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depression A Day In Kennedy's Life

depression A Day In Kennedy's Life

InTech uses cookies to offer you the best online experience. By continuing to use our site, you agree to our Privacy Policy. Chemistry Computer and Information Science Earth and Planetary Sciences Engineering Materials Science Mathematics Nanotechnology and Nanomaterials Physics Robotics Technology Agricultural and Biological Sciences Biochemistry, Genetics and Molecular Biology Environmental Sciences Immunology and Microbiology Neuroscience Medicine Pharmacology, Toxicology and Pharmaceutical Science Veterinary Medicine and Science Business, Management and EconomicsPsychologySocial Sciences Forgot password? Medicine » Gastroenterology » "Screening for Colorectal Cancer with Colonoscopy", book edited by Rajunor Ettarh, ISBN 978-953-51-2225-8, Published: December 2, 2015 under CC BY 3.0 license. © The Author(s). By Parth J. Parekh and Sanjay K. Sikka DOI: 10.5772/61256 [1] Department of Internal Medicine, Division of Gastroenterology and Hepatology, Tulane University, New Orleans, LA, USAThe advent of retrograde colonoscopy in June 1969 revolutionized the field of gastroenterology [1]. It has since evolved to become the gold standard for colorectal imaging [2, 3].As technology continues to advance, so too does the diagnostic utility and therapeutic capabilities of colonoscopy. Thus, it becomes imperative for the clinical endoscopist to perform a thorough colonoscopic evaluation and be cognizant of normal and pathologic findings as indications for colonoscopy expand. Here, we detail normal and pathologic endoscopic findings in a variety of disease states that are often encountered by the clinical endoscopist including colon polyps, inflammatory bowel disease (IBD), and infectious and non-infectious colitides. In addition, we review the diagnostic and therapeutic role of colonoscopy in the evaluation of an acute lower gastrointestinal bleed.Colorectal cancer is the third most common cancer among men and women, and the third leading cause of cancer-related death in the United States [4]. It is estimated that in 2014, 71,830 men and 65,000 women were diagnosed with colorectal cancer with approximately 50,000 mortalities (26,270 men and 24,040 women) as a result of the disease. Globally, colorectal cancer is the fourth leading cause of cancer-related death accounting for approximately 700,000 deaths in 2012 [5]. The vast majority of colorectal cancers stem from benign polyps arising from the mucosal layer. Winawer et al. were among the first to demonstrate that colorectal adenomas have the potential to progress to colorectal adenocarcinoma, thus stressing the importance of colonoscopic polypectomy in colorectal cancer prevention [6]. Subsequent long term data has validated the importance of colonoscopy and colonoscopic polypectomy in the prevention of colorectal cancer-related deaths [7]. To date, colonoscopy remains the cornerstone in colorectal cancer prevention. Unfortunately, the “miss rate” of colonoscopy for colorectal cancer and adenomas larger than 1 cm has been reported to be as high as 6% [8] and 17% [9, 10], respectively.Adenomas and hamartomatous polyps, later discussed in depth, are polyps that carry malignant potential. They are indolent in nature, typically growing slowly over the span of a decade or more. There is a direct correlation between the size of the adenoma and its risk of developing future advanced adenomas or carcinoma with studies demonstrating this risk to be as high as 7.7% [11], 15.9% [11], and 19.3% [12], for adenomas <5mm, 5–20mm, and >20mm, respectively.Chromosomal instability and common point mutations occurring in colorectal cancer-related tumor suppressor genes (e.g., APC, P53) or tumor promoter genes (e.g., K-Ras) architect the progression from benign polyps to colorectal cancer. Figure 1 depicts key point mutations and its impact on morphologic changes of a benign polyp to colorectal cancer. There is, however, considerable genetic and epigenetic heterogeneity resulting in different pathways to tumorigenesis [13]. Luo et al. sought to evaluate the effect of these alterations on the progression to colorectal cancer by conducting genome-wide array-based studies and comprehensive data ysis of aberrantly methylated loci in normal colon tissue (n=41), colon adenomas (n=42), and colorectal cancer (n=64) [14]. They identified three classes of cancers and two classes of adenomas, high-frequency methylation and low-frequency methylation based on their DNA methylation patterns. Mutant K-Ras was found in a subset of high-frequency methylated adenomas. In addition, they found the methylation signatures of high-frequency methylation adenomas to be similar to those of cancer with low or intermediate levels of methylation, and low-frequency methylation adenomas to have methylation signatures similar to that of normal colon tissue. These findings demonstrated genome-wide alterations in DNA methylation to occur during the early stages of progression of adenomas to colorectal cancer, and the presence of heterogeneity in tumorigenesis, even at the adenoma step of the process.Key point mutations and its impact on morphologic changes of a benign polyp to colorectal cancer.In 2003, the Paris Endoscopic Classification arose to describe polyp morphology [15], which can potentially guide the endoscopist toward its malignancy potential [16–18]. Figure 2 provides a schematic overview of the Paris Endoscopic Classification and Figure 3 provides an endoscopic view of differing polyp morphology under traditional white-light colonoscopy. A recent study by van Doom et al. evaluated the interobserver agreement for the Paris Endoscopic Classification among seven expert endoscopists [19]. The seven expert endoscopists assessed 85 endoscopic video clips depicting polyps. Afterwards, they underwent a digital training module and then assessed the same 85 polyps again. A calculated Fleiss kappa of 0.42 and a mean pairwise agreement of 67% suggested moderate interobserver agreement among the seven experts. In addition, the proportion of lesions labeled as “flat” lesions ranged between 13–40% (p<0.001). The interobserver agreement did not change significantly after the digital training module, which led the investigators to conclude there to be only moderate interobserver agreement among experts for this classification system and that use of this classification system in daily practice is questionable and unsuitable for comparative endoscopist research. Thus, the need for a simplified classification system is necessary to better aid the clinical endoscopist.The Paris Classification based on polyp appearance.Endoscopic views of differing polyp morphology under traditional white-light colonoscopy: (A) Pedunculated polyp, (B) Sessile polyp, (C) Flat polyp.In addition to traditional white-light colonoscopy, several studies have demonstrated the utility of narrow-band-imaging (NBI) to be useful in adenoma detection [20–23]. Under NBI, adenomas appear to have thicker and higher volumes of microvasculature compared to normal mucosa and hyperplastic polyps, resulting in distinct pit patterns that may increase diagnostic yield [23]. This section will review the morphology and histology, malignant potential, and provide endoscopic and pathologic depictions of different polyp subtypes.Adenomatous polyps by definition are dysplastic and thus carry malignant potential. They can further be characterized as being an advanced adenoma, synchronous adenoma, or metachronous adenoma. An advanced adenoma is defined as an adenoma with high-grade dysplasia, an adenoma with a size >10 mm, an adenoma with significant villous components (>25%), or an adenoma with evidence of invasive carcinoma [24]. Synchronous adenomas are polyps that are diagnosed at the same time as an index colorectal cancer and metachranous adenomas are ones diagnosed at least six