Do you suffer from chronic, relapsing SIBO or IBS? How about chronic pain or infertility? The answer could lie in addressing abdominal and pelvic adhesions using the Clear Passage Approach and Wurn Technique, a non-surgical drug-free treatment, developed by Larry & Belinda Wurn.
If you suspect you might have abdominal adhesions, click here.
Dr. R’s Fast Facts
- Recurring SIBO or IBS; abdominal pain, bloating, constipation and/or diarrhea
- They can cause:
- Igenix, Advanced Lab, Infecto Labs, Armin Labs
- Infertility, endometriosis
- Other chronic pain or dysfunction
- Adhesions are generally not found in testing and require a manual evaluation to be identified.
- Treatment usually involves 5 days of intense treatment (non-invasive), 20 hours over 1 week.
- Those with SIBO should be treated for SIBO before and during this therapy.
Larry & Belinda Wurn intro…..4:08
Common conditions improved by clearing adhesions…..6:20
Key things to look for in health history to diagnose adhesions…..9:56
Symptoms of a pelvic or an abdominal adhesion…..11:42
Treating SIBO and adhesions…..15:27
The Wurn Technique…..19:09
Qualifications of Wurn trained therapists at Clear Passage…..37:22
- (40:12) Larry and Belinda Wurn http://www.clearpassage.com/
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Abdominal Adhesions; an Overlooked Cause of SIBO, IBS, Gut Pain, Infertility and More with Larry & Belinda Wurn
Welcome to Dr. Ruscio Radio, discussing the cutting edge in health, nutrition, and functional medicine. To make sure you’re up to date on this and other important topics, visit DrRuscio.com and sign up to receive weekly updates. That’s D-R-R-U-S-C-I-O.com.
The following discussion is for educational purposes only and is not intended to diagnose or treat any disease. Please do not apply any of this information without first speaking with your doctor.
Now, let’s head to the show!
Dr. Michael Ruscio: Hey, guys, this is Dr. Ruscio, and before we go into our fast facts, I just wanted to let everyone know that I will be teaching a seminar in London that I’m really, really excited about. It’s a two-day event, January 16 and 17, in London with Melissa Hartwig and myself.
Day one will be a split between Melissa talking about the Whole30 Program and all the great stuff that entails implementing the Whole30 and how to navigate that and just the great program that she’s put together there.
The second half of day one I will come in with what are some first steps someone should go through if they’ve been on a healthy diet like Whole30 and they’re not able to respond fully. This is pretty much what I do in the clinic all day, so I’ll just be expanding upon that.
What I’m really excited about is the second day, which will be an even deeper expansion on all these issues in gut and with a little bit of expansion on thyroid. The second day is geared toward a more educated layperson or a patient who’s suffering with nonresponsive problems or, of course, a healthcare professional. We will be offering continuing education credits for that day, and some of the gut stuff should be really, really helpful. Of course, you’ve heard me talk about all sorts of gut “stuff,” to put it loosely, from testing to microbiota to treatments, so I’ll help outline what some of the most common causes of digestive problems are, what testing you can use to figure that out, and that is oftentimes much easier said than done, so knowing how to perform the right tests to get the right diagnosis and also doing it in a cost-effective manner is really what we’re going to be going after.
Another thing that I’m really excited about is a review of all gut and microbiotal interventions. If we’re talking about probiotics or prebiotics or fiber or FMT or fasting or an elemental diet, what kind of effect do those interventions have for things like IBS, IBD, weight loss, thyroid problems, celiac? I will break all of this down so that you will know for what condition you have—or for what conditions your patients have—what treatments are the most viable and the most validated. Then, of course, we’ll wrap that all together with an algorithm, if you will, or putting-it-all-together kind of action steps as to how to sequence this stuff. That will be about 60 percent of day two.
Then the tail section of day two will be on thyroid, something I haven’t talked a lot about lately on the podcast because we’ve been so inundated with gut stuff, but there’s certainly some very important thyroid stuff, as I’m sure many of you have heard me talk about awhile back regarding thyroid diagnosis, types of thyroid problems, and a simplified model of thyroid disorders. We’ll cover subclinical hypothyroidism, which is a pretty important issue. We’ll talk about iodine and give you some simple, straightforward treatments to navigate through thyroid.
I’m really, really excited about this. If you’re in the UK, I hope you can make it over to London to check it out. If you see the transcript, you will see the link for this, and if you’re just listening, if you google “Re-FIND Health” and then “Michael Ruscio,” you’ll see my name come up. Hopefully this will be something that some of you can attend, and I think it’ll be very well worth it.
