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Essential Orthopedic Testing: Tests That Involve Standing on One Leg
Since these tests have a common mechanism of performance (standing on one leg), there are differential diagnostic concerns during testing. The tests cannot be completely isolated from each other for performance.
Communication 101: Please Explain Yourself!
Twice this past week, I overheard conversations about chiropractic. As you can imagine, it is a topic my ears naturally pick up. In both cases, a patient was talking to a friend about their experience with a chiropractor.
The Heart Protector
On the physical level, the Pericardium is a double-layered sac of fibrous tissue that envelops the Heart. The space between the layers is filled with serous fluid that protects the Heart from external shock or trauma and lubricates to allow for normal Heart movement.
The Wonders of Light Therapy: An Interview with Wes Burwell
I first met Wes Burwell in 2011 when he was teaching a class on light. Since then, every time I hear him speak, his understanding of the benefits, function and capacity of light has evolved.
Managing Patient Expectations About Acupuncture
Last year, I attended the Pacific Symposium in San Diego for the first time in six or seven years. It was the 25th anniversary of this event, and on one evening there was a panel discussion with the title; "What is Qi?."
AOMA Strengthens Leadership Team
AOMA Graduate School of Integrative Medicine, a leading college of acupuncture & herbal medicine, announced the appointment of Donna LaPoint Hurta, MBA as the new VP of Finance & Operations this Fall.
Sports Science: What's in That Drink?
Athletes frequently ask me what the best liquid is to drink during exercise – water or a sports drink? Water provides the necessary hydration, but unfortunately, it lacks the key nutrients to aid in performance and recovery.
Chiropractic Research in Review
Predicting Pain With Disability in Office Workers; Traction Approaches for Discogenic Cervical Radiculopathy; Intra-Articular Gas Bubbles Following Manipulation; Nonresponsive Chronic Ankle Sprains: Think Tendon Rupture.
The Tao of Gender
If you think gender is as simple as having a new client check off the "male" or "female" box on your intake form, we hope this article will expand your understanding and thus the reach of your health care.
Uncle Sam Needs You (Part 2)
Where chiropractic care has been used in the military health services, it has been deemed very successful.
Simple Ways To Find True Happiness
Patients in our clinics are always seeking happiness. As their health advocate, we need to ensure we inform them that in order to find happiness, they have to make sure to identify what makes them happy in the first place.
Pulse Diagnosis: What We Know
I am still finding pearls of wisdom from the books and papers that I inherited from my pulse diagnosis mentor Jim Ramholz.
Healing With TCM at San Quentin State Prison
For the prisoners at San Quentin State Prison, life-sentences are the reality of every day life. It is not often that prisoners get the opportunity to use alternative medicine to deal with common ailments they encounter behind bars such as, depression, anxiety and pain.
A Commonly Missed Spinal Fixation: The Upper Lumbar Spine (Part 2)
As mentioned in part 1, using a flexion-distraction table is a great way to unlock this particular fixation. You have found the stuck segment. You have determined whether it is unilateral, midline or bilateral.
Lime Jello on Morphine
Taste is in the eyes... actually the mouth... of the beholder. My food preferences have changed, lightening from the food of my youth. My parents loved heavy eastern European cuisine and I loved it as a child. Now I enjoy leaner, healthier whole foods.
Jingei Diagnosis: An Effective and Powerful Diagnostic
I graduated from the Kotatama Institute under the direction of Drs. Masahilo and Katsuharu Nakazono in 1984. As a student, I was exposed to the practice of most of the various theories and modalites of Oriental Medicine.
The Case for Immunization
As long as I have been a chiropractor, I have seen many in this profession oppose vaccinations. Indeed, it has often been taken as a "given" that to be a principled chiropractor requires a curmudgeon's willingness to hold aloft that banner of opposition.
Managing Today's Fertility Patient
I recently received an email from one of my fertility patients: "Got my lab results back. FSH is 11, AMH is 0.7. My doctor said these numbers aren't good. I guess I'm infertile. Just as a thought. Just set up an appointment to speak with an adoption agency."
