AAPM Workshop Sept 2014 - American Academy of Pain Management

Transcription

34. Worlds Unite: Treating Pain with Manual
Medicine, Acupuncture, and Nutraceutical/
Herbal Medicine
AAPM CONFERENCE WORKSHOP
Sunday, September 21, 2014 • 8:00 am - 12:00 pm
Presented by:
Jay Sandweiss, D.O., C-NMM/OMM, F.A.A.M.A.
417 S. Fourth Ave. Ann Arbor, MI 48104 USA
email: dr jay@doctorjaysandweiss.com
website: www.doctorjaysandweiss.com
Fax: (734) 668-6529
Integrating Manual Medicine and Nutritional Therapy
with Acupuncture
Dear Friends and Colleagues… It is always a distinct honor
and pleasure to present workshops. As many of you know,
I have been treating patients for over thirty years using
a variety of modalities, including both complementary/
alternative therapies and conventional “standard of
care” medicine. Buzz words like “evidence-based” and
“standard of care” have undergone their own evolution
in the past three decades. As a medical student, I was
chastised for asking questions about the use of folic acid
for the prevention of neural tube defects, magnesium for
certain arrhythmias and migraine, fish oil for autoimmune
disease and cardiovascular health, and the existence of
Helicobacter Pylori(which my course instructor dismissed as
“junk science” proposed by a misguided quack Australian).
We laugh now as these examples have been integrated into
mainstream medicine, but we must not forget that for better
or worse, medical science is a very conservative, skeptical,
critical entity that often dismisses truth with unfortunate
consequences only to embrace these same facts later
Jay Sandweiss, D.O., F.A.A.M.A.
on down the road. Students of medical history are often
appalled by what was the“standard of care” in those past times. Ridiculing and punishing handwashing with soap, femur amputations for the treatment of pernicious anemia, and dismissing
“stocking-glove” paresthesias and carpal tunnel syndrome as psychiatric illnesses or
malingering were all part of a long-established history of blaming the patient whenever possible
and punishing those that threatened the reigning paradigm. As acupuncturists, we have seen a
growing acceptance and demand from the public at large to provide our services. “Evidencebased” studies have slowly infiltrated the mainstream medical establishment to the point
where acupuncture is often included as a viable intervention for numerous conditions. Similar
patterns of change have occurred in the fields of manual medicine and nutritional therapy. The
burden of “evidence-based” studies helps prevent dubious therapies from being accepted but
also limits many legitimate treatments because of the onerous time/money constraints placed
on the investigators. This is particularly true in the field of nutritional therapy where money
is not readily available unless the payoff is a drug patent for the pharmaceutical companies.
Ironically, many drug companies are, indeed, trying to capitalize on the works of
nutritional pioneers by patenting a slight variant of a readily available nutritional product.
Prescription fish oil, time-released niacin, vitamin B-12/Folate and a recently approved
strontium-hybrid are but a few examples. Fortunately, several of the top nutraceutical
companies are sponsoring clinical trials with their products at major research centers around
the world.
My knowledge of nutritionally based therapies represents a conflation of influences from many
great teachers and innovators. A list of resources is included at the end of this introductory
essay. My early teachers were Drs. George Goodheart Jr. and Walter Schmitt, who, along
1
with Harry Eidenier Jr. PhD, introduced me to the late and great genius, Royal Lee, DDS (the
founder of Standard Process Laboratories. To this day, Dr. Lee’s work offers endless clinical
pearls for effective patient care. Another huge leap of knowledge occurred studying the works
of Jeffrey Bland, PhD. His seminars and publications are masterpieces that weave physiology,
nutritional biochemistry, and clinical medicine into a vibrant working model. Many physicians
have been transformed by courses offered by the Institute for Functional Medicine that teaches
much of Dr. Bland’s life work. At the same time, Jonathan Wright, M.D. and Alan Gaby, M.D.
were writing books and offering week-long courses to physicians. Their courses included
applied nutritional therapies for almost every medical sub-specialty.
After attending their course at the Omega Institute in 1988, I became convinced that
medical nutrition was destined to become an integral part of mainstream medicine. Melvyn
Werbach, M.D from UCLA came along with his wonderful Third Line Press publications
that documented the use of dietary, nutritional, and herbal interventions for nearly every
medical condition. Finally, Kirk Hamilton P.A. offered comprehensive reporting on research
in the field of medical nutrition with his Clinical Pearls services. My apologies to all the
many other great contributors, leaders, and pioneers whose names have not been included
in this brief presentation. This workshop pertains to the integration of nutritional medicine
and manual medicine with acupuncture. As medical acupuncturists we appreciate those
interventions that enhance a healthy physiology and homeostasis. Current theories about
acupuncture propose mechanisms that involve cellular molecular biology in its varied forms
including: neurotransmitters, cellular messengers, immune cells and modulators, endogenous
opioids and cannabinoids, and numerous other components of immunology, neurology, and
metabolism. Nutritional medicine shares many similar characteristics. It seems reasonable to
postulate that acupuncture interventions and nutritional interventions are capable of achieving
similar effects under certain circumstances and an enhanced synergistic result in yet others.
Often a pattern diagnosis in Chinese Medicine such as: Damp Heat in the Lower Jiao
may represent in Western physiologic terms: intestinal dysbiosis involving an imbalanced
microbial population in the bowel with overgrowth of candida albicans, the presence of
parasites, and a deficiency of normal probiotic flora resulting in non-specific colitis or irritable
bowel syndrome. An acupuncturist may choose to treat specific points that influence Damp
Heat in the meridians: Spleen/Stomach, Large Intestine, Liver and Gall Bladder. Herbal
formulas might be employed as well to resolve this issue. A functional medicine practitioner
may order sophisticated stool studies, blood tests, and other tests before implementing a
focused nutraceutical/pharmaceutical plan to resolve the abnormalities that appear in these
investigations. Probiotics, prebiotics, antifungals, antimicrobials and nutrients that help heal
and restore normal mucosal integrity may be utilized. Following treatment there will be a
noticeable change in pulse and tongue findings from a Chinese Medicine standpoint in addition
to the obvious clinical improvements. The question frequently arises as to whether or not
acupuncture is necessary or sufficient to resolve these types of clinical disorders. During my
internship year in medical school, I was completely cured by one acupuncture treatment for a
refractory case of ulcerative proctitis that was confirmed by tissue biopsy and unresponsive to
steroids. My physician friend, just back from China, diagnosed a severe Damp Heat invasion of
my Lower Jiao by history, tongue and pulse diagnosis. This ”acupuncture healing” profoundly
affected my life and viewpoint about illness and treatment. Nutritional modalities were not
involved nor were manual treatments.
2
In my experience, acupuncture enhances the therapeutic effects of other modalities such as
manual medicine or nutritional/pharmaceutical interventions. As physicians we appreciate
the seriousness of pneumonia and will often prescribe an appropriate antibiotic. As medical
acupuncturists, we would want to treat the Lung meridian and any additional corresponding
meridian disturbances that were present during the illness and after the pneumonia
had resolved. Furthermore, as healers we would seek out the inherent weaknesses or
vulnerabilities that allowed our patient to acquire pneumonia in the first place. Acupuncture,
nutritional medicine, and manual medicine can be pro-active and preventive in addition to
being treatment responses for medical conditions. They are interventions that promote healing
and homeostasis in addition to attacking pathology and dysfunction.
As an integrative medicine physician, I am frequently treating patients with multiple
interventions simultaneously. It is not unusual for these patients to receive nutritional/herbal
therapies, dietary manipulations, manual therapies, and acupuncture in their total treatment
plans. Identifying the specific curative factor or factors is therefore rather difficult. Each
therapeutic input is intended to address or resolve specific aspects of the troubling condition.
Some refer to the “combination- lock theory “ of healing wherein all the numbers (factors) must
be known and the specific sequence is needed to unlock the lock (heal the condition). A brief
example might be useful here. Suppose the patient has chronic asthma as their chief complaint
and is currently not facing an acute life-threatening crisis. In addition to, or as an alternative
to the typically prescribed medications such as Albuterol, Flovent, Singulair, Zyrtec , etc. one
could prescribe a food elimination diet, nutritional supplements such as: vitamin B-12, vitamin
C, magnesium, n-acetylcysteine, and quercitin to name just a few. Acupuncture needles
could be administered based on the specific etiology imbalances discovered during pulse,
tongue, and history diagnostics. Herbal formulas could be added to support and enhance
the acupuncture effect. Manual medicine techniques could be utilized to remove mechanical
restrictions in the diaphragm, cranium and axial skeleton. Lymphatic drainage and respiratorycirculatory techniques could be used as well. Mind-body therapies could be taught to reduce
“stress” and control triggers from a mental-emotional origin.
We can take advantage of the many readily available diagnostic tests for evaluating :
nutritional deficiencies,toxicities, hormonal and metabolic disorders, food/chemical allergies
and sensitivities, and bowel flora disturbances. Numerous studies have pointed out that