OK, now we’ll jump into the fast facts. Thanks.
Dr. Michael Ruscio: Hey, everyone. Just wanted to give you your fast facts for a really great episode on abdominal adhesions as being a real problem for people with chronic health issues. We had the Wurns on to talk about this topic, so here are your fast facts.
Abdominal and pelvic adhesions, which are essentially scar tissue, can form after surgery, trauma, infection, or inflammation.
When they form, they can then cause recurring SIBO or IBS as they impede on the intestinal tract and can prevent proper motility, and this, of course, can manifest as chronic or relapsing abdominal pain, bloating, constipation, diarrhea, or both. They can also cause infertility and endometriosis or other chronic pain and dysfunction that’s abdominal or pelvic in nature.
Now, it’s important to mention that adhesions are generally not found on testing and require a manual evaluation to be identified, so say, you had an endoscopy or colonoscopy, many times these things are not found on typical imaging studies.
Now, the treatment usually involves five days of treatment. Usually it’s fairly intensively applied. Five days, about 20 hours over those five days, and it’s completely noninvasive. It’s essentially like a deep massage of the abdomen or pelvic area to break down and free up these adhesions.
And how it relates to those with SIBO is if you have chronic and relapsing SIBO, then one of the factors to be ruled out could be abdominal adhesions that could be impairing motility and causing this chronic SIBO. So for those that have had a history of abdominal or pelvic surgery or trauma, this is something to look into. Now, you don’t have to have surgery or trauma. This can even happen from inflammation in the intestines, and you may not even be aware of the inflammation, so I think for anyone with chronic SIBO this is something to think about.
Now, I should also mention that this is not a preliminary therapy for SIBO. This should only be done after SIBO has been dampened or treated down to the lowest level you can get it, and one should be administered antimicrobials while undergoing the Wurn therapy of the Wurn protocol. We expand on this in the episode. It’s a very, very interesting topic, and I hope you guys will enjoy it. OK, thanks.
DR: Hey, folks. Welcome to Dr. Ruscio Radio. This is Michael Ruscio. I am here today with two guests—I am very excited to introduce and share their work—Larry and Belinda Wurn, who I originally heard of and met at last year’s SIBO Symposium. They have been doing some very interesting work in abdominal adhesions and how these abdominal adhesions may, to put it loosely, impede intestinal motility and leave one open to recurring gastrointestinal issues and more specifically, recurring SIBO. I wanted to bring them on and get a chance to kind of pick their brains because, I think, for some people this may be the missing piece to really overcoming SIBO. So, Larry and Belinda, welcome to the show and thanks for being here.
Belinda Wurn: Thanks very much for having us, Mike.
Larry Wurn: Thank you, Mike.
Larry & Belinda Wurn intro
DR: So can you tell guys listening a little bit about your background and kind of how you stumbled across this association?
BW: Sure. I’ve been a physical therapist since 1975, and about 31 years ago, in 1984, I developed cervical cancer. They were very aggressive with me with a lot of external and internal radiation therapy, which killed the cancer but threw me into menopause at 33, and I became a chronic pain patient for about a year and a half. I got tired of the typical allopathic answers that I got to how I could get out of pain. I got really tired of hearing it was all in my head or I had to learn to live with it, so that started me searching me for alternative answers. So I started getting treated with therapists that did different techniques that I read about in PT publications and started studying with whoever helped me. Then Larry got tired of me traveling, so he started studying with the same people and kept treating me and got me out of pain and ready to go back to work. That’s when we opened our first private practice in ‘89.
DR: Gotcha. So you had a very firsthand experience with all this?
LW: Absolutely. Yeah, the thing is that Belinda was diagnosed with frozen pelvis or frozen abdomen. Basically everything was adhered together. Nothing moved. The doctors said—you know, adhesions form whenever we heal from anything and from inflammation, incidentally, which is one of the reasons I think we help with SIBO—but they said, “Well, you really don’t want us to do surgery there because it’s low down in her pelvis. You don’t want more adhesions there. You’re just going to have to learn to live with the pain,” and we weren’t content for my dear wife to live in excruciating pain for the rest of her life, so we started developing our own work to do to treat adhesions, not really thinking of all of the ramifications and all of the conditions that we’ve run across in the last 30 years of treating adhesions.
Common conditions improved by clearing adhesions
DR: That’s maybe a good time for you to outline some of the common conditions that you see improve from doing this work, from clearing these adhesions. Of course, SIBO is one, and I think a lot of our listeners are going to be very interested in the SIBO piece, but I think much of your work was before you even stumbled across the SIBO association, so can you share some of the things that can be aided by clearing abdominal and pelvic adhesions?