Correcting Pelvic Rotation Around the Long Axis: Adjustment Protocol
The pelvis can be considered a ring that can misalign on the sacrum rotating around the long axis. The following is a description of an adjustment that helps to correct sacroiliac rotation around the long axis.
CMT & Stroke Risk: Myth vs. Fact
By now, most of you have probably heard that the American Heart Association recently published a statement regarding the association between cervical dissection (CD) and cervical manipulative therapy (CMT).
Dr. George Goodman and His Legacy to Logan University
Those who knew him called him a revered leader, a visionary and one of chiropractic's biggest advocates. George A. Goodman, DC, Logan University's sixth and longest-serving president, passed away on Sept. 9. He was 70 years old.
Commingling Money: 12 Questions for the ACA About the CHAMP / NCLAF Merger
The American Chiropractic Association recently announced it was merging the National Chiropractic Legal Action Fund and the Chiropractic Health Advocacy and Mobilization Project into a single entity that will support both legal and legislative actions.
March, 2010, Vol. 10, Issue 03
The Silent Progression of Kidney Infections and Stone Formation, Part 2
By Dale G. Alexander, LMT, MA, PhD
The first article in this series postulated that kidney stone formation and chronic kidney infections may be possible causes of your clients' chronic ailments, especially those that relate to the low back, groin, knees, ankles and feet.This article will add more depth and breadth to your comprehension of these two disorders and how we may encourage our clients to seek appropriate medical testing. One point to consider is that individuals who seek out massage therapy on any regular basis may be subconsciously driven by an instinctual sense that they possess an anatomical anomaly or an avoidance of regular medical check-ups. It is our collective responsibility to make referrals when our common sense suggests it.
Let's begin by noting that there are five different kinds of kidney stones that have been identified. These include: calcium oxalate, calcium phosphate, uric acid, struvite (magnesium ammonium phosphate) and cystine. Knowing the type of stone may be especially helpful with an individual who experiences recurrent stone formation. The most common types of kidney stones are calcium oxalate and calcium phosphate.1
There are some questions we might ask to determine if clients have a greater-than-average susceptibility to kidney stone formation.
Have you or other family members have ever had an attack of gout? Kidney stones caused by uric-acid crystals occur in approximately 15 percent of people with gout. This compares to an 8 percent risk of kidney stones in people without gout.2
Have you had any surgery involving the large or small intestine? Conditions that increase the absorption of oxalate from the gastrointestinal tract (short bowel syndrome, chronic diarrhea, previous bowel surgery or gastric bypass surgery) may contribute to kidney stone formation.1 People with Crohn's disease also often have more susceptibility to kidney stones.3
Have you ever been diagnosed with hyperparathyroidism? This is a condition where one or more of the parathyroid glands becomes overactive. As a result, the blood calcium rises to a level that is higher than normal (called hypercalcemia).1 Once a person is identified with this condition, the usual medical protocol is to check for kidney stones via ultrasound or CAT scan of the kidneys. By asking if these tests were done, we can serve our clients.
Another question that is pertinent to ask clients is whether their urine has a foamy head like freshly poured beer? This is a sign that the kidneys are leaking protein.7
In hot weather, we all sweat more, which concentrates urine. "Concentrated urine is a breeding ground for kidney stones."4 Encourage clients to drink more fluids and eat more vegetables, fruit, and grains, which naturally contain water. The goal is to increase the amount of urine that flows through the kidneys and ureters and to lower the concentration of substances that promote stone formation."1 One suggestion is for clients to drink half of your weight in ounces per day. Thus, if you weigh 180 lbs., drinking 90 ounces of water is recommended.5
Two ironic items turned up in my research, suggesting that coffee drinkers have fewer kidney stones whereas those who drink excessive amounts of grapefruit juice have more kidney stones.4 This reminded me of a client from about 20 years ago who came to me with a right knee problem. I asked him if he had ever had a kidney stone and he replied, "about 50." I asked how much grapefruit juice he drank, to which he responded, "about two gallons a day."
