Abdominal Adhesions Can Cause SIBO, Bloating, and Constipation

Intro:

Welcome to Dr. Ruscio radio, providing practical and science-based solutions to feeling your best. To stay up to date on the latest topics as well as all of our prior episodes, make sure to subscribe in your podcast player. For weekly updates visit DrRuscio.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.

DrMichaelRuscio:

Hey everyone. Today I had Larry and Belinda Wurn back on the show. They are with Clear Passage and were on the podcast a few years ago to discuss adhesions or formation of scar tissue in the abdomen and pelvis. Adhesions can cause things like recurring SIBO, abdominal pain, and constipation among a few others. This was a very insightful follow-up with them. They have published two additional papers since the last time that they were on. If you remember back, they’ve published a myriad of papers in peer review journals. Now they have one in one of the most prestigious journals, the World Journal of Gastroenterology. In addition to another case study that was also published in a peer-review journal. Long story short: prior surgery, prior abdominal trauma, or even something that seems as innocuous as just some prior inflammation in your gut or your pelvis can cause scar tissue to form that impedes the movement of food, can slow things down, cause overgrowth or ostensibly dysbiosis, abdominal pain, distension, bloating, and even constipation.

DrMR:

This typically will not show up on traditional imaging other than perhaps the finding of the intestinal lumen, the space in the “garden hose” that is the lining of your intestine, may be slightly narrowed due to some of this scar tissue formation. This is something that’s really piqued my curiosity even further, amongst other things, for nonresponsive patients with constipation and also nonresponsive patients with bloating. This is something that we do probe into via the new patient intake process at the Austin Center for Functional Medicine. There were a few key questions that we cover today that sharpen up some of the rationale behind making this referral. We have since added these to our intake process and it has helped me and the other doctors at the clinic better hone in on when is it the appropriate time and do we have adequate justification to make the referral for adhesion therapy. We have published one case study in our clinicians’ newsletter where this referral done at the right time was pretty much life-changing for the individual. So I just want to make sure to impress upon you, the fact that these conversations are leading to a gradual evolution of everything we do, not only here on the website, but also in our clinical process. If we can ask the right questions at the right time, we can help an individual get to the right care more quickly. Certainly if we can reduce the amount of time someone has to have symptoms, that is a big win. Remember that if you need a resource for how to navigate this, the clinic is there for you. I really hope you enjoy this conversation. Part two with Larry and Belinda Wurn from Clear Passage.

DrMR:

Hi everyone. Welcome back to another episode of Dr. Ruscio radio. This is Dr. Ruscio back again with Larry and Belinda Wurn who, if you remember back a few years ago we had them on to discuss their groundbreaking work in adhesions. Adhesions in the bowel and how these can cause, amongst other things, bacterial overgrowth. They’ve published a number of papers, but they have at least two new ones that they wanted to showcase today. So I’m very excited to have them back. I just want to lead by making sure to say they have published a number of papers. They’ve really done, I think, a huge service to the gut health community in the sense that they’re taking this somewhat esoteric, visceral bodywork concept, and really scientifically documenting how it can help people. I want to commend you guys both for doing that because you do make it much easier for a clinician like me to make a referral because you’ve gone through the rigors of documenting that what you do actually works.

LarryWurn:

Thank you.

BelindaWurn:

Yeah. Thanks.

LW:

It’s been a lot of work.

Background on Clear Passage

DrMR:

In case people haven’t heard that past episode, will you give our audience a quick primer on your background and what you guys are doing over at Clear Passage.

LW:

So some background. Belinda is a Summa Cum Laude, physical therapist. Over 40 years ago she graduated, developed cervical cancer and had a massive dose of radiation therapy, along with pelvic surgery 35 years ago. Developed frozen pelvis from adhesions. About a year later, doctors basically said we cured your cancer, you’re just going to have to deal with the pain for the rest of your life and we don’t want to do surgery there because in the private area of a woman’s body, we’re just going to cause more adhesions and more problems so just learn to live with it.

BW:

Or it’s all in your head.