BW: Yeah. When we first started treating people, we were treating complex chronic pain patients, people with headaches, neck pain, back, pelvic pain, endometriosis. And within the first year of our practice, we were treating a workers’ compensation patient who had a slip and fall, and she also had had a fibroid myomectomy surgery. She asked if we could treat her scar, a keloid, it was really lumpy and bumpy, and she came in one day and told me she was pregnant. Apparently she had had blocked Fallopian tubes, and apparently the work that we did opened those up. So that was a big surprise.
Then just over the years through patient feedback, we’ve helped people with severe endometriosis. I, subsequently after my radiation, years later developed two total bowel obstructions and had to have about 3 feet of my small intestine removed, so we’ve been treating people with bowel obstructions and been able to prevent them from having to have further surgeries.
Yeah, so it’s been a very interesting progression over the years just through patient feedback that arouses our curiosity.
DR: Absolutely. One of the things that really impressed me about your work, and I know my listeners understand this about me, is that I really appreciate the fact that you guys have published quite a mass of published studies. You’ve really done an excellent job, and I should probably take this second to just commend you for doing that, but I was incredibly impressed with the amount of published literature you guys have published, which I think helps clinicians and patients undergo or recommend therapy with much more confidence because you guys have really done a great job or scientifically documenting this stuff.
LW: Thank you very much, Mike.
BW: Thank you.
LW: One of the things, in the beginning, we got tired of physicians saying, “Well, there’s really nothing that shows that your work helps anyone”—
LW: —and then sending us their most complex patients. And then the other thing that happened was that people would come to us and say, “Since you started treating me for this, this is better,” whether it was endometriosis pain or intercourse pain or stuff like that. And when we’d get enough of those, the chief of staff at the hospital got quite fascinated with us and said, “Let’s do research on this.” So when we got eight or ten of those kinds of cases, we would start developing data and then got some biostatisticians involved at the medical school here by the University of Florida who started developing studies for us, so we kind of got into this rhythm, saying, you know, I like being able to look people in the eye and say, this is what we can do, this is what we can’t do, this I’m not sure about.
LW: It has gotten us used to getting good data and being able to just, feet on the ground, look somebody in the eye and say, “Yep. This is what we got, and this is peer reviewed,” and so forth. So thanks.
DR: I love it. Thank you.
Key things to look for in health history to diagnose adhesions
DR: Now, if you can provide these, what are a few kind of key items during history someone may want to be on the lookout for for having abdominal adhesions? To say it loosely, one of the things on my new patient paperwork is a question about, is there any history of abdominal surgery, abdominal trauma, abdominal scarring, or pelvic surgery or scarring? Can you provide some key tip-offs that this might be something that someone wants to investigate?
BW: Yeah, absolutely. The primary things that we look at in a patient’s medical or surgical or trauma history are, have they had a surgery in the abdomen or pelvis? Have they had a trauma—a car accident, getting hit directly in the abdomen, playing volleyball or soccer? Infections—vaginal infections, bladder infections, prostate infections. Any inflammatory conditions like endometriosis, Crohn’s, colitis. And radiation therapy. Adhesions form as a natural part of the healing process after all of those, and the way the adhesions form is sort of like a spiderweb. They can start sticking to anything and everything in the vicinity, causing pain and different kinds of symptoms, and also decrease the ability of many of the organs to function at 100 percent efficiency.
DR: Sure. That certainly makes a lot of sense, and I think it’ll be somewhat easy for someone to recollect if they’ve had an impact trauma or a surgery or an inflammatory condition, so that part seems pretty straightforward.
Symptoms of a pelvic or an abdominal adhesion
DR: This also may be straightforward, but I just want to ask the question. Are there any keynote symptoms that someone may have a pelvic or abdominal adhesion?
LW: Well, yeah, certainly pain, bloating, distention.
Just to go off on what Belinda was talking about, when we first met with SIBO physicians, they said, “Well, we’ll be on a lookout for people that have had surgeries because surgery is the primary cause of adhesions.” And then about two months ago, this woman came in and her abdomen and pelvis were totally adhered. I mean, when you went to put your hand on her, it felt almost like a football. It just wouldn’t sink in at all. We looked at her history, and she had had no surgeries at all and no trauma at all that she could recall. Well, there must be something that’s the cause for those adhesions. She had had SIBO for 15 years. So the very inflammation, the fact that those bowels were inflamed for that long and for so much of that period, the body’s first reaction was to lay down adhesions.
