Diagnosing & Treating Aggressive Energy
Recently, there has been an article, and subsequent discussion, about the subject of Aggressive Energy (AKA "AE"), including ways to detect its presence and an alternative method of treating it.
New Opportunities for DCs
For decades, the model chiropractic practice has been the single-doctor practice. Recent surveys have found that approximately two-thirds of U.S. doctors of chiropractic still practice this way, with another 20 percent practicing in multiple-chiropractor practices.
Prompting Memory: How to Stimulate Cognition
Recently I gave a talk titled, The Art of Memoir – Tapping the Past to Sharpen the Present at a senior lunch event in Austin, Texas.
News in Brief
Parker University Launches New Open-Access Research Journal for Chiropractic; Western States, Cleveland-KC Name New Deans of Chiropractic Colleges; Sherman College Goes Tobacco-Free; Life University Wins 11 Awards.
State by State: Chiropractic Leads Changes in Health Care
Monumental legislative bills in support of the chiropractic profession were passed recently in Washington, West Virginia and Oregon. Here is a review of this important legislation, state by state...
Bastyr University: On the Front Lines of the Pain Epidemic
At University of Washington's Harborview Medical Center, the Seattle region's only Level I Trauma and Burn Center, the demands for in-patient care are dramatically different from a private clinic environment.
Spring Allergies & The Spleen: Looking at Pattern Differentiation
As the season of Spring fades away and we shift into the warm summer months, many patients suffer from chronic allergies. This is by far one of the most common issues I see in the clinic as well as often mistreated and misdiagnosed.
Paving the Way to Integrative Health & Wellness
Jared Polis (D-Colorado) and Mike Coffman (R-Colorado) launched the integrative health and wellness (IHW) caucus in October, 2018.
Chiropractic's Next Frontier: Adjusting the Microbiome
Restoring a healthy microbiome to help treat disease may be the next frontier in chiropractic offices around the country.
Practice Pearls: There's More to ROM Than Meets the Eye
As part of my neuromusculoskeletal examination, I perform range-of-motion (ROM) evaluations. I can "eyeball" the range and measure, I can use a goniometer and measure, I can use my phone app and measure, or I can use various other instruments to help determine degrees of motion.
It's Time for a Functional Approach to Chronic Illness
It seems one of the more modern buzzwords is chronic, referring to diseases – that is to say, "ongoing and incurable." However, we can take a different perspective and recognize that, although the body may have been traumatized and injured, healing should always be viewed in the realm of possibility.
First World Spine Care Graduate: Hildah Molate
Hildah Molate, the first World Spine Care (WSC) scholarship student, graduated from Palmer College of Chiropractic earlier this year and is now working at the WSC community spine clinic in Shoshong, Botswana.
Prevention: Stop Recurrent Urinary Tract Infections
The recurrent urinary tract infection (UTI) is one of those nuisance conditions that can play havoc with quality of life, and this particular infection is much more common than most people realize.
A Novel Way to Prevent Elderly Falls: Toe Strength
In any given year, nearly 40 percent of senior citizens ages 70 and older will fall at least once. Each fall significantly increases the risk of not only sprains, strains and contusions, but also fractures.
Regenerative Medicine: How to Do It by the Books
The "lay of the land" for regenerative therapies, including but certainly not limited to adult stem-cell treatments, seems to change almost daily.
Better With Chiropractic
While chiropractic care is receiving high levels of exposure these days, most pain patients who consult with a health provider still do so with their primary-care MD. And of course, that means in most cases, they're receiving standard medical care, not chiropractic.
The Acupuncturist and the Opioid Crisis: Conquering Pain & Addiction in the U.S.
The current opioid epidemic dominates the discussion among national health leaders, recovery advocates and families nationwide. Opioids include heroin as well as prescription pain relievers such as oxycodone, hydrocodone, codeine, morphine, fentanyl, and others.
Dropping Insurance: 4 Steps
My office manager just got off the phone with the secretary of a long-standing patient. I have treated this woman and 10 members of her family for more than a decade. She has, as have all of my patients, paid my fee at the time of service since I dropped insurance in 1997.
Reducing Allostatic Load & Stress Through Heightened Awareness
Your contemporary mental health and psychotherapy colleagues may often approach the treatment of allostatic load as a mental health condition and use prescription psycho-pharmaceutical medicine to affect general and specific central nervous system (CNS) pathways and brain neuro-chemistry medicine to alleviate the associated symptoms.