LW:

I’ve known Belinda since she was two months old, we grew up together, always admired her brilliance. We said, well, we have to figure out what to do about adhesions. So we started taking courses, physical therapy and physiotherapy courses in Europe as well in America of anything that we thought could help adhesions and help decrease them nonsurgically. After treating her, we started treating people with adhesive pain and women with totally blocked fallopian tubes started becoming pregnant. We realized that we were opening blocked fallopian tubes. The chief of staff at the hospital called me and he said, Mr. Wurn, I’ve been a gynecologist/surgeon for 35 years. What in the world is this about opening blocked fallopian tubes? I handed him half dozen charts and he said I got it. You are doing things with your hands that I don’t think I could do surgically. He said “I’m an excellent surgeon” and I said okay. And he said, yeah this is remarkable. Are you doing any research? I said no and he said well, would you like to? I said well, yeah. I’ll be your medical director or research director and I’m not going to charge you a thing.

LW:

He eventually left the hospital and stayed with us for, well, it’s been 25 years now, I guess. After we published several studies on opening blocked fallopian tubes, people with bowel problems and bowel adhesions started calling. They would say I’ve had multiple surgeries in my abdomen or pelvis. I have pain. I have all these bowel symptoms, food won’t go through. Some of them had bowel obstructions. They would say, if you can open those little tubes, how about bigger tubes? How about the intestines? I responded truthfully I don’t know, but we’ll try. We started doing that and we’re doing very well at clearing bowel obstructions and adhered bowels. Just published in the World Journal of Gastroenterology, showing that we decrease bowel obstructions by 15 times the norm. Two of the authors on that were, Dr. Weinstock, who you know well, and a surgeon out of Harvard. She taught surgery for 20 years at Harvard and she’s now at Stanford. We were going along treating patients and a doctor called and said I wanted to thank you for saving our patient’s life. And I said, great. I didn’t know the patient as she was in one of our outlying clinics. So I asked, what was her diagnosis? He said she had SIBO. The medications we would give her worked for a short time, but then it come right back after a few days or a week or two. She was in a wheelchair. She was so weak in her thirties, down to 86 pounds, you treated her and suddenly the medications are working. What are you doing? Well, we’re treating adhesions in the bowel. What is SIBO? So that was Steven Sandberg Lewis. He flew across the country from Oregon to Florida. Met with us, and the chief of staff of the hospital and a researcher that we had hired to investigate and try to explain why we were having such success. We developed protocols for treating patients with longstanding SIBO, who seemed to respond to meds maybe for a short time, but it comes right back.

DrMR:

That’s fascinating. This was one of the main reasons why I was looking forward to having this conversation. You had said something before we started on the call, which I just want to echo, which is that some of the most adhesed patients that you’ve seen have had SIBO and have had no prior surgery. This poses both a challenge to clinicians in terms of if the prior history finding isn’t incredibly prognostic, what do we use? It’s also very encouraging in the sense that here is a potential item that is an underlying cause of recurrent SIBO. Just to clarify, one thing briefly here for our audience, I’ll state this as simply as possible, adhesions essentially are scar tissue. They impede movement of food through the GI, and when there’s an impediment of food moving through, that can cause both overgrowths and/or dysbiosis. That’s why these things are relevant. It’s also very interesting to hear that there are some patients who have these adhesions, who haven’t had surgery. How you thinking through that? Where do you think these adhesions are coming from? Is it predominantly inflammation or is it perhaps abdominal trauma? I mean, I’m not assuming many people are getting blunt force trauma to the abdomen. So how are you thinking through the etiology of this?

Adhesions and Medical History

BW:

Well, when we look at a patient’s medical and surgical history, we look for the four or five main things that cause adhesions. Of course surgery is a major one, but also trauma. We look at lifetime trauma cause it’s cumulative. Falling off your bike as a kid, falling during play or sports, car accidents, even fender benders, it’s all cumulative. Also after infections of any of the organs in the abdomen and pelvis, and also after any inflammatory conditions like Crohn’s, endometriosis, ulcerative colitis, after radiation, the body lays down adhesions as a natural part of the healing process. But the way the adhesions form is sort of like a spider web. So they not only heal any areas that were cut or traumatized, but like a spider web, they can and do start sticking to anything and everything in the vicinity. That can cause pain and many different kinds of symptoms. They can also decrease the ability of many of the organs to function at a hundred percent because the organs are being squeezed or twisted or pulled on.