months before or after the diagnosis of an index colorectal cancer [25]. The diagnosis of synchronous and metachranous adenomas are of utmost importance as it can potentially identify individuals at risk for hereditary conditions, thus impacting therapeutic intervention and screening intervals for relatives [26].Adenomas are characterized as tubular, villous, or tubulovillous (a mixture of the two) based on their glandular architecture. Tubular adenomas, which account for the vast majority of colon adenomas, are characterized by a network of branching adenomatous epithelium and a tubular component of >75% [16]. Figure 4 depicts a histologic representation of a tubular adenoma in the background of normal colon tissue. Villous adenomas, which account for up to 15% of adenomas, are characterized by long glands that extend straight down to the center of the polyp from its surface with a villous component of >75% [16]. Figure 5 depicts a histologic representation of a villous adenoma in the background of normal colon tissue. Lastly, tubulovillous adenomas, which account for up to 15% of adenomas, are a mixture of the two previous adenomas with a villous component of anywhere from 26–75%. Figure 6 depicts a histologic representation of a tubulovillous adenoma in the background of normal colon tissue.Histologic representation of tubular adenoma in the background of normal colon tissue.Histologic representation of villous adenoma in the background of normal colon tissue.Histologic representation of a tubulovillous adenoma in the background of normal colon tissue.The CpG island methylator phenotype (CIMP) pathway is composed of methylated promoter regions of multiple putative tumor suppressor genes occurring in colorectal cancer and also in adenomatous polyps [27]. Kakar et al. examined villous/tubulovillous adenomas (n=32) and tubular adenomas (n=30) for BRAF/K-Ras mutations and CIMP-status (characterized by methylation of three or more loci at hMLH1, p16, HIC1, RASSF2, MGMT, MINT1, and MINT31) [28]. They found 44% of villous/tubulovillous to be CIMP-positive compared with 27% of tubular adenomas (p=0.08). In addition, villous/tubulovillous adenomas demonstrated significantly higher methylation rates at MGMT (87% vs. 37%; p<0.01) and RASSF2 (94% vs. 70%; p=0.02) when compared to tubular adenomas. Lastly, CIMP-positive adenomas correlated with increased size, right-sided location, and increased villous component in villous/tubulovillous adenomas. This led the authors to conclude that CIMP status is indicative of size, location, and malignant potential, and that methylation of MGMT and RASSF2 increases as adenomas progress from tubular adenomas to villous/tubulovillous adenomas.Serrated lesions account for approximately 30% of colorectal cancers, arising via the serrated neoplasia pathway characterized by widespread DNA methylation and BRAF mutations [29]. They are classified histologically as sessile serrated adenomas/polyps (SSA/Ps), traditional serrated adenomas (TSAs), or hyperplastic polyps, with only SSA/Ps and TSAs carrying malignant potential [30]. SSA/Ps typically lack classic dysplasia, however, those that demonstrate foci of classic histologic dysplasia and molecular profiles exhibiting methylation of DNA repair genes (e.g., MLH-1) are thought to be precursor lesions to sporadic unstable microsatellite (MSI-H) cancers. SSA/Ps also exhibit activation of the BRAF oncogene, a feature seen in many sporadic MSI-H cancers [31]. Figure 7 depicts two potential molecular pathways of serrated neoplasia.Potential molecular pathways of serrated neoplasia.SSA/Ps tend to be more prominent in the proximal colon [32] as compared with TSAs [33] and hyperplastic polyps [34], which tend to be more prominent in the rectosigmoid. Thus, expert recommendations are to completely remove all serrated lesions proximal to the sigmoid colon and all serrated lesions in the rectosigmoid >5mm [30]. They may be more difficult to detect than conventional adenomatous polyps, in particular SSA/Ps, since they are more likely to be flat lesions, and so recent studies have advocated for a longer withdrawal time to increase serrated lesion detection rates [35, 36].Serrated lesions have a distinct endoscopic appearance albeit often very subtle. A retrospective ysis of high-resolution endoscopic video clips by Tadepalli et al. yzed the gross morphologic characteristics of 158 SSPs [37]. They found the most prevalent visual descriptors to be the presence of a mucous cap (which may be yellow or green in white light and red under NBI) (63.9%), rim of debris or bubbles (51.9%), alteration of the contour of a fold (37.3%), and interruption of underlying vascular pattern (32%). Figure 8 depicts an SSP under traditional white-light colonoscopy with a superficial mucous cap, its appearance under NBI, and a histologic representation.A) Sessile serrated polyp with mucosal cap under white-light colonoscopy. (B) Sessile serrated polyp under NBI. (C) Histology of sessile serrated polyp demonstrating expanded crypt proliferative zone, exaggerated architecture in crypt region with basilar crypt dilation, inverted crypts, and a predominance of crypts with minimal cell maturation.Hyperplastic polyps are the most common non-neoplastic polyps in the colon; however, they are oftentimes grossly indistinguishable from adenomatous polyps. Histologically, hyperplastic polyps resemble normal colonic tissue with the exception of proliferation in the basal portion of the crypt and a characteristic “saw tooth” pattern along the crypt axis [38]. The relationship between diminutive hyperplastic polyps in the left colon and proximal neoplasia has long been a topic of debate with studies producing mixed results [39–42]. Hyperplastic polyps found proximal to the left colon, however, have consistently been shown to carry malignant potential and should be resected [39, 43].Hamartomatous polyps are polyps that may grossly resemble normal colonic tissue but are histologically a mixture of tissues growing in disarray. Histologically, they contain mucous-filled glands, retention cysts, abundant connective tissue, and/or chronic eosinophilic infiltration [44]. Traditionally, they have been classified as non-neoplastic but several associated polyposis syndromes (e.g., Juvenile Polyposis Coli, Peutz-Jegher Syndrome, Cronkhite Canada Syndrome, and Cowden Syndrome) do carry a predilection towards colorectal cancer and other gastrointestinal malignancies.Juvenile polyps are a type of hamartomatous polyp characterized by dilated cystic glands rather than an increased number of epithelial cells [44]. They can be found at any age, but as the name implies, are more commonly diagnosed during childhood. They are typically removed due to their propensity to bleed. Peutz-Jegher polyps are a type of hamartomatous polyp characterized by glandular epithelium supported by smooth muscle cells contiguous with the muscularis mucosa. Figure 9 depicts an endoscopic view of a hamartomatous polyp and histologic view of a Peutz-Jegher polyp.Endoscopic view of a hamartomatous polyp and histologic view of a Peutz-Jegher polyp.Inflammatory polyps, typically seen in IBD, are indicative of regenerative and/or healing phases of mucosal ulceration and possess no malignant potential. They are formed from discrete islands of residual intact colonic mucosa that result from the ulceration and tissue regeration that is inherent to the disease course [45]. Scattered throughout the colitic region of the colon, they are often numerous, filiform, and can be large enough to encompass the lumen resulting in intussusception or luminal obstruction [45, 46]. The clinical endoscopist ought to be cognizant of clusters of localized giant pseudopolyposis as they may be associated with occult dysplasia [47]. Histologically, inflammatory pseudopolyps are characterized by inflamed lamina propria and distorted colonic epithelium [48]. Surface erosions, congestion, hemorrhage and/or