Lexington, Kentucky; March 29–April 1, 2012
And Now for The Rest of the Story …
Radio icon Paul Harvey served as a link to both headlines and human interest stories for three generations ahead of the dot-com boom. Daily "nutrition newsletters" blaring the latest research … often promote "the most advanced products" for you to take best advantage of the "newest knowledge." For almost 30 years, semiannual meetings of ICIM (the International College of Integrative Medicine) have offered a refreshing potpourri designed to inform and excite practitioners with pragmatic details on emerging treatment strategies that can be implemented in their offices in the coming days or weeks.
William Faber, DO (milwaukeepainclinic.com), tackled head-on the need for "continuing-ed training" in easily learned techniques by assembling a program on "Rapid Therapeutic Response" for the Lexington, Kentucky, meeting at the end of March. He has had an interest in rapid healing for years, since patients with lingering problems despite repeated visits to various specialists become miserable and hopeless. In fall 2011, Dr. Faber authored The Osteopathic Medicine Advantage: How Medical Miracles Are Made. As program chair, he gathered experts to share their nuts-and-bolts experience to assist our doctors and their staff to move patients toward better health.
Instant Pain Relief
L. Terry Chappell, MD (healthcelebration.com), shared an exciting "rapid response" Pain Neutralization Technique (PNT) developed over several years by Stephen Kaufman, DC, of Denver, Colorado. A quick understanding is to consider this as "neural therapy without needles," using trigger points to identify painful areas. Simple light pressure strokes are used to gain 60% to 100% relief of discomfort at the trigger point, and two or three painful areas are treated during any one session. The method works for many pain patterns, both acute and chronic. Dr. Chappell demonstrated the hands-on finger pressure on audience volunteers, then attendees paired up to see how easy this is to learn.
One treatment session, according to Dr. Kaufman, has removed pain "permanently" in up to one-third of patients; perhaps another third will require multiple weekly sessions for over a month or two. A neat "twist": acupuncture point K27 (below the clavicle, just lateral to the sternum on the left) responds to a gentle circular rubbing pressure for about a minute, relieving feelings of "stress." Dr. Kaufman has in-person and on-video training programs for this and other pain-relieving techniques (painneutralization.com). For a lagniappe, Dr. Chappell demonstrated the PNT applied to the IRR (Infraspinatus Respiratory Reflex) originally described by Harry H. Philibert, MD, to aid with reactive airway issues (asthma) and allergies, but the PNT approach does not rely on the use of injectable cortisone. Dr. Kaufman has applied these procedures to help with other frustrating medical problems.
Uncovering Hidden Beliefs
Joel P. Bowman, PhD, and Debra Basham of Subtle Communications Systems (scs-matters.com) addressed ways to invite patients to engage actively in integrative treatment programs despite their limiting hidden beliefs and values. Briefly introducing NLP (neuro-linguistic programming) approaches, they illustrated how behavioral patterns are influenced by the hierarchy of values, beliefs, strategies, and environment. Lasting changes require addressing the underlying values that can restrain a patient from progressing toward desirable goals. Merely teaching "how to feel better" is destined to fail if a patient's identity is intertwined with his/her health issues: "my cancer," "my asthma." Universal qualifiers demonstrate underlying distortions and can be particularly hazardous: "I've always been sick," "I might feel better but I can never get well."
Linguistic pattern shifts can help patients gain valuable insights that better motivate them to participate more fully in treatment programs. One useful tool is to ask questions to "fill in the blanks," to uncover hidden values and beliefs and get into the unconscious mind … "What leads you to believe that?" and "Who/What/Where/How exactly?" Dr. Bowman and Rev. Basham invite practitioners to share their questions as well as their own effective phrases, to be collated and made available to those interested: firstname.lastname@example.org. (Ask to subscribe to their helpful hints e-newsletter!) Detailed techniques are reviewed in their excellent 2009 manual, Healing with Language: Your Key to Effective Mind-Body Communication, which served as the basis for their excellent one-day lead-in seminar before the general sessions, titled "Anchoring: Stimulus-Response Conditioning." Participants in the minicourse learned how to anchor and "recall" positive phrases and experiences for patients, helping the reframing process with intentional language.
