This is a copy of an article published in the Journal of Palliative Medicine 2013 copyright Mary Ann Liebert, Inc.; Journal of Palliative Medicine is available online at: Clearing Bowel Obstruction and Decreasing Pain
in a Terminally Ill Patient via Manual Physical Therapy
Amanda D. Rice, PhD, Evette D’Avy Reed, PT, Kimberly Patterson, PTA, LMT, Belinda F. Wurn, PT, and Lawrence J. Wurn, LMT Decreasing pain and improving function and quality of treatment techniques. At initial evaluation, she said she life are important topics for patients that refuse, or are not must reside near a hospital, due to PICC line and recurring candidates for traditional medical interventions, and those at end stages of disease. Patients with inoperable, metastatic bowel carcinoma that experience pain and small bowel She demonstrated improvement through the duration obstruction (SBO) as a result of adhesions are a subset of of therapy with significant pain decrease and functional these patients. The standard treatment, adhesion and/or increase. By discharge, her physician had removed the resection surgery followed by post-surgical medications to PICC lines because she had returned to eating a normal diet prevent infection and decrease pain, may not be ideal in (including hamburger). She was then able to travel overseas end-stage cancer patients. We treated such a patient using a with her husband, a significant increase in her quality of life.
manual soft tissue physical therapy with goals of decreasing her pain and alleviating symptoms of bowel obstruction Alleviating pain and dysfunction, and returning life secondary to adhesions successful y, using a protocol we quality are challenging goals in patients with inoperable developed initial y to open fallopian tubes that were blocked gastrointestinal cancer. Here we report a successful nonsurgical treatment for abdominal adhesions, pain and dysfunction in a terminal y ill patient. Before therapy, The patient was a 61-year-old married woman with a she lived with recurring SBOs, repeat surgeries, pain and history of multiple abdominopelvic surgeries over the last dysfunction. Her only nutrition was intravenous TPN. 12 years including hysterectomy, ileostomy and ileostomy After undergoing this manual soft tissue physical therapy, reversal with chemotherapy and radiation for treatment of she was able to eat a normal diet, and participate in stage IIIB ovarian/peritoneal carcinoma. She experienced SBO episodes every 2-3 months and had five adhesiolysis and/or resection surgeries to attempt to repair the References
bowel. Because she had undergone a recent exploratory 1. Alternative Medicine and Rehabilitation. Wainapel SF, Fast laparoscopy that revealed metastasis to the omentum, her A (eds). Demos Medical Publishing, 2003. Available from: physicians were reluctant to perform any further surgeries, (Last and the patient requested no more surgical interventions. 2. Principles of manual medicine, 2e. Greenman PE. Williams & She was unable to eat or drink, so a peripheral y inserted central catheter (PICC line) was placed, and she received 3. Brown JS. Rehabilitation of Soft Tissue Injuries in the 1990s. total parenteral nutrition (TPN) daily. She experienced chronic pain associated with the SBOs at a level of 4-5/10 4. Wurn BF, Wurn LJ, King CR, Heuer M a, Roscow AS, that increased throughout the day with movement. The Hornberger K, et al: Treating fallopian tube occlusion with patient was undergoing chemotherapy, and medicated with a manual pelvic physical therapy. Altern Ther Health Med Nexium 40mg qd, Compazine 10mg prn, Zofran 4mg prn, Ativan 1mg qd, multivitamin bid, Vitamin D 2000mg qd, 5. Wurn BF, Wurn LJ, King CR, Heuer MA, Roscow AS, Scharf Co-Enzyme Q10 qd and Dilaudid prn for pain. Her goals ES, et al: Treating female infertility and improving IVF were to relieve the abdominal pain, decrease SBO incidents, pregnancy rates with a manual physical therapy technique. 6. Wurn BF, Wurn LJ, Patterson K, King CR, Scharf ES: The patient underwent 29 hours of a manual soft tissue Decreasing dyspareunia and dysmenorrhea in women with physical therapy 1–6 over six months, focused on detaching endometriosis via a manual physical therapy: Results from the abdominal adhesions and was instructed in self two independent studies. J Endometriosis 2011;3(4):188–96.


Medical appeal board

This is not the original version of this decision. It is a revised version that has been edited for public disclosure to protect confidential and third party personal information. Dr. Frances Forrest-Richards, Member Counsel for Appellant Heard at Port Alberni, B.C. on July 9 & 10, 1990, in Vancouver, B.C. on January 14 & 15, 1991 and at Nanaimo, B.C. on April 12, 1991. Majority O

Section of Dermatology • ' Tinea' is derived from the Latin word meaningclothes-moth which the Romans thought wasresponsible for this condition. • It is caused by a superficial fungus that colonizeskeratin (hair, nails and the stratum corneum)• There are three genera of dennatophytes infectingthe skin: Microsporum. Epidermophyton andTrichopyton• Tinea infections often result from

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