Multi-Dimensional Acupuncture: 3D, 4D & 5D
Maggie is an intuitive healer and workshop leader who I met on a recent hike. While we were talking she told me how she had to take it easy because of her knees. She said that her doctor told her that she has the early signs of arthritis.
Transforming Exam Delivery
The NBCE Board of Directors has never wavered on its promise to deliver an excellent, on-campus computerized testing experience to students. Likewise, there has never been a compromise to the delivery of fair, valid and legally defensible exams.
Catch the Workplace Wellness Wave
Do you offer workplace wellness services to local businesses? If not, you might want to consider this lucrative channel for expanding your practice. Workplace wellness programs and wellness-related benefits have grown in popularity over the past several decades.
NBCE to Reinstitute Computer-Based Exams
The National Board of Chiropractic Examiners (NBCE) has announced it will reinstate computer-based testing in January 2019 courtesy of a partnership with testing and assessment solutions provider Prometric.
Is Primary Spine Care the Answer for Chiropractic?
Recently, we sat down with Mark Studin, DC, FASBE(C), DAAPM, DAAMLP, to discuss the state of chiropractic and why primary spine care may hold the key to chiropractic's future. Read what he had to share in this exclusive interview.
Cyber Threat Checklist: Defend Your Business With These 10 Steps
Living in an internet connected society brings many conveniences and benefits. The power of the internet to connect us with customers, store data, and find information has opened the door for many small business owners to grow and flourish.
Acupuncture's Standard of Care
Both a concern and critique of acupuncture, frequently espoused by the bio-medical community is, "there is no standard of care in acupuncture." The following is why I believe this statement is disingenuous at best.
Old Trend, New Risks: Heavy Weight Training
With more opportunities to exercise than ever, a greater selection of exercise options, and the subsequent opinions supporting and challenging their merits, it's easy to be confused as to which approach is best.
Missed Causes of LBP: It's the Syndrome, Not the Subluxation
When I read the chart notes of other chiropractors, I am usually disappointed. They list what vertebrae are fixated or misaligned. They may describe the involved fascia and muscles.
Official NCCAOM Practice Tests
The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) is excited to announce the launch of the new NCCAOM Exam Preparation Center.
February, 2009, Vol. 09, Issue 02
By Ruth Werner, LMP, NCTMB
In the absence of any feedback or requests relating to my previous article, "Body Art: Tattoos and Piercings" (MT December 2008), I have decided to discuss an entirely different topic: bariatric surgery, sometimes known as "gastric bypass." This comes about because of an interaction with a particularly generous individual who willingly shared her experiences with me during a workshop. Since some of us are probably still recovering from holiday-related overeating, and since about 120,000 people will undergo some related procedure in the country this year, it seems timely and appropriate to take a closer look at how we can serve clients who have had bariatric surgery.
What Is It?
Bariatric surgery is a collective term for several different surgical options, all of which are designed to interfere with the uptake of nutrients in the gastrointestinal tract. Drastically limiting the capacity of the stomach reduces not only the amount of food a person eats, but also their capacity to digest what they take in. The result is typically massive weight loss.
In the United States, more than 60 percent of all adults are functionally overweight, and about 12 million people have a BMI of 40 or above; this is at least 100 pounds overweight for men and 80 pounds or more for women. When people experience this level of obesity their ability to reverse their situation becomes progressively more limited: knee and hip arthritis make exercise impossible, diabetes becomes resistant to treatment and fatty liver disease interrupts liver function. Patients become more vulnerable to secondary infections, certain kinds of cancer and early mortality.
At some point in this cycle, the safest, most effective intervention becomes surgically interfering with the volume of food that is eaten or the absorption of nutrients: bariatric surgery. When this is accompanied by improved eating habits and exercise, many of the illnesses associated with extreme obesity can be more manageable or even reversed.
Types of Surgery
Most types of bariatric surgery can be conducted laparoscopically, unless the patient has some specific limitations. This reduces the risk of secondary infection, and usually shortens recovery time.
Adjustable gastric band. This procedure places an adjustable band around the stomach. The size of the outlet can be controlled with a small balloon inside the band.