crypt abscesses may also be present [48]. Figure 10 depicts an endoscopic and histologic view of an inflammatory pseudopolyp.Endoscopic and histologic view of an inflammatory pseudopolyp.In patients with a clinical presentation suggestive of IBD, colonoscopy with ileoscopy can be used to make the initial diagnosis as it allows for direct visualization and biopsy of rectal, colonic, and terminal ileum mucosa [49]. In addition, it can assess disease activity and monitor therapeutic response, provide surveillance of dysplasia or neoplasia, and lastly provide therapeutic intervention such as stricture dilation [49] or closure of fistulae and anastomotic leakages [50].The use of endoscopic appearance in distinguishing IBD from other non-IBD colitides is limited [51] as there are a number of ‘IBD mimickers’ including but not limited to colonic tuberculosis [52], Behçet's disease [53], and segmental colitis associated with diverticular disease [54]. In addition to tuberculosis, there are hosts of other infectious colitides that can also endoscopically mimic IBD [51, 55]. Table 1 provides an endoscopic description of various infectious colitides. Once these other etiologies have been excluded, colonoscopy can often shed light in distinguishing Crohn’s disease (CD) from ulcerative colitis (UC), which is important for disease management. The data gathered from an index colonoscopy is of utmost importance owning to the fact that once therapy is initiated for IBD, discriminating features of CD from UC may be obscured [56, 57].Endoscopic description of various infectious colitides [54].Endoscopically, classic UC starts in the rectum and progresses proximally, sometimes as far as the ileo-cecal valve, in a circumferential and contiguous fashion with diffused and continuous inflammation [58]. Endoscopic features suggestive of UC include erythema, edema resulting in a loss of the usual vascular patter, granular appearing mucosa, increased friability, and small superficial erosions and ulcers surrounded by diffuse inflammation [59]. These classic visual features are used to endoscopically score the extent of the disease. The Mayo Scoring System was derived in order provide an objective measure describing the endoscopic extent of the disease. Lemmens et al. sought to evaluate the correlation between endoscsopy and histology with use of the Mayo Scoring System [60]. This retrospective study included 236 biopsy sets from 131 patients with known UC. Endoscopy was performed by IBD specialists and graded using the Mayo Scoring System. Biopsy specimens were yzed by expert gastrointestinal pathologists using the Geboes and Riley histologic scoring systems. They found that at both extremes, inactive and severely active disease, there was a very high concordance rate. For mild disease, however, there were important differences, as histologic examination seemed to have detected more severe disease than endoscopically suspected, thus stressing the need for a combined histologic and endoscopic scoring system when assessing disease activity. Figure 11 depicts the classic endoscopic appearance of UC in relation to the Mayo Scoring System.Classic endoscopic appearance of UC in relation to the Mayo Scoring System.Inflammation in CD can span the entire gastrointestinal tract with nearly 55% of cases involving the terminal ileum and colon, 40% involving exclusively the ileum, and 25% involving the colon alone [61]. Rectal involvement occurs in up to 50% of patients with CD [62]. It should be noted that while terminal ileal involvement is strongly suggestive of CD, it might also occur in patients with UC, particularly pan-colitic UC, by way of “backwash” of cecal contents or “backwash ileitis” [63, 64]. The exact pathogenesis of “backwash ileitis” remains poorly understood, however it is believed that in patients with pan-colitic UC, the terminal ileum becomes inflamed stemming from chronic exposure to cecal contents.Endoscopically, classic CD appears as “skip lesions” or areas of inflammation interposed between islands of normal mucosa, “cobblestone” appearance of the mucosal surface due to submucosal inflammation and edema, and deep, longitudinal, polycyclic ulcers [55]. In 2004, the SES-CD was derived in order to provide an objective measure describing the endoscopic extent of the disease [65]. To date, prospective data evaluating the utility of SES-CD in predicting corticosteroid-free clinical remission and long-term disease progression is lacking [66, 67]. Figure 12 depicts the classic endoscopic appearance of CD as well as the SES-CD. Table 2 illustrates the key endoscopic differences between UC and CD.Classic endoscopic appearance of CD as well as the SES-CD.Key endoscopic differences between UC and CD [54].While microscopic colitis by definition is a histologic diagnosis, emerging data suggests that it may not always present with normal endoscopic findings [68–72]. Microscopic colitis is further subdivided into lymphocytic colitis and collagenous colitis depending on the presence of lymphocytic predominant infiltration or collagen deposition, respectively [73]. There have been several macroscopic lesions associated with collagenous colitis including longitudinal ulcers [69,70], hypervascularity [71], loss of normal vascularity [72], and exudative bleeding [73]. A retrospective study by Park et al. sought to investigate macroscopic lesions seen on the endoscopy in 14 patients with diagnosed lymphocytic colitis [68]. Patients with more severe diarrhea demonstrated macroscopic lesions on colonoscopy that included hypervascularity and exudative bleeding, which led to the conclusion that lymphocytic colitis may not always present with a normal endoscopically appearing mucosa. Figure 13 depicts lymphocytic colitis associated with hypervascular mucosa and exudative bleeding.Hypervascular mucosa and exudative bleeding associated with lymphocytic colitis.Eosinophilic disorders can span the entirety of the gastrointestinal tract, including the esophagus (eosinophilic esophagitis), stomach and small intestine (eosinophilic gastroenteritis), and the colon (eosinophilic colitis). Eosinophilic colitis is the least frequent manifestation of primary eosinophilic gastrointestinal disorders with only a few reports reported over the last four decades [74]. Secondary eosinophilic colitis can stem from several conditions including parasitic infections (e.g., Strongyloides stercoralis [75], Enterobius vermicularis [76], and Trichuris trichiura [77]), drug-induced (e.g., clozapine [78], carbamazepine [79], rifampicin [80], non-steroidal anti-inflammatory drugs [81, 82], tacrolimius [83], and gold [84]), auto-immune disorders (e.g., scleroderma [85], dermatomyositis and polymyositis [86, 87], and vasculitides (e.g., Churg-Strauss syndrome [88]). Endoscopic features suggestive of eosinophilic colitis include an edematous mucosa with loss of normal vascular pattern, patchy erythema, and superficial ulcerations [74].Ischemic colitis occurs as a result of inadequate blood supply to the large colon, typically affecting the critically ill and elderly population [89]. A recent retrospective study by Church et al. examined the role of urgent bedside colonoscopy in critically ill patients [90]. This study included 41 patients totaling 49 bedside colonoscopies with the most common indication being to exclude ischemic colitis (n=25). Of those 25, the diagnosis was confirmed in 19 with 14 patients subsequently undergoing surgical intervention, which led the authors to conclude that bedside colonoscopy is helpful in the diagnosis of acute lower gastrointestinal disease and can potentially guide therapeutic management in critically ill patients. There are several endoscopic findings that may assist in the diagnosis of ischemic colitis, one of which is the colon single-stripe sign. Zuckerman retrospectively studied 26 patients with endoscopic evidence of the colon single-stripe sign and compared it with 58 