I don’t know that that actually answers the question that you asked, but I thought it was probably worth mentioning.
DR: No, that’s very interesting, and it’s certainly not a far-fetched concept that if there’s even inflammation in the intestines, like in IBD, for example, that can form stricture over time that can impede the intestinal lumen. So certainly just having internal inflammation, we’ve seen that documented in other conditions to potentially impede the intestines and impede motility and to cause problems.
I like that additional piece because I think using all this information, where do we place this sort of assessment? If you have a different outlook on this, please, let me know, but the way I look at this is if someone has gone through initial therapies, let’s say they’ve tested positive for SIBO, they’ve cleared or greatly improved their SIBO, but it keeps coming back, and the clinician can’t figure out why, if you’ve gone through the initial therapeutics and then this becomes recurrent or non responsive, that’s when I think this is a great next step in terms of an evaluation. Would you agree with that sort of sequencing?
BW: Yeah, absolutely. We were contacted by Dr. Allison Siebecker and Dr. Steven Sandberg-Lewis at the beginning of this year because they put their heads together with us and it made sense to them and to us that if people have SIBO that’s treated and it goes away but it comes back, usually it’s because they have a history of some sort of either surgery, trauma, infection, or inflammation that caused adhesions that are blocking the small intestine, keeping that bacteria from being able to get out of the small intestine where the overgrowth doesn’t belong.
DR: Right. That makes perfect sense, and I think a way we can think about this is certainly there could be something from history that would put someone at risk for this, but to Larry’s earlier point, there also may be nothing from the history but an internal inflammatory condition that the patient may not even be aware of that may cause these adhesions. So I think if we put this kind of in the algorithm for something that’s a primary suspicion after someone has failed out of the frontline therapies or initial therapies for SIBO, that’s where I think this makes a lot of sense, and it sounds like that’s what you guys are seeing also.
Treating SIBO and adhesions
DR: You also had mentioned something, which I agreed with theoretically, that you prefer to see someone at least have their SIBO initially treated and at a lower or the lowest possible level before undergoing your therapy because you’re concerned about potentially liberating these pockets of bacteria and causing problems if someone doesn’t get the SIBO somewhat under control before undergoing your manual work. Is that correct?
LW: That’s right. In other words, we are an adjunct to the medications, whether they are herbal or pharmaceutical antibiotics. We don’t kill the bugs that are in there. The problem—that you alluded to, and you said it perfectly, I think, Mike—is that the physicians can prescribe medications that can knock down the bugs, the intestinal bacteria, but then they’re stuck in there and they can’t get out. Then it recurs.
LW: That’s what happens. Our first case was very dramatic. Would you like to hear about her?
DR: I’d love to!
BW: OK. When we first learned about this, we had a patient who came to one of our facilities; it wasn’t even at our home office. She was under the guidance of a SIBO specialist physician, and the medications would knock down her SIBO, and then a few weeks later, it would recur. And in her case, it was very serious. The bacteria were actually consuming her food and she wasn’t getting her nutrition. She was down to about 84 pounds. Then she came to one of our Clear Passage clinics. We treated her, and the physician continued to treat her with antibiotics during and after treatment, and suddenly all the bugs were gone, and her weight went back up. She’s 126 pounds now. She’s normal, she’s healthy, she’s cured. Her physician got in touch with some other physicians, and they got in touch with us and said, “Hey, we think that you may be the answer for a lot of these patients who have that kind of history, where the SIBO maybe responds to the medication but then comes back.”
DR: Exactly. I’ve referred, to date, two patients to a local provider who does the Wurn protocol. I just recently came across your work, so I can’t say I’ve heard back from these patients yet in terms doing the therapy and seeing the post-treatment results, but I am really curious to see what kind of results these people have. Again, you guys have done a good job of scientifically documenting this, so to your earlier point, I don’t have much trepidation making the referral because you’ve done a great job of going through the rigors of having this stuff peer reviewed and published. Yeah, I share the excitement to hopefully help my patients get to the same relief that you described for this gal here.
BW: Yeah, we hope so. And just so you know, we have a PhD researcher on staff at our home office in Florida, and she is compiling… we send follow-up questionnaires to all of our patients post-treatment, so we are going to be putting together a SIBO study, hopefully sometime in the next year.
DR: Great. Will you, please, let me know when that’s ready to publish or when it does publish and maybe we can have you guys back on to kind of outline that study?
BW: Oh, absolutely.
DR: That would be fantastic.