DrMR:

One of the things that I’ve been doing in the clinic to help me make better referrals over to you guys, by the way, I should say that we’ve published at least one case study in our clinicians newsletter discussing a patient who we referred to Clear Passage for therapy. This was an absolute game changer for her. She was a bit easier to identify because she was kind of your textbook presentation. Chronic symptoms, multiple surgeries, only partial at best response to things like Rifaximin, anti-microbial therapy, probiotics. The adhesion therapy for her was literally life-changing. One of the challenges is if there are many things underneath the umbrella of potential causative factors present for an individual, it becomes murky in terms of, well, when do we make a recommendation? Because lots of people have probably had falls, some degree of inflammation, surgery is a little bit less common, but certainly for if we’re using just general trauma, falls and inflammation, as a screening, a lot of people get through that screening.

DrMR:

And there are a lot of referrals being made that potentially may not be necessary. One of the simple things that I’m doing is making sure we work people through a therapeutic hierarchy as I oftentimes harp about on the podcast where we go through some of the frontline therapeutics and even some of the more esoteric, maybe second line therapeutics first. Modifying their diet, modifying their lifestyle, always a foundation, probiotics, anti-microbials, potentially immunoglobulins, potentially prokinetics, elemental dieting and see how far we can get. Then, if we come up against this recurrence or partial responsiveness, that’s when a referral for adhesions makes more sense. Especially if we’re able to document one or a couple of surgeries, it’s very justified my opinion. If there have been signs of inflammation. Obvious signs would be a diagnosis of some type of inflammatory bowel disease, you know, less obvious would be certain symptoms that denotative of inflammation.

DrMR:

I hope this helps our clinicians in terms of where do you put this in your differential diagnosis? When do you want to make this referral? While we’re on that, do you have any advice for clinicians in terms of how to be thinking through when is the right time? If we could wave a magic wand and have a patient have every workup and referral at once, we would do it because it would be easy and convenient. But it’s not easy and it can be costly. So trying to have a sequence we work people through and certain guidelines they try to follow, I think is really helpful. Curious to get your thoughts there.

The Right Time to Refer

LW:

Well, you have to understand that just because we get a referral, we don’t accept that patient. We have a screening process ourselves that is quite extensive. We have the patient fill out a medical history form because we want to see if we can help. If we don’t, we’ll say so. There’s no cost to the patient for this, but we want him or her to complete the medical history form for us. We have a referral sheet with contraindications and cautions to therapy. We may want to get a CBC and see if there’s an inflammatory process, something where we might have to spread treatment out a little bit. So we’re pretty cautious and pretty clear about whether or not we’re going to accept a patient. That depends on whether or not we think we can help them.

LW:

So we can take a lot of the responsibility off of the referring physician, by just saying send them over and let them complete a history and let us talk with them. We may want to talk with the physician a little bit. We may order some tests or see what diagnostic tests they’ve had. We can pretty much tell them whether we can help them once we’ve gone through that process and once they’ve developed adhesions. We know what to look for. Does that answer that question?

DrMR:

Yeah. I think it does. Especially when combined with how I’m thinking through this. As someone who focuses on the application of the therapeutics for IBS, IBD, SIBO, when am I finding it from my vantage point an intelligent time to make a referral? I should commend you guys for doing a good job with screening that you do. One of the challenges I think many clinicians like myself grapple with is there are certain areas that we refer to where there seems to be this ethos “everyone has X”. I think this can sometimes be a little bit endemic in things like Lyme and mold. It’s also hard for the clinician because the diagnostic tools there are kind of hazy. It’s hard to screen using things like tests because many of the tests there are ambiguous. Knowing that the person you’re making the referral to is not going to accept every patient and kind of have the hammer nail mentality is really important to me.

DrMR:

I try to be very selective about the referrals that we make through the clinic, because the last thing I’d want to do is refer someone to a provider who’s overzealous, and then they end up spending time and money to get nowhere. I think clinicians can rest assured that you will go through your due diligence. It’s also fantastic that there is no cost associated with that early screening. That’s another factor for patients that is an issue. If it takes $1,300 to get to a no, while it’s helpful getting to the no, not having a big cost barrier to surmount to get there is also really helpful.

