DNM - a desperate try

[Kim LeMoon]

After four years of not accepting new clients (too busy), I opened up my practice again earlier this month. The first new one has been great. She referred #2 who came in today. This was the most frustrating session I've ever had.

Hx: Fibro 15 yrs since dx, numbness in feet, IBS with constipation, GERD, and severe LBP (buttocks actually) for past 3 wks

I did a phone consult with her a few days ago and after she told me all of her symptoms, I asked what she'd been doing to get support. She told me she'd been a patient of the Network Chiro in town for the past 8 yrs and how much he's helped her. I held back my cynicism (you're in that bad of shape, yet you say he's helped?)

I spent 15 minutes before the treatment talking/listening and getting an idea of what I might do to help. She gets on the table and another few mins. are spent trying to find a comfortable/bolstered supine position. She's okay, she says and adds that she'd just like to zone out.

I begin at her head, start some very very gentle skin moves over her temples and she starts to wince. I ask if it's tender - yes it hurts, I move to her neck - do tiny gentle toggles on the TPs - she winces again. I touch her shoulder - wince again. She tells me that she's used to putting up with the pain she feels during massage or chiro because it helps. I tell her I'm not comfortable doing anything that will increase her pain with my touch. I suggest maybe she'd like to try sidelying. At this point, I'm thinking that the only hope I have of letting her body receive my touch is to use DNM.

She's on her side, pillow/blanket all snuggly and I tell her about DNM and what I am going to try. I tell her about the skin, the brain and how I have no way of knowing where her tender spots are. Although I would like her to be able to zone out, I need her to help me so that I don't hurt her. I spent the next 45 mins doing DNM on her buttocks and back - each time, gently touching spots until she let me know that it was another tender one. Skin stretch for up 3-5 mins at each spot. Everytime, it got warm, some slight reddening, and the skin softened and could glide over the area quite nicely. At the end of the session, I tell her that I have no way of knowing if what I did helped and that instead of booking another appt right away, I would suggest that she wait a few days and see if it was something that felt was beneficial. She got dressed and when I came back into the room, she said, "It hurts so much worse." She had tears in her eyes and I don't think they were from pain. I think I touched something emotional.

My hunch is that she wanted me to do what others have done in the past - touch her anyway - even if it hurt and she was wincing. I don't think anyone has asked her where she needed to be touched and if each spot was tender. At no point during DNM did she experience pain. She actually remarked that she couldn't believe that I could touch her buttocks without it hurting.

I have never felt so ineffective or so tired after working with someone. I got a bad bad headache that is only now starting to ease (5 hours later).

I doubt she's coming back, but any advice on how I might have handled her differently?

[Diane]

It happens sometimes Kim, it's rare but sometimes it happens.
I expect her pathways are pretty screwed up (both the pain pathways and the cognitive ones) if she's had chiro for 8 years... but don't get me started on that..

Seriously, it sounds as though she may have a wind-up type of pain, which is a type of pain pathology (to do with abnormal receptors in the spinal cord) as opposed to just a normal system that is way revved up and has no down regulation because it's not been well-handled. The way to know would be to test her with von frey fibres, that whole thing. If her ordinary afferents are nociceptive, she would classify as an abnormal pain processor or as having neuropathic pain (i.e., she may have "pathological" pain as opposed to "non-pathological" pain).

If you don't "do" von frey fibre testing (and I don't), the other way to pick out these people is to listen to them closely: if they mention anything like, "..I always feel way worse after any kind of treatment. In fact, every time I've ever even scraped myself somehow, I have pain in that place for years after" ... do NOT use any kind of manual treatment. Do only pain education, refer on if necessary to a pain clinic.

It's much better if they bring this up themselves, volunteer the information. People are so suggestible that you would want to be very very careful how you ask them about something like this. You want to ask open questions, non-specific, like, "Tell me a bit about what kind of treatment(s) you've had in the past." Then wait for them to tell you. You could ask, "How did your pain system respond to that?", or, "How did you usually feel after treatment of that kind?", or, "Do you remember feeling better after a session of x therapy? Worse? the same?"

DNM (and every other sort of manual therapy under the sun) works best, of course, on the ordinary, persistent, non-pathological type of pain.

People who have windup pain do not do well with any sort of manual treatment, pretty much... perhaps she's a candidate for a pain clinic.