nutritional deficiencies are common and often go unrecognized in our elderly population. As
our “life energies” or “Jing” wanes with age there are often corresponding deficiencies seen
with nutrients and hormones that if treated can markedly improve quality of life parameters.
I hope you will find useful, information in this presentation that can benefit your patients, your
families and yourselves. Applied nutritional therapy is wonderfully synergistic with medical
acupuncture. While you treat a Liver problem from an acupuncture perspective with needles,
you can simultaneously identify specific dietary and nutraceutical interventions by history,
examination, and diagnostic testing. One can also treat the liver organ itself with viscreal
manipulation.
3
TRAUMA : AN INTEGRATIVE MODEL FOR DIAGNOSIS AND TREATMENT
internally causing a tissue reaction. Pain is the resultant which has varying degrees of intensity
and effective interpretation with numerous avenues of transmission.” This lecture introduces a
variety of treatment principles and modalities for patients who have suffered trauma in their
past and are unable to move forward in their recovery. This presentation will not address the
management of serious acute trauma that requires emergency interventions or acute hospital
care. Rather, we will discuss approaches that can be utilized after the patient is medically
stable but is “stuck” and unhappy with their current state of recovery. We often encounter
these patients who have been told: “You’ll have to learn to live with it” (for the remainder of
their lives). Be it chronic pain, loss of function, loss of motion, depression, or other sequelae to
by traditional
mainstream medicine. As acupuncturists we are quite familiar with these truths and most of
us have already helped numerous patients with needles, moxa, and/or herbs. This session is
meant to add to that growing list of possible complementary and alternative approaches for
healing past trauma.
THE “LIST”
Osteopathic Manipulative Medicine: Cranial Osteopathy, Visceral Manipulation, StrainCounterstrain, Myofascial Release, Functional Release, Muscle Energy Technique, High
Velocity Thrust, Facilitated Position Release, Balanced Ligamentous Tension, Percussion
Hammer
Special Attention to: Breathing( 3 Diaphragms), Visceral Mobility and Motility disorders,
Sacrum-Coccyx(Holds fear/insecurity), Dural strains, Cranial/TMJ dysfunctions (often
unexamined), Greenman’s “Dirty Half-dozen” (non-neutral facet joint restrictions, symphysis
pubis shears, sacral posterior torsion or nutation, hip bone shear, short-leg/pelvic tilt syndrome,
and muscle imbalance of the trunk and extremities), Nerve Restrictions, “Energy Sinks”
(Robert Fulford’s Concept that is treated with the Percussion Vibrator)
Chiropractic: Applied Kinesiology (Injury Recall Technique, Emotional Neurovascular Holding
Points), Sacro-Occipital Technique (Suture Releases), Neuro-Emotional Technique
Homeopathy: Arnica, Hypericum, Symphytum, Natrum Sulphuricum, Ruta Graveolens
Bach Flower/ Other Flower Essences: Star of Bethlehem, Rescue Remedy, Revive All
(FlorAlive Remedies)
Aroma Therapy: Spruce, Rose, Lavender
EMDR (Eye Movement Desensitization and Reprocessing): Psychotherapy Tool
Redcord: A Revolutionary Rehab Device
Prolotherapy: For hypermobilty unresponsive to other modalities or strengthening
Nutritional/Metabolic: Evaluation of: Nutritional status (intracellular vs. other), Endocrine
balance (blood, urine, saliva), Toxicity (hair, blood, urine, feces), Food and chemical
Dysbiosis/”Leaky gut syndrome” (Comprehensive Stool Analysis), Immune panels with other
traditional laboratory and diagnostic studies.
Hypnotherapy, Biofeedback, Neurofeedback et al: Brain, behavior, and psyche
Bioenergetics and other Mind-Body oriented therapies: Somato-emotional therapies
4
Rolfing, Hellerwork, Soma Bodywork, Anatomy Trains: Core patterns
Magnets, Crystals, Lasers, and other energy transfer devices: Energy fields
Shamanic Healing and other forms of “Soul Retrieval”
Chinese Medicine: Seven Dragons, Chakra Acupuncture, Yintang, Shao Yin- Jue Yin
groundingreleasing points: H-7, PC-6, LR-3, K-3, K-25, 26, 27, CV-17
Treat the “scattered” or “suspended” Qi, treat the loss of Heart Qi,
Heart pulse is Fine and Tight, Complexion is bright-white or bluish tinged forehead.
Pulse is rapid, short, shaped like a bean, vibrating
Eyes may be dull without glitter** (from Giovanni Maciocia)
As an osteopathic physician I have been greatly influenced by my teachers, mentors, and the
past masters of my profession. To better understand the osteopathic philosophy and treatment
approaches to trauma, I can highly recommend the writings and methods of: Andrew Taylor
Still M.D./D.O., Rollin Becker D.O., Robert Fulford D.O., William Johnston D.O., Viola Frymann
D.O, Myron Beal D.O., William Sutherland D.O., Fred Mitchell Jr. D.O., Lawrence Jones D.O.,
Anne Wales D.O., Irwin Korr Ph.D., Philip Greenman D.O., Robert Ward D.O., Anthony Chila
D.O., Edward Stiles D.O., John Upledger D.O. and Jean-Pierre Barral D.O. This is a partial
list but certainly representative of the rich and prolific tradition of osteopathic healers and
educators.
My first mentor, George Goodheart Jr., D.C., developed a unique system of diagnosis and
treatment using manual muscle testing. His system, Applied Kinesiology, has been in a state
of continual evolution for over 60 years. A central theme runs through his work known as
the “Triad of Health”. This concept proposes that there is a continuous interaction between
structure, chemistry, and emotional/energetic facets. When a patient presents with posttraumatic pain, there will undoubtedly be multiple somatic dysfunctions present. A careful
history and thorough examination usually reveals biochemical and emotional- energetic
problems as well. Food allergies, chemical sensitivities, toxicities, nutritional deficiencies,
endocrine disturbances and subtle disorders of metabolism such as mitochondrial dysfunction
are more common than one might imagine. “Post-Traumatic Stress Disorder” with its myriad
of manifestations: Depression, Anxiety, OCD, ADHD, Paranoia, Phobias, Insomnia, Somatic
Disorders, and Sexual Dysfunction, (just to name a few) is also quite common.
Perhaps a case example might illustrate the application of this “Triad of Health” paradigm. A 45
year old white female has had three years of pain in the cervical, mid-thoracic and lower back
regions following a whiplash injury. Additionally, she complains of retro-orbital and temporal
headaches, jaw tension with “clicking and popping,” insomnia, fatigue, depression, anxiety,
irritable bowel syndrome, irregular periods, right carpal tunnel syndrome, left patella pain,
and “foggy, dull thinking.” All of these complaints began after the accident. She was stopped
at a red light and was rear-ended at approximately 35 mph. She hit her head on the driver’s
window, hit her knee cap into the dashboard, and felt extreme strain to her wrist during the
accident. A month after the accident she developed a thyroid nodule with goiter and became
hyperthyroid requiring Tapazole medication. Patients with these scenarios are often treated
as if their entire whiplash injury is strictly limited to their musculoskeletal system. Medications,
injections, physical therapy, chiropractic, massage and other musculoskeletal modalities are
often employed. The lucky patients recover with those interventions alone. Some are not so
lucky.
5
This patient requires deeper attention to the specific disruptions of her structure, chemistry,
and energetic psychology. Osteopathic examination reveals: cranial somatic dysfunctions
involving a petro-jugular dislocation, fronto-sphenoid compression, lateral sphenoid strain,
lowered cranial rhythmic impulse and impairment of venous sinus drainage. Physical
examination reveals TMJ dysfunction which is supported by an MRI, documenting a dislocated/
torn disc and capsule allowing for complete dislocation of the TMJ disc during opening and
closing. Cervical MRI demonstrates atrophy of the rectus capitis superior minor muscle with
resultant instability of the occipito-atlantal joint. Neural and myofascial tension is noted from
the anterior cervical regions down the right arm into the wrist and hand. The diaphragmatic
breathing pattern is markedly dysfunctional with dyskinesis of the thoracic, pelvic, and cranial
diaphragms. Hypermobility of the cervical and thoracic ligaments is noted at multiple levels.
The sacrum and coccyx are abnormally tight and intra-osseously compressed with a backward
sacral torsion. A right pelvic shear is evidenced by the asymetrical positions of the ischial
tuberosities. “Listening” reveals a restricted and mildly ptosed left kidney. The liver’s mobility
and motility are also restricted.
The treatment of the above structural somatic dysfunctions would require skilled interventions
with cranial manipulation, visceral manipulation, prolotherapy, neuro-fascial release, myofascial
release, and temporomandibular joint treatment from a dentist familiar with cranial- mandibular
mechanics (severe TMJ pathology may require surgery). Many of these patients benefit
from the intelligent use of nutraceutical products including: vitamins, minerals, trace minerals,
enzymes, amino acids, anti-oxidants, and herbs. Magnesium, zinc, vitamin C, proline, and a
host of other nutrients are necessary for connective tissue integrity. Chronic inflammation can
be treated with an anti-inflammatory diet (Mediterranean diet minus their food sensitivities)
along with therapeutic levels of Omega-3 fatty acids, boswellia serrata, tumeric, bromelain,
ginger, garlic, devil’s claw, MSM, CoQ10, and alpha lipoic acid. Several companies offer intracellular nutrient testing to specifically identify deficiencies.
The hypothalamic-pituitary-adrenal axis is universally stressed and often dysfunctional posttraumatically. Patients need a thorough examination of their endocrine system to determine the
extent of abnormal hormonal involvement. The most common finding is adrenal dysfunction:
either hyperactivity or exhaustion. Continuous stress on the adrenal system leads to fatigue,
depression, idiopathic rashes, paradoxical wakefulness at night, sugar and stimulant cravings,
gastrointestinal irritation, weakened ligaments, dilated pupils, orthostatic hypotension,