LW:

One of the things that may be appropriate for some patients, especially if they have constipation, but for some patients to do is to go through a small bowel follow-through test where you swallow what tastes like a malted milk, but it’s got a barium tracer in it. They x-ray, because remember Dr. Ruscio, we’re looking at a strictly mechanical condition here. It’s not medication related when it comes to our intervention. If they swallow this, the diagnosing physician, usually a radiologist will take x-rays as this barium goes through their body. It may take two hours. It may take six hours, but it’s not a very expensive test, but we can see if there’s narrowing anywhere in the bowel. That’s key factor. We published one study with a Crohn’s patient. Actually, she was scheduled for emergency surgery.

LW:

She had a stricture, or a narrowing, about three inches long in her intestines. It looked like a coffee straw. She had another narrowing, which is more common, that looked like an hour glass. The surgeon said, we’re taking you in and we’re scheduling you for surgery. She came to us first. So we happened to have before and after x-rays. It was one of the more recent ones that we published. This patient happened to have Crohn’s. She came to us before surgery and after surgery, then she did another small bowel follow through, and it was a normal bowel. So we could see clearly where we needed to treat and what was going on there. Then we treated it and we could see the effects of treating. So the same authors published that study. So,

DrMR:

Yeah, that’s really helpful because I was under the impression that most adhesions won’t come up on any type of imaging study. It sounds like there are certain imaging studies that have their merit. As you’re saying here, small bowel follow through. Is there anything else that one may want to consider either in tandem or in making referral over to you?

LW:

They do cancer MRIs where they inject a tracer into a vein. So there’s other imaging that can see, not the adhesions, but they can see the effect of the adhesions and the narrowing of the bowel.

DrMR:

Gotcha. Okay. One of the things that Alison Seabecker and I have discussed in the past, I believe it was a small bowel follow through with multiple angles of image capture. I believe if I’m remembering correctly from that conversation about three years ago. But nothing else that you think is worth discussing?

LW:

Well, there’s a pill you can now swallow with a camera in it.

DrMR:

The smart capsule.

LW:

Yes, the smart capsule. It can film the inside of the intestines all the way through, from top to bottom.

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DrMR:

Now, how often are you finding that in chronically constipated patients there is some type of luminal narrowing? Is that a fairly common finding? If it is common, can you give us a rough kind of percentage?

LW:

I think most of our patients with constipation have luminal narrowing. Whether their adhesions are on the outside, squeezing the intestines like a garden hose. Or whether they are actually within. Adhesions are microscopic, they’re like the strands of a nylon rope. They’re very strong, but they’re microscopic and they form where there’s inflammation. So when they form within the wall of the intestine, they create a stricture, a narrowing, and you can’t see those because they are actually within the wall. That’s where we feel like so many of these strictures come from. It’s very often.

DrMR:

Have you published anything on constipation?

LW:

We’ve mainly been publishing on bowel obstructions.

Adhesions & SIBO

DrMR:

That that would grab a lot of heads. I feel like the constipation piece. In any case, coming back to SIBO, I know that this is something that’s fairly on the mind of our audience. How often are you seeing adhesions in SIBO patients?

BW:

A hundred percent of the time.

DrMR:

I’m assuming this is probably because you’re being referred the chronic SIBO cases. Can you kind of unpack, how often do you think this may be in a more general population? To whatever extent you’re able to do so, help people understand, when they should, as their own healthcare advocate, be asking their doctor about this. For a clinician, when should they be thinking about it?

LW:

Palpation is one of the things I can kind of walk you through for just a moment. That may help. If a person is lying on their backs supine and bring their knees up, so that everything starts to relax and put their hands one hand on one side of the abdomen and one on the other, and just bring the two sides in toward each other for bout 20-30 seconds, just to help everything relax. Then start letting your fingers go in, in different places and ask, is it soft everywhere? There are some hard places. This is really how we find adhesions. They may be like an anchor that comes down and then goes across the front of the pelvis. They can be like a seatbelt, where it starts at the upper left and goes across midline and comes down to the right side. There’s no physical structure in the body that’s like either of those things. If you can get everything relaxed so that you can let your hand sink in on someone or do this with your partner. When it feels kind of hard and it gets your partner’s attention. Then you just follow it down and you’ll get more response. It’s not following the organs. It’s just in this fascial sweater of the body. So I’m not sure if that explains it well or not.