[EricM]

Yes she sounds very much like some of the patients I see in the pain clinic. Interestingly, I often find that sustained, heavier, compressive forces with the palm of my hand directly over something like the GHJ or the greater trochanter, or, perpendicular to the quads is enjoyed much more by these people than light, gentle touch. Unfortunately, the experience is all too often fleeting, so like Diane suggests, best not to bother going there at all. Teach them about movement, and how it can help the non-pathological pains; introduce ideomotion.

On the other hand, there is a slim chance that your patient may tell you that things changed for her, if even for a short time, 2 or 3 days after the treatment. Physiology takes time. If so, future sessions might prove to be more successful.

[Barrett Dorko]

Kim,

Well, it may certainly be too soon to tell, but if this happened to me I'd lose heart.

Perhaps a better way of putting that would be to say something to you only a chosen few have heard from me here. Ironically, it has become an unofficial welcome to the site as a thoughtful contributor and fellow clinician with a real passion for the work.

It is this:

You're a dead man.

No need to thank me.

[pht3k]

yes it happens sometimes.

i remember a patient shouting as she were about to die, because she stepped back and her back touched (smoothly) the wall behind her. saw her once.

looked for those von frey fibers and found this article:
Quantifying Allodynia in Patients Suffering From Unilateral Neuropathic Pain Using Von Frey Monofilaments (http://www.somasimple.com/forums/showthread.php?p=45944#post45944)

[pht3k]

On the other hand, there is a slim chance that your patient may tell you that things changed for her, if even for a short time, 2 or 3 days after the treatment. Physiology takes time. If so, future sessions might prove to be more successful.

i agree

[Diane]

Thanks for posting that paper, pht3k.

Ideomotor movement would likely be fine (as she would be moving herself), and doesn't involve much stimulation of skin.

Kim, I don't think you are a "dead man" - maybe a dead woman, and only with that one particular patient.

DNM will likely work just fine with the next thousand you treat. :)

[BB]

Hi Kim,

One thing I learned after a couple of these experiences is to be careful not to do too much during the initial introduction of 2 people's nervous systems.

If I've been given any reason to think that a latent reaction tends to occur in this person, or that they might occur in this person, I select a few spots, usually far away from each other, and that's enough to start.

I've never encountered this phenomenon when I stick to this approach.

Also, if I've started someone on DNM and they respond in a way that I'm not sure I like, I go straight into simple contact.

[Jon Newman]

Hi Kim

I don't know what


I spent 15 minutes before the treatment talking/listening and getting an idea of what I might do to help.

entails but you may consider starting with five questions (http://www.somasimple.com/forums/showthread.php?t=2404)

[Kim LeMoon]

Very helpful advice from all of you. I spent the last few hours reading all of the links before I responded.

pht3k - thanks for linking the article about Van Frey monofilaments - I didn't know much about these. Interesting.

Diane - in reading your description of how windup pain shows up, I don't think she has pathological pain. I shook her hand on arrival and her grip was firm and sure and she didn't wince. She seemed to respond well to DNM while it was happening - sighs, warmth, gentle voice, deeper slower breathing. The tender spots were all less tender, some not tender at all after DNM.

Cory - yes, I thought that maybe I had done too much in one session. And I wished that I already has SC training, because I probably would have started there to begin with. Her body let me know from the start that it didn't want to be manipulated.

Eric - I'm hoping for that slim chance too that she'll feel better in time. I even told her that her initial increase in pain was not predictive of how she'd feel over the next few days. Wait and see.

Jon - the five questions thread was really helpful. These weren't the questions that I asked directly, but I see that my intentions were there. I mainly wanted to establish some trust, some connection, demonstrate concern with my listening, and listen for cues that might help me to know how I might work with her. This type of intake is one that I reserve when I perceive that someone is scared.

That five ?? thread spoiled some surprises I may have gotten in Barrett's workshop. Don't matter, I'm a dead-woman anyway.;)

Barrett - if I sit quietly during your workshop at times, not answering your questions, please don't think that I am not interested. I just might be letting the others experience surprise.

After a few hours of sleep and plenty of reading here, I wonder if her increase in pain was due to cognitive dissonance. I certainly said and did things which ran contrary to what others have said and done. I invited her to be in charge of the session, asking her where she'd like me to touch next. The chiro and the 2 massage therapists she's worked with in the past are very directive. I invited her to report all sensation as I worked, and told her that I was committed to not touching her in ways that increased her pain. I invited her to be comfortable, warm, quiet, but present. I needed her help, as there were no obvious palpatory clues of where to work (if there ever are??).

