TRI-5, Wk5, Day 289 - Wednesday, June 9th

I've been taking it easy for the past couple days ...well, I guess there's only been one day away from school besides today (Friday) but it seems like a while. I took a lot of naps yesterday (thur) which I'm sure didn't hurt me any. Got a little more energy today and just got back from a local track to get in some jogging.

I had thoughts of running out to the Logan homecoming today for a Diff Dx lecture but the overcast skies made the thought of driving unappealing (and the thought of jogging more appealing)

I have four test next week and four the following week. In many classes we only have two exams, a midterm and a final. So, if I get nice grades on my midterms then I'll be feeling pretty good about things for the rest of the semester and if I get poor grades then I'll be significantly more stressed.

I was just playing Volume 2 of my Diversified Adjusting DVD and decided to list the moves on the first part of the disc below. I'll have to know the last 17 adjusting moves for my practical next Tuesday.

Today we have a nice picture of the upper cervicals - only two vertebra, C1 (aka the Atlas) and C2 (aka the Axis). 17 moves just for those two little bones and that's just from one adjusting technique (Diversified).

Thoracic Counter Rotations

12. Double Transverse/Pisiform

13. Couble Pollicus (Counter rotation)

Retrolisthesis / Extension Malposition

14. Double Pollicus (Retrolisthesis)

15. Knife Edge

Flexion Malposition Bilateral Posterior Disc

16. Double Pollicus (Disc Protrusion)

Lateral Flexion Malposition - Typical

17. Thumb-Pisiform (T4 & Lower)

18. Policus Pisiform (T3 & Lower)

Lateral Flexion Malposition - Atypical

19. Thumb-Pisiform (T4 & Lower)

20. Pollicus-Pisiform

21. Pisiform-Pollicus

22. Pisiform-Traction

Thoracis Rib Adjusting

23. Pisiform Contact

24. Pollicus Contact

Lower Cervicals C3-C7

Rotational Malposition - Prone

01. Lateral Index - Side of Laterality

02. Flat Thumb - Side of Laterality

03. Lateral index - Opp. Side of Laterality

04. Flat Thumb - Opp. Side of Laterality

05. Lateral Index - Head of Table

06. Flat Thumb - Head of Table

Luschka Trauma / Lateral Flexion Malposition

7a. Head of Table

7b. Side Opposite of Involvement

7c. Side of Involvement

Retrolisthesis / Foraminal Compression

08. Bimannual Recoil

09. Thumb Index

10. Knife Edge

Lower Cervical Adjusting - Supine

11. Rotational Malposition - Lateral Index

12. Luschka Trauma - Lateral Index

Lower Cervical Adjusting - Seated

13. Rotational Malposition - Chiro. Index

14. Luschka Trauma - Chiro Index

Upper Cervicals

Seated Adjusting

01. Posterior Occiput

02. Anterior Occiput

03. Inferior Occiput

04. Posterior Atlas

05. Atlas/ Axis - Counter Rotation (for C2)

06. Atlas/ Axis

Supine Adjusting

07. Posterior Occiput

08. Inferior Occiput

09. Posterior Atlas

10. Anterior Atlas

a. Side of Anteriority Up

b. Side of Anteriority Down

11. Atlas Axis Counter Rotation (for C2)

12. Atlas Axis Counter Rotation (for C1)

Prone Adjusting

13. Inferior Occiput

14. Anterior Occiput

15. Posterior Atlas

16. Atlas Axis Counter Rotation

For Roxanne

Hi Roxanne,

I could probably help with the insight if we could communicate more directly. I have to approve all comments before they are published so, if you'd like to leave your email address as a comment, then I'll can get your address then reject the comment so it is not published and privacy could be maintained.

I'm not sure why everyone is dumbfounded because I know we discussed a situation similar to yours in our Cardio Dx class. That is, a block presenting itself upon or after exertion. I've forwarded your comments to the doctor who teaches our Cardio class plus, that's my first class tomorrow morning so I'll be sure to find out more information then.

When you mentioned lightheadedness the word syncope came to mind which has to do with fainting, this is also sometimes referred to as a "Stokes-Adams" episode. While there can be many reasons for a person to experience Stokes-Adams episodes, the most common cause is Sick Sinus Syndrome which has a couple of aka's such as Sinus Arrest or SA Block and P-pulmonale may also be used. When we talk about P-pulmonale we're essentially talking about the right side of your heart which is the pump that sends blood to your lungs. A situation such as COPD or emphysema are the most common conditions associated with P-pulmonale.