DrMR:

It does. One follow-up just to make sure I’m reiterating this accurately. Someone would lay down on their back, bend their knees, relax the abdomen. And then they’re going to feel around for spots that don’t feel like the other spots. Most feel soft, now you’re feeling these tense bands or sections that are oftentimes tender. Is that a fair way of stating this?

BW:

Yeah, I mean, definitely. We feel for areas that feel think or tender or tight or lumpy. I mean, you should be able to let your finger pads sink in to any spot in the abdomen or the pelvis and the tissues should feel soft. If you try stretching in different directions, it’ll become obvious that in one direction, it feels like you hit a wall and that’s the adhesions.

DrMR:

Okay. And they’re often tender.

BW:

Yes, definitely tender. I mean, some of our patients at the beginning of the week are very distended and they don’t tolerate very deep pressures. As we’re treating people, it’s sort of like we’re peeling an onion. We’re peeling a straight jacket off of these areas and tissues and structures. So they’re able to gradually tolerate deeper and deeper work as things get freed up.

DrMR:

And you said something there I was intending to ask you about, which was bloating and distension and how often you’re seeing patients who either report a feeling of bloating or an appearance of looking distended. How often does that factor in? I’m sure most clinicians are kind of perking up in their chairs and saying, yeah, this is a certain presentation that can sometimes be challenging. We have to kind of dig deeply into our toolkit and oftentimes even we’ll see other symptoms improve, but, but these may to some extent, persist. So what do you have to say about bloating and distension?

BW:

Well, all of our patients who have any kind of gut issues, most all of them have some amount of distension or bloating. Especially if they have surgical adhesions and post-trauma adhesions, things start getting backed up. To palpation different spots feel tender. We see that pretty much with all of our gut patients. Some have more distension than others, but most of them have distension and bloating to some extent as we first start working with them.

DrMR:

Is this something you feel is one of the more noteworthy improvements that a individual will notice after going through therapy? An improvement in the bloating and distension?

BW:

Absolutely. Yeah. Most all of our patients have at least a significant reduction in the severity, even if we don’t resolve all of it. As well as us treating the patients over the course of the week, we also spend some time and teach them self-treatment techniques and an at home program, so they will know enough things they can do to themselves using their own hands or different tools that we have. So they’ll they’ll know enough things to do that they will be able to maintain the improvements that they gained from our treatment. I mean, our goal is not for our patients to have to keep coming back or our goal is to free things up as much as we possibly can, and then teach them things they can do at home to maintain those improvements and even gradually progress from there.

DrMR:

Which I love. I think people really appreciate that. I don’t think anyone likes to feel dependent upon the clinician myself included. Is there a certain kind of avatar that you see? A certain assortment of characteristics, male versus female, IBS versus not, IBD versus not? Are there certain things that you see fairly commonly that, that may help either our audience or our clinicians key in on when an individual may be, you know, the type of person that lends himself well to the therapy that you do.

LW:

Longstanding pain, having ruled out organic causes or medical causes. Then we’re going to start looking at mechanical reasons they are having symptoms that are not resolving with the medications.

BW:

And dietary changes.

DrMR:

You mean non-responsiveness to dietary changes?

BW:

Correct.

Risk of Particular Type of Surgeries

DrMR:

Coming back to surgery for a moment, one of the things I try not to do is just lump all surgeries in as having equal risk for forming abdominal or pelvic adhesions. But I actually haven’t looked into this nor have I asked you guys specifically, are there certain surgeries that pose more risk than others? C-section versus hernia versus tubal ligation versus hysterectomy. Are there some surgeries that don’t pose much risk and are there other surgeries that are much more tightly associated to formation of a adhesions?

BW:

Well, I think all surgeries.The way the patient heals is through adhesion formation. My sense is some people scar more heavily than others. So that has something to do with it. A great portion of our patients, the first surgical procedure they have done is very, very frequently an appendectomy. Especially if the appendix ruptured, because the body sees the contents of the appendix as foreign. So they tend to form massive adhesions and get peritonitis. Also vaginal hysterectomy. In my experience over 30something years, women who have vaginal hysterectomy have a much harder time healing than women who actually have the open bikini incision. My sense is because having the uterus, ovaries and tubes all pulled out through the vagina, that downward and outward pressure and stretch leaves that pattern in the body. I don’t know if they form more adhesions, but they tend to have more severe problems, compared to regular hysterectomy.