consecutive patients without a stripe [91]. All patients in the colon single-strip cohort had a stripe that was >5cm in length predominantly in the left colon (89%). Patients with the colon single-stripe sign were significantly more likely to have evidence of a preceding ischemic event (62%) compared to the colitis comparison group (7%). Histologically, patients with the colon single-stripe sign had microscopic evidence of ischemic injury compared to the colitis cohort (75% vs. 13%, respectively; p<0.0001). Next, the clinical course and outcome of the 26 patients with the colon single-stripe sign was compared with 22 patients with circumferentially involved ischemic colitis. None of the patients with the colon single-stripe sign required surgical intervention compared with 27% of patients with circumferential ischemic colitis. In addition, mortality rates were higher in the circumferential ischemic colitis group compared with patients with the colon single-stripe sign (41% vs. 4%, respectively; p<0.05). This led the authors to conclude that the colon-single stripe sign can manifest endoscopically, typically in a milder disease in the clinical spectrum of ischemic colitis [91]. Other endoscopic manifestations of ischemic colitis include petechial hemorrhages, edematous and fragile mucosa, segmental erythema, scattered erosions, and longitudinal ulcerations [92]. The ‘watershed areas’ areas (e.g., splenic flexure and transverse colon) are areas most vulnerable to ischemia due to the fact that they have the fewest collateral circulation. Figure 14 depicts various endoscopic manifestations of ischemic colitis.Various endoscopic manifestations of ischemic colitis.Acute GVHD is associated with significant morbidity and mortality in the first 100 days following allogeneic hematopoietic progenitor stem cell transplant [93]. Acute GVHD can have GI manifestations (abdominal pain, nausea/vomiting, and diarrhea), obstructive jaundice, or skin rash. Gastroenterologists are often times consulted for endoscopic evaluation to rule out GHVD, when post-transplant patients present with GI manifestations in the absence of liver or dermatologic involvement. In a majority of patients, flexible sigmoidoscopy with rectal biopsies allow for histologic diagnosis of GVHD and thus colonoscopy is not necessary [94, 95]. Endoscopic features of GVHD include diffuse edema, hyperemia, patchy erosions, scattered ulcers, sloughing, and active bleeding [96].The incidence of LGIB is approximately 20 per 100,000, with an associated all cause mortality of 3.9% [97]. The three most common causes of LGIB include angioectasias, diverticular bleeding, and hemorrhoidal bleeding [98]. Colonic ulcerations secondary to underlying IBD or chronic NSAID use, stercoral ulcer, Dieulafoy’s lesion, or colorectal varices are less common etiologies of LGIB. In addition, an upper gastrointestinal source should also be included in the differential being that upwards of 15% of patients with severe hematochezia are found to have an upper gastrointestinal source [99]. In a hemodynamically stable patient, colonoscopy remains the cornerstone in the diagnosis of an LGIB. Figure 15 is a suggested algorithm by Parekh et al. for the role of colonoscopy in the evaluation of a hemodynamically stable LGIB [100].Suggested algorithm by Parekh et al. for the role of colonoscopy in the evaluation of a hemodynamically stable LGIB [100].Diverticulosis of the colon is an out-pouching of colonic mucosa through weakened layers of muscle in the colon wall. The incidence of diverticular increases after the age of 40 [101]. While in itself benign, complications of diverticular disease include diverticulitis, which is the inflammation or infection of diverticula, and painless bleeding, which may be life threatening. Therefore, it is important for the endoscopist to inform the patient of symptoms of potential complications of diverticular disease.Colonic angioectasias, previously referred to as arteriovenous malformations or angiodysplasias, are a common source of lower gastrointestinal bleeding [102]. They can often times be difficult to identify if not actively bleeding. Figure 16 is an example of colonic diverticula and an angioectasia seen endoscopically. Colonic diverticula and an angioectasia seen endoscopically.Hemorrhoids are vascular structures in the c that act as cushions to help with stool control [103]. When they become swollen or inflamed, internal hemorrhoids (above the dentate line) can present as painless rectal bleeding. External hemorrhoids can result in pain when thrombosed, or painful bleeding if ulceration occurs from pressure necrosis [103]. Skin tags may be evidence of prior thrombosed external hemorrhoids.An fissure is a linear tear or crack in the distal c. It often presents as painful defecation. Initially it usually involves only the epithelium and progresses to include the full thickness of the mucosa. Figure 17 is an example of an internal hemorrhoid, external hemorrhoid, skin tag, and an fissure.Internal hemorrhoid, external hemorrhoid, skin tag, and an fissure.Colonoscopy is important in the diagnosis and therapeutic management of several disease states. To date, colonoscopy remains the gold standard in colorectal cancer prevention. It is the cornerstone in the diagnosis and therapeutic management of IBD, particularly with the recent paradigm shift in the therapeutic management of IBD stressing the importance of endoscopic remission in addition to symptomatic remission. In addition, a thorough colonoscopic exam can aid in the diagnosis of other non-IBD colitides. In the acute setting, findings during colonoscopy are not only crucial in diagnosing the underlying etiology but also driving therapeutic management. As technology evolves and indications for colonoscopy expand, it becomes increasingly more crucial for the clinical endoscopist to be knowledgeable of normal and pathologic findings during colonoscopy.           « Previous Chapter RECOMMEND TO YOUR LIBRARIAN Download as PDF Export Citation »    Next Chapter » Open for submissions © 2004–2017 IN TECH



Are you feeling blue? Temporary feelings of depression are normal healthy reactions after a life-changing or traumatic event such as isolation, health challenges, the death of a loved one, the loss of a job, etc. However, if a person suffers from chronic depression, melancholia or dysthymia, this is a major depressive disorder. What is the difference and what steps can you take right now to help with your symptoms of depression? Continue reading →Are you looking for an effective treatment for pain, anxiety, depression, stomach ache, allergies, fatigue, or other common ailments? Have you been going to multiple doctors without finding any diagnosis or treatment? If you are seeking alternative solutions to health and wellness, check out the Yuen method, a noninvasive, energetic healing technique. Continue reading →What are the benefits of yoga? How does the daily discipline of yoga affect the body, mind and spirit?30 Yoga BenefitsWhat is the History of Yoga? Yoga is a holistic health and wellness activity that both relaxes and energizes the body. Yoga is a Sanskrit word meaning “union with God.” The common belief that Yoga derives from Hinduism is a misconception. Yoga actually predates Hinduism by many centuries. Ancient archeological finds discovered the Indus Valley provided unquestionable evidence that Yoga was practiced earlier than 3,000 B.C.E. and the classical techniques of Yoga may date back  to more than 5,000 years. The word Yoga means “to join or yoke together,” and it brings the body and mind together in harmony with one another. The whole system of Yoga is built on three main structures: exercise, breathing, and meditation. One of the earliest texts on Yoga  is believed to have been compiled by a scholar named Patanjali. This book contains Yoga theories and practices and is entitled Yoga Sutras (“Yoga Aphorisms”) and is thought to have been written as early as the 1st or 2nd century B.C. or as late as the 5th century A.D. This system is known as “Ashtanga Yoga.”  