A Simple Miracle: Treatment for Mysterious Foot Pain
Under the old ICD-9 diagnosis codes, there was actually a diagnosis for "adventures in medical mismanagement" to describe patients who had been run down the rabbit hole of poor case management and care. I encountered one of those patients in my office today.
Electrotherapy Gives Hope for Patients With Spinal Cord Injury
There has been little optimism for recovery from a spinal cord injury because the central nervous system does not repair itself well. The severity of the injury depends on the affected area.
2018 Gallup-Palmer Report: Key Findings
The fourth annual Gallup – Palmer College report is out; here are some of the key findings excerpted directly from the executive summary regarding Americans' experiences with chiropractic care relative to the management of neck and back pain:
VA Chiropractic Reduces Veterans' Use of Opioids?
Utilization of pain medication – particularly opioids – has been massively high in among veterans for decades, but Veterans Administration guidelines that recommend nonpharmacological first-line treatment options create a greater opportunity than ever for VA chiropractors to make a dent in the opioid and overall pain-management crisis.
The Top 5 Strategies to Manage Your Reputation Online
You don't need an acupuncture website anymore! Okay, maybe that statement is a little over the top. But it's not that far from the truth. A recent study on Google searches revealed that 34 percent of all searches resulted in no clicks at all.
Knocking Down the Doors: Big Media Success for F4CP
Three articles authored by a DC or a chiropractic organization and promoting the value of chiropractic care – par for the course if you're Dynamic Chiropractic, but if you're Forbes, BOSS Magazine and Becker's Spine Review, three media outlets tailored toward high-level executives and decision-makers, we're talking about an entirely different story.
A New President for AOMA: A Conversation With Mary Faria
Dr. Faria was formerly a health care executive for over 30 years, the last 17 of those years as vice president and chief operating officer of Seton Southwest Hospital in Austin. She chairs the board of Austin Mayor's Health and Fitness Council.
VA Choice Claims Denied? Here's How You Can Get Paid
The VA Choice Program (PC3 as well) indeed pays for chiropractic care including manipulation (CMT 98940-98943) and some physical medicine services.
Cynicism and Burnout: It Can Happen to You
Trying to achieve fulfillment as a doctor in today's health care environment is a "rigged game" and physicians are programmed to burn out. At least this is the opinion of Dike Drummond, MD, in his thehappymd.com blog.
News in Brief
A Comprehensive Model of Spine Care; Dr. Christine Goertz Appointed Vice Chair of PCORI Board of Governors.
Malpractice Insurance: Understanding the Cover Letter
Purchasing medical liability insurance is quick, easy and not terribly expensive. The benefits are clearly listed on a certificate—but do you really know what you are getting with that peace of mind?
Bad for the Back! Exercises That Can Prevent Healing
The questions "Who gets well? Who doesn't? Why?" prompted the following observations based on my close to 40 years of chiropractic practice.
A Guide to CBD Dosing: The Correlation Between Dose & Potency
There is an abundance of information available about the daily use of whole plant hemp CBD oil to help maintain and support a healthy lifestyle, however there remains a lack of sound guidance on CBD oil dosing.
Goodbye, Year of the Dog: Two-Thousand-Eighteen Comes to a Close
As Year of the Dog (2018) comes to a close we can look back and see the progress this profession has made. For example, the International Classification of Diseases (ICD) added traditional medicine codes, which were released in June.
The Raw Food Debate: Practitioners Discuss Nutrition & TCM
Licensed acupuncturist and fellow blogger Elissa Gonda joins this month's column for a conversation about raw food diets. She brings her perspective on the healing potential of a raw primal diet.
The Truth About Malpractice Claims Against DCs (Pt. 1)
Over the past 20 years of active practice, I have seen a number of scary case scenarios regarding signs, symptoms and patient presentations in my office. These presentations scream, This patient is going through an event or This patient does not need chiropractic care, they need emergency care.
Dietary Supplements That Help Restless Leg Syndrome
It is estimated that 7-10 percent (possibly up to 15 percent) of the U.S. population has restless leg syndrome. It is a bit more common in women than men.
Year in Review: DC's Best of the Best for 2018
As 2018 winds down, let's highlight the most popular articles in Dynamic Chiropractic by month (December – this issue – excluded, of course).
A Soy Isoflavone That Packs a Punch: Genistein
Soybeans contains unique substances called isoflavones, most notably genistein and daidzein, which have been shown to block the buildup the dangerous type of testosterone in the prostate gland linked to prostate enlargement and prostate cancer.
Reaching for Our Roots: Healing Digestion With a Simple Traditional Therapy
Are you ignoring a powerful tool in your doctor's bag? Many acupuncturists realize that Spleen Qi deficiency has reached epidemic proportions in the U.S. Yet, we don't prioritize educating our patients about the importance of warm, cooked foods.
Map It: Understanding the Customer's Journey
One of the biggest marketing mistakes most practice owners or administrators make is not putting themselves in their prospective or current patients' shoes. How do they think and feel about you and your practice? What makes them take action?
ACA Champions H.R. 7157; ICA Voices Major Concerns
While the American Chiropractic Association recently penned an open letter – signed by not only the ACA, but also the Congress of Chiropractic State Associations, Association of Chiropractic Colleges, Clinical Compass and a number of state associations.
Exercise Therapy Following Motor Vehicle Trauma (Pt. 2)
In cases of cervical spine trauma, particularly trauma related to a motor vehicle accident, my plan is to teach the patient one exercise per session and build a progression. This is an effective approach I call an "activation circuit."
Reality Check: Do We Need to Try Harder?
While waiting for a flight to a recent chiropractic event, I overheard the ticket agent at the gate next to mine on his cellphone. His side of the conversation went something like this: "Where are you now? How long before you think you can be at the gate? OK, that will work, see you soon."
When Computers Cause UCS: Adjusting Strategy
With the widespread use of mobile devices such as smartphones and tablets, the incidence of "text neck" has reached almost epidemic proportions. But there is another challenge to the spinal health and well-being of our technology-driven society.
Acupuncture in Hospital Systems: Transitioning From Tolerated to Celebrated
I've had the pleasure of working with Susan Luria, Director of University Hospitals Health Systems Connor Integrative Health Network (CIHN) for the past year on the Integrative Health Policy Consortium (IHPC) Board of Directors and Federal Policy Committee.
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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