LW:

I would say in general, the hernia repairs are not such a huge cause. Anything that’s invasive and certainly anything that lets bacteria from the intestines out into the interstitial spaces between the organs within the body is, as Belinda indicated, awful. People develop awful adhesions. As far as the C-sections and a lot of the others, really, a lot of it seems to depend on what they do afterwards. Some women undergo C-sections and they have no problems at, and some just come back to us and they’ve had developed massive adhesions, but maybe they were picking up the baby too early or doing things that kind of strained and caused a subsequent inflammation or pulling inside of the body. So they healed differently.

DrMR:

One of the things that we ask in our new patient intake paperwork is about any prior abdominal or pelvic trauma or surgery. And this is one of the reasons why we ask is because what we’re trying to collect as many data points as we can to either rule in or rule out something like, in this case, adhesions. For our audience, coming back to one of the reflections I had on the podcast recently about why we don’t go into depth about things like breastfeeding or Cesarean birthing, I don’t feel that impacts the differential you’d make for the individual at current. Meaning, how they were born doesn’t impact now. If you’re the mother and had a C-section, that’s abdominal trauma. I’m talking about asking the individual when you were born, were you born vaginally or C-section, were you breastfed? Were you bottle fed?

DrMR:

I don’t see that changing my differential, which is why I don’t find that incredibly constructive. Now some may disagree with that. That’s how I’m looking at this. Something like, have you had a hysterectomy? More broadly, have you had abdominal trauma or surgery? If so, please list here. This now adds justification behind a referral for adhesions. So just to tie this together for our clinicians, in terms of how all these things get integrated into a clinical process from the first touch point with the patient all the way up through potentially making referral for a specific therapeutic. Larry, did you have something there?

Digging Deeper into History

LW:

I did have one other thing to say, and that is something that we kind of glanced over, but it is so common and something that you may want to ask as a clinician. When you talk about constipation, how often have we, as children, been roller skating or ice skating and fallen onto our butts and landed on our tailbones. If you get a significant injury there, adhesions form as a first step in the healing process, once you’ve healed, they remain there. But if that tailbone is forward, then later in life, you may get symptoms. The adhesions can spread from there, but you may have symptoms. As a clinician, you may want to ask this, do you have pain with intercourse? Because that tailbone is forward, that door is partway shut. It can lead to constipation because things just can’t come out. Or when you have a bowel movement, it’s narrow.

LW:

So that tailbone may be forward. Do you have pain with deep intercourse? If you’re a woman, during intercourse, does your partner feel like he’s hitting something? He could be, and it could be your tailbone. It’s such a common occurrence. The other thing we see with that, because of the connections of the dura, which surrounds the spinal cord all the way up to the base of the skull and into the head, because of the connections with the dura and the lack of mobility in that dura top to bottom, when you tell bone gets pulled forward, it can pull down on the base of your skull and pull the base of your skull down onto the top of your neck. When we see the kind of headaches that are going to the emergency room once a month, or once every two months. Terrible migraines or terrible headaches. We used to just treat the neck and up in the shoulders, then we started moving down the body and got all the way down to the tailbone and treated internally.

LW:

Bringing that tailbone back, suddenly the body lengthens. It takes the pressure off. So you may ask if your chronic constipation people are their stools narrow? If it’s a woman, do you have pain with intercourse? Do you have headaches at the base of your skull or at your temples? That might indicate a mechanical process that may have happened back when you were five years old at the bottom of the sliding board.

DrMR:

That’s a great insight. Also for either sex, are you finding pain upon defecation? Is that another way of assessing this or does that not track?

BW:

Yes, Often.

DrMR:

Okay. So pain with intercourse, pain upon defecation, narrow kind of thin bowel movements, headaches, and temple pain.

LW:

Even pain after orgasm.