Her body was curious to me. It felt like tight skin over no muscle, only a soft pillowy pannicular fascia and bones. I don't think she's moved much in the last 15 years. Probably too scared to.

[ian s]

Kim -- this is my strictly non 'scientific' answer . You saw this person as someone who was suffering not a gravy train or business proposition . Unless a patient wants long term therapy as a social support mechanism -treating someone with 'fibromyalgia' or an up regulated n/system for years is unethical (that's my opinion) . A health professional should aim for independence anything else is encouraging learnt helplessness which happens frequently.
Your own reaction may be a clue. I communicated with the author of his book an Osteopath who is now a Psychotherapist .
http://books.google.com/books?hl=en&id=LAuAWV2FAZ4C&dq=the+embodied+psychotherapist&printsec=frontcover&source=web&ots=P79ohcRryx&sig=KLFUPKGrn8vKirhE6Je5TE384lI
if link doesn't work search Robert Shaw Embodied Psychotherapist.
With someone like this I would use ''Explain Pain' and shft to pain management. In my remit in the pain clinic i prefer to look at 'energy' of the person ie sleep patterns /energy levels/ breathing pattern recognition / postural awarness hinting at mood and withdrawl with this population . I use simple massage in conjunction with tai chi exercises to encorage self management. If the issues are deeper and point to strong psych/social factors i still use explain pain and acknowledge 'suffering' but define my boundries of practice .
I am not convinced that a 'scientific' neurophysiological explanation is sufficient in these cases but that is my opinion . I am reading this
http://www.bmj.com/cgi/content/full/331/7512/357 which in the latter part is a revelation and makes me think a great deal.
Ian

[nari]

Kim,

I have only just now had time to consider your original post.

I concur completely with Ian's response. Imagine how she would feel, after attending a clinician for so long and yet continues to have a major problem (or two or three). She has learned to attend for social reasons, which clearly would make her feel better because 'it helps'...but I know you would have realised that. I'm just reinforcing...

She needs to recognise her learned helplessness and trust you; but she may not want to do that, and may not know how. Education is the key, and that is no mean feat to try and achieve with someone like this poor woman. I am quite familiar with her presentation as you have described her; she is the "heartsink" patient that doctors mention, and some have no doubt conveyed, unwittingly or not, that emotion to her. Also other health professionals. She may behave quite differently when not being observed by a clinician; or maybe not.

I think there is a lot we can offer; but it's almost all verbal. The five questions could be enlightening to both of you.

She is one of those patients who needs therapy, but not physical - not yet. See how you go with her, if she stays with you. Do you have access to a psychologist, if you feel she needs specialised therapy?

By the way, I worked in a pain clinic for about 2 years, and believe it or not, I liked seeing patients like yours. Challenging work for the brains of both patient and therapist.

Hope she returns to you.

Nari

[Kim LeMoon]

You're right Ian, my body's reaction and my frustration are both telling. I don't understand how empathy works, but that book you pointed to may help me learn.

And I'm in agreement that it's unethical to treat an up-regulated NS for years. All my other FM clients continue to come for social support. I listen, we laugh, and I focus very little on trying to relieve their physical pain. It happens sometimes anyway.

I did a little bit of pain education in the session. This is a new kind of dialogue for me, so I kept it simple. We'll see if she received the information at all.

The last link you posted makes Internet Explorer crash. I'm curious about what you pointed to. Any other way I can access the information?

[ian s]

hi kim--google 'understanding depression / iona heath /bmj .
Iona Heath reviewed this book (she is an inner city GP in London and writes brilliantly about many issues which are common in our culture.
Here is an abstract -------
Dowrick explores the many and diverse ways in which human culture and language have responded to the experience of suffering and distress and, in this context, finds the modern concept of depression to be stultifying in the narrowness of its vision and disabling in its allocation of a passive sick role to the sufferer. Set alongside this persuasive analysis is the knowledge that depression operates to the advantage of many powerful interests: pharmaceutical companies have made huge profits from the manufacture and promotion of antidepressant medication with an ever wider range of indications; mental health professionals and academics have built careers on creating and analysing an evermore complex classification of depression; general practitioners have sought refuge in the label as a means of controlling uncertainty in the consulting room and diverting attention from the causes, nature, and extent of human suffering; and politicians have found that depression is a convenient packaging of society's ills, which might otherwise require more fundamental solutions and a more equal allocation of hope and opportunity. I suspect that there are few general practitioners who have not prescribed antidepressant medication when what is needed is a home that is not overcrowded, damp, and squalid.