susceptibility to infections, and marked susceptibility to joint injuries. B- complex vitamins,
vitamin C, minerals, ginseng, gotu kola, saspirilla, rehmannia, adrenal glandular products, and
selective Chinese herbal formulas can help restore energetic and metabolic balance to the
gland. Occasionally, the patient will require physiologic doses of Cortisone (Cortef). Thyroid
dysfunctions are very common and often present after severe stress or trauma particularly
to the head and neck. In general, any gland may exhibit post-traumatic dysfunction. The
pancreas may become
hypo-functioning on an endocrine or exocrine basis. Menstrual irregularity may follow head or
back injury. Each case is unique and needs to be evaluated for possible deleterious sequelae..
Ideally, successful manipulation of “ key lesions”, dietary adjustments, individualized nutritional
and herbal therapies and acupuncture can provide considerable relief and improvement to
their former condition.
6
One can not underestimate the importance of also treating the mental-emotional, psychic,
etheric, and spiritual dimensions of trauma. As triune beings we resonate in accordance to
the health and balance of our mind-body-spirit. Treating the subtler energy fields can at times
produce the greatest changes in our patients. Many patients are stuck in their fixed attitude,
posture, and energy resonance. EMDR, Bach Flower Remedies, Homeopathy, Hypnosis,
Reiki, Hands of Light, Chinese Medicine, and other modalities on “The List” work with those
dimensions that are rarely acknowledged by conventional medical treatments. Dr. Fulford said
that the goal of the healer is to help the patient find their destiny. To put the patient in touch
with what their ultimate purpose was for being on this earth in this lifetime. Once a patient is
doing what they were meant to do, everything else begins to fall in place. Sometimes trauma is
a gift that leads to an awareness of what is important and what needs to be done.
Trauma can occur in “ one fell swoop” or as the “straw that breaks the camel’s back.”
Repetition stress is commonplace and what I see in my practice is a body finally running
out of adaptations. We see this often in children today playing sports or having a series of
injuries where each one leads to an adaptive response that eventually can’t compensate. Too
often, parents are told that their child athlete is fine and will ”get over it” because he’s just a
kid. Soccer trauma, gymnastics injuries, and all the other trauma prone sports are creating a
nation of “walking wounded child-athletes“ who are only given ice and ibuprofen for their aches
and pains. Very little attention is paid to the specific, discrete nature of their injuries that can
be treated by competent manual medicine practitioners and/or acupuncturists. A child might
present with headaches or neck pain that is the result of untreated ankle or lower back strains
from past injuries. The athlete will keep compensating for their previous injury with altered
posture and motion mechanics which will ultimately take them down a path of new injuries.
Gaining the skills to diagnose and treat somatic dysfunctions as they occur in the child or adult
proves rewarding to the patient and doctor alike. “An ounce of prevention is worth a pound of
cure” and treating and resolving trauma in a timely fashion can restore function and prevent a
lot of unnecessary pain and suffering down the road.
Trauma: An Osteopathic Approach authored by Jean-Pierre Barral D.O. and Alain Croiber D.O.
is an outstanding text for exploring the varied depths and multi-dimensional consequences
of trauma. “Nothing is forgotten”, ”Nothing is isolated”, “Everything accumulates”, “Everything
is recorded”, summarizes several critical concepts that are at the foundation of traditional
osteopathic thought. All structures and tissues do not respond identically to the same given
traumatic forces. The pre-existing state of the person’s mind/body/spirit influences the outcome
of any traumatic event. Barral and Crobier describe in great detail the biomechanics and
physics of trauma. Each system of the body is included in their analysis. Novel diagnosis
and treatment procedures are presented for treating: cranial, dural, visceral, neural, vascular,
and osteoarticular injuries. (Several of these modalities are presented in the powerpoint
presentation).
Foundations for Integrative Musculoskeletal Medicine: An East-West Approach authored
by Alon Marcus D.O.M., L.Ac., D.A.A.P.M. is certainly one of the most comprehensive texts
I’ve ever read regarding the musculoskeletal system. Dr. Marcus has done an amazing job of
merging orthopaedic, neurological, and osteopathic principles of diagnosis and treatment with
that of Chinese Medicine; both acupuncture and herbal medicine. A wonderful reference text
for almost any clinical presentation in musculoskeletal medicine.
Enjoy! Jay Sandweiss D.O., C-NMM/OMM, F.A.A.M.A.
7
8
9
Do the Prescriptions You Take
Deplete Your Nutritional Status?
SOURCE: DRUG-INDUCED NUTRIENT DEPLETION HANDBOOK, 2ND EDITION
NUTRIENT
DEFICIENCY
POTENTIAL HEALTH PROBLEM
Vitamin B12
Folic Acid
Vitamin D
Calcium
Iron
Zinc
Anemia, depression, tiredness, weakness, increased cardiovascular risk
Birth defects, cervical dysplasia, anemia, heart disease, cancer risk
Osteoporosis, muscle weakness, hearing loss
Osteoporosis, heart and blood pressure irregularities, tooth decay
Anemia, weakness, fatigue, hair loss, brittle nails
Weak immunity, wound healing, sense of smell/taste, sexual dysfunction
B Vitamins
Vitamin K
Short term depletion affects are minimal, but failure to re-inoculate the
GI tract with beneficial bacteria (probiotics) often results in dysbiosis which
causes gas, bloating, decreases digestion & absorption of nutrients, and also
may lead to a variety of other health problems.
Tetracyclines
Calcium
Magnesium
Iron
Vitamin B6
Zinc
Osteoporosis, heart & blood pressure irregularities, tooth decay
Cardiovascular problems, asthma, osteoporosis, cramps, PMS
Slow wound healing, fatigue, anemia
Depression, sleep disturbance, increased cardiovascular disease risk
CHOLESTEROL DRUGS
Coenzyme Q10
Various cardiovascular problems, weak immune system, low energy
Coenzyme Q10
Vitamin B2
Problems with skin, eyes, mucous membranes and nerves
Vitamin B6
Oral Contraceptives
Folic Acid
Vitamin B1
Vitamin B2
Vitamin B3
Vitamin B6
Vitamin B12
Vitamin C
Magnesium
Selenium
Zinc
Birth defects, cervical dysplasia, anemia, cardiovascular disease
Depression, irritability, memory loss, muscle weakness, edema
Problems with skin, eyes, mucous membranes and nerves
Cracked, scaly skin, swollen tongue, diarrhea
Depression, sleep disturbances, increased cardiovascular disease risk
Lowered immune system, easy bruising, poor wound healing
Lower immunity, reduced antioxidant protection
ANTICONVULSANTS
Vitamin D
Calcium
Folic Acid
Biotin
Carnitine
Vitamin B12
Vitamin B1
Vitamin K
Copper
Selenium
Zinc
Hair loss, depression, cardiac irregularities, dermatitis
Blood coagulation, skeletal problems
Anemia, fatigue, cardiovascular and connective tissue problems
DRUG
ANTACIDS/ULCER MEDICATIONS
Pepcid, Tagamet, Zantac, Prevacid,
Prilosec, Magnesium & Aluminum
antacids
ANTIBIOTICS
Gentomycin, neomycin,streptomycin,
cephalosporins, penicillins
Lipitor, Crestor, Zocor, and others
ANTI-DEPRESSANTS
Adapin, Aventyl, Elavil, Pamelor,
& others
Major Tranquilizers (Thorazine,
Mellaril, Prolixin, Serentil & others)
FEMALE HORMONES
Estrogen/Hormone Replacement
Phenobarbital & barbituates
Dilatin, Tegretol, Mysoline
Depakane/Depacon
Copyright
2009 SpectraCell
DOC
Copyright
© 2008©
SpectraCell
Laboratiores, Inc.Laboratories
All Rights Reserved.
FIA 306306-01.09
- 12.08
( 5227)
Visitususatat www.spectracell.com
Visit
www.spectracell.com ororcall
callususatat 800.227.LABS
800.227.5227
10
ADVANCED CLINICAL TESTING
ADVANCED CLINICAL TESTING
Do the Prescriptions You Take
Deplete Your Nutritional Status?
SOURCE: DRUG-INDUCED NUTRIENT DEPLETION HANDBOOK, 2ND EDITION
NUTRIENT
DEFICIENCY
POTENTIAL HEALTH PROBLEM
Calcium
Vitamin D
Magnesium
Zinc
Vitamin C
Vitamin B6
Vitamin B12
Folic Acid
Selenium
Chromium
Lowered immunity, easy bruising, poor wound healing
Depression, sleep disturbances, increased cardiovascular disease risk
Elevated blood sugar, cholesterol & triglycerides, diabetes risk
NSAIDS (Motrin, Aleve, Advil, Anaprox,
Dolobid, Feldene, Naprosyn and others
Folic Acid
Aspirin & Salicylates
Vitamin C
Calcium
Folic Acid
Iron
Vitamin B5
Lowered immune system, easy bruising, poor wound healing
Anemia, weakness, fatigue, hair loss, brittle nails
fatigue, listlessness, and possible problems with skin, liver and nerves
DIURETICS
Calcium
Magnesium
Vitamin B1
Vitamin B6
Vitamin C
Zinc
Coenzyme Q10
Potassium
Sodium
Depression, sleep disturbance, increased heart disease risk
Lowered immunity, easy bruising, poor wound healing
Irregular heartbeat, muscle weakness, fatigue, edema
Muscle weakness, dehydration, memory problems, loss of appetite
Potassium Sparing Diuretics
Calcium
Folic Acid
Zinc
CARDIOVACSULAR DRUGS
Coenzyme Q10
Vitamin B6
Zinc
Vitamin B1
ACE Inhibitors (Capoten, Vasotec,
Monopril & others)
Zinc
Bete Blockers (Inderal, Corgard,
Lopressor and others)
Coenzyme Q10
DRUG
ANTI-INFLAMMATORIES
Corticosteriods: Prednisone, Medrol,
Aristocort, Decodron
Loop Diuretics (Lasix, Bumex,
Edecrin)
Thiazid Diuretics (HCTZ, Enduron,
Diuril, Lozol, Zaroxolyn, Hygroton
and others
Antihypertensives (Catapres,
Aldomet)
DIABETIC DRUGS
Metformin
Sulfonylureas (Dymelor, Tolinase,
Micronase/Glynase/DiaBeta)
ANTIVIRAL AGENTS
Zidovudine (Retrovir, AZT & other
related drugs)
Foscarnet
Coenzyme Q10
Vitamin B12
Folic Acid
Birth defects, cervical dysplasia, anemia, heart disease, cancer risk
Coenzyme Q10
Increased blood lipids, abnormal liver function and glucose control
Anemia, fatigue, cardiovascular and connective tissue problems
Irregular heartbeat,
muscle weakness, fatigue, edema
Copyright © 2007 SpectraCell Laboratiores, Inc. All Rights Reserved.
Carnitine
Copper
Zinc
Vitamin B12
Calcium
Magnesium
Potassium
Copyright © 2008 SpectraCell Laboratiores, Inc. All Rights Reserved. FIA 306 - 02.08
Copyright © 2009 SpectraCell Laboratories DOC 306-01.09
Visit
at at www.spectracell.com
or call
call us
us at
800.227.5227( 5227)
Visitusus
www.spectracell.com or
at 800.227.LABS
11
ADVANCEDCLINICAL
CLINICALTESTING
TESTING
ADVANCED
Disclosure:
Nothing to disclose
Dr. George J. Goodheart