DrMR:

Okay. Taking notes here. These in my mind are gold because the more that I can do as a clinician in the initial intake process to capture these data points, use them as I’ve discussed in the podcast in the past to build out a dashboard of data for the individual, including a differential, with support and even better, if I can kind of sub-note, highly supported, moderately supported, minimally supported. This is how I think clinicians can function to be much more accurate and efficacious. Rather than just thinking that a handful of fancy tests give us all the data. The tests, they do have a time and a place, but where I think functional medicine could do a lot better is really honing its history taking to track with the therapies that we’re trying to either recommend or not recommend. So questions like this, again, in my opinion, are absolute gold because this sharpens even further, my ability, before I even see a patient to be able to say, you know, high, moderate, or minimal suspicion of adhesion. So thank you guys for that. Very, very helpful.

LW:

Last thing on that. Do you have difficulty sitting for long periods of time? You find you have to sit on one cheek and then the other? That would be two other indicators.

DrMR:

This is great stuff.

RuscioResources:

Hi everyone. This is Dr. Ruscio. In case you need help, I wanted to quickly make you aware of what resources are available to you. If you go to drruscio.com/Resources, you will see a few links you can click through for more. Firstly, there is the clinic, which I’m immensely proud of. The fact that we deliver, cost-effective, simple, but highly efficacious, functional medicine. There’s also my book, Healthy Gut, Healthy You, which has been proven to allow those who’ve been unable to improve their health, even after seeing numerous doctors, to be able to help them finally feel better. There’s also our store where there’s a number of products like our Elemental Heal line, our probiotic line, and other gut supportive and health-supportive supplements. We now offer health coaching. So if you’ve read the book or listened to a podcast like this one, or are reading about a product and you need some help with how or when to use, or how to integrate with diet, we now offer health coaching to help you along your way. And then finally, if you are a clinician, there is our clinicians’ newsletter, the Future of Functional Medicine Review. I’m very proud to say, we’ve now had doctors who’ve read that newsletter, find challenging cases in their practices, apply what we teach in the newsletter and be able to help these patients who were otherwise considered challenging cases. Everything for these resources can be accessed through drruscio.com/Resources. Alrighty, back to the show.

DrMR:

Okay. So one other question that comes up is some patients will want to make a referral and they’re kind of reflexive and saying, well, is there someone near me? Our answer is, well, you go to the Clear Passage headquarters, they do their evaluation, and then they can find someone local to you. But it does beg the question of Clear Passages technique versus other visceral therapy. So as to make sure that I’m not straw manning, this, this would be other kind of competent, well-trained, visceral therapists. We had on the podcast recently, Jason Wysocki with 8 Hearts Health. He seems to really be very well-trained and someone, I would be confident in making a referral to. What he does is different, but similar. This is a common question that we get at the clinics. So I’m wondering how we can best answer this question for people.

LW:

Well, I think everybody has to make their own choice. We’ve been doing this for 35 years and probably two dozen studies. So we know what we’re good at. We will take people through the whole process of trying to determine whether or not we can help. We’ve treated thousands of patients. We’re not the only clinicians out there. I can’t speak to other people’s expertise. I don’t know Jason’s work. I know we’ve taken some visceral courses. We’ve taken some fascia release course. I’ve taught some of those. I think everybody has to make their own choice of where they want to start. We may have become the gold standard in treating adhesions just because we’ve been studying them for over 35 years. We really know what we’re doing. I don’t know how else to answer that?

Published Studies

DrMR:

Well, one of the things that is reassuring for me is you’ve gone through, again, the rigor of documenting what you do works. This is, I’m sure our audience can imagine, a growing concern for me. There is far too much multi interventionism in natural medicine, That’s overkill and maybe one facet or that intervention could have helped the individual. My fear is that there are many things being done in practice that aren’t necessary that make care too expensive, too daunting. One of the only ways to cut that fat so to speak is to go through a rigorous process of evaluating and questioning what you’re doing. This is why my preference has always been, and continues to be, work with people who are both clinicians and researchers. It’s that research mind that’s skeptical and discerning, and usually finds a way to cut out from the model things that aren’t helpful.