The Wurn Technique
DR: So can you tell us a little bit about what the therapy looks like? Let’s say someone is listening to this and they’re saying, “Wow, that sounds like me, that sounds like me, that sounds like me.” We’ve given them kind of an outline in terms of when this would make sense to do from a sequencing perspective, and let’s say now they really want to try and go do it. What does it look like, and what might their next step be in undergoing the therapy?
LW: Well, first we’d want them to complete a medical history questionnaire. We’re going to look at it. We’re going to have our PhD look at it. She has two postdoctorates and is a specialist—she’s quite brilliant—in disease modeling. She looks at their questionnaires, and if she has concerns that there may be an ongoing inflammatory process that would be flared up by treatment, we’re going to first request that patient get a CBC with differential and see what the white blood counts are doing. We’re going to pretty thoroughly screen patients because we want to help. If we can’t accept you now, we’re going to make some suggestions of what you need to do so that when you come in we’re just treating the adhesions and we’re not spreading anything.
DR: Now, is SIBO included? If you suspect SIBO and some of the telltale IBS/SIBO symptoms, are you referring for a breath test also?
BW: Most of them have already had the breath test, and we definitely look at the results.
BW: Yeah, Dr. Rice is making sure that their white count isn’t elevated. Again, she wants a recent CBC with differential and a complete metabolic profile just to make sure that the patient isn’t in an active inflammatory phase such as if they have Crohn’s or colitis.
DR: Right, and I understand you guys aren’t necessarily a medical clinic, so you can’t do everything there. I just want to make sure to outline this clearly for people listening because I know sometimes people get excited about something new and then they might want to run out and do it prematurely. So I guess this is a good chance for me to reiterate, if you have symptoms of IBS—gas, bloating, constipation, abdominal pain—and you haven’t yet been tested for SIBO, that should come first before undergoing therapy with the Wurn protocol.
LW: Absolutely. And then we’re going to kind of walk them through the process. We’re not, like, gungho to get you in. We’re gungho to get you better and to give you accurate information, so we don’t charge for consults or stuff like that. We’re going to walk patients through and make sure that they’re appropriate for therapy. Once we’ve determined that they have SIBO and are working with their physician, we will generally request that physician start a course of low-dose antibiotics about three days before we start treatment and continue that course through the week of treatment. Most patients fly in for therapy to one of our locations, and we have about eight of them now from the West Coast to England. For most, we’ll do two hours of therapy in the morning and two in the afternoon for five days for 20 hours of therapy, and all of our studies are based on 20 hours.
LW: If someone really has a long history of adhesions or numerous surgeries, in some cases we may suggest that they either come back or that they stay for two weeks, but we don’t push them. Similarly, in other cases we may say, “You know, I think in your case we’re going to be a little bit better to spread things out, maybe two hours a day instead of four hours a day.” We look at that pretty scrutinously to help design a course of therapy that is the most appropriate for each individual.
DR: And when you’re doing the therapy, I’m assuming you’re, of course, getting in there with your hands and you’re manually breaking this down, but can you share any more of what the specifics look like, what the recovery looks like, just so if there’s someone who’s considering undergoing this or a physician who’s considering making a referral, you can give people listening a little better idea of what it looks and feels like?
BW: Yeah, sure. First of all, all the organs in the abdomen and pelvis should be free to move freely over and around each other as they function, depending on what body system they’re in, but also as we do all our daily activities. What happens when there are adhesions is things get stuck together, causing pain and the bloating and the distention and the different kinds of symptoms. So we do a regular physical therapy assessment, looking at posture and looking at where things might be being pulled from surgical scars, and then we do a very detailed palpation, feeling and checking all the organs in the abdomen for restricted mobility as well as motility, and we check for restricted mobility of soft tissues throughout the body but especially, obviously, in the abdomen and pelvis. And wherever we feel restricted mobility of the organs or the tissues, we’ll focus on those areas, just gradually stretching things and detaching the adhesions and deforming them. By gradually restoring improved mobility, motility improves and pain symptoms start to decrease and get better, and the organs are able to function more normally because they don’t have all these tensions and pulls pulling on them.
Some patients get a little sore after treatment or fatigued, so we suggest patients drink a lot of water while they’re getting treated and throw two cups of epsom salts in a hot tub and soak for about 20 minutes every night they get treated, and that can help minimize any fatigue or soreness posttreatment. Then we teach them a home program and some self-treatment techniques to help maintain the improvements that they gain with our treatment.
DR: Great. And I’m sure this is clear, but just in case anyone listening is a little confused—and correct me if I’m wrong—this is completely noninvasive, nonsurgical. There’s no cutting. This is all just manual therapy done on the outside of the skin kind of like a massage—of course, different—but that’s similar to the kind of contact people are going to be experiencing, right?