This is the eight limbs of Yoga, and referred to today as Classical Yoga. Most all forms of yoga include a variation of Patanjali’s original ancient yoga system. What are the Different Types of Yoga? There are over a hundred different schools of Yoga. There are many Yoga poses or postures within each of the different schools of Yoga. Some of the most well known schools of Yoga are as follows: What Does Research Tell Us About the Effectiveness of Yoga? Sudarshan Kriya Yoga was concluded to be a potentially effective treatment in reducing or eliminating depression in a study by Janakiramaiah N and others (2000) and a review of clinical studies of the effectiveness of Hatha Yoga on depression by Uebelacker et al  (2010).The prac­tice of yoga has been shown to be therapeutically useful in bron­chial asthma. Nagarathna R, Nagendra HR (1985) concluded that “There was a significantly greater improvement in the group who practised yoga in the weekly number of attacks of asthma, scores for drug treatment, and peak flow rate.”  However, a 2011 systematic review of clinical studies suggests that there is no sound evidence that yoga improves asthma.Multiple studies  have found yoga to be a helpful treatment in low back pain such as Sherman KJ, Cherkin DC, Wellman RD, et al (2011) and Tilbrook HE, Cox H, Hewitt CE, et al. (2011).   Other studies have shown yoga to be potentially helpful treatment for cardiovascular disease, such as Raub (2002), type II diabetes mellitus (Innes and Vincent, 2007),  stress and hypertension (Kiecolt-Glaser JK, and others, 2010) as well as other conditions. The practice of yoga can also play a role in the rehabilitation of those who have physical and mental challenges (Uma, et al, 2008).  Many other benefits are inherit in the practice of yoga as described below.What Are the 30 Benefits of Yoga?Have you tried yoga? If so, how has it helped YOU?  Best wishes for a yoga-riffic day!! _______________________________References Bower JE, Woolery A, Sternlieb B, et al. Yoga for cancer patients and survivors. Cancer Control. 2005;12(3):165–171.Innes, KE, Vincent HK, The Influence of Yoga-Based Programs on Risk Profiles in Adults with Type 2 Diabetes Mellitus: A Systematic Review, Evid Based Complement Alternat Med., Dec 2007; 4(4): 469–486. Jain SC, Talukdar B. Bronchial asthma and Yoga. Singapore Med J 1993;34:306-308Janakiramaiah N. , Gangadhar B.N. , Naga Venkatesha Murthy P.J. , Harish M.G., Subbakrishna, D.K., Vedamurthachar A.  Antidepressant efficacy of Sudarshan Kriya Yoga (SKY) in melancholia: a randomized comparison with electroconvulsive therapy (ECT) and imipramine Volume 57, Issue 1 , Pages 255-259, January 2000Kiecolt-Glaser JK, Christian L, Preston H, et al. Stress, inflammation, and yoga practice. Psychosomatic Medicine. 2010;72(2):113–121.Monro R, Power J, Coumar A, Nagarathna R, Dandona P. Original research yoga therapy for NIDDM; A controlled trial. Complem Med J 1992;6:66-68.Nagarathna R, Nagendra HR. Yoga for bronchial asthma; A controlled study. Br Med J 1985;291:1077-1079.Ramesh L. Bijlani, Rama P. Vempati, Raj K. Yadav, Rooma Basu Ray, Vani Gupta, Ratna Sharma, Nalin Mehta, and Sushil C. Mahapatra.  A Brief but Comprehensive Lifestyle Education Program Based on Yoga Reduces Risk Factors for Cardiovascular Disease and Diabetes Mellitus The Journal of Alternative and Complementary Medicine. April 2005, 11(2): 267-274. doi:10.1089/acm.2005.11.267.Raub, JA. Psychophysiologic effects of hatha yoga on musculoskeletal and cardiopulmonary function: a literature review. The Journal of Alternative and Complementary Medicine. 2002;8(6):797–812.Sherman KJ, Cherkin DC, Wellman RD, et al. A randomized trial comparing yoga, stretching, and a self-care book for chronic low back pain. Archives of Internal Medicine. 2011;171(22):2019–2026.Telles S, Naveen K V. Yoga for rehabilitation : An overview, Vivekananda Kendra Yoga Research Foundation, No. 19, K.G. Nagar, Bangalore-560 019., India,  Indian J Med Sci 1997;51:123-7Monro R, Power J, Coumar A, Nagarathna R, Dandona P. Original research yoga therapy for NIDDM; A controlled trial. Complem Med J 1992;6:66-68.Tilbrook HE, Cox H, Hewitt CE, et al. Yoga for chronic low back pain: a randomized trial. Annals of Internal Medicine. 2011;155(9):569–578.Uebelacker LA, Epstein-Lubow G, Gaudiano BA, et al. Hatha yoga for depression: a critical review of the evidence for efficacy, plausible mechanisms of action, and directions for future research. Journal of Psychiatric Practice. 2010; 16(1):22–33.Uma K, Nagendra HR, Nagarathna R., Vaidehi S, and Seethalakshmi R., The integrated approach of yoga: a therapeutic tool for mentally retarded children: a one-year controlled study, Journal of Intellectual Disability Research, Vol 33, Issue 5, 28 JUN 2008, DOI: 10.1111/ j.1365-2788.1989.tb01496 _________________________________ This article is written by Jean Voice Dart, M.S. Special Education from Illinois State University. Jean is a published author and has written hundreds of health articles as well as hosting a local television program, “Making Miracles Happen.” She is a Registered Music Therapist, Sound Therapist, and Master Level Energetic Teacher, and is the Executive Director, founder and Health and Wellness Educator of the Monterey Bay Holistic Alliance. The Monterey Bay Holistic Alliance is a registered 501 (c) 3 nonprofit health and wellness education organization. For more information about the Monterey Bay Holistic Alliance contact us or visit our website at www.montereybayholistic.com. Disclaimer: The Monterey Bay Holistic Alliance is a charitable, independent registered nonprofit 501(c)3 organization and does not endorse any particular products or practices. We exist as an educational organization dedicated to providing free access to health education resources, products and services. Claims and statements herein are for informational purposes only and have not been evaluated by the Food and Drug Administration. The statements about organizations, practitioners, methods of treatment, and products listed on this website are not meant to diagnose, treat, cure, or prevent any disease. This information is intended for educational purposes only. The MBHA strongly recommends that you seek out your trusted medical doctor or practitioner for diagnosis and treatment of any existing health condition.If you are eating right, getting plenty of sleep and practicing safe sex, sexual activity can be very healthy for mind, body and spirit. Research has shown that those who have a sexually active life, are generally healthier and happier. Here are some of the benefits backed up by research: – The muscles used in achieving orgasm are the same muscles used in bladder control. Frequent sexual activity can strengthen muscles of the pelvic floor and  help women and men avoid incontinence and premature ejaculation. You can strengthen these muscles by practicing Kegel exercises.  If you not certain how to flex these muscles, the best way to discover the muscles it to practice stopping the flow of urine. A Kegel squeeze is performed by drawing your lower pelvic muscles up and holding them up high and tight.   The brain produces more than 50 identified active drugs. Some of these are associated with memory, others with intelligence, still others are sedatives. Endorphin is the brain’s painkiller, and it is 3 times more potent than morphine.   Researchers have found that the more often one engages in sex, the more likely they are able to live a healthier longer life, and/or vice versa. The healthier one is, the longer they are able to engage in a healthier sex life. In a study entitled, “Sex, health, and years of sexually active life gained due to good health: evidence from two US population based cross sectional surveys of ageing,” researchers Stacy Tessler Lindau, Associate Professor  and Natalia Gavrilova, Senior Research Associate concluded:“Sexual activity, quality of sexual life, and interest in sex were positively associated with health in middle age and later life.”  