Inflammation is 'Repair Deficit'
Physiology is the basis for understanding pathology – or at least that's what we're told in medical school. Integrative medical practices clearly base many of their testing and treatment approaches on a daily reliance on fundamental principles. Russell M. Jaffe, MD, PhD (email@example.com), returned to the ICIM lectern to share his ever-evolving perspectives on disease and wellness. Acute inflammation means repair that can't keep up – chronic inflammation means deficit of antioxidants/other essentials and/or excessive distress. Two Americans every minute have avoidable coronary events … heart attacks! By 2025, about 50 million people will have diabetes – all of whom will be at high risk for heart disease. When cells run out of essentials, they shift from protective/repair mode to survival mode, to wait out the distress … most worrisome is when your deficient cells "live there," struggling and gradually failing for years. First responder cells protect, recycle, defend, and repair. Health habits are, by nature, hourly and daily investments in balancing and promoting more optimal functions, particularly with regard to inflammation control.
Dr. Jaffe reviewed measurable nutritional deficiencies in their contribution to limitation of detoxification and inflammation/repair. C-reactive protein, as an example, helps to enhance the uptake of LDL by macrophages – so those with higher levels are simply signaling a need to have optimization of antioxidant parameters. Homocysteine elevations can be similarly viewed, where proper nutritional replacements and health habits can dramatically improve cardiovascular survival. Insulin resistance, weight gain, adiposity – all are related to loss of inflammation control. Healthier physiology is associated with hsCRP <0.5 mg/L, homocysteine <6 umol/L, oxidized HDL/LDL and 8-oxo-guanine basically 0, first morning urine pH 6.5–7.5, 25-OH-vitamin D 50–80 ng/L. These risk markers can be measured monthly as needed to motivate patient beliefs and enhance compliance, particularly with regard to "healthy intake values" rather than simply "RDA" levels that merely prevent signs of deficiency disease. Dr. Jaffe has a website to help practitioners find where to obtain less common testing that is useful to advise and manage patients (both medically and metabolically) with virtually all degenerative diseases: betterlabtestsnow.com. This splendid lecture summarized over 30 years of studying food intake, supplementation, and daily habits to promote healthy alkalinization in a rational approach to obtain and maintain optimal health.
Take A Bite Out of Disease
You're stuck with your genetics, right? Well, time to step back and rethink our biases. John D. Laughlin III, DDS (HealthCenteredDentistry.com), tackles tough medical issues from a holistic perspective. This River Falls, Wisconsin, dentist made sequential pacifier-molds for little John, a classic Prader-Willi patient brought in at 1 month old. Over the course of several months, this passive baby, struggling to breathe, became the star patient (ever!) in his P-W clinic. While P-W babies rarely move much before 1 year of age, you'd have to keep up with John as he crawls across the floor. Watch the almost unbelievable video and judge for yourself how biological dentistry can contribute to the management of "impossible" medical (and dental) problems, especially those affected by endocrine or respiratory impairments: http://www.healthcentereddentistry.com/testimonial-frameset.html.
Dentistry is no longer "prophy every 6 months": observations of asymmetric face form, head-forward posture, imbalanced gait, impaired swallow or speech, distressed TMJ function, and breathing patterns. Hands-on training (a first for an ICIM general session!) overseen by Dr. Laughlin showed how simple maneuvers such as "internal pterygoid muscle release" can be done quickly in-office, providing greater comfort for patients with limited jaw opening, headaches, odd visual difficulties, even endocrine imbalances. (Aqualizer.com offers a temporary splint that can help enhance and maintain improvements achievable with pterygoid muscle release.)
Reach Out and Touch Your Pain
Janet Travell brought trigger points to the fore in medical practice about 50 years ago (more recently: Myofascial Pain and Dysfunction: The Trigger Point Manual, volumes 1 and 2). Now we've discovered many more of the muscle pain patterns that cause agony almost universally missed by conventional physicians. When proper pressure is applied to the correct isolated points, Hal Blatman, MD (blatmanpainclinic.com), author of The Art of Body Maintenance: Winners' Guide to Pain Relief, has shown that myofascial release can be dramatic in providing rapid relief. Surprise: zones of referred pain can themselves develop myofascial pain syndrome triggers even though no "injuries" have occurred locally. Look for the "knot" in the most tender part of the "tight/ropey" muscle – there's your trigger point. Myofascial pain always involve several muscles, not just one; all fascial bands interconnect and pain patterns can refer up, down, and around the body. Fascia has 10 times more sensors than muscle … these fiber sheets support the frame and organs and serve the purpose of proprioceptive awareness. Acupressure, dry needling, and trigger point injections are effective methods for quieting the trigger points.
The infraspinatus "drives the bus" for upper body pains, especially in the arms. The tibialis posterior does the same for the foot/lower leg. Dragging skin is required for stretching fascia, which further helps myofascial pain syndromes. Headache, migraines, fibromyalgia, back pain, tennis elbow, golfer's elbow, shoulder pains, and plantar fasciitis are common examples of pain syndromes that readily improve with easy-to-learn techniques. Prolotherapy injections are the key to permanent relief in more advanced cases (the American Osteopathic Association: www.acopms.com; Dr. William Faber: milwaukeepainclinic.com).