LW: Right. People say it’s like a very slow, deep massage. We’re very site specific to adhered areas. People that are very delicate we’ll start really easily. We like to stay within each person’s tolerance level, of course, but it is a very slow and deep freeing, often a stretching, of the organs away from each other. If you think of a run in a sweater, it may be a good comparison because when adhesions form, they consist of tiny strands of collagen, like little strands of a nylon rope, that lie down upon each other in a random pattern. That’s what forms to help start the healing process. When we’re treating, we’re really shearing apart those strands from each other in a very slow and deliberate fashion, detaching the cross-links that have attached to each other, the little building blocks of adhesions, so most of the work is external. Sometimes there will be a reason to consider treating internally, either vaginally or rectally. We certainly never push anybody into that, but if we feel like there’s indication of that, we will say so and then it’s that person’s choice, but most all of the work is external, and in many cases, that’s all there is.
DR: Gotcha. Is there anything else regarding interesting SIBO cases that you’d like to share?
LW: Well, I talked to our PhD just before we spoke to you so I could give you whatever information she had, and she said we’re getting really good responses as far as decreases in diarrhea and bloating and distention and—
LW: —pain decreases. She said we don’t have data yet. We don’t have numbers yet. This may be an interesting one: Part of what happens in some cases with SIBO patients and patients who have had surgery is after a while those adhesions form and they can actually close the bowel, and people get bowel obstructions. If a bowel obstruction is a total bowel obstruction or even partials, they end up going to the hospital. “Let me put an NG tube through your nose into your stomach, let me give you IVs for hydration and pain, and let’s just wait and see if that clears. In quite a few cases, it does not clear. If it doesn’t clear, we’re going to do surgery.” The average hospital stay, according to the Centers for Disease Control, is a little over 14 days. If they do have a surgery, 18 percent of them—about one out of five—return to the hospital for another surgery within 30 days. In a lot of cases, that’s because a little bit slipped out when the surgeon was taking out the part of the bowel that had become necrotic or was bad and a little bit of the contents of the bowel slipped into the interstitial spaces of the body, so then they seal them up and that starts to grow again, and now we’re looking at peritonitis. And then at the end, the surgeon says, “Well, we’re done with that. That was great. Here’s my card. You’re probably going to be calling me again because bowel obstructions recur in about 35 percent of patients.”
One of the things that started happening after we started opening blocked fallopian tubes is we started opening larger tubes, clearing tubes for people with bowel obstructions. We do have really good data. We just addressed a large group of 15,000 gastroenterologists in Washington, DC, so we have good data. Our return-to-surgery rate is 3 percent now, where the normal return-to-surgery rate is 30 to 35 percent.
DR: That’s great.
LW: So for those patients, we have developed—and we will do this for the SIBO patients as well—a good understanding for each patient of what’s going on, what is it about adhesions, and we’re going to give them a home maintenance program that’s not very difficult to do but it’s very empowering to know that they don’t have to go through this anymore, if their problem has been bowel obstruction—and it is for some of these SIBO patients. So there’s something for you.
DR: That’s great, Larry. Congratulations! A 27 percent reduction is pretty significant!
BW: Thanks. Dr. Rice and all of our therapists developed a tool that can be used by anybody for bowel problems, and actually a lot of the questions apply to SIBO patients. This is our validated questionnaire tool.
DR: I see. OK.
LW: In order to actually publish results about bowel obstruction we had to first create a questionnaire validated by a biostatistician and then by a group of peer reviewers to create a sort of a test that we can give to somebody, saying, “Over the last 30 days, how many days were you on a liquid diet?” and so forth. There are 40 questions. We give that to patients when they first come in, and then we’ll give it to them four months later, and then we’ll give it to them a year later. That way we can get long-term results on our patients.
DR: I agree. I have the same affinity for tracking in my practice. We have two studies right now in SIBO running, and we’ve been working with a PhD also to develop a pre/post assessment that both looks at IBS symptoms and general quality of life, and we’re administering those now fairly routinely pre- and posttreatment because I really want to get a sharp sense of how much these things work, or if we’re comparing a new treatment to an old treatment, what is the difference between the two.
It’s just really a breath of fresh air to see this being done with your work because one of my criticisms of this more kind of progressive medicine, integrative medicine space is sometimes things are done and really lofty claims are made, but there’s very little substantiation. I oftentimes am quite concerned that the clinician or whoever has fallen in love with a certain idea and now they’re just very strongly placebo-ing themselves into seeing an association that’s not really there, and then that lets a lot of patients down when they try a certain treatment and don’t see a certain result.