Resources: Charnetski and Brennan,”Sexual frequency and salivary immunoglobulin A (IgA),” National Center for Biotechnology Information (NCBI)Brody, Veit and Rau, “A preliminary report relating frequency of vaginal intercourse to heart rate variability, Valsalva ratio, blood pressure, and cohabitation status,” National Center for Biotechnology Information (NCBI)Julie Frappier, Isabelle Toupin, Joseph J. Levy, Mylene Aubertin-Leheudre, Antony D. Karelis Energy Expenditure during Sexual Activity in Young Healthy Couples, Public Library of Science, October 24, 2013  _______________________________ This article is written by Jean Voice Dart,  M.S. Special Education from Illinois State University. Jean is a published author and has written hundreds of health articles as well as hosting a local television program, “Making Miracles Happen.”  She is a Registered Music Therapist, Sound Therapist, and Master Level Energetic Teacher, and is the Executive Director, founder and Health and Wellness Educator of the Monterey Bay Holistic Alliance.  The Monterey Bay Holistic Alliance is a registered 501 (c) 3  nonprofit health and wellness education organization.  For more information about  the Monterey Bay Holistic Alliance contact us or visit our website at www.montereybayholistic.com. Disclaimer: The Monterey Bay Holistic Alliance is a charitable, independent registered nonprofit 501(c)3 organization and does not endorse any particular products or practices. We exist as an educational organization dedicated to providing free access to health education resources, products and services. Claims and statements herein are for informational purposes only and have not been evaluated by the Food and Drug Administration. The statements about organizations, practitioners, methods of treatment, and products listed on this website are not meant to diagnose, treat, cure, or prevent any disease. This information is intended for educational purposes only. The MBHA strongly recommends that you seek out your trusted medical doctor or practitioner for diagnosis and treatment of any existing health condition.Do we abuse prescription drugs? Are there alternative solutions to using prescriptions? What Does Research Tell Us About Our Prescription Use? Some individuals need prescriptions for severe medical symptoms in order to stay alive. Each person’s needs differ medically. However, Medical News Today recently reported that in 2011, doctors wrote 4.02 billion prescriptions for drugs in America. That averages out to about 13 prescriptions for every living man, woman and child. How could this be possible? Do we need ALL of these prescriptions?According to a report from the July 26, 2000, Journal of the American Medical Association, Dr. Barbara Starfield, a respected public-health researcher at the Johns Hopkins School of Public Health concluded that medical drugs were killing Americans at the rate of 106,000 per year. Marijuana and prescription pain medications are the top two leading causes of drug abuse among teenagers.Alternative therapies are available including taking responsibility for our health by getting regular exercise, sleep, and proper nutrition. Are we as a nation being responsible…or are we just looking for a quick fix?Prescriptions to veterans for Vicodin (and generic forms) have soared since the Iraq and Afgahanistan wars.Why Are Opiods Dangerous and What Are They? Research statistics tell us that more than seven million people abused prescription drugs this past year.  Out of those seven million people,  more than five million people abused pain relievers. The drugs that are of most concern are opioids. Opioids are any morphine-like synthetic narcotic that produces the same effects as drugs derived from the opium poppy (opiates), such as sedation, pain relief,  constipation and respiratory depression from 5 million to nearly 45 million and for opioid gesics from about 75.5 million to 209.5 million, or about 36% increase. The most potent opioids are morphine, meperidine, methadone; other opioids include hydromorphine–Dilaudid®, codeine, oxycodone–Percodan®, propoxyphene–Darvon®,  Naloxone–Narcan®, and Pentazocine–Talwin.®The 2009 National Survey on Drug Use and Health determined that Native American and Alaskan Native populations lead all other ethnic groups in misuse of prescription-type drugs (psychotherapeutics).According to the National Institute on Drug Abuse (NIDA), unintentional death from overdose of opioids  has quadrupled steadily since 1999 and now outnumbers those deaths from heroin and cocaine combined.  Between 1991 and 2010, prescriptions for stimulants increased from 5 million to nearly 45 million and for opioid gesics from about 75.5 million to 209.5 million, or about 36% increase.Acupuncture needles in woman’s spineChinese cupping treatment on young man.Chinese cupping treatment on young man.Yoga Arsanas Poses for BeginnersYoga Arsanas Poses for BeginnersTherapeutic massage is an effective alternative to prescription drugs.Therapeutic massage is an effective alternative to prescription drugs.Studies show that a change in diet and nutrition often can help to reduce or eliminate pain.Studies show that a change in diet and nutrition often can help to reduce or eliminate pain.Foot reflexology massage chartFoot reflexology massage chartAccording to a recent report by the NIDA, 25% of adults who started abusing prescription drugs at 13 years of age or younger met clinical criteria for addiction later in life.Summary Research has shown that doctors are writing more than 4 billion prescriptions in the United States alone, every year, averaging 13 prescriptions for every man and woman and child alive today. Clearly something is seriously wrong. Prescription drug abuse affects teenagers, young adults, adults and elderly resulting in hundreds of thousands of deaths annually. Natural herbal supplements,  complimentary methods of healing, such as acupuncture, massage, chiropractic care, physical therapy, nutrition and diet changes, and many others listed above, can be very effective as a alternative solution to taking prescription drugs. Talk with your trusted health professional to determine the health treatment approaches that will be best for you.Resources Medical News Today Journal of the American Medical Association National Institute on Drug Abuse (NIDA)_______________________________________ Disclaimer:The Monterey Bay Holistic Alliance is a charitable, independent registered nonprofit 501(c)3 organization and does not endorse any particular products or practices. We exist as an educational organization dedicated to providing free access to health education resources, products and services. Claims and statements herein are for informational purposes only and have not been evaluated by the Food and Drug Administration. The statements about organizations, practitioners, methods of treatment, and products listed on this website are not meant to diagnose, treat, cure, or prevent any disease. This information is intended for educational purposes only. The MBHA strongly recommends that you seek out your trusted medical doctor or practitioner for diagnosis and treatment of any existing health condition.WHAT IS REIKI? Reiki (霊気) is a spiritual practice developed in 1922 by Japanese Buddhist Mikao Usui, which since has been adapted by various teachers of diverse traditions. Reiki is also considered a spiritual or meditative type of healing or a form of prayer.   It uses what has been commonly called palm healing or hands on healing as a form of complementary, alternative, or holistic healing. therapy.Reiki is also sometimes classified as oriental medicine by some professional medical groups. Reiki practitioners or Reiki Masters use the hands to move energy through the body.  