1
12
Dr. David Walther
The goal of manipulation is to restore maximal pain-free
movement of the musculo-skeletal system in postural
balance.
Test:
Latissimus
Dorsi
Tightness creates and weakness permits asymmetry.
Weakness creates and tightness
maintains asymmetry.
2
13
MUSCLE-MERIDIAN RELATIONSHIPS:
• SUPRASPINATUS=CONCEPTION VESSEL
• TERES MAJOR=GOVERNING VESSEL
• DELTOID=LUNG
• TENSOR FASCIA LATA= LARGE INTESTINE
• PECTORALIS MAJOR CLAVICULAR= STOMACH
• LATISSIMUS DORSI=PANCREAS
• SUBSCAPULARIS=HEART
• QUADRICEPS=SMALL INTESTINE
MUSCLE-MERIDIAN RELATIONSHIPS:
•  PERONEUS TERTIUS=BLADDER PSOAS= KIDNEY
•  GLUTEUS MEDIUS=MASTER OF THE HEART
•  TERES MINOR=TRIPLE ENERGIZER
• POPLITEUS=GALL BLADDER
•  PECTORALIS MAJOR STERNAL= LIVER
• 14 MUSCLE-MERIDIAN DANCE
• MUSCLE WEAKNESS AS AN INDICATOR OF MERIDIAN PROBLEM
• LOCATION OF SPINAL SEGMENTAL SOMATIC DYSFUNCTION AS
INDICATOR OF MERIDIAN PROBLEM (SHU POINT)
3
14
Visceral
Manipulation
for Liver!
Mobility
(seated)!
Reproduced with permission from
Visceral Manipulation!
Revised Edition, Eastland Press!
4
15
5
16
Reproduced from A MANUAL OF
ACUPUNCTURE by Peter Deadman
6
17
Acupuncture points and their associated
channels exist in anatomical locations that
can be influenced by manual medicine
interventions. Manual medicine treatments
can be utilized before or after acupuncture
needling to enhance the total therapeutic
effort.
7
18
8
19
Acupuncturists may wish to apply manual
therapies to specific body regions that have
seemed refractory or difficult to treat with
acupuncture alone. Likewise, manual medicine
practitioners may wish to utilize acupuncture
when their manipulative efforts are insufficient
at producing a satisfactory response in the
patient.
9
20
Barrier Concept: Define your problems before
you can hope to fix them
Biomechanical: Employed to restore local
Arthrodial motion loss
Respiratory-Circulatory:
• Change in PEFR in COPD and Asthma patients
after thoracic HVLA
• Gordon Zink
Neurological:
Metabolic-Energetic:
• WAKE UP the autonomics segmentally
• T 4 (Larsens) Syndrome
• Trickle down from improved neuro, resp, circulatory
10
21
MANUAL MEDICINE TECHNIQUES THAT TREAT
CHANNEL RESTRICTIONS
MANUAL MEDICINE TECHNIQUES THAT TREAT
CHANNEL RESTRICTIONS
•! SMALL INTESTINE: SI-11,13,14 COUNTERSTRAIN , SI-19 TMJ
RELEASES
•! CONCEPTION VESSEL: CV-17 COUNTERSTRAIN
•! GOVERNING VESSEL: GV-1 COUNTERSTRAIN, GV-20 CRANIAL
•! LUNG: LU- 1&2 COUNTERSTRAIN, LU-7-9 MYOFASCIAL RELEASE
•! BLADDER: ANY SPINAL LEVEL ( e.g. BL-23) MET/
COUNTERSTRAIN
•! LARGE INTESTINE: LI-4 UNWIND THUMB, LI-11 COUNTERSTRAIN/
MFR
•! KIDNEY: KI-10 COUNTERSTRAIN, KI-27 MET
•! STOMACH: ST-41 MUSCLE ENERGY TECHNIQUE OR THRUST
TECHNIQUE
•! SPLEEN: SP-2,3,4 MYOFASCIAL RELEASE OR MUSCLE ENERGY
TECHNIQUE
•! HEART: HT-1 ACTIVATED RELEASE, HT-3 COUNTERSTRAIN OR
THRUST
•! TRIPLE ENERGIZER: TE-10, 11, 12 DEEP MYOFASCIAL RELEASE
•! GALL BLADDER: GB-34,40 MET TO FIBULA, GB-20 MET OR
COUNTERSTRAIN, GB-21 COUNTERSTRAIN OR MYOFASCIAL
RELEASE
•! LIVER: LR-2,3 MFR OF TOE, LR-4 MFR OF ANKLE MORTISE, LR-14
VISCERAL
Osteopathic Manipulation!
Special Attention to:!
• Breathing (3 Diaphragms)!
• Visceral Mobility and Motility disorders!
• Sacrum-Coccyx(Holds fear/insecurity)!
• Dural strains!
• Cranial/TMJ dysfunctions (often unexamined)!
• Greenman’s “Dirty Half-dozen” (non-neutral facet
joint restrictions, symphysis pubis shears, sacral
posterior torsion or nutation, hip bone shear,
short-leg/pelvic tilt syndrome, and muscle
imbalance of the trunk and extremities)!
• Nerve Restrictions!
• “Energy Sinks” (Robert Fulford’s Concept that is
treated with the Percussion Vibrator)!
Myofascial Release!
Muscle Energy Technique!
Strain-Counterstrain!
Functional Release!
Cranial Osteopathy!
High Velocity Technique!
Still Technique!
Facilitated Position Release!
Balanced Ligamentous Tension!
Percussion Hammer!
Cranial!
Diaphragm!
Thoracic!
Diaphragm!
11
22
Listening with traction on the!
Cylinder of the dura mater!
Pelvic!
Diaphragm!
Visceral
Manipulation
for Liver!
Mobility
(seated)!
Muscle
Energy!
Position For
Treatment of An
L2-ERSR!
Patient Pulls Right
Scapula Down
Toward Doctor’s
Finger With Slight
Right Rotation!
12
23
At the spinal level, attention to several!
attachments of the dura mater is required!
for successful osteopathic manipulation:!
•! Foramen magnum!
•! C2!
•! Sacrum!
•! Coccyx!
•! Vertebral foramen!
Acute Low Back Pain in a NCAA Division I Basketball Player
Resolves with One Acupuncture Treatment and Osteopathic Manipulation
Jay Sandweiss D.O., C-NMM/OMM, F.A.A.M.A.
Abstract
Background: Lumbo-sacral and/or sacroiliac sprain/strains are common afflictions
affecting competitive basketball players.1 Star athletes and their coaching staff seek
fast effective treatment modalities for their injuries to facilitate a full and speedy
return to the game.
Objective: This case demonstrates an immediate resolution of low back pain in a
college basketball player utilizing acupuncture and osteopathic manipulation in one
treatment.
Intervention: The patient was treated once with acupuncture and osteopathic
manipulation the day of a Big Ten basketball game. One treatment resolved his
painful movement, motion loss, antalgic body posture and right-sided lumbago.
Patient was given samples of Traumeel ointment (homeopathic) to apply later that
day. The player refused using any pharmacological medications (including
Ibuprofen) as he was philosophically opposed to Western allopathic drugs.
13
24
INTRODUCTION
Main Outcome Measure: Resolution of disabling pain, painful movement,
motion restriction, antalgic posture, right-sided low back pain.
Results: Resolution of all symptoms with one treatment of medical acupuncture
combined with osteopathic manipulation. The patient played six hours post
treatment in a NCAA Division I basketball game without evidence of symptoms.
In fact, his performance was one of his best of the season.
Case Report:
This author received a midday contact from a Division I basketball
staff member requesting immediate treatment for an acutely injured
player. Schedules were adjusted and the player was seen in my
office shortly thereafter for acute right–sided low back pain. The
pain had started the previous day and now made him unable to
stand upright, have difficulty rising from a chair, and have spasms in
the right sacroiliac, right gluteal/buttock and right lumbo-sacral
areas. He was supposed to play in the starting line-up that same
evening six hours later. The patient could not recall the exact
etiology of the injury, but had fallen several times while leaping for a
ball or from being fouled during a play. The training staff had
attempted to stretch him out and provided ice and modalities that
had not resolved this issue. X-ray studies taken earlier that day of
his lumbar, sacral, and sacroiliac regions were negative for
pathology.
Conclusions: This case demonstrates that an acutely symptomatic injured
athlete can be successfully treated with a single treatment of acupuncture and
osteopathic manipulation and return to full capacity that same day. Certainly this
particular situation does not reflect all soft tissue conditions but it serves to
respect the potential for immediate resolution of injury and inactivity.
Objective physical findings:
22-year-old African-American male with a postural list to the right, walking with
apprehension when loading weight to the right hip. Decreased extension of
lumbar spine and sacrum. Difficulty rising from a chair. Marked tension and
trigger points present in right gluteus medius/minimus, piriformis, quadratus
lumborum, and psoas muscles.
Patient received osteopathic manipulation to the above
somatic dysfunctions using Muscle Energy Technique, High
Velocity Low Amplitude Thrust and Myofascial Release. 2,3
The acupuncture treatment combined Neuro-Anatomical
principles with Tendinomuscular meridian and Curious
meridian activation.
Positive right standing and seated flexion screening tests for PSIS motion
asymmetry. Right hip crest inferior while standing. Upslipped right innominate.
Right on left sacral torsion. L3-FRSR, L5- FRSR.
Weakness of right hip abductors 4-/5. Mild right innominate rotation. C2-FRSL,
C3-FRSR.
Pain pattern distribution and “Ashi “tender points located along the trajectory of
Tai Yang channel.
Needles used:
Spring Ten Handle 0.20X30mm sterile disposable
acupuncture needles with insertion tube.
Point selection:
Left SI-3, Right BL-62, 67
Bilateral BL-21, 22, 23, 24, 26, 27, 28, 31, 36, 52, 40
GV-3, 4
Right BL-53, 54
Electroacupuncture Device:
Pantheon Research PENS Electrostimulator 12c.
Pro Model
Electrical stimulation was applied at a frequency of
25Hz to 10 points bilaterally:
BL-21, 22, 23, 24, 28
BL- 53, 54 were stimulated at 25Hz right side only
Acupuncture treatment time: 25 minutes
14
25
Discussion:
Acute low back pain arising from sprain and /or strain of soft tissues is a common presentation
from highly competitive athletes. This patient received care using both osteopathic
manipulation and electrical acupuncture during the same treatment session.4 The patient
received acupuncture using electrical stimulation at a frequency of 25 Hz. This frequency has
been highly effective for treating pain and muscle weakness due to athletic injury in this author’s
experience.5 Both forms of treatment have shown efficacy in treating acute low back pain.6,7,8
The proposed mechanisms of action for both interventions involve the activation of several
sites in the central and autonomic nervous system as well as receptors in the peripheral
nervous system. The release of peptides, neurotransmitters and endogenous opioids is well
studied. 9,10,11 Neuro-imaging studies with fMRI, performed by Vitaly Napadow PhD et al,
suggest that neuroplasticity changes occur in the brain with acupuncture treatment.12 This
suggests yet another neuromodulatory effect distinct from the previously noted mechanisms.
At the AAMA 26th Symposium, Narda Robinson, D.O., D.V.M. reviewed the theory of
acupuncture treatments inducing changes in the cytoarchitecture of fibroblasts and the
metabolism of connective tissue components. She went on to describe the effects of
acupuncture on the fascia “within and between cells in the extracellular matrix” affecting multiple
functions such as: nutrient transfer, nerve signal transduction, regulation of intercellular