Of course, your one cardiologist already mentioned hyper-vagal tone (aka vagotonia, aka a type of parasympatheticotonia) You might want to notice that I made the letter "o" bold faced in parasypatheticotonia, because if you decide to Google that word, there is another very similar word but instead of that letter "o" there is a letter "a" in it's place. When the word is used with an "o" it represents an increase, in this case, an increase in your vagus nerve (which is a parasympathetic nerve). When you see it with a letter "a" then we have a lack of input coming from the parasympathetic nerve (i.e., Carnial Nerve number 10, aka the vagus nerve)

When it comes to the heart, parasympathetic nerves slow the heart down while sympathetic nerves speed it up. However, please don't think a loss of sympathetic innervation would play a role in this condition because the sympathetic nervous system provides exclusive innervation to the ventricles but only minimal innervation to the atria, while the right vagus nerve directly innervates the SA node and the left vagus nerve innervates the VA node.

Also, the sympathetic nerves emanate from your neck (cervical region) and your sacrum while the middle of your spine (predominately the thoracic region) is where your sympathetic nerves emit from the spinal cord. I'm just giving you this bit of neuro-anatomy because if you see a chiropractor then you would want to have him look at your cervical region because that's where your sympathetics are located ....

OK - I'm thinking off the top of my head now about the vagus nerve. There are baroreceptors in your carotid arteries (in your neck) as well as in your aortic arch which contain vagus nerve innervation. ...I guess I'm trying to think of possible mechanics behind your situation. You exercise - bp goes up, you stop, then maybe there's some delay and baroreceptors are ...well, perhaps they are a bit hypersensitive to the pressure and vagal stimulation is elicited which turn the heart rate (via the SA node) down a bit too far.

Incidentally, there's also a hormone release by the right atrium called ANP (atrial natriuretic peptide) which is one of the few hormones the body releases to reduce blood pressure.

I guess I could provide better guesses with a look at a 12 lead EKG. If you have one there should be EKG output for leads I, II & III along a left column followed by leads aVR, aVL and aVF then the right half of the output should be for leads V1, V2, V3, V4, V5 & V6.

along the very bottom would be an output for Lead 2 which traverses the entire bottom of the page. If you look at that Lead II strip, and compare to the picture of the normal EKG I've included with this blog, do you have a bigger than normal P wave? (this could indicate P-pulmonale) or, does your S-wave plummets down deeply? (perhaps an indication of SA block)

I hope this is all somewhat helpful.

I'm kind of reminded of a sign I saw at the first chiropractor I ever visited. It read something to the effect of "if yours is not a chiropractic problem then chiropractic will not help but, if yours is a chiropractic problem then nothing else will help"

If it's not a chiro issue then ischemia of the SA node or drugs may contribute to possible etiology of an SA block. From a chiro standpoint, a subluxation of the cervical spine may be related to this issue.

Again, please consider leaving an email address as a comment (i will NOT publish it) but will use it to get hold of you with my own personal email in case you might want to share an EKG that I could use to consult w/ my cardio dx teacher then provide feedback.

Best wishes,

Scott :)

TRI-5, Wk5, Day 288 - Tuesday

Made it home before 8 p.m. tonight! :)

I stayed for Radiological Positioning tutoring tonight and it was a very valuable use of time. (...insert time lapse here...)

had to get my classes organized, it's almost 10:30 now - need to clear off & label some lectures I've been recording then get to bed.

of interest ....well -

From Lab Dx we learned a few things that can cause a pregnancy test to be positive besides pregnancy and that would include testucular tumors and hydatiform moles. We started talking about positive urine glucose test which would generally indicate diabetes and learned renal glycosuria could also cause glucose to be excreted in urine.

TRI-5, Wk5, Day 287, Monday

Glancing back at Friday's entry I suppose this day wasn't quite as long yet, I still left home by 6 a.m. and just got back a bit before 9 p.m.

Logan has their 75th Anniversary Homecoming this week. I heard Logan was paying $65 per person for hors d'oeuvres for just one of the evening events which is rather generous considering they're only charging students & staff $35 per ticket. I'm 'not sure if I'll be able hang out all day to take advantage of any of the evening activities but I would like to make some of the earlier morning lectures.

Let's see ...next week we have test in Physical Dx, Cardio Dx, Diversified IV and Lab Dx

The following week is ...hmmm, not positive - I think maybe Biomechanics, Toxicology and HCP ...maybe - the week after that would be Dx Imaging which is the big dog of test ...at least in my mind it's the grand daddy of upcoming exams.

Today's Pic - Logan has a billboard campaign and the picture I choose for today is the billboard I see on the way home off highway 64. Be sure to click on the pic for a full view. Pretty classy campaign if you ask me.

TRI-5, Wk4, Day 286

Heck of a day - left home around 6 a.m. and got home just a little before midnight. After class got out today I hooked up with my study partner and knocked out chapter 3 reading of Physical Diagnosis (phys dx) then headed back up to the school to finish printing out some supplementary material for Radiographic Positioning and Diagnostic Imaging (dx imag).

I've gotten some great comments and feedback lately. A 47 yo by the name of Roxanne found a blog I did earlier on hyper vagal tone (parasympatheticotonia). She was told she needed a pacemaker but later a heart specialist took an EKG and said her heart was strong and healthy and she had a hyper vagal tone.