Reiki can also be described as “laying on of hands.” The practitioners believe that they are transferring universal energy (i.e., reiki) in the form of qi (Japanese: ki) or Chi, through the palms, which brings self-healing and balance. Today there are many branches or styles of Reiki but there are two major traditions, Traditional Japanese Reiki and Western Reiki.  Traditional Japanese Reiki is normally used to describe a system based on Usui’s original teachings. Western Reiki (西洋レイキ, Seiyō reiki) is a Reiki system that can be accredited to Hawayo Takata.   The teaching of Reiki outside of Japan is commonly divided into three levels:  First Degree – Shoden “初伝”, Second Degree – Okuden “奥伝”, and Third Degree – Shinpiden “神秘伝” or Master level.  In Western Reiki, it is taught that Reiki  the meridian energy lines and seven major chakras on the body are used with the hand positions.WHAT HAPPENS IN A REIKI HEALING SESSION? Generally in a western Reiki healing session the hands are placed just off the body or lightly touching.   Typically, the client is lying down, as in a massage therapy position.   Some Reiki Masters also practice “long-distance” Reiki sessions.  In a Reiki session, the practitioner is said to bring Universal Life Energy to the client.  During the healing session, a client will go into a state of deep relaxation.  During this relaxed state he or she might experience a reduction of pain and sense of peace and well-being.   Those trained in Reiki are referred to as Reiki Masters or Reiki practitioners depending on their level of training.IS REIKI EFFECTIVE? Current research studies are inconclusive in providing clinical evidence as to the effectiveness of Reiki. It is thought that more research is needed.  However, individual clients and Reiki Masters and practitionerss claim that Reiki can be very effective in healing or providing relief for the following health concerns:For more information about Reiki and a wide variety of natural medicine and health and wellness topics, check out our video library at http://www.youtube.com/MBHolistic Best wishes and loving energy from your MBHA health and wellness friendsGreetings friends!30 Benefits of Qigong and Tai Chi. Click, copy, download, save and share with family members and friends.WHAT IS QIGONG and WHAT IS TAI CHI?The word Qigong (Chi Kung) consists of two Chinese words. Qi is pronounced “chee” and is usually translated to mean “the life force”or vital-energy that flows through all things in the universe.  The second word, Gong, pronounced “gung,” means accomplishment, or skill that is achieved through disciplined effort or continued practice. Together, Qigong (Chi Kung) means cultivating energy, it is a system for healing and increasing energy or vitality.“Stillness and action are relative, not absolute, principles.  It is important to find a balance of yin and yang, not just in qigong, but in everyday life.  In movement, seek stillness and rest.  In rest, be mindful and attentive.”Ken Cohen, The Way of Qigong: The Art and Science of Chinese Energy Healing, pages 4-5Tai Chi (Taiji Quan) is a style of qigong.   It is slow and fluid-like.  Other types of qigong exercise are for developing specific systems or parts of the body– nervous system, endocrine system, etc.,  but Taiji Quan is an exercise for the whole body, mind, and spirit with the goal of restoration and wholeness. HOW DOES QIGONG HELP IMPROVE HEALTH?The breathing, gentle movement, and meditation techniques  of qigong help to cleanse, strengthen, and circulate the life energy (qi). Qigong practice leads to better health and vitality and a tranquil state of mind. In the past, qigong has also been called nei gong (inner work) and dao yin (guiding energy).   Research studies show that qigong may be effective in the treatment of many illnesses including cancer and heart disease.  Recent studies show that qigong delays the effects of aging and is useful with elderly and those experiencing symptoms of dementia.Here is a listing of thirty benefits and positive effects of qigong and/or tai chi, as noted in a variety of reports, reviews, and research studies.Research suggests that qigong and/or tai chi can be very helpful and effective in bringing balance, harmony, and healing to the body, mind, and spirit for people of all ages and cultures. More research is needed in controlled settings, over a longer periods of time, to better determine the effect that qigong has on health and wellness. Changes in diet and other alternative and orthodox medical treatments are also influential and work with qigong to bring about wellness.   Always confide in your trusted health professional for advice.Best wishes to you from your health and wellness friends at MBHA.The Qigong Research Society The Qigong Institude – Scientific Papers and ReviewsWHAT IS INFLAMMATION?Inflammation is an immune response. It is the body’s natural and automatic way to protect itself and fight off injury, infection, and disease. The body’s immune cells collect in an area of concern in the body through the blood stream.  Then the blood vessels increase blood flow at the site and it becomes warm, swollen, sometimes reddish in color.  This is experienced as discomfort, pain or tenderness.  Inflammation is a natural part of healing.  Chronic inflammation, however,  is another situation. Something has gone wrong in the body’s mechanism, resulting in continuous inflammation.WHY IS CHRONIC INFLAMMATION SERIOUS?The body is not supposed to be “overheated” for extended periods of time.  When the body is in a state of chronic inflammation, it is essentially being attacked, and slowly begins to die.  This can be a very serious situation, if neglected.  Chronic inflammation is a primary cause of all degenerative diseases, including heart disease and cancer.WHAT ARE INFLAMMATORY DISEASES?Inflammation is the “itis” in all of the “itis” diseases, such as:and many, many more.WHAT ARE SYMPTOMS OF CHRONIC INFLAMMATION?TESTING FOR INFLAMMATIONIf you believe that you have inflammation, you might want to get tested. The first test you should know about is called the C Reactive Protein test. There are two CRP tests: 1) The specific test that MUST BE REQUESTED to provide information about inflammation and cardiac risk, is the H.S.C.R.P. test. This is a high-sensitivity cardiac reactive protein test.2) Another test used is the consisting of CRP and IL-6 tests and TNF (tumor necrosis factor), interleukins -1 beta and 8. If you are concerned and want accurate test results, ask your doctor specifically for these tests by the complete and full name.  Other similar tests might not provide the information you need or might be misleading.STOPPING CHRONIC INFLAMMATION IS CRITICAL TO WELLNESSWhy is chronic inflammation so common in our society today?  There are different types of inflammation. There is the swollen, painful, visible inflammation, such as when one sprains an ankle or if one has an infected tooth or gingivitis. There also is a silent killer. This is inflammation of a different sort, inflammation deep within the cells of the body. We often do not realize this inflammation exists, as we are experiencing general flu-like symptoms of discomfort that don’t seem to disappear, therefore, many of us are unknowingly experiencing chronic inflammation and are not taking measures to stop it.If  inflammation is diagnosed, such as in the case of arthritis, medical doctors will often prescribe a life-time of NSAIDS or non-steroidal anti-inflammatory drugs, to reduce or stop inflammation in the body. Most doctors today, combine this treatment with a change in lifestyle and diet. This is because many research studies have shown that a change in lifestyle and diet can dramatically reduce and eliminate inflammation.  Research has also shown that certain foods increase inflammation in the body such as trans fats commonly found in commercially processed packaged foods. Food additives and chemicals also increase inflammation.   