communication, and the transmission of mechanical stresses on the fibroblast cytoskeleton. Her
lecture further emphasized the similar effects achieved from acupuncture, Yoga, and
massage(manipulation) to alter fibroblast activity and “change stiffness and viscosity of
connective tissue within minutes”. Finally, Dr. Robinson discussed the concept of “Fascial
Acupuncture” that sees the acupuncture channels as fascial planes.13 As fascia envelops all
structures in the body, one can postulate the possibility of acupuncture stimulation modulating
physiology through this vast intricate network of fascia as described by Finando et al.14
Results:
During his acupuncture treatment the patient
frequently described a relaxing euphoric feeling that
made his muscles and pain release. After standing up
from the acupuncture treatment his posture was erect
and symmetrical. All pain with motion was gone. Rising
from a chair and walking were painless. Six hours later
the patient played outstanding basketball without any
evidence of pain or gait disturbance. This author had
the pleasure of attending that game.
Two Weeks of Recalcitrant Cervical Pain, Weakness, and Restricted Motion in
an Olympic Wrestler, Successfully Treated with Acupuncture and Osteopathic
Manipulation
Conclusion:
Acute soft tissue sport injuries are commonly treated with the PRICE formula
(Protect, Rest, Ice, Compress, Elevate) or some variation of that theme.15 Nonsteroidal anti-inflammatory medications, massage, and physical therapy
modalities are frequently used by athletic departments when treating their
injured athletes.16 Severe injuries may require surgery, injections, bracing or a
prolonged period of rest.
This particular case demonstrates the effectiveness of a single treatment
utilizing medical acupuncture and osteopathic manipulation to quickly and
effectively resolve pain, weakness, spasm and motion restriction with
asymmetry in an acutely injured basketball player.
Clearly not all athletic injuries can be expected to respond immediately to a
single treatment. However, this case shows the potential for impressive results
to occur with only one treatment in an acute setting. Perhaps more professional
and college teams will consider the benefits of adding this treatment approach
to their current armamentarium.
Jay Sandweiss D.O., C-NMM/OMM, F.A.A.M.A.
Abstract
Background: Cervical sprain/strain is a common condition afflicting athletes
participating in aggressive contact sports.1 Competitive athletes often seek immediate
results that allow for a rapid return to full activity and high performance levels.
Objective: This case demonstrates a swift resolution of cervical pain, weakness, and
restricted motion in an Olympic wrestler utilizing acupuncture and osteopathic
manipulation.
Intervention: The patient was treated with acupuncture and osteopathic manipulation
four times over a course of five days. Eighty percent improvement was achieved
immediately following the initial treatment. Patient was prescribed a nutraceutical
product to use for soft tissue inflammation (See Appendix A).
.
Main Outcome measure: Resolution of pain, weakness, and restricted motion
of cervical spine region.
Results: Total resolution of all symptom parameters was achieved after three
treatments. The fourth acupuncture treatment was given for mind-body focus
only. This patient went to the final U.S.A. Olympic trials two days post treatment
and won his weight division. He represented the U.S.A. at the 2012 Olympic
games in London, England.
Conclusions: This case suggests that acupuncture treatment with osteopathic
manipulative treatment can accelerate soft tissue injury resolution time. Athletes
may be able to return to full activity levels sooner than they would have using
more conservative treatment modalities. Randomized controlled trials are
indicated
15
26
MANUAL MEDICINE!
PROCEDURES AND !
NUTRITIONAL/HERBAL!
THERAPIES AS THEY!
APPLY TO ACUPUNCTURE!
POINT AREAS!
Muscle
Energy
Treatment:
Posterior
Fibular
Head!
Muscle Energy Treatment: Anterior Fibular
Head!
Pearls of GB- 34 :
COMMON ISSUES: !
Gallbladder Symptoms, Tendon /Joint Problems,
Headaches, Fibula Issues at Knee and Ankle, IlioTibial Band Syndrome
CHECK: !
BIle Salts, Bile Thinners (Vitamin A, Beet leaf juice
extracts, dandelion root), Iodine need, Feverfew,
Silymarin, Schizandra, Choline
16
27
Pearls of LI - 11 :
COMMON ISSUES: !
Facial Flushing, Heat Signs, Upper Limb and Elbow
Pain, Large Intestine Issues: Colitis, Irritable
Bowel,Toxic Bowel, “Tennis Elbow”
Counterstrain
Tx:!
Radial Head
(Tennis
Elbow)!
CHECK: !
Stool Analysis, Probiotics, Bowel Detoxification, Radial
Head, Enzymes, Chronic Candida
Quadratus
Lumborum
Strain-!
Counterstrain!
Strain-!
Counterstrain!
Treatment of
Posterior
Lumbar TPs!
Posterior Lumbar
Transverse Process (TP)!
Treatment of Posterior
Lumbar Spinous and !
Medial TPs!
17
28
Pearls of BL-23
COMMON ISSUES:
Low Back Pain, Weak Back, Easily Chilled, Decreased
Libido, Fear and Insecurity, Knee Problems, Dental
Problems, Infertility, Erectile Dysfunction, Chronic
Fatigue, Sore Throats, Chronic Illness, Ear Problems,
Tinnitus, Genito-Urinary Issues
CHECK: Rehmannia, Adrenal Formulas, Ginseng,
Tribulus, Astragalus, Vitamin A, Vitamin C, Uva Ursi,
Cranberry Extracts, Licorice, Rhodiola, Withania
Gluteus Maximus
Pectoralis Major - Sternal
Strain-!
Counterstrain!
Treatment of High
Ilium With Flare-Out
Left!
Good For
Coccydynia!
18
29
Pectoralis Major - Clavicular
Subclavius
Subclavius
Screening
Test for S-C
Joint
Restriction
(Patient
Shrugs)!
MET Tx For
S-C Joint!
Dx:
Restriction
of Inferior
Glide!
19
30
Abdominals
Rectus abdominals
Inferior
Abdominals
Inferior Middle
Triceps Brachii and
Anconeus
Visceral
Manipulation
for Liver!
Mobility
(seated)!
Direct Myofascial
release to Triceps
Fascia!
20
31
Pronator Teres
Counterstrain
Tx:!
Radial Head
(Tennis
Elbow)!
Hamstring
Peroneus Longus
and Brevis
21
32
Muscle
Energy
Treatment:
Posterior
Fibular
Head!
Muscle Energy Treatment: Anterior Fibular Head!
Peroneus Tertitus
Reproduced from A MANUAL OF ACUPUNCTURE by Peter Deadman
Gastrocnemius
22
33
Tibialis Anterior
Muscle
Energy
Treatment:
Distal
Fibula
(Pump
Ankle)!
Myofascial
Release of Ankle
Mortise (seated)!
Extensor Hallucis
Longus and Brevis
High Velocity:
Anterior Talus
Manipulation!
23
34
Flexor Hallucis
Longus
Myofascial
Release of Great
Toe!
CERVICAL REGION PEARLS
•! PROBLEMS OF THE CERVICAL SPINE REGION CAN COME FROM
ANYWHERE!
•! SACROILIAC FIXATIONS = INHIBIT POSTERIOR CERVICAL
EXTENSOR MUSCLES
•! COMMON NEUROMUSCULOSKELETAL CAUSES OF THESE
PROBLEMS INCLUDE:
•! CRANIAL FIELD SOMATIC DYSFUNCTIONS ( JUGULAR FORAMEN:
CN9,10,11)
•! VISUAL DISORDERS
•! (OFTEN UNDIAGNOSED VERTICAL HETEROPHIA OR OTHER VISUAL
PERCEPTUAL DEFECTS), TMJ AND HYOID BONE DYSFUNCTIONS.
•! THESE MUST BE IDENTIFIED AND TREATED TO ACHIEVE LASTING
CORRECTIONS
•! LOVETT BROTHER REACTIVITY:
SACRUM=OCCIPUT, L5=C1, L4=-C2, L3=-C3, L2=C5, L1=-C6
•! UPPER THORACIC VERTEBRA, RIBS, AND UPPER EXTREMITIES
GREATLY INFLUENCE CERVICALS
•! VISCERAL PTOSIS (USUALLY KIDNEY OR LIVER) OR VISCERAL
RESTRICTIONS FROM THE THORAX(PLEURA/LUNG) CAN CREATE
OR PERPETUATE CERVICAL SYNDROMES
•! AFTER WHIPLASH INJURY NEED TO TREAT DIAPHRAGM, DURAL
STRAINS, CRANIAL DYSFUNCTION ( OFTEN PETROJUGULAR
DISLOCATION), LOCAL SOFT TISSUES: MUSCLE SPINDLE CELLS,
FASCIA, MUSCLES, GOLGI TENDONS
24
35
OTHER IDEAS TO CONSIDER:
•  POSTURAL ERGONOMICS:
•  “THE HEAD IS A HEAVY BOWLING BALL”
ALEXANDER TECHNIQUE, WORKSITE EVALUATION, POSTURAL
TRAINING MAY ALL BE NECESSARY
•  ALL ACUPUNCTURE CHANNELS AND POINTS IN THE HEAD AND
NECK REGION ARE YANG EXCEPT FOR THE CONCEPTION
VESSEL IN THE VENTRAL MIDLINE
•  GAIT AND LOWER EXTREMITY INVOLVEMENTS: SHORT LEG,
FOOT PRONATION, TIGHT TALOCRURAL MOTION,
ASYMMETRICAL GAIT SWING, “WALKING GAIT” DISORDERS
CAN ALL CAUSE OR PERPETUATE CERVICAL PROBLEMS
•  4 OF THESE YANG CHANNELS ARE CONNECTED TO THE EYES
( BL, ST, TH AND GB)
•  4 OF THESE YANG CHANNELS ARE CONNECTED TO THE TMJ
REGION (SI,ST,TH, AND GB)
•  DISTURBANCES IN ANY OF THESE CHANNELS CAN BE A CAUSE OF
CHRONIC CERVICAL COMPLAINTS. DISTURBANCES CAN INVOLVE
ORGANS AND GLANDS ASSOCIATED WITH THOSE CHANNELS.
( EXAMPLE: GERD MAY BE CAUSED BY”REBELLIOUS STOMACH QI”.
GERD MAY CAUSE SORE THROAT OR OTHER SYMPTOMS IN THE
CERVICAL/TMJ AREA WHICH FOLLOW THE TRAJECTORY OF THE
UPPER STOMACH MERIDIAN.) THIS IS ANOTHER WAY OF
UNDERSTANDING VISCERO-SOMATIC PAIN PATTERNS. GALL
BLADDER MERIDIAN PROBLEMS MAY PRESENT AS NECK OR
SHOULDER PAIN
•  “BOTTLE NECK”: CONNECTOR BETWEEN THE HEAD
(MIND) AND BODY (HEART) BECOMES SYMPTOMATIC
WHEN THERE IS CONFLICT BETWEEN MIND AND
EMOTION
•  SADNESS AND GRIEF STORED THERE
•  REPRESENTS THE INHERENT FLEXIBILITY TO SEE BOTH
SIDES OF AN ISSUE
•  THE NECK IS A VULNERABLE, SENSITIVE AREA: CAROTID
ARTERIES, THYROID, PARATHYROIDS, TRACHEA, SPINAL
CORD VAGUS AND PHRENIC NERVES
25
36
UPPER EXTREMITY PEARLS
Multiple reflex systems affect the upper extremity from the opposite
side of the body:
Muscle Interlink
Ligament Interlink
Gait Reflexes/Brain Cortex
Acupuncture Meridians: Inverse /Contrary pairings
Shoulder = Opposite Hip
Elbow = Opposite Knee
Wrist = Opposite ankle
Fingers = Opposite toes
Upper Extremity = Opposite Cortex (80%)
Upper extremity problems may be locally and/or distally induced and
perpetuated
Always evaluate the whole patient/whole body for somatic
dysfunctions of the spine, ribs, cranium, pelvis, sacrum and lower
extremities
Muscle testing helps identify the source of many problems. It helps to
gauge the success of treatment by testing pre and post muscle
response
Many upper extremity issues come from cervical and upper
thoracic/rib somatic dysfunctions
Yang Meridians run from fingers to face (Large Intestine - Small
Intestine - Triple Warmer)
Think brachial plexus trouble makers (cervical spine, T1, scalenes,
upper ribs)
Yin Meridians run from trunk to fingers (Heart – Lung –
Pericardium)
LOWER EXTREMITY PEARLS !
Organ and meridian disturbances create upper extremity problems by
referral through reflexes and channels
•  ALWAYS EXAMINE THE WHOLE PERSON FROM TOP TO
BOTTOM AND FROM BOTTOM TO TOP. BRAIN, SPINE, AND
PELVIS MUST BE CHECKED AS WELL AS LOCAL
STRUCTURES (KNEE, ANKLE, FOOT)
Poor posture/poor ergonomics are a form of repetitive stress on the
upper extremity in addition to typical repetitive stressors
Stretching and strengthening is essential for total recovery
•  GAIT DYSFUNCTION CAUSES REPETITION STRESS