In an increasingly medicalised world obsessed with disease taxonomies, depression has become a procrustean label that fails to acknowledge the diversity of individual experience and further disables the labelled. In A Fortunate Man, John Berger asked, "What can the word `depressed' mean to the depressed? It is no more than an echo of the patient's own voice."

Dowrick proposes systematic avoidance of the label and argues that this opens up many more opportunities for restitution. He prefers to agree with his patient that "something bad has happened" and, in so doing, to normalise distressing experience and oppose the increasingly pervasive expectation of a continuous state of happiness and contentment. With less diagnosis and more understanding, fewer prescriptions and more listening, it may be possible to locate renewed meaning within the patient's life story and so find a way forward.

Info on emotion and mirrors here.......
http://news.softpedia.com/news/How-Do-Mirror-Neurons-Work-39171.shtml

ian

[Kim LeMoon]

Nari,

Your words always convey such gentleness and wisdom. I aspire to both.

It's comforting to know that you recognize this woman as a familiar type and that you've found ways to help this sort. I have a vast network of psychotherapists to refer her to. In my little town, names of pschotherapists fill 3 pages of our 5 page chamber of commerce listing. I share a waiting room with 2 and there are dozens more that are my clients. Finding the right one won't be hard. Getting her to go might be.

I hope she comes back too. In the past, anytime I was on a learning edge, people showed up who would give me the perfect opportunity to learn more. She has already done so.

[Jon Newman]

Hi Kim,

The last link you posted makes Internet Explorer crash. I'm curious about what you pointed to. Any other way I can access the information?Consider getting a browser other than IE explorer. Firefox (http://www.mozilla.com/en-US/firefox/), for example, is very popular but there may be others. You cold also send an error report to the folks at IE explorer.

Hi Ian,

I am not convinced that a 'scientific' neurophysiological explanation is sufficient in these cases but that is my opinion.

Do you mean that using such an explanation for the patient is insufficient or that such an explanation doesn't exist in the first place?

[Jon Newman]

Hi Ian,

Quote:
I am not convinced that a 'scientific' neurophysiological explanation is sufficient in these cases but that is my opinion.
Do you mean that using such an explanation for the patient is insufficient or that such an explanation doesn't exist in the first place?I suppose this is not an either or question. My opinion (since I hadn't already offered it) is that they are both insufficient. Scientists nor philosophers have nailed the pain problem (well maybe the problem but not the solution) and even if they did, neither of their explanations would likely suffice in the clinic.

[Diane]

"It hurts so much worse." She had tears in her eyes and I don't think they were from pain. I think I touched something emotional.

My hunch is that she wanted me to do what others have done in the past - touch her anyway - even if it hurt and she was wincing. I don't think anyone has asked her where she needed to be touched and if each spot was tender. At no point during DNM did she experience pain. She actually remarked that she couldn't believe that I could touch her buttocks without it hurting.

If she does not have neuropathic pain, then it seems like you may have put her more in "touch" with herself. I had a study subject who responded a bit like this - she had had "sciatica" for 20 years and kept on in spite of it. Her remark was, "I think I might have screwed up your data a bit.. I didn't realize how much pain I actually had been living with until it started to leave - you know, I just blocked it off. So all the pre-treatment data is measuring the walled-off pain. So it's going to look like I have more during the treatment phase. But I don't - there is actually less of it, but I can feel it so much more clearly." (I told her not to worry, that the researchers would figure it all out and the graphs would look like whatever they'd look like in the end.)

This probably pertains to Jon's comment as well. The state of pain research might not be perfect yet, but it's a lot further ahead from where/what it used to be.

[Luckbox]

What an interesting case. I'd like to know more. Bear with me as I think-out-loud.

Has she had the IBS/GERD for 15 years as well or are those more recent? All the time, or intermittent?
How old is she?
Her LBP that you described as more of a 'buttock'
type of pain. How is her gait? DTR's hypo/hyerreflexive? Babinski's? SLR's? Minor's Sign?
Is the LBP she was seeing the DC for? Prior to three weeks ago, has she had similar?

The neuropathy, is it ascending/worsening? Does she describe anything similar in the hands?