DR: Again, I love what you guys are doing because it just helps give any doctor—or hopefully, any patient—so much confidence in what to expect with a therapy when you go through the rigors of documenting it like this. So again, thank you, guys, for doing that. That’s great.
BW: Well, thank you for doing it as well. It would be interesting to compare our assessment tools.
LW: Yeah, we should get together sometime.
BW: We should get together on them. Yeah.
DR: Will you guys be at the SIBO Symposium this coming year?
LW: I’m sure we will.
DR: We’ll have to make it a point to connect when we’re both there because I’ll be there, too.
BW: Great! Yeah, it’s June 4 and 5.
LW: And, Mike, good for you because you know—because you’re doing this as well—just how difficult it is to create clinical research and publishable research and to gather data and how long it takes. Sometimes it’s as exciting as watching paint dry.
LW: But when we actually have results that I feel I can stand on my feet and say, “This is what we do,” it’s breathtaking. So good for you.
DR: Thank you, guys. Thank you.
BW: That’s great you’re doing it, as well.
DR: Yeah, I think there’s a big need in this space for us to start documenting these things because there are a lot of therapies, natural and progressive therapies or manual therapies, therapies that are not in the standard treatment box, that are effective, and we just need to document those and also be open to the fact that, hey, some of the stuff that we’ve been doing may not be effective and that’s OK. That’s what we have science for! To help us determine what’s effective and what’s not effective. Then you stop doing what’s not, you do more of what is, and that’s how something progresses to become better. Yeah, I’m glad that we’re both, hopefully, on the forefront of our own respective areas in that regard.
LW: That’s right. Our PhD really impressed us in the beginning as we saw she had been awfully busy. I said, “What have you been doing?” because I had been busy myself, and she said, “Well, I just went through 1400 files of infertility patients you’ve treated, divided them up per diagnosis of blocked fallopian tubes, endometriosis, PCOS, unexplained infertility, hormonal conditions, and I’ve compared them with surgical and pharmaceutical techniques with the standards and created a comparison. We have 300 people in this category and 400 people in this category, and now you can stand back and you can look at it and you can say, ‘Oh my gosh, that’s remarkable.’” It’s so much better than someone saying, “Oh yeah, I get good results with that,” but then not having anything to stand on.
DR: Exactly. She sounds like a real gem.
LW: Oh, she’s incredible.
BW: She is, yeah. She’s scary smart!
DR: Good! So I have another question now that I’m wondering what your thoughts are on. One of the things that if I were a patient I would be wrestling with… Well, let me take a big step back and say—and, please, correct me if I’m wrong—you have have your clinic in Florida, and then you also have others that you’ve trained that do this all over the United States.
Qualifications of Wurn trained therapists at Clear Passage
DR: One of the things that I’d be wondering as a patient would be, “Well, is someone that’s been training, is that going to be as good as going there? Can I get away with going to the person that’s an hour-and-a-half drive away if I feel like I have a really severe case, or would it be worth me flying to Florida?” And I know it’s probably hard because when you train people you’re going to have all different levels of skill and aptitude, but for someone wrestling with that question, what would you say to them.
LW: Well, we’re going to tell them straight whatever we think, but we don’t just decide, “Well, hey, we need to open in New York City,” or, “We need to open in wherever.” We look around to find therapists that are highly skilled. This week we happen to be training two. One is from San Diego with 39 years of experience. One is in the San Francisco Bay area near you, and she has 26 years of experience, or 27. Our therapists average about 27 or 28 years of experience, so we don’t train spring chickens. We have a really strict protocol when we do train and certify someone, and we’ve turned down a lot of people. As a matter of fact, we turn down most people.
BW: We’re very particular about the therapists that we even accept to go through our clinical internship training program. Like Larry said, they have to have a certain number of years of experience, they have to love doing manual, hands-on work and have a certain number of years doing it, and they have to have good hands.
DR: Well, that’s good to know.
BW: Yeah. I got in a bad car accident in 2001 and started writing a therapist training manual, and it turned into a four-year project! Five hundred eighty pages later, we hired artists to do original anatomical drawings, and we purchased the right to use Netter’s Atlas of Human Anatomy, the colored plates, and we had another artist do drawings of the hand placements, so we put together a clinical internship training program. It took a while to design it, but it seemed to work, and before we certify therapists, we have to all agree that we feel they’re doing the techniques as close to how we would do them in Gainesville before we certify them.