INJURY. THE AVERAGE PERSON REPEATS A GAIT CYCLE
ONE MILLION TIMES A YEAR
Worksite evaluations are very appropriate and helpful. Occupational
Therapy is invaluable with many tough cases
Ask patient about job, cell phones , keyboarding, mouse, one sided
carrying habits
•  FASCIAS ARE IMPORTANT TO TREAT BECAUSE THEY
STORE AND RELEASE ENERGY DYNAMICALLY. FASCIAL
DYSFUNCTIONS IN THE LOWER EXTREMITIES WILL
GENERATE MULTIPLE PROBLEMS INTO THE TRUNK AND
PELVIS
Often Cranial/TMJ involvement:
Screen with Applied Kinesiology Protocols
Breathing patterns– use upper extremity muscle group
TMJ Protocol- use upper extremity muscle group
•  THE KNEE IS A PLACE OF MANY MINOR MOVEMENTS
(SLIPPING, EXTERNAL AND INTERNAL ROTATION OF THE
TIBIA). VERY FREQUENTLY, A DECREASE IN A MAJOR
MOVEMENT COMES FROM RESTRICTIONS OF MINOR
MOVEMENTS.
•  AFTER TRAUMA, THE TISSUES WILL RETAIN THE INJURY PATTERN.
INDIRECT SOFT TISSUE TECHNIQUES MUST BE USED TO RESTORE
PROPER PROPRIOCEPTION AND FUNCTIONING. REST AND
STRENGTHENING IS NEVER ADEQUATE TO RESTORE NORMAL
FUNCTION.
•  KNEE PAIN IS USUALLY CAUSED BY A PROBLEM ABOVE OR
BELOW THE KNEE UNLESS THERE WAS DIRECT TRAUMA TO
THE KNEE
•  MOTION TEST ALL FOOT AND ANKLE BONES TO ASSURE THEY ARE
DOING THEIR JOBS. PARTICULARLY CALCANEUS, NAVICULAR,
CUBOID, TALUS, AND CUNEIFORMS
•  LONG BONES LIKE THE TIBIA AND FIBULA MUST BE
EVALUATED AT BOTH ENDS AS THE TWO ENDS MOVE IN
OPPOSITE DIRECTIONS. AN APPARENT ANTERIOR
TIBIO-TALUS DISTALLY CAN ACTUALLY BE A POSTERIOR
PROXIMAL TIBIA AT THE FEMUR
•  CAREFULLY CHECK FOR “TRUE” SHORT LEGS VERSUS
FUNCTIONAL SHORT LEGS
•  MANY KNEE, CALF, ANKLE AND FOOT PROBLEMS ARE DUE TO
ADRENAL GLAND STRESS OR OTHER VISCERAL-SOMATIC ISSUES
26
37
FUNCTIONAL RELEASE EXERCISE
A KEY LESION IS CONSIDERED TO BE THAT MOBILE SEGMENT IN THE MIDDLE OF A 3
SEGMENT STACK OF VERTEBRAE THAT BEHAVES EXACTLY THE OPPOSITE OF THE
SEGMENTS ABOVE AND BELOW IT.
CAREFUL PALPATION WILL REVEAL THAT THE MOTIONS THAT INCREASE TENSION IN
THE TISSUES SURROUNDING SEGMENTS ABOVE AND BELOW THE KEY LESION, WILL
ACTUALLY DECREASE TENSION IN THE TISSUES ADJACENT TO THE KEY LESION. THIS
WILL ALSO BE TRUE OF THE TISSUE RESPONSES TO INHALATION AND EXHALATION.
STAND BEHIND YOUR STANDING PATIENT LIGHTLY HOLDING THEIR FOREHEAD
WITH YOUR OTHER HAND MAKE SOFT REPEATED POSTERIOR TO ANTERIOR ( PA) GLIDES WITH YOUR THUMB AND FINGERS TOUCHING THE POSTERIOR
FACET PLANES OF THE CERVICAL SPINE REGION
BEGIN BY SHEARING P-A AT THE OCCIPUT LEVEL AND THEN PROCEED ONE
VERTEBRAL LEVEL AT A TIME UNTIL YOU HAVE INDIVIDUALLY APPRECIATED A PA GLIDE AT EACH LEVEL C-0 THROUGH C-7
TREATMENT IS GENERALLY PERFORMED WITH THE PATIENT SUPINE.
THE LEVEL OF THE KEY LESION IS TOUCHED BILATERALLY BY THE PRACTITIONER’S
RELAXED FINGERTIPS AND THE ELBOWS ARE SUPPORTED IN SUCH A WAY AS TO
SUPPORT THE PATIENT’S HEAD.
YOU MAY NOTE THAT ONE OR MORE LEVELS SEEM TO PRODUCE MORE
RESISTANCE TO THE P-A GLIDE THAN THE LEVEL ABOVE AND BELOW THAT
LEVEL
THE TREATING HEALTH PROFESSIONAL WILL PASSIVELY INDUCE THE 6 MONITORING
MOTIONS WHILE NOTING WHICH DIRECTIONS PRODUCE GREATER OR LESSER
TENSIONS IN THE PALPATED TISSUES. THE PATIENT IS ASKED TO INHALE AND EXHALE
AS WELL.
AGAIN NOTING WHICH PHASE OF RESPIRATION PRODUCES THE GREATEST
SOFTENING OF THE TISSUES.
YOU MAY ALSO DO THIS PROCEDURE WITH YOUR PATIENT SEATED
ONCE YOU HAVE IDENTIFIED A PARTICULAR CERVICAL SPINE LEVEL THAT
EXHIBITS MORE RESISTANCE TO P-A GLIDE THAN THE LEVELS ABOVE AND
BELOW, YOU WILL FOCUS YOUR PALPATORY SKILLS AND ATTENTION TO
COMPARE THE RELATIVE COMPLIANCE VS. RESISTANCE OF THOSE
PARTICULAR TISSUES AS THEY RESPOND TO THE MOTIONS YOU WILL INDUCE
PASSIVELY. YOU MUST ALSO NOTE HOW THE PATIENT’S TISSUES RESPOND TO
INHALATION AND EXHALATION.
ONCE ALL MOTIONS HAVE BEEN EVALUATED AND APPRECIATED FOR THOSE THAT
PRODUCE THE GREATEST COMPLIANCE VS. RESISTANCE,
THE TREATMENT IS PERFORMED BY “STACKING” ALL THE MOVEMENTS THAT INCREASE
COMPLIANCE (EASE ) IN THE TISSUES WITH THE PHASE OF RESPIRATION THAT
INCREASES COMPLIANCE (EASE)
TMJ PROTOCOL
1. Find strong muscle (e.g. TFL)
2. Have patient therapy localize the TMJ with thumb and 5th finger opposing each
THESE MOTIONS INCLUDE:
FLEXION/EXTENSION
3.
SIDEBENDING
ROTATION
ANTERIOR/POSTERIOR GLIDE
LATERAL GLIDE
4.
TRACTION/COMPRESSION
INHALE/EXHALE
A SENSE OF RELEASE AND SOFTENING OF THE PALPATED KEY LESION TISSUES WILL BE
FELT UPON SUCCESSFUL PERFORMANCE OF THIS PROCEDURE.
other, while 2nd, 3rd, and 4th fingers touch jaw joints.
Ask patient to:
* Bite hard
* Open a little
* Open wide
* Lateralize left
* Lateralize right
* Extrude jaw
* Retrude jaw
* Chew slowly (aerobic)
* Chew fast (anaerobic)
* Swallow
* Talk
If any procedures described above weaken the patient, have them repeat the action
while holding only the left side of jaw alone and then only the right side of jaw.
Whichever side they were touching when their muscle weakened, is the involved side.
(You may need to change their head position up/down or
left/right for this problem to display itself.)
RE-EXAMINATION OF THE PREVIOUS ASYMMETRICAL FINDINGS AND PATTERNS SHOULD
DEMONSTRATE MARKED IMPROVEMENT THAT NO LONGER PRODUCES PARADOXICAL
FINDINGS BETWEEN THE KEY LESION AND THE VERTEBRAL LEVELS THAT ARE
ABOVE AND BELOW THAT SEGMENT.
TMJ PROTOCOL
(continued)
5.
There is a specific treatment procedure for each specific pattern of weakness.
6.
You may place paper or tongue depressors between their teeth and see if a specific
change in vertical dimension changes their bite weakness. For example, if a person
weakens when they clench their teeth forcefully, but they no longer weaken when two
tongue depressors are placed between their teeth, then they probably need a bite splint
that will approximate this correction. In other words, send them to a dentist who does
TMJ work.
Final note: The above screening procedure helps confirm that there is a problem with
the jaw that needs attention. The patient may have already shown signs and symptoms
of TMJ problems in the initial history and physical.
TMJ Screen: Jaw Clenched Tight –
Muscles Tested
27
38
TMJ Screen: Lateralize Jaw
to Left-Muscles Tested
TMJ Screen: Jaw Opened
Wide-Muscles Tested
TMJ Screen: Extrude Jaw Muscles Tested
TMJ Screen: Lateralize Jaw to
Right-Muscles Tested
THE “LIST”!
 Osteopathic Manipulative Medicine!
 Chiropractic !
 Homeopathy!
 Bach Flower/ Other Flower Essences!
 Aroma Therapy!
 EMDR (Eye Movement Desensitization and Reprocessing)!
 Gyrontonic and Redcord!
 Prolotherapy!
 Nutritional/Metabolic: Toxicity, Food/Chemical Sensitivities Endocrine!
 Hypnotherapy, Biofeedback, Neurofeedback et al!
 Bioenergetics and other Mind-Body oriented therapies!
 Rolfing, Hellerwork, Soma Bodywork, Anatomy Trains!
 Magnets, Crystals, Lasers, and other energy transfer devices!
 Shamanic Healing and other forms of “Soul Retrieval”!
 Chinese Medicine!
 Reiki, Hands of Light, Therapeutic Touch, Polarity Therapy et al!
28
39
The most common finding is adrenal
dysfunction: either hyperactivity or
exhaustion. Continuous stress on the
adrenal system leads to fatigue,
depression, idiopathic rashes,
paradoxical wakefulness at night, sugar
and stimulant cravings, gastrointestinal
irritation, weakened ligaments, dialated
pupils, orthostatic hypotension,
susceptibility to infections, and marked
susceptibility to joint injuries.!
The hypothalamic-pituitary-adrenal
axis is universally stressed and often
dysfunctional post-traumatically.
Patients need a thorough
examination of their endocrine
system to determine the extent of
abnormal hormonal involvement.!
In general, any gland may exhibit posttraumatic dysfunction. The pancreas
may become hypo-functioning on an
endocrine or exocrine basis. Menstrual
irregularity may follow head or back
injury. Each case is unique and needs to
be evaluated for possible deleterious
sequelae.!
B-complex vitamins, vitamin C, minerals,
ginseng, gotu kola, saspirilla, rehmannia,
adrenal glandular products, and
selective Chinese herbal formulas can
help restore energetic and metabolic
balance to the gland. Occasionally, the
patient will require physiologic doses of
Cortisone (Cortef).!
Dr. Fulford said that the goal of the
healer is to help the patient find their
destiny. To put the patient in touch with
what their ultimate purpose was for
being on this earth in this lifetime. Once
a patient is doing what they were meant
to do, everything else begins to fall in
place. Sometimes trauma is a gift that
leads to an awareness of what is
important and what needs to be done.!
Chronic inflammation can be treated
with an anti-inflammatory diet
(Mediterranean diet minus their food
sensitivities) along with therapeutic
levels of Omega-3 fatty acids,
boswellia serrata, tumeric, bromelain,
ginger, garlic, devil’s claw, MSM,
CoQ10, and alpha lipoic acid.!
29
40
An Integrative/Functional
Medicine Approach
for a Woman With
Chronic Pain
and
Inflammation
47-year old white female with two year history of chronic
pain and other health problems post-motor vehicle
accident (MVA) with whiplash.
Pain includes:
Retro-orbital and temporal headaches,
Cervical, mid-thoracic, and lower back pain. Right wrist
pain, left patella pain, and jaw tension.
ALL THE ABOVE COMPLAINTS BEGAN
AFTER MVA
CRANIAL
•!
•!
•!
•!
•! Insomnia
•! Anxiety with Depression
•! Irregular Periods
•! Irritable Bowel
•! “Foggy/Dull” Thinking
•! Thyroid Goiter with Nodule---Thyroiditis
•! Profound Fatigue
•!
•!
•!
Petro-Jugular Dislocation
Fronto-Sphenoid Compression
Lateral Sphenoid Strain
Low CRI (Cranial Rhythmic Impulse)
TMJ
Opening and Closing Click
Pterygoid Muscle Spasm
(MRI- torn capsule/disc)
CERVICAL
•!
•!
•!
•!
O-A Joint Instability (Hypermobility)
MRI-Atrophy of Rectus Capitus Superior Minor
Loss of Cervical Lordosis
Lateral Disc Bulge C5-C6 Right
VISCERAL
THORACIC
•! Ptosis Left Kidney
•! Restricted Mobility and Motility Liver
•! Restricted Diaphragm
•! Pain in Supraspinous Ligament T4 - T10
•! Weak Tight Rhomboid
LUMBAR/ SACRUM/PELVIS
•! Upslipped Right Innominate
•! Backward Sacral Torsion
EXTREMITIES
•!
•!
•!
•!
Hypermobile Carpal Bones
Restricted Right Proximal Radius
Tibial Torsion Left Knee
Inhibited Vastus Medialis Muscle
30
41
Treatment for Structural Findings:
•!
•!
•!
•!
•!
•!
•!
•!
•!
•!
•!
Pertinent Laboratory Results:
•!
•!
•!
•!
•!
•!
•!
•!
•!
•!
•!
•!
•!
•!
Cranial Osteopathy
Cranio-mandibular Dental Appliance
Prolotherapy to Hypermobile Areas
Myofascial Release
Strain and Counterstrain
