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Is the EHR Ship Setting Sail Without Us?
The numbers are in: As of July 2014, 10,253 doctors of chiropractic have received $123,059,868 in EHR stimulus funds – and yet that represents less than 15 percent of our profession.
News in Brief
Major Organizations Announce Joint Conference; Fighting for Section 2706; New Vice President of Chiro. Program at Parker; Two Families, One Chiropractic Dynasty.
Overcoming Barriers to Exercise Compliance
One of the most common questions other practitioners ask me is, "How do I get patients to do their exercises?" I am not frustrated by my patient compliance, as many doctors are; in fact, I am actually happy with my patients' involvement and commitment.
We Get Letters & E-Mail
Not All Evidence Is Equal; An Abundance of Misinformation; A Well-Researched Decision; Far Too Dangerous.
Defending With Vitamin D: Helps Prevent Progression to Diabetes
A 2014 clinical trial published in the American Journal of Clinical Nutrition provides additional evidence that optimal vitamin D nutritional status may be important in preventing the progression of prediabetes to diabetes in prediabetic adults.
Love a Nurse – and They'll Love You Back
According to various sources, there are about 3 million registered nurses in the U.S., and according to the American Nurses Association, they are under serious pressure in today's health care reality.
Peer Points: Always Seeking To Grow
Ellen "Kiki" Geary has spent the last decade honing her craft. As a specialist in integrative holistic care, she went straight from completing her master's degree in acupuncture and chinese herbal medicine from Bastyr University to building a successful and thriving practice in the small community of Anacortes, Washington.
Billing for Same-Visit Extraspinal and Spinal Manipulation
Q: I have always been under the premise that when billing 98943, extraspinal chiropractic manipulation, on the same visit as spinal manipulation, 98940-98942, that the extraspinal manipulation requires modifier 51.
Women's Health: Herbal Formulas to Help Patients With Dysmenorrhea
Chiropractors have long treated women for menstrual pain (dysmenorrhea). Since roughly 60 percent of all chiropractic patients are women and 30-50 percent of women have a history of menstrual cramps, the vast majority of doctors of chiropractic will inevitably see patients with dysmenorrhea.
The Art of Day-to-Day Assessment and Treatment: Clinical Pearls
Let's focus on the day-to-day process of assessing and treating the patient. I am proposing a particular attitude; a way of looking at the patient. This often evolves over a few treatments and then changes as you figure out what is significant.
The Wisdom of the Second Office Location (SOL)
There are some things I never want to do again, like riding a motorcycle 100 mph. I call these things my "negative bucket list." Other things I have on that list include water skiing, riding a roller coaster and eating habanero peppers.
Building From the Bottom Up
I caught up with my dear friend Honora Wolfe, in her Colorado painting studio where, if she is not praying in Bhutan or doing charitable work in a Nepali free clinic, she spends most of her time now.
A History Worth Telling
The popularity and the use of acupuncture for the treatment of animals in the United States is at its peak.
Image Is Everything: The Power of Branding
Successful businesses use color and design to attract people to their service. They understand how important image is and hire experts to create an attractive package. Starbucks works hard to create an atmosphere that is warm and inviting.
State by State: Comparing Chiropractic Scope of Practice
"The issue of 'scope of practice' has been a bugaboo ever since our early quests for legal recognition for chiropractic," according to Dr. Claire Johnson, editor in chief of JMPT and National's other two chiropractic journals.
Medical Qigong for the Heart: Part III
Part 1 and Part II of this series focused on the physical aspect of the Heart and mental emotional aspects of the Heart respectively. Now, I would like to focus on the spiritual aspect of the Heart.
A Guide for Talking to Doctors about Acupuncture and Brain Chemistry
Before I begin any discussion of how to talk about the effects of acupuncture on brain chemistry, nervous and endocrine function, it is essential to understand just what physicians most need help with.
Finders Keepers: The Secret to Relationship-Based Marketing
Becoming a successful practitioner has less to do with what you learned in school, and more to do with your ability to find new patients and keep them!
A Chinese Medicine Story: An Interview with Mazin Al-Khafaji
Mazin Al-Khafaji's work has interested me for years. In February 2014, we invited him for the second time to speak at the Southwest Symposium in Austin, Texas.
A Dream Come True for Chiropractic: Funding Prevention and Public Health
Back in 2005, Sen. Tom Harkin (D-Iowa) said: "Let's face it, in America today we don't have a health care system, we have a sick care system.
Are Your Work Orders in Order?
There are times when a patient's occupational duties will delay or prevent them from recovering. These circumstances create the need for the doctor to recommend modified duty or remove the patient from work.