Does she complain of any visual disturbances? Diplopia? From an oculomotor standpoint, did you notice anything?

Does she seem aversive to bright light? Did you happen to check her pupillary responses, if so were they sluggish
or fast? Did they hold or did they fail? It would intersting to see what her corneal reflexes are like.

Is she steady in Romberg's? Do you perform a cerebellar exam? If so, what did you see?
Has she had any imaging? MR, CT, plain film?

I would like to check her for any hemisphericity.

Very interesting, and thank you for posting.
I realize this is a lot of information and I would not expect you to be able to answer most of it
after one patient encounter but would like to hear your reply.
This is my second attempt at posting, guess I timed out last time, hope it works.

[Jon Newman]

Hello Luckbox,

Welcome and consider starting a thread introducing yourself in the Welcome forum. (http://www.somasimple.com/forums/forumdisplay.php?f=126)

If you encounter the timing out problem again, don't worry, you didn't lose your post. Simply log back again as prompted and your post should appear.

[ian s]

jon --
you are right --philosophy nor science has nailed it . Quinter to my mind has it more right with his idea of an aporia and the info on his site seem to be balanced......I like the title to Creative pain ......
http://www.creativepain.com.au/
To move out of pain takes creativity when distress/ emotion merge and are inseperable .
Looking at altered HPA/SAM , central mechanisms etc etc are 'correct' at one level but how do you measure things like hope , motivation , meaning and other things that can never be reduced to activity in a pet scanner . However, that is my take since i am reading more about meaning responses and the philosophy of agnositicism than pathophysiology http://www.markvernon.com/meaning/ for an essay on placebo ( not that the brain processes and physiology e.g Galezzi's work to explain placebo is not interesting but there are other things that are too)
ian

[Jason Silvernail]

Hello Luckbox, welcome.

You've got a lot of questions, to make sense of where you going, perhaps talking through what you're considering regarding differential diagnosis would help?

[Luke Rickards]

Hello Luckbox,

Most of the extra information you have requested suggests that you are concerned about more serious pathologies of the CNS. Could you expand on why this is your first thought when someone presents with a 15 year history of FM and a recent onset LBP? I realise that she describes a numbness in both feet, but this sensation does not equal neuropathy. Are you worried about B12 deficiency from the GERD and IBS?

Also, I'm curious about your interest in her 'hemisphericity'. How would you measure this? Is this measure valid and reliable? What is the relevance, and how would it inform your treatment?

Thanks.

[Kim LeMoon]

Hi Luckbox,

Welcome to Soma Simple. I invite you to keep posting here, you seem to know about things that I don't and potential for learning is what I am here for. I'm happy to try and answer your questions if I can. Thanks for taking an interest in my interesting client :rolleyes:

Has she had the IBS/GERD for 15 years as well or are those more recent? All the time, or intermittent?
IBS is more recent - less than 5 yrs and it's intermittent.
How old is she? mid 50s
Her LBP that you described as more of a 'buttock' type of painShe called it LBP, but I always ask them to show me with their hand where it hurts. Her pain is mostly mid-cheek, not at any of the bony landmarksHow is her gait? DTR's hypo/hyerreflexive? Babinski's? SLR's? Minor's Sign? Gait is not something I worry too much about. She walked pretty normally. I don't check the other signs. I am not a diagnostician, though frequently I arrive at a correct diagnosis based on pattern recognition.
Is the LBP she was seeing the DC for? Prior to three weeks ago, has she had similar? Yup, DC for LBP and she's had episodes of this since the FM dx.
The neuropathy, is it ascending/worsening?No it's a numbness in her feet, constant but not painful Does she describe anything similar in the hands?No, her hands seem to be asymptomatic. She had a good handshake and her hands were the only place in her body that seemed to have any muscle.
Does she complain of any visual disturbances? Diplopia? From an oculomotor standpoint, did you notice anything?Nothing obvious, she wears glasses, but didn't mention any visual disturbances.
Does she seem aversive to bright light? Did you happen to check her pupillary responses, if so were they sluggish
or fast? Did they hold or did they fail? It would intersting to see what her corneal reflexes are like. My office is not brightly lit, so I have no way of knowing if bright light bothers her.
Is she steady in Romberg's? Do you perform a cerebellar exam? If so, what did you see? Has she had any imaging? MR, CT, plain film? MRI of lumbar spine - negative findings. Nerve conductivity tests (and other tests she couldn't remember names of) for the neuropathy - conclusion: ideopathic. I don't know about Romberg's or how to do a cerebellar exam.