Got Your Flu Vaccine Yet?
With pharmacies advertising "flu shot discounts" and businesses insisting on 100% immunization compliance, the epidemic of flu shots has become alarming. Those who argue that vaccinations can contribute more to creating illness than they do to preventing spread of influenza will find comfort in the observations of Kalpana D. Patel, MD (65 Wehrle Drive, Buffalo, NY 14225; 716/833-2213), assistant professor of pediatrics at SUNY-Buffalo school of medicine and coauthor (with William Rea, MD) of the four-volume set Reversibility of Chronic Degenerative Disease and Hypersensitivity. Triggering of mast cells in the connective tissue matrix leads to massive amplification in the neuroimmune system axis and activation of chemoreceptors.
Patients who have frustrating symptoms (such as chronic cough), recurrent viral syndromes (including "chronic mono," shingles, oral or genital herpes, hepatitis, others), who become ill with "the flu," or who develop systemic changes (such as period irregularities, autistic changes) after certain immunizations are ideal candidates for this treatment program. Vasoactive neurotransmitters (dopamine, serotonin, others) affect homeostasis balance and this is the basis of provocation-neutralization (P-N) therapy, and treatment is tailored to the patient's needs. P-N-based antigen injection therapy has shown results across a broad-range of "allergy-associated" symptom patterns and illnesses. Intradermal testing – evaluating "wheel-and-flare" reactions – can be remarkably more sensitive than other allergy determination tests. (Clinical training in P-N is available through aaemonline.org/AboutUS.html.)
Recurrent sinus or lower respiratory infections have responded uncommonly well to P-N testing, often interrupting the frequency of repeated infections. The allergy conditions improved with P-N treatments are particularly notable, because the technique can provide relief where others have failed. The causal connection is easily established by confirmation testing. Administer the precise dose, to confirm that it reproducibly improves the patient's condition through inducing "information" in the extracellular connective tissue-based immune system. Sublingual testing and administration can be used for the same reason as intradermal; namely, the rich blood supply and concentrated innervation.
New Treatment for Heavy Metal Toxicity
Chemistry Professor and Chair Emeritus (University of Kentucky) Boyd E. Haley, PhD (firstname.lastname@example.org), addressed the increasing levels of heavy metal toxics in our environment. Oxidative stress is the underlying pathology mechanism in degenerative diseases (and many acute as well). Reducing intracellular toxic metal concentrations is the key … but charged molecules (including chelators) are unable to pass through cell membranes. Mercury in mitochondria generates damaging hydroxyl radicals, oxidatively stressing all cells and directly interrupting the porphyrin pathways (possibly leading to decreased solubility, and hence deposition, of beta-amyloid … Alzheimer's!).
Pyridine analog NBMI is a lipid-soluble potent free radical scavenger, developed at the university. Because of its safety and efficacy, patented NBMI has been designated an orphan drug in the European Union and full-approval studies are under way. Mercury scavenging rates are above 99% in virtually any situation, and the compound will not release the toxic metal once bound. ORAC and HORAC scores (the ability to prevent oxidation) are 10-fold higher than the closest other "antioxidant." Glutathione levels are enhanced in those receiving NBMI, improving detoxification mechanisms. A glutathione-toxic metal complex is easily cleared from within cells into plasma and then readily excreted from the body.
Safety parameters are exceptional, with no toxicity demonstrated – and test animals first given double the lethal dose of mercury and then NBMI survived without any harm. NBMI binds with and removes lead and other toxic metals at well – but the binding is so tight that laboratory "challenge testing" is not effective. Arterial endothelial cell membrane damage by mercury (and other toxic metal) compounds is prevented by NBMI pretreatment – similar results are found with organic chemical exposure. The compound enters the cells of all tissues and crosses the blood-brain barrier – then readily leaves the body … with mercury (and hydroxyl radicals or other toxic metals) in hand.
NHANES results from 2006 have shown rising blood mercury levels in Americans, especially over the past decade. American vaccination rates are the highest in the world … and our neonatal and childhood survival rates are embarrassingly low compared with those in other nations. Babies in Minnesota are showing surprisingly elevated mercury concentrations in new reports. Testosterone impairs mercury excretion, while estrogen enhances it, so relative toxicity is gender-related, possibly a significant factor in development of autism. Dental amalgams remain the greatest exposure source, both for the individual and for the developing fetus, according to World Health Organization data. Uses for NBMI might include inhibition of viral infections and other immune enhancement, though clinical studies have not been performed. Those who have difficulty with intake of sulfite (such as sprayed on vegetables at a salad bar or contained in wines) might have a molybdenum deficiency, which should be addressed before NBMI administration. An application is being prepared for the FDA to approve NBMI for eventual marketing in the US.