DR: Great. I’m sure that’s very reassuring for people. Man, I haven’t heard Netter’s Anatomy since back in school. You’re bringing me back now a number of years!
DR: Now, if someone wants to find these referrals, is there a database listed through your website of practitioners that you’ve trained?
LW: Yeah, you can go to our Locations page, and it’ll give you the name of everyone. Our website is ClearPassage.com (1a), just all one word, and if you go to our Locations page, you can see not only every single therapist, they’ll be a video of them so you can kind of meet them beforehand, and also where patients travel from. There’s a little picture with a world map. I don’t think it’s updated quite yet.
The website also takes you through different conditions. SIBO is listed there. Bowel obstruction is listed there. A thorough explanation of adhesions. There’s a testimonials page with videos from people with all of the various conditions or with a variety of conditions. I think the entire website is maybe 500 or 550 pages, so it’s quite extensive. It’s designed to be able to educate yourself to say, “Does this make sense to me, or does it not make sense to me?”
LW: Thereafter, on every page of the website, you can click a little button that allows you to apply for a free half-hour consult, generally with Belinda here, but certainly with one of our trained therapists. It’s either Belinda or probably one of our trainers.
BW: Dr. Rice, our researcher, also schedules free phone consults with patients on Tuesdays and Thursdays. Especially if they have really complex histories, we really like her to talk with them as well as me or one of our therapists.
DR: Gotcha, and we’ll put the website link in the transcript that goes along with this page.
DR: As I’m just flipping through your website, I see an insurance button. I know insurance is a hard question to answer, but is insurance coverage generally pretty good on this? Is it so-so? What have you guys found with that?
LW: We see it all over the board. Some insurance pay for 100 percent. Some pay for none. Most pay for some. More and more, the insurance companies want physical therapists to be treating several patients an hour, so they don’t like to pay for individual coverage, but you can petition. That insurance page kind of tells you what codes we’ll be billing and how to have a conversation with your insurer before attending so you’ll get a pretty good sense of whether or not you’ll get coverage and how much.
DR: You guys have really thought of everything, it sounds like.
BW: We’ve tried!
DR: Practice makes perfect, I guess, right?
LW: It’s been a few decades now.
DR: So to bring us to a close here, is there anything else that you feel is important to mention for someone listening to this?
LW: You know, we seem to do well with the things that nobody else is figuring out because adhesions do not show up on any radiological test. They don’t show up on x-ray, CT, MRI, ultrasound. Doctors tend to dismiss them or not even notice them, so if your physician tells you it’s all in your head, but you know it’s not, then you should probably call us and let’s have a conversation. It doesn’t cost you anything, as I said, for any of these conversations. We like educating people. Do you have anything to add to that, Belinda?
BW: I can’t think of anything else. Adhesions are soft tissue, and the radiologic tests usually show up solid things—tumors, cysts, fibroids. So, yeah, if patients have had multiple radiologic tests done and the doctors say it’s normal, and they have pain and they have a history of adhesions, they probably do have adhesions.
LW: And then finally, just look at your history and think, “Did I have a severe fall on my bottom? What kinds of traumas have I had? Was a flyer when I was a cheerleader?”—all of those things.
LW: Once adhesions form in the body, once you’ve been injured and adhesions form, after about 10 days they stay in your body, the ones that have remained there. They’re with you for life, and they either stay the same or they grow, so that if you have weird symptoms or unexplained symptoms, you need to look back at your history and say, “Did something happen to me back then? Oh, yeah, that’s right. I remember when I fell skating,” or whatever.
BW: Also a history of abuse, physical or sexual abuse, causes a lot of pelvic adhesions, unfortunately. It’s pretty common.
DR: All right, so there’s definitely a lot for people to think about in this area. I’m really happy that we were able to have you guys on to showcase this because I think this is potentially a big miss for a lot of people that may be suffering with chronic abdominal issues, whether they be IBS related or SIBO related or just pain. I’m happy that we had a chance to have the discussion, and if people want to track you down, it’s just ClearPassage.com, right?
LW: That’s it.
BW: That’s it.
LW: Thank you so much, and we compliment you so much for your website and for bringing information from various healthcare professionals to your audience.
BW: Yeah. Thank you very much for having us.
DR: Thank you, guys. It was a pleasure. Please, let me know when you’re getting ready to publish your SIBO study, and we’ll definitely have you back on.
LW: OK, great.
BW: Great! Absolutely.
DR: All right, guys, thanks again. Take care.
BW: You, too. Bye bye.
DR: Bye bye.
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If you suspect you might have abdominal adhesions, click here.
What do you think? I would like to hear your thoughts or experience with this?