LW:

That’s right. I mean, to publish, you have to be peer reviewed. You have to have physicians that are looking over your work and saying, you know, I’m a little skeptical about this. You’re going to have to answer these questions before I’m even going to think about publishing this data. So it’s really easy to say, Oh, I bet I can help that. But it’s very difficult to actually go through and create controlled studies where you have a group of patients that you’ve treated and a group of patients that is similar that you haven’t treated. To track the difference and have independent biostatisticians and independent physicians writing the studies. Then peer review means that they’re totally independent and blinded to you. People reviewing those before the editor will accept them into a paper. So we were really touched to be accepted into the World Journal of Gastroenterology, which is a highly respected international journal. That’s the process you go through. It’s grueling, but it is so important to be able to, and important to us, to be able to feel like we have our feet on the ground. We can say, this is what we know we can do. This is what we don’t know. This is what our percentages have been with these patients and so forth. So to be able to speak was the authority and truth.

DrMR:

Well, the scientific method seems to be the antidote to hubris, which I think is definitely a problem. That really goes through the questions that I wanted to ask. We could talk probably here for a few hours, but are there any other things that you want to hit that you feel important for the patient or the clinician out there trying to improve their health as it pertains to the work that you guys do?

LW:

I kind of touched on this earlier, if you have a situation where you’ve done your tests for everything medical or organic you can think of, and you’re still running into a brick wall, you still have some problems. Then there’s very likely something mechanical going on. The main mechanical thing that tends to happen and does happen in everyone is adhesions form when you have an injury or an inflammation like Crohn’s or ulcerative colitis, or IBS. These tiny strands of collagen come rushing in and lay down on each other in a random pattern to create an internal scar. Once you’ve healed that scar remains and sometimes grows because it can pull in life as we talked about the woman with the C-section that was lifting her baby afterwards.

LW:

The difficult part is that adhesions cannot be seen as you so astutely pointed out. They can’t be seen in any diagnostic tests. You can see the effects of them. The only way to see adhesions is under surgery, but the surgery causes nearly invariably causes more adhesions. There’s great data on that at our website. Five decades study that showed that adhesions form in 55 to a hundred percent of abdominal surgeries, 90% of pelvic surgery. Think about the fact that there’s something mechanical going on that you can’t see. Even during the surgery, they can’t see them inside the lumen or wall of the intestine. If you want to contact us, let us review the history with the patient and we would be glad to talk with the doctor. We’re not trying to get patients in here, we’re trying to help patients. So let us review that, get some input from us, and we’ll do the best we can to guide. But if you can’t find an organic or medical reason, you’re looking at something mechanical.

Episode Wrap-Up

DrMR:

Hopefully today through some of the questions that we’ve outlined, this will help clinicians who may be saying, Oh my gosh, that reminds me of Susie or whoever. At your next visit, run through some of these questions and firm up your suspicion and make the referral. Again, rest a little bit more assured that Clear Passage will go through this initial screening process to make sure that they’re only working with people who they have at least some level of assurance that they will be able to help. For me, as a referring provider, this makes me rest a lot more easily that I’m not just throwing a patient out there to the wolves. You guys are obviously cautious, diligent scientists who are trying to really do the best for people. Something I think we need more and more of in this field. Tell us your website again?

LW:

It’s ClearPassage.com and incidentally Dr. Ruscio we’ve had so many physicians ask us to explain what we do that we published a 32 page physician package has got a referral sheet on the back with cautions and contraindications. That is quite thorough. I’m glad to send that to any physician that wants it or any patient that wants it. We did publish a book recently, a smaller consumer book called Adhesions. It’s available at Amazon. It explains adhesions and how the whole process works. I think it’s like three bucks on Kindle. We tried to make it really easily accessible. So if somebody thinks they want to come in, they can just go to our website, ClearPassage.com, click the little button that says I’d like more information, give us your contact information. From that point, they can just leave it at that or they can go on and complete a medical history form right there. The website leads you right into it. We review those. It takes about two or three days to review those. And we’ll get back with the patient who let them know what we think.

DrMR:

Awesome. Well, Larry and Belinda, I want to thank you guys again for all the good work you’re doing, and it’s just great to have you on the show. Amazing to see that you’re now publishing really in one of the most well-respected gastroenterology journals in the world. I was just really appreciative of all the hard work that you’re doing and making my job a little easier in terms of giving me some science to look over and a referral process I can be confident in. So just very much appreciative of everything that you’re doing.

BW:

Thank you so much. Thanks for having us. We appreciate it very much.

LW:

You bring much to the world, to the clinicians and the patients under your purview in this whole GI tract through these podcasts. We really respect and appreciate you so much.

Outro:

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