible bird's nest is the nest made by the Swiftlet bird of Southeast Asia that is usually prepared as a soup and prized in Chinese culture as a healthful delicacy.
The Acupuncturist's Problem
I want share with you some observations and insights into what seems to be the most common problem my colleagues in the acupuncture profession struggles with. If you also struggle with this problem, I hope you get a valuable "aha" moment from reading this.
Term Limits: What's in a Word?
It was the French historian and philosopher Voltaire who once declared the Holy Roman Empire was neither holy nor Roman nor an empire.
PCOM Granted Regional Accreditation
Pacific College of Oriental Medicine (PCOM) recently announce it has received regional accreditation from the Western Association of Schools and Colleges (WASC). This achievement reflects five years of hard work on the part of faculty, staff, and students.
Marijuana, Apathy and Chinese Medicine, Part 1
This article was written in response to the unheeded acceptance of marijuana as a harmless substance that potentially does good when used for the medical relief of pain.
Applying the Thin Skull Principle
The "thin skull" principle, also known as the "you take your victim as you find them" principle, is a legal principle that can be summed up by the following statement.
A View From the ER
The University of Western States has inked an innovative agreement with local nonprofit health system Legacy Health whereby UWS sports-medicine fellows can experience observational clinical rotations in emergency-room settings within the Legacy system.
Animal Acupuncture: A Case Study in the Treatment of Traumatic Injury in the Equine
The rise of animal acupuncture in the U.S. began in the early 1970's as a result of the work by members of the National Acupuncture Association in Westwood, Calif.
Optimism = Compassion = Trust
A randomized clinical trial recently published online in JAMA Oncology examined how patients viewed their doctor based upon how the practitioner presented bad news to the patient.
The Tide is Rising in the Acupuncture Profession
Former President Ronald Regan said, "When the tide rises all boats float." The tide is rising for the acupuncture profession. Many forces outside the profession are helping the tides to rise.
Talking to Patients About Lumbar Facet Denervation (Medial Branch Neurotomy)
Lumbar facet denervation, more appropriately termed medial branch neurotomy (MBN), is a procedure that may be considered when patients suffer from recalcitrant non-radicular axial back and/or leg pain.
Sleep, Less Sleep or No Sleep?
I had a dream I wasn't getting enough sleep. It was a very realistic dream, even though I was probably slightly awake and not really deep dreaming. Most likely I had been dozing, caught in that twilight of sleep and wakefulness.
Integrating Art with Clinical Practice for Patients with PTSD: The Artemis Project
Are you restricted by those one-on-one clinic dynamics? Why not join colleagues and clients in experimental group settings? Three of us volunteered to do just that in Austin on behalf of women veteranss from all branches of the service.
5 Simple Steps to Create an Effective Marketing Calendar
In the educational experience of most healthcare practitioners, business and marketing are overlooked topics.
Medicine is Clumsy, Don't You Be
All medical systems have clumsiness in them. If the technique isn't, the practitioner is. Everyone in every form of medicine is striving to improve. That is why we call it practice.
The Challenges of Integrating Eastern and Western Medicine
My Masters thesis was titled, "The Challenges of Integrating Eastern and Western Medicine," which highlighted several reasons why it is hard for these two worlds to mix.
Low Back Pain in Professional Golf: A Common Muscular Relationship
Every sport creates its own unique demands on the body. Some sports require such a myriad of body positions that assessing pathology is often difficult and unpredictable.
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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