Medical Board and Other Law Issues
ICIM general counsel Al Augustine, Esq. (email@example.com), former chief prosecutor for the Illinois state medical board, gave his semiannual update on current practice issues. E-mail is an increasingly utilized resource … but remember that the laws were written with the "real world" in mind. Whenever possible, try to see the patient in your office … or talk on the telephone … and consider e-mail as a last alternative. At the very least, see the patient for an initial visit and then at least once annually. If you use e-mail, make sure that you have an office policy in place … including that the messages have to be printed and placed into the medical record. Sensitive or medically urgent materials should not be sent by e-mail (HIPAA issues!). Be extra careful regarding server security and privacy issues. Consider an informed consent specifically for e-mail communications – and terminate discussions if you insist on an in-person visit and the patient refuses.
Marketing always raises questions for the authorities. Website materials will be considered part of your medical practice by the board. Having your statements reviewed makes sense – and avoiding superlatives and claims is important. Look to include specific cautions: "results will vary" and "informational purposes only, not to be relied upon for diagnosis or treatment." Multilevel marketing raises various concerns of undue influence, particularly where the doctor encourages patients to become distributors and to enlist others. "Groupon" and other discount offers, where percentage payments are due to the promoting firm, might have some potential issues in some states.
Functional diagnostic testing raises other questions. If a particular test is nonstandard, the doctor is wise to record clinical diagnoses in the chart and to avoid basing a diagnosis or treatment exclusively on such a test. Clinical judgment based on the patient presentation and other tests remains senior in every instance. Be clear in explaining to patients the results of their tests, especially that you do not rely solely on nonstandard tests.
In every "prescription" case, be sure that you have records of check-ups and treatments – especially with "pain" medications. Consult your state laws and regulations regarding any limits on prescribing practices. Record-keeping remains central to better medical practice. Be sure that "positives" are in the chart, not just "negatives" or "the basics." The board will insist that "if it is not in writing, then it didn't happen." View all patients as "traditional" from the beginning, then go above and beyond standard SOAP practices. Informed consents are essential: a basic one introduces the patient to the practice … then use a specific one for particular treatment programs, such as intravenous therapies. Review with an attorney specializing in state medical issues the informed consents that you use – and then keep them in your charts! Update and re-sign the consent forms every 6 to 12 months.
Pick your patients wisely and keep them happy. Do smart advertising and assemble your website carefully. Keep great records. Avoid being the only doctor doing a particular treatment. Stay current with medicine and law issues … including reading local bulletins, reviewing state board reports, and attending traditional CME programs. Belong to a professional group that assists and supports your interests. If a government representative from any agency calls, writes, or visits, do not talk to him/her without an attorney. Don't ever ignore the board, don't ignore the rules of the changing climate of medicine. Don't assume that being "pure of heart" will protect you. Don't believe that you are "smarter" than "them." Don't wait to protect yourself. Be sure that all forms and informed consents used in your office are legally sufficient. Always be aware of patient privacy and of patient rights to information. Be sure to train your staff to understand office systems and policies and to respond properly to patient concerns. Know the laws and rules for medical practice in your state.
When you receive a letter from the board, take it seriously and call your board-specialist attorney. If there is an investigator at your door, cordially advise him/her that you will need to have your attorney present … say nothing else. If you are called by the government, do not talk. If you receive a subpoena, see your board-specialist (or malpractice) attorney. ICIM proudly offers a "Medical-Legal Risk Analysis" program as an invaluable membership feature, helping doctors begin the planning for dismissal from the very start of any issue.
Pearls in the Most Pleasant Places
The general session included a feature for which ICIM has become famous: Clinical Pearls shared by our members, both long-term and newbies. Perhaps the most interesting of these – and one that your patients will enjoy right away – is ….. well, why not order the CDs from the ICIM office and listen to each of these diverse comments that captivated our audience! (icimed.org) (Editor note: icimed.com)
Three More 'Beyond-Honorable Mentions'!