Thanks again for your interest. Like Luke, I'm curious what you are looking for with these questions.

[Luckbox]

Thanks for the input Kim.

I'll try and explain my reasoning to you and other posters kind enough to chime in.

The length and lack of progession of her symptomatology suggest something physiologic rather than ablative.

That being said, MS did come to mind briefly.

The more I read, the more I began to focus on the mesencephalon, hence my interest in the pupillary responses and corneal reflexes.

You also mentioned that she likes to 'zone out', a fact I missed
during my first read, this to me has mesencephalic implications.

Also, let's not forget the periaqueductal gray and her pain syndomes.

Hemisphericity, I'd map the physiological blind spots. However, I'm not thinking cortical here but more information would be helpful.

It would be interesting to perform a detailed exam regarding eye movements and pursuits.

Testing for optokinetic nystagmus would be on my list as well.

Basically, she may be suffering from too much stimulation, of the mesencephalon in particular, and in need of therapy that will inhibit rather than excite an already 'wound-up' system.

I hope you get to see her again.

If she develops anymore neuropathy or exhibits and visual/oculomotor abnormalities I'd be pushing for MR brain. The proverbial 'zebra'.

[Luke Rickards]

The more I read, the more I began to focus on the mesencephalonIf I recall, the mesencephalon is involved in vision, eye movement, hearing and body co-ordination. Besides "zoning out", what other things about Kim's original description made you focus more and more on the mesencephalon? And what do you think it could mean? Are you worried about a tumor, or something?

How does mapping blind spots indicate hemisphericity? Couldn't this lead to false positives if there is a primary optic or visual problem?

[ian s]

http://home.uchicago.edu/~decety/publications/Jackson_Pain06.pdf

kim -hope this paper is of use to you . Having a clear out and i 'found' it --I thought it was really good and practically and clinically relevant.

Don't worry too much about CNS testing .
It is nice to understand 'why' you are doing things however . I would understand simple tests (which may allude to serious pathology) such as Rombergs , reflex testing and Babinski . Clinically ,out of a ratio of 1-10 somatisation/depression /chronic stress , fear avoidance and plain deconditioning makes up about 9.5 the other .5 is what a Dr needs to worry about. However, I pick up things occasionally such as ataxia due to the simple failure to look at people as the consultation invariably is done sitting and often patients don't get physically examined very well.
Let me know what you think of the paper .
ian

[BB]

I don't understand how empathy works, but that book you pointed to may help me learn. -kim

Nice paper, Ian. Also, there is an article on empathy in the current scientific american mind (http://www.sciam.com/sciammind/) magazine, along with a nice article on phantom limb pain and amputee envy (phantoms apparent opposite).

[Kim LeMoon]

Let me know what you think of the paper.

Great information in that paper, Ian! Even without understanding some of the most technical aspects, I was able to make much better sense of how pain empathy works. I would be curious to learn how much the capacity for empathy differs between people. I seem to be more perceptive than most when it comes to identifying the emotional and physical states of those around me.

[Diane]

Here is something (quite old by now) on mirror neurons (http://www.pbs.org/wgbh/nova/sciencenow/3204/01.html). If you do a search here, for mirror neurons, you'll find around a hundred threads to do with the topic. Matthias (who originally linked that nova site here) has an entire series on mirror neurons/mirror therapy on his blog. You can find the series linked on the right, here (http://neurotonics.blogspot.com/).

[ian s]

kim --glad you liked it ......
http://scienceblogs.com/cortex/

go here -half way down --men women and empathy --interesting stuff. I agree people differ and i think there is a sex difference too (see above) . I work with people in a c pain clinic and my work colleague is amazing as her empathy batteries never seem to flatten. I admit that mine do as these cases are hard or the social situations are often impossible! This is why in my opinion clinicians harden and become technicians . Maybe its not conscious or just plain self - preservation but many c pain patients get 'treated' as body parts or conveyor belt acupuncture is the 'holistic' option in the hospital.Engagment is difficult but ultimately it is the only way i can practice that may provide 'results' -however you have to look after yourself too!
ian

[BB]

Just read something by Harriet Hall on Blind Spot Mapping and remembered this thread.

I'd map the physiological blind spots.

You may want to read this (http://www.chirobase.org/06DD/blindspot.html) first.

