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Integrative Medicine for the Underserved: A Seat at the Table
Numerous organizations have risen to the challenge of providing care to medically-underserved populations and here we feature one such group.
Nomenclature and Classification of Lumbar Disc Pathology: Version 2.0
The Nomenclature and Classification of Lumbar Disc Pathology consensus, published in 2001 by the collaborative efforts of the North American Spine Society, the American Society of Spine Radiology and the American Society of Neuroradiology, has guided radiologists, clinicians and the public for more than a decade.
NCCAOM Video Contest
The NCCAOM is excited to announce the launch of the second annual video contest "Because it Works!" 2015.
Should You Change an Athlete's Natural Running Form?
Once past the ankle, impact forces travel at about 200 mph into the knee. In addition to allowing the quad to absorb force, bending the knee (E) prevents the hip and pelvis from moving up and down too much (F), which is important for injury prevention and efficiency.
Going On-Site With Chiropractic Care
The Foundation for Chiropractic Progress has released a position paper highlighting the financial, clinical and patient-satisfaction benefits of providing chiropractic care at on-site corporate health clinics.
Leg-Length Inequality and Pelvic Fixation: A New Approach to the Negative Derifield (Part 3)
A patient with sacroiliac fixation and dysfunction ordinarily demonstrates a noticeable leg-length inequality when placed in the prone position on the adjusting table.
Free Yourself From the Pocketbook Practice
Let's take a journey together; there's an important lesson to be learned. Imagine a town or city just like yours.
Marketing with a Microphone
When given an option, it stands to reason that people prefer to do business with those they know, like, and trust.
Sports Medicine 101: Surgery or No Surgery?
In the world of sports medicine, many careers are saved by surgeries that correct traumatic damage to the body. Muscle tears, ligament damage, fractures, spinal disc herniations, and joint instabilities are a few of the issues frequently addressed with surgical intervention.
Treatment of PTSD: An Opportunity for the Practice of Integrated Medicine
PTSD is widespread across America today. Not only do many of our honored men and women in uniform bring it home with them from the war zones they have been active in, but it often follows any life-threatening event people go through when their lives have been in danger.
An International Life: An Interview with Mary Elizabeth Wakefield
I met Mary Elizabeth Wakefield during her class last summer in Seneca Falls, New York at the Finger Lakes School of Chinese Medicine.
Chinese Doctors Poke Holes in Australian Study
A recent Australian clinical trial, published in the Journal of the American Medical Association (JAMA) in 2014 by Rana Hinman, et el., evaluating the effectiveness of both needle and laser acupuncture for chronic knee pain.
The Source-Luo Point Combination, Part 2
The Da Cheng includes symptoms for the source-luo points that indicate when to use them for treatment. Yang defines the method as the guest-host (it is one of a variety of acupuncture point combinations called guest-host).
The Risks I Took
We all take risks when we choose this profession. For some, it is not knowing if you can make a living practicing TCM. For others, it is parental or cultural disapproval.
I was sitting in a Pizza Hut in Peoria, Ill., with my friend Reggie, sometime in the spring of my senior year in college, when he started doodling on his paper placemat. In those days, the company had a picture of U.S. on the mats, showing all the locations of the "Huts" in the country.
The Three Heater Official
This Official, belonging to the element Fire, is responsible for maintaining and regulating the heating system of the body, mind, and spirit. It is named for its function. The trunk is divided into three "burning spaces" or "jiaos."
Creating Relationships at Southwest Symposium
The month of May brought many interesting activities. As I have said in many previous columns this year, this profession is moving in a very exciting direction. Make sure you are getting involved. If you're not, you just might get left behind.
Desert: A Metaphor from the Study of Genetics
In most of the human lives I know about, there are stretches of time which feel stagnant, or worse. We can feel adrift, or wounded and sidelined, and these times don't seem to carry much usefulness while they are unfolding.
News in Brief
Investigating the Cellular Impact of Mechanical Force; National Board Seats (Not-So) New Officers at Annual Meeting.
Meet Cheyenne: Your Future Colleague
Allow me to introduce you to Cheyenne (Chey), the daughter of some of our family's closest friends. We attend and serve at the same church together, and have known each other for many years.
Key Changes and Updates to the 7th Edition CNT Manual
Acupuncture Today recently interviewed Jennifer Brett, ND, L.Ac. regarding the updates to the CNT manaul.
November, 2008, Vol. 08, Issue 11
The Progression of Cervical Stenosis Toward Cervical Spondylotic Myelopathy (CSM), Part 3
By Dale G. Alexander, LMT, MA, PhD
Since beginning to describe the progressions of chronic dysfunctions last year, I propose that my research and intuitive extrapolations have tripped over many of the default settings of the human aging process.1 My instincts suggest that there are more progressions than what has occurred to me. Six appear to be clear.
I have already proposed and described how gallbladder difficulties may underlie many of the gastrointestinal difficulties and their somatic expressions that accompany aging.2 Included in part 2 of that series, the connection between the progression of gallbladder dysfunction and the emergence of type 2 or non-insulin-dependent diabetes mellitus was noted. In this present series, I am describing and postulating how many motor-coordination and chronic sensory complaints are likely to be associated with cervical stenosis progressing toward cervical spondylotic myelopathy (CSM).3
The other four proposed progressions include: osteoporosis, atherosclerosis (deposition of fatty materials in arterial walls), desiccation and dehydration, and senility (the cognitive decline associated with dementia and Alzheimer's). I plan to explore these in future articles, so I invite you to consider what other progressions may exist and either let me know or write about them yourself. Please send me a copy. Let's combine our profession's capacity for astute observation, our willingness to listen to our clients and, our collective common sense to make a lasting contribution to humanity.