Human physiology is an integrated whole. I postulate that few instances of kidney stones express themselves without a tendril of connection to other subtle physiologic progressions. According to NYU's David Goldfarb, director of the Kidney Stone Prevention Program At Saint Vincent Medical Center: "I tell my patients that the kidney stone that brought them to my office may be the least of their problems, and that any stones are the harbinger of their increased risk for diabetes, high blood pressure, and osteoporosis."4
Remember that the physiologic role of the kidneys includes re-absorption of glucose, amino acids and other small molecules; regulation of sodium, potassium, and other electrolytes; regulation of fluid balance and blood pressure; maintenance of acid-base balance; and the production of various hormones including vitamin D and erythropoietin (a hormone produced by the kidney that promotes the formation of red blood cells in the bone marrow).6 The kidneys also allow surplus concentrations of excess calcium or protein to be excreted in the urine. In this case, the most important question is why isn't the body absorbing and using these substances in a balanced metabolic fashion? An excess or shortage of biochemicals in our bodies can push our homeostatic capacity over the edge into the beginnings of pathology.
Statistically, more men will develop kidney stones, but my clinical experience is running 50-50. This variation may be a function of my specialization in working with chronic problems. An important revelation for me in researching this article is that kidney stones in children are on the rise.8 Children are less able to describe what they feel inside, so we are challenged to let their behavior and bodies speak to us.
Let's shift our attention to some pertinent anatomy. The functional workhorses of the kidneys are the nephrons. The two kidneys contain about 2 billion nephrons, each capable of forming urine. The nephron is basically a glomerulus through which fluid is filtered from the blood and a long tubule in which the filtered fluid is converted into urine on its way to the pelvis of the kidney. Most kidney difficulties relate to the destruction or damage of the nephrons so that they simply cannot fully perform their normal functions.9
There are many progressive disorders that may lead to this deterioration of nephron function: chronic glomerulonephritis, traumatic loss of kidney tissue, congenital absence of kidney tissue, congenital polycystic disease (in which large cysts develop in the kidneys and destroy surrounding nephrons by compression), urinary tract obstruction resulting from renal stones, pyelonephritis (infections) and diseases of the renal vasculature.9 Many of these difficulties can brew for years until pressure, obstruction or infection begins to affect the capsule of the kidneys or the ureters, or until infection spreads beyond the kidneys.
Chronic kidney infections may also morph into chronic kidney disease. A number of my clients have been medically diagnosed with kidney infections. These clients tend to be between the ages of 50 and 75, and often note that they have one or two of the conditions often associated with the decline of kidney function, kidney disease in their family, urinary tract infections, hypertension, diabetes or a beginning decline in their bone density. If a client says, "yes" to two or more of the questions from Parts 1 and 2 of this series, encourage them seek regular medical check-ups.
Medical tests that may be more sensitive to the early stages of progressive kidney disease include a 24 hour urine collection, a creatinine clearance test and a microalbuminuria test. These tests may be more appropriate because the standard screening for creatinine and blood urea nitrogen (BUN) for analyzing blood plasma "will not be raised above the normal range until 60% of total kidney function is lost."9
If a client's somatic complaints are consistently associated with the low back, groin, knees, hips or feet this raises my alert flag. Such complaints will often move between these areas during a series of sessions. I translate this as the body's attempt to distribute the internal strain of vascular and neurological congestion. It is also not uncommon for clients to respond quickly to bodywork only to have different, similar or the same complaints return. The quicker the reassertion of somatic difficulties, the more urgently I encourage clients to seek medical testing. My interpretation is that the body is signaling from the "inside-out" that there is more afoot than meets the eye.
Yes, people do have lumbar disc problems, accumulated strains, injuries or previous surgeries. However, if their history suggests that they have already been to competent physicians, orthopedists, chiropractors or physical therapists, this is another alert flag. By educating our clients to what possible difficulties exist empowers them with the capacity to choose, to select among the options to improve their quality of life.
Editor's Note: Join Dale as he teaches the pre-convention workshop (The Inside-Out Paradigm/Visceral Mobilization/Gall Bladder Dysfunction/Disease) for the AMTA National Convention in Minneapolis, Minn. Register at www.amtamassage.org after April 1. Inquiries can be sent to . Reading his Gall Bladder Article Series via www.masagetoday.com is a pre-requisite to attending the course.
Click here for more information about Dale G. Alexander, LMT, MA, PhD.
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