Below are some supplements and lifestyle changes that have been known to be effective in stopping or reducing inflammation.  Always work carefully with your trusted health practitioner to determine which diet and healthy living plan is best for you.20 REMEDIES TO REDUCE CHRONIC INFLAMMATIONRESOURCES Inflammation Research FoundationFrom Fat to Chronic Inflammation Chronic Inflammation and Late-Life Decline  Chronic Inflammation – International Wellness DirectoryGod dag, Hej, health and wellness enthusiasts.Click, copy, save and share with friends and family members. What do you use to alleviate headache pain?Headache is one of the most common ailments and can be the result of a variety of causes including physical, emotional and mental distress, and chronic or acute illness or injuries. The majority of people choose to eliminate headache pain as quickly as possible, through the use of prescription or nonprescription drugs.Most people experience common minor headache pain because of stress and tension due to the affects of changes in behavior, diet, or environment. The following natural remedies for headache may prove to be very helpful. These remedies are not intended as a cure or substitute for a doctor’s care.   Headaches can be a symptom of a more serious underlying problem, so always check with your doctor or trusted health-care professional.Here are a few helpful home remedies that might aide in relieving headache pain:What has been effective in relieving your headache pain? Best wishes to you for a healthy, happy day. Your health and wellness friends at MBHA.WHAT IS CHIROPRACTIC? According to the General Chiropractic Council, chiropractic is “a health profession concerned with the diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system, and the effects of these disorders on the function of the nervous system and general health.”WHAT HAPPENS IN A CHIROPRACTIC SESSION? Typically the chiropractor will ask about your symptoms, your general health and previous health challenges or symptoms.  He or she will give you an examination and examine your spine and posture.  The chiropractor will try to determine your source of discomfort or pain, and might choose to x-ray your spine.  The initial assessment is typically 45 minutes to 60 minutes.   The chiropractor will most likely describe a plan of treatment for you and may give you a spinal adjustment. If you are asked to undress you should be offered a gown.The chiropractor uses a variety of manual techniques with the main technique being spinal manipulation. He or she might manipulate, muscles, bones, and joints around the spine. Usually this is not painful but there many be some discomfort around the joint. If you have significant discomfort, tell your doctor immediately.  You may hear loud sounds during manual manipulation. This is a normal part of manual manipulation. WHAT IS THE THEORY AND HISTORY OF CHIROPRACTIC CARE? Chiropractic was founded in 1895 by Daniel David Palmer.  D.D. Palmer was a grocer, a magnetic healer and was interested in phrenology (diagnosing disease based on the bumps of the skull) and spiritualism. It is believed that Palmer discovered the principle of chiropractic when he allegedly cured a janitor of his deafness by manipulating his cervical spine (the neck). However, this may or may not be true since the hearing mechanism is not connected to the nerve passageways in the neck.The term “chiropractic,” is translated to mean “done by hand” and was created by Palmer.  Palmer created the subluxation theory based on the principle that all disease is caused by subluxated bones, which 95% of the time are spinal bones, and which disrupt the flow of energy to the various areas of the body.  Palmer didn’t not base any of his ideas on research, but rather went directly to treating patients and to creating a school for training chiropractors in his methods. The benefits of Chiropractic care.HOW DOES CHIROPRACTIC TREATMENT HELP? Chiropractic treatment has been very helpful to people all around the world for the management and relief of a variety of problems such as:HOW EFFECTIVE IS CHIROPRACTIC TREATMENT Research studies have been conducted on the effectiveness of  of Chiropractic treatment for migraine headaches, back pain, neck pain, fibromyalgia, gastrointestinal disorders and other disorders. Patient satisfaction surveys and research studies have been conducted to determine customer satisfaction on the effectiveness of chiropractic treatment.   Chiropractic care has a high success rate among patient satisfaction, and show that 90% of patients feel that their treatment has been effective. Have you had success with chiropractic treatment? Are you a chiropractic doctor?  Maybe there is something that is not on the list that you would like to add.  Feel free to share your experiences.ORGANIZATIONS American Chiropractic Association California Chiropractic Association National Chiropractic Association International Chiropractors Association REFERENCES Kaptchuk TJ, Eisenberg DM (November 1998). “Chiropractic: origins, controversies, and contributions”. Arch. Intern. Med. 158 (20): 2215–24. A, Tuchin PJ, Russell MB (April 2011). “Manual therapies for migraine: a systematic review”. J Headache Pain 12 (2): 127–33. Ernst E (2011). “Chiropractic treatment for gastrointestinal problems: A systematic review of clinical trials”. Can J Gastroenterol 25 (1): 39–49.Schneider M, Vernon H, Ko G, Lawson G, Perera J (2009). “Chiropractic management of fibromyalgia syndrome: a systematic review of the literature”. J Manipulative Physiol Ther 32 (1): 25–40. doi:10.1016/j.jmpt.2008.08.012Cherkin D (November 1989). “AMA policy on chiropractic”. Am J Public Health 79 (11): 1569–70. Smith M, Carber LA (2008). “Survey of US Chiropractor Attitudes and Behaviors about Subluxation”. Journal of Chiropractic Humanities 15: 19–26. _________________________________This article is written by Jean Voice Dart, M.S. Special Education from Illinois State University. Jean is a published author and has written hundreds of health articles as well as hosting a local television program, “Making Miracles Happen.” She is a Registered Music Therapist, Sound Therapist, and Master Level Energetic Teacher, and is the Executive Director, founder and Health and Wellness Educator of the Monterey Bay Holistic Alliance. The Monterey Bay Holistic Alliance is a registered 501 (c) 3 nonprofit health and wellness education organization. For more information about the Monterey Bay Holistic Alliance contact us or visit our website at www.montereybayholistic.com. Disclaimer:The Monterey Bay Holistic Alliance is a charitable, independent registered nonprofit 501(c)3 organization and does not endorse any particular products or practices. We exist as an educational organization dedicated to providing free access to health education resources, products and services. Claims and statements herein are for informational purposes only and have not been evaluated by the Food and Drug Administration. The statements about organizations, practitioners, methods of treatment, and products listed on this website are not meant to diagnose, treat, cure, or prevent any disease. This information is intended for educational purposes only. The MBHA strongly recommends that you seek out your trusted medical doctor or practitioner for diagnosis and treatment of any existing health condition.DO YOU WISH YOU COULD ALTER YOUR DNA? Do you want to change your health genetics? Join Paulette Suzanne, Naturopathic Health Counselor, in this FREE workshop Wednesday, November 1, 2017, from 5:30 – 7:00 pm (Doors open 5:15) at the Monterey Public Library, 625 Pacific Street, Monterey, CA 93940.  For more information, contact Paulette Suzanne at 760-505-8025   or email her at paulettesuzanne@peoplepc.comEnter your email address to follow this blog and receive post notifications by email.





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