Muscle Energy Technique
Functional Release
Visceral Manipulation
Physical Therapy
Core Strengthening Program
Gyrotonic, Red Cord, Pilates
Positive for Thyroid Peroxidase Ab Elevation
Positive for Anti-Thyroglobulin Ab Elevation
Elevated a.m. Cortisol (27) [Normal 8-22]
Deficient DHEA-S (26)
Positive for Anti-gliadin Ab
Positive for Tissue Transglutaminase Ab
C-reactive Protein Elevated (1.5) [Normal <0.5]
Vitamin D Deficiency (25,OH) (17) [Normal >30]
Vitamin B12 Low Normal (285)
RBC Magnesium Low Normal (1.6) [Normal 1.5-2.5]
Positive for ANA 1:320 Speckled Pattern
Fasting Glucose (116) [Normal <100]
HgA1C 6.0% [Normal 4-6%]
Ferritin Low Normal (12) [Normal 10-300]
SPECIALTY LAB TESTING
Stool Analysis:
•!
•!
•!
•!
•!
Deficient Bifidobacterium, Lactobacillus
Increased sIgA Gliadin Markers
Increased Cholesterol, Triglycerides
Positive for Candida Albicans 3+
Positive for Blastocystis Hominis
Spectracell (Intracellular Nutrition Levels)
•! Deficiency: Vitamin B-12, Folate, CO-Q10, Carnitine,
Vitamin D, L-Glutamine, Glutathione, Magnesium,
Zinc, Vitamin C, Glucose-Insulin Dysregulation
SPECIALTY LAB TESTING
HAIR ANALYSIS (Doctor’s Data)
ALCAT:
•! Elevated Mercury, Cadmium, Antimony
•! Multiple Food/Chemical Sensitivites: Anchovies, apples,
onion, turkey, pork, black pepper, mustard, wheat, barley,
basil, rosemary, MSG, malvin, yeast, beet sugar, cane
sugar, trout, beef, white potato, almond, pecan, vanilla
•! Drug Sensitivities: Ibuprofen, penicillin, acetaminophen,
aspirin, piroxicam, neomycin
•! Multiple Mold Reactions: Alternaria, pullularia, mucor
racemosus
URINE TOXIC ELEMENTS ANALYSIS
•! Elevated Mercury
FECAL TOXIC ELEMENTS
•! Elevated Mercury
31
42
CHINESE MEDICINE FINDINGS:
•!
•!
•!
•!
Salient Physical Findings:
•!
•!
•!
•!
•!
•!
•!
•!
•!
•!
Swollen, flabby tongue with “toothmarked edges”
Color of tongue reddish-purple
Coating of tongue grey-yellow greasy
Hara/Abdominal Diagnosis:
–! Tender Alarm Points: Stomach, Gallbladder, Large Intestine,
Kidney
•! Pulses:
–! Deficient: Kidney, Spleen, San Jiao, Heart
–! Excess: Gallbladder, Stomach
Overweight (increased waistline, buttocks)
Weak, under-conditioned lumbar area, increased lordosis
Ridged fingernails with some white spots
Dry skin, cracked heels
Dry hair, slight male pattern balding
Puffy dark lower eyelids
Eczematous patches in creases of knees/elbows
Rubbery goiter with small nodule
Pes anserinus tenderness with valgus knees
Pronated flat feet
Treatment Plan:
•!
•!
•!
•!
•!
•!
•!
•!
•!
•!
•!
•!
•!
•!
•!
•!
Gluten-Free diet
Vitamin D3
First Line Therapy Approach
Probiotics
Enzyme Replacement with meals
Food/Chemical Elimination
Supplement Nutritional Deficiencies
Mercury Elimination (Metalloclear, Ultra-Clear Renew)
EFAs, EPA-DHA
Acupuncture
Chinese Constitutional Herbs for Spleen Deficiency, Kidney-Adrenal
Deficiency
Kaprex AI for autoimmune problem
Adrenal Support: Herbs, nutrition, lifestyle
Parasite, Yeast Treatment with nutraceuticals and prescription drugs,
( if needed)
Exercise
Mind- Body Activity
32
43
Biochemical Individuality
Genetic and Environmental Uniqueness
Toxic
Chemical
Exposure
Drugs,
Alcohol
Poor Diet
Trauma
Radiation
Smoking
Stress,
Negative
Emotions
Lack of
Exercise 198!
33
44
Genetic and Environmental Uniqueness
Support healthy biotransformation
Decrease oxidative stress
intestinal function
Improve
Cells
Reduce inflammatory activity
Minimize environmental triggers
Functional Detoxification
Stress and sleep management
Exercise and perspiration
Nutritional support and elimination
199!
200
Gastrointestinal health is a
critical component in the
inflammatory cascade
•! Approximately 60%-80% of your immune
system is found in the GI tract (MALT/GALT)
•! Necessary to identify what should and
should not enter the circulatory system
† CLINICAL AND VACCINE IMMUNOLOGY, May 2007, p. 485–492
34
45
Immune tissues line your
gastrointestinal tract
Proper communication between GI and
immune tissues is critical for good health
Poor
Proper
GI Barrier
diet,
dietary
toxins
andsignals
MALT/GALT
and pro-inflammatory
and beneficial
tissuesmicroflora
are
nutrients
in
support
contribute
constanta communication!
healthy
to inflammation!
immune response!
!"#$%&'(#
Gut Associated
Lymphoid Tissues
(GALT)
Permeability and
Damage
•! Poor Nutrition
•! Bad bacteria
•! Yeast
•! Toxins
Peyer’s Patch,
Mesocolic
Lymph Nodes
Antibodies line
the GI tract
Toxins
)*+$,!*+$#
Dietary Signals
Immune
Cells
ines
Cytok
Nutrients
Communication
T-lymphocytes
Chemokines
Antigen
Cy
to
Good
bacteria
Probiotic Signals
kin
es
B Cell
Antibodies
GI inflammation may initiate a cascade of
events that can increase systemic
inflammation
Protein
s
Leaky Gut/
Inflammatory
Triggers
Localized
Inflammatio
n Joints, etc.
Liver
Stress/
Kupffer
Cell
Activation
Toxi
Systemic
ns
Inflammati
Scharz B, et al. Intestinal ischemic reperfusion syndrome: pathophysiology, clinical
on
significance, therapy: Wien Klin Wochenschr1999;111(14):539-48.
MALT/
GALT
Activation
The Six R’s of “Fixing the Middle”"
1. Remove:!
Food allergens, parasites, fungal overgrowth, improper
bacterial strains, irritants (NSAIDS)
2. Repair:!
The mucosa/intestinal lining to reduce "Leaky Gut
Syndrome", including goblet cells, mucosal cells, immune
cells at the surface linings
3. Replace:!
Digestive enzymes and all factors needed for proper
digestion and absorption
4. Re-innoculate:!
Restore normal, healthy gut ecology with prebiotic and
probiotic factors
5. Revitalize:!
Chronically blocked pathways with acupuncture
6. Rebalance!
35
46
Direct interaction between immune cells
and dietary inputs impact the
inflammatory process
the 4R Program!
•! Lymph nodes in the GI tract allow immune cells
triggered in the GI to circulate throughout the body†
the 5R Program!
•! Transmigration of antigens across the GI barrier
may trigger a systemic immune response
the 6R Program!
† CLINICAL AND VACCINE IMMUNOLOGY, May 2007, p. 485–492
Address GI issues in the Context of the
REPLACE
4R Program
REMOVE
4R Program
REINNOCULATE
REPAIR
What does your patient need to
support the healing of the mucosal
barrier?
36
47
REBALANCE
4R Program
RELIEF
Spleen/Pancreas
Spleen/Pancreas
!Specialty Testing:
•! ALCAT Platinum blood sensitivity test
(200 foods and spices, environmental chemicals,
food additives, coloring, molds, pharmacoactive
substances, and drugs)
•! Comprehensive Digestive Stool Analysis & Parasitology,
e.g., MetaMetrix GI 2100 Effects Test
•! Glucose - Insulin testing
•! SpectraCell Comprehensive 5000
(Identifies intracellular nutritional deficiencies)
Spleen / Pancreas: Bloating, gas, indigestion, abdominal
swelling, nausea, generalized abdominal pain or
discomfort, fatigue, aching muscles, tendency to
accumulate phlegm, lumps, cysts and tumors, fibroids,
insulin resistance, sweet cravings, anxiety, rumination.
Spleen / Pancreas Nutraceuticals,
Cont’d:!
Spleen / Pancreas Diet & Nutrition:!
Eat cooked food in a generally low-carbohydrate diet,
e.g., South Beach Diet, Zone Diet, etc.
Cook with ginger
Avoid cold, raw and phlegm-producing foods !
!
!(Dairy products, tofu, etc.)!
PRE AND PROBIOTICS!
Vitamin D3 - test Vitamin D (25,OH) level, then treat - (2,000 I.U. daily
is common)
Chlorophyll complex perles!
Lactic acid yeast - Saccharomyces boulardii/Bifido Lactis HN019/
Lacto rhamnosus HN001 with meals
Spleen / Pancreas - Other Tx
Considerations:!
Betaine hydrochloride USP - 500 mg per meal
Look for Thyroid problems and treat accordingly
Eliminate all food and chemical irritants found on ALCAT
test
Visceral, spinal and cranial manipulation
Prebiotics: Fructo-oligosaccharides (FOS), Inulin, whey protein
Probiotics: (Bifidobacterium species, Acidophilus, Lactobacillus
species, et al)
37
48
Spleen/Pancreas
Spleen / Pancreas Nutraceuticals, Cont’d:
Small Intestine/Absorption/transformation of food &
contributions to digestion
Yeast and Parasite control!
Berberine Sulfate TriHydrate - 200 mg B.I.D., Coptis, Oregan Grape,
Chinese Skullcap, Phellodendron, Ginger, Licorice, Chinese Rhubarb
root and rhizome
•! Pancreatic enzymes- increased fatty markers in stool,
stool floaters, fat soluble vitamin deficiencies
(Spectracell & serum testing, ie Vit D, A, E etc)
•! Veggie enzymes- patient preference but not as strong,
increase dose
•! Exocrine vs. endocrine
exocrine = enzymes, endocrine=blood sugar
Puts fat in the middle (see insulin resistant protocols
later in the lecture)
Grapefruit Seed Extract - 200 mg daily
Pumpkin Seed, Ginger, Barberry root, Oregon Grape, Goldenseal root,
Bromelain, Peptidase
Oregano oil, Red Thyme oil, Sage Leaf extract, Lemon Balm
extract
" Read: Overcoming Thyroid Disorders, Second Edition !
!
!
David Brownstein, M.D.
!
Spleen/Pancreas
Spleen/Pancreas
Rules dampness & moisture
(mucous formers) fluids thickening
cysts, lumps
Rules dampness & moisture
Fluids thickening (mucous formers) cysts, lumps
•! Vitamin D – labs
•! Chlorophyl- healing leaky gut, halitosis (bad breath),
chronic intestinal inflammation
•! Saccaromyces Boulardii- important constituent of all
probiotics, protects against C-difficile, prevents antibiotic
induced colitis
•! Probiotics- anyone who has taken antibiotics, people w/
immune problems
•! Prebiotics- works synergistically with probiotics to
establish a healthy intestinal population, diarrhea, people
who didn’t get better w/only probiotics
•! Berberine- unbelievably effective antifungal, antimicrobrial, used
as an alternative to antibiotics, kills yeast and bacteria but doesn’t
disturb probiotic status as much, food poisoning, treat diarrhea
from bad food reactions
•! Oregano- yeast overgrowth
yeast cleverly adapts & becomes resistant
mucous formers, constant phlegm & mucous
*Rotation Plan (building up in dose slowly)
-Berberine 1st for 2-3 weeks
-Oregano 2nd for 2-3 weeks
-Artemesia or Cats Claw following for 2-3 weeks
Earth Element/Phase: ST-SP (Pancreas)!
!Specialty Testing:!
•! H. Pylori breath test /antibody tests!
•! Heidelberg test (swallowed pH meter to
measure acid/pH of stomach!
•! Vitamin B12/Methylmalonic acid tests!
•! Parietal cell antibody!
•! Intrinsic factor antibody!
•! Serum Gastrin Level
!"#$%"&'%())(*+,-(%.(+/0'#%
+0%."&"1(%$023%4"+,(&+#5%
',1(#+,-(%*/"66(&1(#%
38
49
Patients are coming to you for relief from
Gastrointestinal health is the gateway
to good health or disease
•! Gastritis
•! Peptic Ulcer Disease
•! Diverticulosis
•! IBD (Ulcerative Colitis, Crohn's Disease)
•! “Functional Disorders”: chronic diarrhea,