[Luke Rickards]

Thanks Cory. I knew something was fishy about that. What a croc.

[Jono]

Hi all.

My first boss used to have an expression which might apply to some of these patients "You can help every body but you can't help every person"

Sometimes there's more going on with a patient than we can help with.

Jono

[Luckbox]

Thanks Cory. I knew something was fishy about that. What a croc.


I understand your unfamiliarity with blind spots, but I cannot understand your reflexive attitude that it's 'fishy' and a 'croc'.

If you wish, you can read Dr. Carrick's response to Harriet Hall.

http://www.blindspotmapping.com/page/page/3823275.htm

I'm not yet conversant with many of the ways in which topics are discussed, ie. mesodermalism, ectodermal derivates, and mesodermalists using orthodigms.

Not having this familiarity does not cause me to instantly recoil and label it 'pseudoscience', 'bunk', 'fishy', or a 'croc'. It generates my interest and pursuit of knowledge therein.

I think we're all trying to summit the same mountain, we're just taking different paths.

[Diane]

Hi Jono, Hi all.

My first boss used to have an expression which might apply to some of these patients "You can help every body but you can't help every person"

Sometimes there's more going on with a patient than we can help with.

Jono
It looks as though you are new to SomaSimple - welcome. :)
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[bernard]

Now let us address the million dollar prize from the James Randi Educational Foundation. James Randi has an international reputation as a magician and escape artist, He is very entertaining, and I have seen him and enjoyed his performance. His Foundation offers a one-million-dollar prize to anyone who can show, under proper observing conditions, evidence of any paranormal, supernatural, or occult power or event. I do not consider my work in the field of brain function to be associated with the paranormal, supernatural or occult powers. In fact, I take exception at any suggestion that it could be related. I looked at the Amazing Randi’s Foundation site. I am not interested in attending that party. I forwarded his “invitation” to the legal council of the American Chiropractic Association. It was perhaps the most insulting thing that I have ever read and I do not desire to do anything with this man or his foundation.

Hmm, Luckbox, I do not understand this refusal. Dr Carrick has a chance to smash down Dr Harriet Hall and he denies. Such a vigorous denial may emphasize the Dr Hall position. That's weird.

[Luckbox]

Hmm, Luckbox, I do not understand this refusal. Dr Carrick has a chance to smash down Dr Harriet Hall and he denies. Such a vigorous denial may emphasize the Dr Hall position. That's weird.


Bernard,

I don't know how Dr. Carrick can be more explicit.

"His (James Randi) Foundation offers a one-million-dollar prize to anyone who can show, under proper observing conditions, evidence of any paranormal, supernatural, or occult power or event. I do not consider my work in the field of brain function to be associated with the paranormal, supernatural or occult powers. In fact, I take exception at any suggestion that it could be related."

Despite this, you find it 'weird' that he doesn't accept?

Had the offer been extended to Vilayanur Ramachandran to show how the use of a simple mirror can resolve phantom limb pain, would you expect him to Dr. Ramachandran to oblige Mr. Randi?

[bernard]

Had the offer been extended to Vilayanur Ramachandran to show how the use of a simple mirror can resolve phantom limb pain, would you expect him to Dr. Ramachandran to oblige Mr. Randi?
Sorry Luckbox but fMRI made it.
That's not the case with Dr Carrick.

[Luckbox]

Bernard,

I'm now under the realization that there is no additional
information I can provide, your mind is made up.
I find this disconcerting and quite honestly a little
perplexing, the blanket dismissal of someones work.

Regarding fMRI. Please don't put all your eggs in that basket.
It's certainly a valuable tool but I would not hang my hat on it.
I certainly would not say it 'makes' anything.

fMRI is not to neuorscience what the telescope
is to astronomy. Other authors are much harsher than I,
calling fMRI 'The New Phrenology'.

I'm going to provide a link to a recent Dr. Carrick interview.
Should you wish, you can learn a little more about him,
his area of expertise, and some of his past and current work.
The blind spot mapping study is just a small fragment
of his prior work.
http://www.theamericanchiropractor.com/articledetail.asp?articleid=881&category=8

[bernard]

Other authors are much harsher than I, calling fMRI 'The New Phrenology'.
I didn't read, yet, such a comment about fMRI but I could be wrong.
BTW, that's a nice escape. It doesn't respond anyway to the question: we aren't questioning fMRI validity but some obscure reasons Dr Carrick isn't searching a definite proof of his claims.