This series of articles is devoted to the 2nd factor in chiropractic®, specifically the recognition of visceral dysfunctions that cause muscle contractions that perpetuate and prevent correction of structural misalignments. The resulting loss of joint range of motion and associated discomfort arc often diagnosed as having a structural cause. If the real cause is not accurately identified, the patient docs not receive the benefit of chiropractic care that they deserve. Any form of prolonged stress can create this diagnostic dilemma. It doesn't matter if the stress is structural, emotional, or caused by visceral dysfunction. Involuntary muscle contractions and loss of range of motion arc always involved regardless of the source. The key to success is finding the cause because when it is known, then the required therapy becomes obvious. I have previously suggested that before the patient leaves the treatment room, you ask him or her to be seated and perfonn the 60-sccond chiropractic screening test. The purpose of our screening test is to identify if stress, from either a stnictural or visceral source, remains after your adjustment. No doubt, the stnictural problems have been relieved, if not removed, and what probabh remains is involuntary muscle contraction from a visceral source. Our exam includes three simple palpatory findings and one passive rangc-of-motion test. It takes 60 seconds or less to perform, and it identifies if the patients body cannot presently meet the demands for energy being placed upon it. Ask the patient to be seated and palpate across the top of the shoulders for muscle contraction. I refer to this as the universal stress area for obvious reasons since even the palpation "feels good." If that area is positive, then ask the patient to sit up as straight as possible and bend his or her head down. Now slide your fingers down the spinous processes from Tl toward T12. You should feel the normal "C-shapcd" posterior curve of a normal thoracic kyphosis. Observe if there is a loss of that normal kyphosis and if a depression or liattcning of the curve has formed in the middle dorsal spine. This condition is not a permanent or static condition. It is transitory and caused by involuntary muscle contractions emanating from the abdominal organs, especially those abdominal organs associated with digestive dysfunction (stomach, biliary system, pancreas, duodenum, or jejunum). Last month. I described the relationship of the stomach and the biliary system and indicated that hypochlorhydria and biliary dysfunction arc synonymous. Now we need to address their spinal in-ncrvations. Dysfunction in either area will cause involuntary muscle contraction and temporary loss of the normal thoracic kyphosis. The stomach is innervated from T5 to T9 and there is a spinal ganglion tliat receives spinal nerves from that area. However, the biliary portion of the liver receives inncrvation from as high as T4. and that is significant to us. There is not a spinal ganglion located in the upper thoracic area that synapses with spinal nerves from Tl to T4. Rather their presvnaptic fibers join the superior \ cervical ganglion (Cl to C4). My point I is that while stomach (T5 to T9) and pancreas (T5 to T9) dysfunctions affect the thoracic spine, shoulders, and rib cage, the biliary system also affects the upper cervical spine. So. before your patient leaves following an adjustment, perform our screening procedure: palpate the universal stress area, perform the passive shoulder abduction test, and palpate Pottcngcr"s saucer. If the patient's chief complaint involves any of these areas and there is a visceral dysfunction involving these digestive organs, then his or her next meal will initiate involuntary muscle contractions and perpetuate and prevent correction of the structural involvement. In the vernacular of some of my patients. "Good adjustment last time, but you didn't quite get it. Doc. It came back." How mam- of your patients arc taking proton pump inhibitors? I wrote about them extensively in my last article, but I did not mention H2 blockers such as Zantac. While the clinical affect is the same regarding blockage of stomach acid production and activation of the cn/ymc pepsin to begin protein digestion, the chemistry is different. If the chemistry is different, the side effects are different. So let's discuss them, but before we do. ask voursclf: How many of your patients take histaminc-H2 blockcrs such as Tagamct. Pcpcid. Axid. or Zantac? • How main have chronic headaches? How main have chronic shoulder problems? How mam- chronic cervical flexion-extension (whiplash) injuries do you treat? Do any of them take proton-pump inhibitors or H2 Blockcrs? H2 Blockers Histamine-H2 Blockers inhibit the action of histaminc at the histaitiinc H2-rcccptor sites found in gastric cells. This results in decreased gastric acid secretion and gastric volume, as well as reduced hydrogen ion concentration. They arc intended for short-term and maintenance therapy of peptic ulcers and gastroesophageal reflux disease (GERD). More commonly, though, they are used for relief of heartburn, so-called acid indigestion, and sour stomach. H2 Blockcrs can also be used with NSAIDs to reduce the risk of ulccration. but proton-pump inhibitors arc considered more effective for the prevention of NSAID-induccd ulcers. In addition, they arc part of a niultidnig regimen for H. pylori eradication to reduce the risk of duodenal ulcer recurrence. Side Effects of H2 Blockers It is not my intention to warn against the use of medications, but chiropractors should be aware of what compensations the body must make when the production of stomach acid is blocked in patients who are not diseased and only experience the vague symptoms of digestive distress. The most common side effects of H2 Blockers include: Constipation or diarrhea • Dizziness Headache Hives Nausea or vomiting • Problems with urination All dnigs in this class have the potential to cause vitamin B12 deficiency because of reduction in food-bound vitamin B12 absorption. Elderly patients taking H2 receptor antagonists arc more likely to require vitamin B12 supplementation than those not taking such dnigs. Finally, by suppressing acid-mediated breakdown of proteins. H2 blockers may lead to an elevated risk of developing food or dnig allergies due to undigested pro- tcins that pass into the gastrointestinal tract where sensitization occurs. Patients who take these agents develop higher levels of immunoglobulin E (IgE) antibodies against food, whether they had prior antibodies or not. Elevated levels of IgE are found even months after discontinuation of the drug. You might be interested to know that Zantac, for example, enters breast milk, with peak concentrations seen at five and a half hours. So when treating a nursing child who has colic, check to see if the mother is using an H2 B locker. It is difficult to imagine that protein digestion should be blocked in a nursing or growing child, but you should be aware of the possibility nevertheless. Next month, we move on to the biliary-pancreas connection and the viscerosomatic relationships with those organs. I'll close by asking how long it took you to conduct the 60-second chiropractic screening test before a patient left your office. Do you think it would be worthwhile? Dr. Howard Loomis has an extensive background in enzymes and enzyme supplements. He is the founder and president of Enzyme Formulations®, Inc. His knowledge of physiology, biochemistry, and enzymol- ogy has made him a sought-after speaker and a prolific writer. Dr. Loomis published ENZYMES: The Key to Health in 1999. Contact info: 6421 Enterprise Lane, Madison, Wl 53719, customerservice@ loomisinstitute. com
