resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
If You Get a Request for Records, Respond!
In our previous two articles, we discussed two of the main reasons for denial when chiropractic records are reviewed by Medicare contractors.
A Glimpse Into China's Top Brain Hospital
The sounds of the city pass through the open window are overwhelming the microphone - car horns, construction machinery - and then there's the family at the adjacent bed talking loudly on cell phones, yet you can still hear the faint beep of our patients monitoring equipment.
Healing Community Trauma in Israel and Palestine
It's the beginning of August and Israel and Hamas have just agreed to a 72-hour ceasefire after a month of brutal fighting. In the last four weeks, 1,830 Palestinians and 67 Israelis have been killed.
The Spirit of the Point
After receiving a large amount of positive feedback on my San Zhen Protocols series, I have decided to focus this article on some relevant clinical aspects of acupuncture therapy prior to moving on to San Zhen Protocols III.
Help Secure Our Future by Sharing It
The National Board of Chiropractic Examiners (NBCE) conducts one of the most comprehensive surveys of the U.S. chiropractic profession every 4-5 years.
A Commonly Missed Spinal Fixation: The Upper Lumbar Spine (Part 1)
When we think of lower back pain, we tend to think in terms of the lower lumbar spine and the SI joint. These joints and their discs are obviously important. However, we tend to miss fixations that occur just above – in the upper lumbar spine. Three questions come to mind: 1) Why is the upper lumbar spine so important? 2) Why do we miss the fixations here? 3) How can we adjust them?
History of Animal Acupuncture: Part II
In Part I of this article, I had gone back to 1969 and tried to describe the atmosphere and events of that year that engulfed many of the younger generation, some who were all the core members of the National Acupuncture Association.
MPA Media Wins Seven Publishing Awards
MPA Media, publisher of Acupuncture Today, among other titles, has been recognized for editorial and design excellence with an unprecendented seven publishing awards by the ASBPE, the nation's largest organization for business-to-business publications.
Get Ready For AOM Day
This year, AOM Day 2014 falls on Friday, (October 24th). This is a great opportunity to make your AOM Day celebration or event even bigger by extending it throughout the weekend!
When Big Pharma Meets Chinese Medicine
Earlier this year, Bayer made a media splash with their decision to buy the Dihon Pharmaceutical Group Co., a Chinese TCM manufacturer.
Rethinking GMO: Less Panic, More Context
Some of you may have noticed that after writing parts 1 and 2 of “Genetic Modification of Organisms for Human Consumption” a while back [Nov. 15, 2013 and Jan. 1, 2014 issues], part 3 never appeared.
Thoracolumbar Syndrome: The Great Mimic
The thoracolumbar junction is a common area of joint dysfunction. The most obvious cause is dysfunctional breathing or lack of diaphragmatic breathing. Treating this breathing problem will ultimately be the long-term cure for the syndrome.
Let the Patient Tell Their Story
Often when a patient presents with an injury, they want to tell their story. People by nature like to talk about themselves, particularly when they're worried about their health.
The Problem With Prolonged Sitting
We need to constantly talk to our patients about spending less time sitting and about what can go wrong with poor sitting postures. The fact is we sit too long in repetitive malpositions.
Uncle Sam Needs You
Scrutiny into the Department of Veterans Affairs (DVA) continues to grow after efforts to reform the DVA by the former Secretary of Veterans Affairs, Eric Shinseki, were deemed "a stunning period of dysfunction" by Senate Minority Leader Mitch McConnell (R-Ky.).
The Truth About Herbs
I appreciate the effort and research put into the article written in the June issue of Acupuncture Today regarding pesticides and Chinese herbs.
A Healthy Dose of Failure is Vital to Your Success
As an acupuncturist I tend to see people after they have already suffered for years and "tried everything." They are so desperate for some relief that they want to know everything about how to get better, right now.
The Science Behind Happiness
Are you happy right now? Whether yes or no, there are a myriad of reasons why you feel that way. A whole academic discipline has developed to find out what causes or obstructs happiness, and how to amplify it.
Improving Our Political Effectiveness
The November 2014 elections are right around the corner; members of Congress, governors and state legislators are all running. Now is a good time to talk frankly about our overall political involvement.
Medicalization and Mindfulness
The past several years have seen a veritable explosion of research on mindfulness. Research abstracts we've published in each issue of Health Insights Today under the heading "Mind-Body News" have increasingly reported on studies about mindfulness interventions.
Thoughts to Live By
When speaking to your patients about their health make sure to ponder the following points and have them assess if they are making themselves even more sick by the thoughts they have about life. Are these some of the traits and thoughts that your patients might have?
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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