Roux-en-Y gastric bypass. In this procedure, food absorption is decreased by stapling the stomach to be about the size of a walnut and directly connecting it to the distal end of the small intestine.
Gastric sleeve. This surgery is often the first stage of another procedure called biliopancreatic bypass. This procedure removes much of the stomach, but leaves the intestines intact.
Biliopancreatic bypass with a duodenal switch. This surgery removes the lower portion (about 80 percent) of the stomach and connects the rest to the lower parts of the small intestine. It is extremely effective, but has a higher risk of complications than other surgeries.
If a bariatric surgery is successful, a patient can expect to lose 50-60 percent of their excess weight within the first year after surgery. This weight loss can continue and stabilize if the patient is careful about diet and exercise. In addition, many of the disorders associated with obesity can be averted. The severity of osteoarthritis, type 2 diabetes, high cholesterol, high blood pressure, sleep apnea, and GERD (gastroesophageal reflux disease), which is linked to esophageal cancer, may all be reduced. Some research also indicates that bariatric surgery may reduce the risk of colorectal, breast and several other types of cancer for obese patients.
Bariatric surgeries are obviously not risk-free. Short-term problems include bleeding, leaking if intestinal sutures fail, infection, perforation of part of the gastrointestinal tract, and post-surgical blood clots that may cause pulmonary emboli. "Dumping syndrome" describes what happens when stomach contents move into the small intestine too quickly; this leads to nausea, vomiting, dizziness and sweating.
Longer-term issues include malnutrition and vitamin deficiencies, strictures (scarring in the GI tract), kidney stones, gallstones, and hernias: bulges that press through the surgical scar or through the mesentery - the fascia that suspends the intestines from the abdominal wall. Annoying but less threatening complications include hair thinning, feeling cold all the time, and dry skin. Finally, it is important to point out that about 10 percent of all bariatric surgeries are unsuccessful. In other words, patients do not experience adequate weight loss, or their weight loss is only temporary.
Massage and Bariatric Surgery
This article came about because I was involved in a class discussion on the benefits of abdominal massage even - or especially - for people who struggle with issues of body image and weight control. It was not surprising that most of the therapists in the class didn't make a habit of including abdominal massage. "Most people would rather just have extra time on their backs or legs" was a common comment. Nanette, one of the class participants, spoke up about her experiences receiving abdominal work in massage school several months after her roux-en-Y surgery:
"I felt horrible. It was unnatural, foreign. I felt anxious, nervous. Clockwise strokes on my abdomen made me feel sick. I wondered if somehow they had rearranged my insides with the surgery. I didn't feel safe. It spooked me."
Part of our job as massage therapists is to "in-corpor-ate" - literally help to weave together - our clients' bodies. For someone who doesn't feel connected to their belly, the experience (even if all it entails is a few unhurried breaths with warm hands on top of the sheet on the abdomen) can be an unusually powerful chance to experience that part of her body as positive, included, woven in. The students in Nanette's massage school were unable to help her do that, and after her initial experiences, she was unwilling to pursue it further.
Granted, Nanette's experience also included significant and painful post-operative complications, and although she lost more than 100 pounds, her general experience with the surgery was frustrating. Students (some of whom probably struggle with their own body image issues!) were not her best resource for abdominal work. But it is still an important goal for us to help our clients feel supported as full and beautiful whole beings, not as disintegrated, disconnected parts.
Massage is finding a place in many traditionally medical niches, including in the context of surgery. It is not unusual now to find therapists delivering pre-surgical massages for stress reduction, and post-surgical sessions for pain, improved sleep and general discomfort. Obviously modalities must be adapted to meet the resilience of the patients.
For clients who have had bariatric surgery, abdominal work clearly must be done with extra care. Nanette obviously needs a therapist with patience and expertise if she is ever to be comfortable with receiving even non-moving touch on her abdomen. Other clients will also appreciate the value of confident, sensitive, gentle strokes on their bellies.
Our unique ability to offer positive, therapeutic, nonjudgmental touch to our clients who do not fit our culture's expectations for normal size or appearance is an incomparable gift. Whether our clients consider bariatric surgery or not, we can provide a welcoming, accepting environment that will be much appreciated.
For next time: The floor is open, readers! Let me know, what's on your table? Until then, many thanks and many blessings.
Click here for previous articles by Ruth Werner, LMP, NCTMB.
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