Since ICIM members and "taste-testers" come from different backgrounds and practices, our meetings feature specialty "lead-in" programs that help broaden our perspectives. A couple dozen physicians enjoyed a rare full-day comprehensive presentation by the "Mistress of Mesotherapy," Aline Fournier, DO, of Escondido, California. "Rapid Results Using Complex Injectable Homeopathy" was more than a mouthful – it was an inspiring and pragmatic introduction to successful mesotherapy approaches. Mesotherapy is defined as "injection of a small amount of a dilute medication into the dermal layer as close to the pathology as possible … and not too often." These dilute medications are homeopathic preparations from plants, minerals, animal tissues, and toxins, even pharmaceuticals. Over 18 years of intensive focus and practice, Dr. Fournier has evolved a teaching and treatment approach second to none, and she freely shared her thought processes and special techniques with us. The "lab" included multiple break sessions for attendees to "treat" (successfully!) various musculoskeletal and other distresses in their partners. Kudos for a stunning presentation!
ICIM icon Dr. Chappell conceived of and chaired an immensely popular daylong seminar on "Saving a Million Hearts." Moderated by Jeannette Soriano, MD, of Calgary, Alberta (Canada), the symposium featured several leading physicians who addressed audience questions from nutritional, chelation, and patient management perspectives. Sharing of protocols and analytical approaches was much greater in depth than is available during the Clinical Pearls segment of ICIM general sessions. Panelists included Robban Sica, MD; James Carter, MD, DrPH; Charles Mary, MD; John Wilson, MD; Garry Gordon, MD; Conrad Maulfair, DO; Russell Jaffe, MD, PhD; L. Terry Chappell, MD; Ellie Campbell, DO; Jim Smith, DO; Joseph Hickey, MD; and Lambert Parker, MD.
Dr. Chappell explained that the seminar took its inspiration from a news release dated September 13, 2011, from the Department of Health and Human Services: "New Public-Private Sector Initiative Aims to Prevent 1 Million Heart Attacks and Strokes in Five Years." The release noted that cardiovascular disease currently costs the nation $444 billion yearly in medical fees and lost productivity. The "Million Hearts" program is focused on improving aspirin use, blood pressure control, cholesterol control, and tobacco reduction, along with reducing sodium intake and artificial trans-fat consumption. Clearly, the ICIM seminar emphasized different lifestyle changes – including nutritional supplements and chelation therapy – that (in our professional opinion) could save far more than a mere million hearts. These "unconventional" approaches take on far more importance in light of published studies that demonstrate, for example, increased vascular reactivity as a result of the toxic effects of mercury, lead, and gadolinium, which can increase endothelial production of free radicals and angiotensin II.
The third lead-in seminar was taught by Dr. Bowman and Rev. Basham, of Subtle Communications Systems, mentioned earlier. They addressed ways to invite patients to engage actively in integrative treatment programs despite their limiting hidden beliefs and values. (It should always be so easy, right?)
So, You Might Ask, What's Next?
Great question! Ronald Casselberry, MD, will host us in Cleveland, Ohio, for "Sex, Lies, and Hormones," gathering together a fantastic array of speakers We'll hear from Robert Anderson, MD, on psychoneuroendocrinology; Ty Vincent, MD, on testosterone treatment for young (and older) men; Marianne Marchese, ND, on PCOS (polycystic ovarian syndrome); Arden Anderson, MD, on diet and nutrition, especially the effects of pesticides and genetically modified (GMO) foods; Phyllis Bronson, PhD, on hormones, moods, and emotions; Ken Stoller, MD, on oxytocin; James Wilson, DC, ND, PhD, on adrenal fatigue and xenoestrogen; Robban Sica, MD, on women's health; and a detailed discussion on menopause and BHRT (balanced hormonal replacement therapy) featuring Malcolm Sickels, MD; Holly Lucille ND, RN; and Allan Warschowski, MD.
Want even more? Lisa Everett, RPh, will host a lead-in workshop on "Applied Endocrinology: The Hormone Connection." And David Getoff, ND, will feature "Cellular and Whole Body Detoxification Made Simple" as a lead-in as well. Did I mention that James Smith, DO, will give an outstanding workshop on "Clinical Metal Toxicology: Diagnosis and Treatment" for beginning and experienced practitioners?
Sounds like you would like to join us in the future? Mark your calendar to attend our 56th congress this fall, to enhance your practice for years to come: we'd love to introduce you to our world!
As our hero Paul Harvey closed each broadcast: "Good day!"
Contact ICIM at 419-358-0273 (fax 610-680-3847), or e-mail our executive director, Wendy Chappell-Dick, MBA, at firstname.lastname@example.org. Browse the website at www.icimed.com for details on becoming a member and attending our fall 2012 conference in Cleveland, Ohio, September 19–23 (www.icimed.com/conferences.php). CDs of the various lectures (and past conferences) are available.
Dr. Trowbridge (email@example.com) is a past president of ICIM and coauthor of Bantam Books' classic reference The Yeast Syndrome, now available in multiple e-book formats.