October, 2010, Vol. 10, Issue 10
Managing Irritable Bowel Syndrome
By Leon Chaitow, ND, DO
This brief review of irritable bowel syndrome (IBS) management suggests that there are possible biomechanical, behavioural, as well as dietary strategies, that can commonly be helpful. IBS has been defined as abdominal pain, experienced more than once a month, associated with bloating and altered bowel habits.(Moore & Kennedy 2000) By definition, IBS is functional, that is, there is no infection or pathology associated with it. (Abrams et al 2002) It is more common in women than men, and is often associated with other chronic pelvic pain (CPP) symptoms. When IBS is chronic, core muscles (e.g. pelvic muscles) may become hyperalgesic with multiple trigger points. (Fall et al 2010)
Tak & Rosmalan (2010) discuss the role of the body's "stress responsive systems" in what has been termed functional somatic syndromes, such as IBS, as involving a "multifactorial interplay between psychological, biological, and social factors." Therefore, there is a need to move beyond a search for single causes of most conditions such as IBS, since, like many other complex and difficult-to-treat conditions, they commonly have multi-factorial aetiological features - possibly interacting with predispositions and altered stress-coping functions.
Beales (2004) has described a scenario that highlights multiple contributory factors to functional somatic syndromes: "Too much sustained, [stress] leads to the loss of internal balance, and results in reduced performance and a mind-body system in overdrive. In this state, the metabolism is struggling and cholesterol, blood sugar and blood pressure are often raised, resulting in ill health ... for instance, sufferers from irritable bowel syndrome may also commonly experience back pain, fatigue and loss of libido. Negative emotions, such as frustration and despair, can trigger exhaustion, which in turn can trigger breathing pattern disorders, as a consequence of the perceived threat to survival eliciting fight, flight or freeze reactions."
Massage offers a highly suitable stress modulating approach. (Moraska et al 2008)
Overbreathing & Colon Constriction
Ford et al (1995) have reported on the high incidence of increased colonic tone and dysfunction in hyperventilating individuals. Hypocapnic hyperventilation (low CO2 blood levels) produces an increase in colonic tone, and phasic contractility in the transverse and sigmoid regions. These findings are consistent with either inhibition of sympathetic innervation to the colon, or the direct effects of over-breathing on colonic smooth muscle contractility, or both.(Chaitow 2007)
Prather et al (2009) expand on these relationships, in review of the anatomy, evaluation, and treatment of musculoskeletal pelvic floor muscle (PFM) pain in women.
They note that persistent muscle contraction of the pelvic floor, related to noxious visceral stimulation, such as that deriving from endometriosis or irritable bowel syndrome, can lead to splinting and pain, with reduction of normal PFM function. Specifically, they report that viscerosomatic reflex activity may be responsible for increased resting tone of the pelvic floor with reduced ability to fully relax the muscle group as a whole. As a result, they suggest, adaptation occurs via recruitment of global muscles in the region (e.g. psoas and iliacus) leading to symptoms such as posterior pelvic and low back pain. Prather et al also point out that: "Proper breathing techniques, while performing exercises and activities, are essential for pelvic floor relaxation ... pelvic floor contraction during exhalation allows for synergy between the pelvic and respiratory diaphragms."
This is also a key to assisting IBS dysfunction.
In a comprehensive review of the subject Heizer et al (2009) suggest that dietary changes are worth attempting in an effort to relieve irritable bowel syndrome (IBS) symptoms. It is recommended that dietary restrictions should be introduced one at a time, beginning with any food or food group that appears to cause symptoms based on a careful patient history or review of a patient's food diary. The most effective duration for dietary trials has not been well studied, however 2 to 3 weeks is commonly suggested. A modified exclusion diet, followed by stepwise reintroduction of foods is likely to be more effective in finding problem foods, but it is more time-consuming.
General dietary recommendations for patients with IBS, based on clinical experience and anecdotal reports (Heizer et al 2009) include:
Research suggests that use of peppermint oil, particularly in cases of relatively mild IBS is likely to be of benefit in symptomatic treatment of IBS. (Capello et al 2007)
While some studies have shown potential benefit for use of turmeric (curcumin) in treatment of IBS (a member of the ginger family of plants), no placebo-controlled studies have been conducted. (Heizer et al 2009)
The conclusion of a review of the evidence for use of probiotics in both IBS and inflammatory bowel disease are cautiously positive.(Iannitti & Palmieri 2010) Two meta-analyses (Nifkar et al 2008, McFarland & Dublin 2008)) and two comprehensive narrative reviews (Wilhelm et al 2008, Spiller 2008) on the use of probiotics in the treatment of IBS. All concluded that probiotics may be useful but there are many variables affecting the results such as the type, dose, and formulation of bacteria comprising the probiotic preparation, the outcome measured, as well as size and characteristics of the IBS population studied.
IBS is common. Patients with this condition may respond well to stress reduction, better breathing patterns, biomechanical normalisation (pelvic structures) and trigger point deactivation. For more on the topic of pelvic pain in general, enhanced breathing strategies, and manual therapy, go to: www.leonchaitow.com, or blog: http://chaitowschat-leon.blogspot.com.
Click here for more information about Leon Chaitow, ND, DO.
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