One of the most reliable indicators that one or more progressions may be occurring is that a client presents with one or more chronic somatic complaints without a recent precipitating event. My clinical experience has repeatedly shown that for a large majority of clients, chronic difficulties are the "canary in the coal mine" of underlying degenerative progressions. These fly under the radar of medical testing because they take decades to undermine physiologic function until reaching a tipping point of degradation and clinically detectable expression. Understanding such progressions will add to our collective ability to assist clients to make more informed medical and lifestyle choices.
All of these subtle progressions contributing to declining capacity, function and pain have two common denominators: the body's capacity for delivering nutritious oxygenated blood and the length of time it takes for the return of venous and lymphatic fluids to deliver the raw materials so that the lungs and heart can make new blood. As massage therapists, facilitating the movement of bodily fluids is at the core of our training. We are uniquely oriented to assist our clients to maintain the quality of their lives as they age.
Returning to the progression of cervical myelopathy, let's begin with my own cervical MRI from the previous article. The process of having an MRI is fairly simple and painless, especially one that allows you to sit or stand. Reading the radiologist's report however, was more of an emotional experience than I had anticipated. Even though I have reviewed thousands of medical reports, to read one that described what is going on inside of my own neck was sobering yet very educational. Early detection translates into an increased field of choices for us all.
My report described C4-5, C5-6, and C6-7 as having moderate to severe disc compression with posterior bulging of the discs, one of which is impinging upon the left side of the thecal sac (the meninges). It also noted left-sided and right-sided foraminal narrowings (where the spinal nerves exit) between each of these vertebrae. The report certainly helped me to understand how and why my upper extremity pain and numbness could express itself on either side or bilaterally and why my left lower extremity has been more symptomatic over many years. There was no evidence of frank spinal cord compression, only the stenosis or pinching of the left-sided thecal sac at C4-5.
In a discussion with my personal physician, he noted that he has seen many such MRI reports that reflected more significant stenosis along with frank spinal cord compression, but without accompanying symptomatic pain or numbness; instead, the patient's motor coordination was generally more the presenting problem. I also requested that a retired radiologist take a look at the films to confirm what the report stated. His response was, "What are you going to do, Dale? You're 55; it's not bad enough for surgery." My response was a declaration that I was going to attend to the integration of my soul and personality, seek out excellent bodywork, refrain from working with my neck in extension and arms over my head, as I do trimming the tropical trees and plants in our yard, and seek out nutritional sources to quell the activation of the inflammatory process. "That makes sense," he concluded. He also noted that more information would have been obtained had the MRI been done with my neck in extension as this would more directly activate the cervical ligaments. So, do pass this on to any clients who might seek out such information for themselves.
When I subsequently asked an orthopedic physician who is a client and has had surgery for CSM himself for his opinion of my MRI results, he advised me that what he saw did warrant surgery. I didn't want to hear that. This is what our clients are very often faced with - real dilemmas with differing medical opinions. I took to heart my personal physician's distillation of the human condition from his many years of medical experience: "Clots and inflammation are what disable us leading to our eventual deaths." Thus, based on his advice, the course of action I am pursuing is to contain the inflammatory process through the use of prescription-strength omega-3 salmon oil, baby aspirin and over-the-counter anti-inflammatory medication at the first sign of an escalation, and regulating more judiciously the number of hours I work each day in my clinic. This approach has reduced my daily upper extremity pain and numbness dramatically.
I am pleased that I followed my instincts in seeking out more information. I consistently offer this caveat to clients: "If you don't look, you don't know." Medical tests have their place and they are not always conclusive. However, with additional information we all have more perspective from which to make a choice.
Based on my research thus far, my current guidelines for encouraging clients to explore a surgical option for CSM include the following somatic profiles (individually or in combination): unrelenting upper extremity/neck pain or numbness, atrophy of the deltoid muscle group or muscular hand wasting (usually associated with the muscles of the thumb or the central portion of the palm), the development of an ataxic gait pattern (a clumsy and jerky walking style), and an escalating frequency of urinary or bowel urgency or episodes of incontinence. This last symptom is the one that slides under the radar for many.
It is important to consider that more than one degenerative progression may simultaneously co-exist in the same body. This was the case for both of the clients with CSM for whom I was unable to stem the tide of its progression. One was a male client who has been chronically overweight for years and I suspect has gallbladder dysfunction and/or progressed into a pre-diabetic state. For the other, a female client, her osteoporosis had insidiously accelerated despite her best efforts to track it with periodic bone density tests.
Researching this progression has been a humbling and rewarding personal and professional experience. Humbling to experience the "zone of limits" that my genetics and trauma history may be signaling in my own aging process. Rewarding in the vast appreciation for how well our bodies do adapt overall and in the realization that the progression of CSM is truly a broad symptomatic continuum that affects some more than others, both functionally and clinically across a wide spectrum of somatic expressions.
In my next installment of this column, I will touch on the issue of gender and CSM, and finish up by discussing my studies of CSM.
Click here for more information about Dale G. Alexander, LMT, MA, PhD.
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