constipation, bloating, flatulence (symptoms
of IBS), nutrient malabsorption and GERD
Do You Have The Answers?
•! 70% of humans have GI symptoms or disease
•! Most sensitive organ where a wide range of insults
can lead to dysfunction
•! GI dysfunction leads to diverse clinical
manifestations
•! Normalization of gut function results in improved
clinical outcomes across many diverse diseases
There’s more…
•! Research has shown associations between
compromised GI function and conditions as varied as
rheumatoid arthritis, asthma, eczema and certain
neurological conditions.
•! GI dysfunction can underlie many apparently unrelated
conditions with symptoms not localized in the GI tract.
•! It’s no wonder so many healthcare professionals are
“treating the gut” more often in their patients.
!"#$%&'(&)*++*,-&.)$%*/0-1&$23$%*$-/$&
1,)$&4*-5&,6&5*7$18#$&3%,9+$):&&&&&&&&&&&&
"#$%&;<&)*++*,-&3$,3+$&0%$&=,13*>0+*?$5&
$0/=&@$0%&6,%&/0%$&,6&701>%,*->$18-0+&
3%,9+$)1&0-5&>=$&&
>,>0+&=$0+>=&/0%$&/,1>1&$2/$$5&&
AB<&9*++*,-&0--C0++@:DE&
E.)$%*/0-&F,++$7$&,6&G01>%,$->$%,+,7@&
GI hyperpermeability may be
connected to a variety of systemic
conditions
Causes of hyperpermeability
and dysbiosis
•!NSAID use
•!Proton pump inhibitors
•!Antibiotics
•!Poor diet
•!Stress
•!Pathogenic organisms/infections
•! Systemic inflammatory and immune-related symptoms may be
caused by macromolecules crossing a “leaky gut” (intestinal
hyperpermeability)
•! RA, Ankylosing spondylitis, eczema, chronic urticaria, IBD and
others
•! Dysbiosis can lead to altered immune function, malabsorption
problems and inflammation
•! Common manifestations include IBS, vitamin B12 deficiency in
elderly, Rheumatoid Arthritis
39
50
Add prebiotic fiber to support healthy
probiotic bacteria
!"#$%&'(!)*&+,-&
J%$9*,8/&5$K-*8,-L&
!.&3%$9*,8/&*1&0&1$+$/8#$+@&6$%)$->$5&*-7%$5*$->&>=0>&0++,M1&
13$/*K/&/=0-7$1N&9,>=&*-&>=$&/,)3,1*8,-&0-5O,%&0/8#*>@&*-&>=$&
701>%,*->$18-0+&)*/%,9*,>0&>=0>&/,-6$%1&9$-$K>1&C3,-&=,1>&
M$++9$*-7&0-5&=$0+>=D&
235
HI(&
!.1>020->=*-&=01&7,,5&>=$%03$C8/&$P$/>&,-&0/$8/&0/*5Q*-5C/$5&
701>%*/&C+/$%&*-&%0>1:D&
!R$0&),5*K$1&>=$&*->$18-0+&)*/%,S,%0N&%$5C/*-7&C-5$1*%09+$&
90/>$%*0&0-5&*-/%$01*-7&9$-$K/*0+&90/>$%*0:D&
!TUV&W#*>0)*-&U&%$/$3>,%X&3+0@1&0&/%*8/0+&%,+$&*-&)C/,10+&90%%*$%&
=,)$,1>01*1&9@&3%$1$%#*-7&>=$&*->$7%*>@&,6&YC-/8,-&/,)3+$2$1&0-5&
>=$&=$0+*-7&/030/*>@&,6&>=$&/,+,-*/&$3*>=$+*C):&R=$%$6,%$N&#*>0)*-&U&
5$K/*$-/@&)0@&/,)3%,)*1$&>=$&)C/,10+&90%%*$%N&+$05*-7&>,&
*-/%$01$5&1C1/$389*+*>@&>,&)C/,10+&50)07$&0-5&*-/%$01$5&%*14&,6&
Z[U:D&&
.)&\&J=@1*,+&G01>%,*->$1>&]*#$%&J=@1*,+:&&
H<<^&\0-_H'BW;XLGH<^Q;`:&a3C9&H<<b&"/>&H(:&
GC>&[0%%*$%&U1@6C-/8,-&]$051&>,&
Z-/%$01$5&R,2*/*>@&0-5&Z-S0))08,-
2--%#
;<*"71
3/4516-0
*='->-=
2--%#3/5(
Normal
Intestinal
Permeability
c@3$%3$%)$09*+*>@
"0:5'6-01
7819/-1/1
*069/-6'1
$-./01
Endotoxins
Antigens
!"#/0?&@@&6-0#&03#=5&A8#4B(#/0/6&(5#&#'&1'&35#&
-:#1/40&=/04##5C50(1#(>&(#'&0#/0'%5&15#/0?&@@&6-0D
<'>&%E#FG#5(#&=D#"0(5160&=#/1'>5@/'#%5H5%:B1/-0#1803%-@5I#
H&(>-H>81/-=-48G#'=/0/'&=#1/40/J'&0'5G#(>5%&H8I#K/50#L=/0#
K-'>501'>%MNNNOMMMPMQRISTNUQVD#
;
Systemic
Inflammation
H
40
51
Case !
Study:
CASE HISTORY: INITIAL VISIT NOVEMBER 2013
54 Y/O W/M ENGINEER REFERRED BY HIS MASSAGE THERAPIST
CHIEF COMPLAINT:
MULTIPLE PROBLEMS RESISTANT TO TREATMENT INCLUDING:
LONG TERM GERD, THORACIC PAIN T5-T7, WEIGHT LOSS, FATIGUE,
LACK OF FOCUS, CHRONIC SORE THROAT, FROZEN SHOULDER,
DEPRESSION, INSOMNIA, HEMORRHOIDS, JOINT PAINS SCATTERED
ALLERGIES: PCN (HIVES), RAGWEED, DUSTMITES
MEDS: WELLBUTRIN XL 300MG, CLARITIN 10MG, PEPCID AC 10MG,
AMBIEN 10 MG, DGL prn, LACTASE prn, Whole Foods PROBIOTIC bid
Case !
Study:
Case !
Study:
41
52
Case !
Study:
Case !
Study:
Case !
Study:
Case !
Study:
Case Study:
Case !
Study:
42
53
Case !
Study:
Liver: Toxicity Issues!
Specialty Testing: !
Heavy metal toxic elements (hair, urine, stool, blood) Doctor’s Data, Genova
Diet & Nutrition:!
Clean up the diet, eliminate refined carbohydrates,
hydrogenated oils, all “junk” and fast foods,
alcohol, drugs, (unless medically necessary)
Increase dietary fiber and pure water intake
GallBladder
Wood Element/Phase: GB-LR!
Fat Malabsorption, food intolerance, migraine
headaches, bloating/nausea after eating
!Gall Bladder: Headaches, migraines, bloating/
nausea after eating, refractory pain right-sided
between shoulder blades or in the shoulder, knee
pain w/o orthopedic signs
•  Vitamin A- Thins bile (sludge bile), thins lymph
•  Lipotropics- thins bile, aids in production of healthy bile
and fat breakdown
•  Iodine- thins bile
Gall Bladder - Nutraceuticals:!
Liver Detoxification Overview
MYCELIZED A: Vitamin A - (mixed carotenoids and
palmitate) 5,000-10,000 I.U. (short term for 7-10 days)
then 2,000-3,000 I.U. as maintenance
  Each person has a specific threshold after which the liver
becomes unable to detoxify at a rate capable of preventing
symptoms. !
  Phase 1 & Phase 2 pathways are critical for removal of
toxins, and many nutrients are dependant for each
detoxification pathway.!
Lipotropics- Choline Bitartrate USP – 500 mg daily,
Inositol, Taurine, L-Methionine, Artchoke Leaf, Chen Pi,
Betaine HCL, Vit. C, B6, Folate, B12, Mag
  Detoxification problems can be found in either one or both
pathways.!
Iodine (Potassium Iodide USP as kelp) - 250-1,000 mcg
daily (watch thyroid function)
  A major issue for liver detoxification is maintaining
Glutathione levels.!
43
54
Additional laboratory tests to help you identify
elevated toxic burden in your patients!
Clinical Importance of the
Cytochrome P450
Evens WE and McLeod HL, New Engl J Medicine 2003; 348:548
260
Patients with symptoms of toxicity may
have compromised detoxification pathways
Toxins from the environment and diet may
lead to health challenges in your patients
•! Excessive toxic load and poor expression of clearance
enzymes and transport proteins may lead to a buildup of toxins
in the body
•! Continuous exposure to dietary and environmental
toxins may lead to an impairment in the ability of
patients to metabolize and clear damage causing
compounds from their body
Supportive Nutrients for
Liver Detoxification Pathways
2>&15#"""I#"0'%5&153#B%/0&%8#&=A&=/0/(8#@&8#1BHH-%(###
5.'%56-0#-:#@&08#9/-(%&01:-%@53#(-./01#
Neutralized
Toxin
TOXINS
Neutralized
Toxin
Phase I
Functionalization
263!
Phase II
Conjugation
Phase III
Alkaline urine
supports
excretion
44
55
•! Many of your patients’ health challenges are
associated with accumulated toxins
! Patients presenting with:
–! Generalized muscle aches
–! Chronic fatigue
–! Fibromyalgia
–! Food allergies or chemical sensitivities
266!
Major Detoxification Activities
in Drug Metabolism
From Iarovici (1997)
267!
268
CYP-450 Phase I under-expression:
–! Toxins accumulate in adipose tissue
–! Rates of metabolism for toxins are compromised
–! Exhibits symptoms of toxicity
CYP-450 Phase I over-expression:
–!Creates more reactive intermediaries than can be
neutralized by Phase II enzymes
–!Places patients at risk for tissue damage from
reactive compounds
270!
269!
45
56
272
“Some patients metabolize ... so rapidly that
therapeutically effective blood and tissue
concentrations are not achieved; in others,
metabolism may be so slow that usual doses
produce toxic effects.”
Merck Manual Section 22, Chapter298
271!
Reduce the amount of incoming toxins
–! Elimination diet with a 10- or 28-day protocol
Provide nutritional support
–! Organic low-allergy-potential protein, medium
chain triglycerides, and complex carbohydrates
with highly bioavailable vitamins, minerals, and
antioxidants
Fed Proc. 1986 Feb;45(2):142-8.
273
Nutrient Support for Phase II
Detoxification Pathways
274!
Liver Detoxification - Nutraceuticals:
Phase II Pathways:
Detox Medical Foods- !
NAC, Silymarin from Milk thistle, EGCG from Green Tea
Extract, Sodium Sulphate, Taurine, Choline, Artichoke
Leaf extract, Watercress, Ellagic Acid from
Pommegranate, Methylators (B6, B12, Folate, Biotin, B5),
Mg, Z, Se, Cu, Mn, Vit A etc !
Sulfation:
–! N-acetylcysteine, Sodium Sulfate
Acetylation:
–! Vitamin B5, Magnesium
Methylation:
–! Vitamin B12, Choline, 5-MTHF
275
46
57
Liver: Toxicity Issues!
Specialty Testing: !
Heavy metal toxic elements (hair, urine, stool, blood) Doctor’s Data, Genova
•! “The presence of dietary
simple sugars, saturated
fats, and salt within an
organism may echo its
stress experience – an
experience assimilated by
others when consumed.”
•! “As each successive
consumer in the food chain
incorporates the stress
phenotypes of its dietary
components, cues for stress
may accumulate in a game
of “you-are-what-you-eat.”
Diet & Nutrition:!
Clean up the diet, eliminate refined carbohydrates,
hydrogenated oils, all “junk” and fast foods,
alcohol, drugs, (unless medically necessary)
Increase dietary fiber and pure water intake
Yun and Doux, Med Hypotheses 2007; 69:746-751. 278
Turmeric/Curcumin
Turmeric (Curcuma longa) roots have long been
used as both a food ingredient (spice, coloring
agent) and medicinal agent in East Asia. This
plant, related to ginger, contains the potent antiinflammatory agent, curcumin, Curcumin is
known to be a potent inhibitor of NF-kB, COX-2,
LOX as well as many other enzymes within the
inflammatory pathway (many regulated through
NF-kB). Curcumin also reduces other
inflammatory mediators such as IL-6, LL-1ß,
MCP-1 and metalloproteinases in animal models.!
279
Reports have confirmed that oral doses of
curcumin inhibit the production of COX-2,
limiting the formation of PGE2, as well as
reducing pro-inflammatory mediators from
LOX in animals and humans.!
Curcumin is considered to be extremely safe
and no toxicity is noted even at high doses.!
Plummer SM, et al. Inhibition of cyclo-oxygenase 2 expression in colon cells by the
chemoprotective agent cucumin involves inhibition of NF-KappaB activation via
NIK/IKK signaling complex. Oncogene 1999 Oct 28;18(44):6013-20.!
47
58

AAPM Workshop Sept 2014 - American Academy of Pain Management

Transcription

Similar documents

Brochure - Acupuncture Continuum

CCAOM "Know Your Acupuncturist"

Kirkman® Roadmap

Reversal of a Sudeck`s Atrophy by the Adjunctive Use of

16 21x 60% - RetailMeNot

Nutritional Merits of Home Grown Vs. Store

Estroven Menopause MonitorTM

View PDF - e-Science Central

treatment of Multiple sclerosis With Chinese scalp Acupuncture

Garden Cannellini Bean Salad - Produce For Better Health Foundation

Cervical Traction System

ACUPUNCTURE and NATURAL MEDICINE