FYI - when we're talking about hyper vagal tone, we're talking about cranial nerve number 10 usually denoted CN X. It's a parasympathetic nerve. Two of it's branches innervate the heart, the left branch innervates the VA node and the right branch innervates (connects with) the SA node. The SA node is (ideally) the pace maker of the heart and for most individuals we'd probably like to see that in the 60-90 range. Most books will put that range at 60-100 with over 100 designated as tachacardia and under 60 bpm as bradycardia.

The parasympathetics which innervate the heart act to slow the heart rate down. One can stimulate the vagus innervation by performing a carotid massage which stimulates a baroreceptor which is also innervated by the vagal nerve.

....dang - study partner is here so it's time to crack open the books - i only say dang because there's so much more to talk about ....

TRI-5, Wk4, Day 285

I need more time ...

I fit in some walking during my lunch hour today so I came home right after class but after eating it was still after 8 p.m. hmmm, it's 9 p.m. now so I guess I could claim the better part of an hour if I wasn't screwing around on facebook. Might have to make some changes there. There were some interesting factoids I learned today ...let me see if I can dig them up ...

Let's see, the notion of dehydration came up today in Lab Dx. Dehydration means you've lost solvent. What is a solvent? Imagine 100 marbles in a gallon of water. The marbles represent the solvent. Now, dump out half the water. We still have 100 marbles of solvent but now only 1/2 gallon of water. which is like having a concentration equivalent to 200 marbles per gallon.

The brain is the first thing to go with dehydration -

People can last about 3 or 4 months without a calcium intake. This is because the body will take what it needs from the bones. The first step in saving calcium is that our body will stop excreting it.

Dx Imaging tutoring was interesting. I talked with our tutor after class about all the people who are taking the class over and she mentioned that she was surprised that so many people had to take it over and she was especially surprised because they weren't the people she would have guessed to have taken any classes over.

I think I understood what she meant. Sometimes one might get the impression that people aren't taking a class (or school in general) serious enough and therefore might not be too surprised if they have to repeat a class. Apparently, there were a lot of people who did take things seriously and are still repeating.

Who knows.

Heck, I think I still need to get some notes sent out to our class.

OK - notes are out - now it's almost 10 - can't wait to sleep!!! :)

Today's picture was obtained by Googling "Bundle Branch Block" (BBB). It's kind of a nice picture of the heart and I guess that's the EKG that's supposed to go with it. From the downward peaks and the picture it looks like a Left BBB which is life threatening while a right BBB is benign. Also looks like a heart rate of 75 bpm. :)

TRI-5, Wk4, Day 284

OK, I remember something we went over yesterday in Dx Imaging. It was a study done by a journal called Spine back in 1995 which compared various levels of MDs & DC when it comes to radiology.

Ø Survey Says ….

Groups % Accuracy

Chiropractic Radiologists 71.00
Skeletal Radiologists & Fellows 70.18

Chiropractic Radiology Residents 61.54
General Medical Radiologists 51.64
Medical Radiology Residents 44.64

Medical Clinicians 31.26
Chiropractic Clinicians 28.38

Chiropractic Students 20.45
Medical Students 5.74

Pretty cool Survey as Chiropractors got bragging rights in 3 of the 4 categories :) Also, the 5 radiologist that participated from Logan all scored 100%. The actual study may be found here; Spine vol 20 number 10 1995.

I did see some interesting things on some x-rays today including lung pleura and the abdominal aorta. These things basically appear as shadows on the x-rays but you simply have to know what you're looking for ...and ...having two of those people that scored 100% on the Spine journal study guiding you through things doesn't hurt either. ;)

I've got a handout with 22 EKG strips that need to be interpreted...

I actually am done with classes tomorrow at 12:50 but I'm going to need to hang around for Dx Imaging tutoring which runs from 3:45 to 5:45 so I'll be getting home tomorrow at 7 p.m. instead of 2 p.m. .....

oh well, it's part of my job and will help me to do my job better so that's what I'll do.

Today's picture shows an x-ray with paraspinal stripes which are the shadow outlines I mentioned at the beginning of the blog. This is a pretty cool picture and the stuff looks even better in person. We can also tell a lot about the x-ray by the level of the diaphragm. If the diaphragm is low and you can count all 12 ribs then it's a sign of asthma or COPD, maybe emphysema.

TRI-5, Wk4, Day 283 ....

I'm having trouble remembering what we did in school today - I know I've got some homework due tomorrow and we have our Physical Dx practical. I think I might have overdone the extracurricular activities last week with those 32 miles. Instead of having more energy, I've been wiped out. I know I nodded off in two different classes today ...definitely not the way to good grades.

I cut the after school walking miles down to 2.7 today and am heading to bed early tonight. :)