Adhesions are a particular risk for people with SIBO, and can often be an underlying cause of SIBO developing. In this episode Rebecca is joined by Larry Wurn LMT and Belinda Wurn, from Clear Passage Physical Therapy to talk all about their important work on adhesions. Belinda co-developed the ‘Wurn technique’ to address adhesions non-surgically after experiencing debilitating chronic pelvic pain. They talk with Rebecca about how adhesions develop and what the risk factors are, such as endometriosis or surgery. Belinda and Larry tell Rebecca more about how solving the problem of adhesions can aid recovery from SIBO.
In Episode 25 of The Healthy Gut Podcast, we discuss:
✓ What adhesions are and how they develop
✓ The risk factors for developing adhesions and what they do to you
✓ How adhesions affect the abdominal cavity and intestinal system
✓ The link between adhesions and SIBO
✓ The common symptoms of adhesions, and how to find out whether you have them
✓ Other conditions that are commonly interlinked with adhesions, ie. endometriosis, inflammation, infection, radiation, surgery or trauma
✓ How Clear Passage physical therapy works, and what results can be achieved
✓ What happens after you’ve treated your adhesions
✓ How removing your adhesions can aid recovery from SIBO
Larry Wurn, LMT is Research Chair at Clear Passage Physical Therapy, a network of physical clinics in the U.S. and U.K. that address internal adhesions non-surgically. Bowel adhesions can slow or stop bacteria from leaving the intestine, preventing medications from resolving SIBO. By addressing adhesions, this natural treatment has provided an effective adjunct to physician’s care for patients with SIBO. Larry has presented to 15,000 physicians and staff at Digestive Disease Week. He was also was a featured speaker at two national conferences of SIBO professionals and the Annual Meeting of the American Association of Naturopathic Physicians.
Belinda Wurn is Director of Services for Clear Passage. Belinda began developing her work after surgery and massive doses of radiation therapy left her with “frozen pelvis.” Most of her pelvic organs were adhered to each other, leaving her in debilitating pain. Her doctors said that surgery would only cause more adhesions, making things even worse. Unwilling to accept a life of pain, she and her husband, massage therapist Larry Wurn, began to study with teachers in the U.S. and Europe to create their own protocols to relieve adhesions. They combined the most effective techniques of the instructors with whom they studied, over decades refining and creating their own techniques to produce the unique treatment approach they use today.
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Rebecca Coomes is an author, entrepreneur, passionate foodie and intrepid traveller. She transformed her health after a lifetime of chronic illness, and today guides others on their own path to wellness. She is the founder of The Healthy Gut, a platform where people can learn about gut health and how it is important for a healthy mind and body and coaches people on how to live well with SIBO. Rebecca is the author of the world’s first cookbooks for people treating Small Intestinal Bacterial Overgrowth (SIBO) and the host of the SIBO cooking show and The Healthy Gut podcast.
REBECCA: Welcome to the Healthy Gut Podcast Larry and Belinda Wurn. It’s absolutely wonderful to have you here today. Thanks for joining me.
LARRY: Thank you. It’s great to be here.
BELINDA: Thanks so much for having us.
REBECCA: I really like to start off with your own personal stories around how you ended up developing clear passage because I think that the story of how this came to be is just so interesting and fascinating and I’d love for you to share that with the listeners of the Healthy Gut Podcast.
LARRY: Sure. Let me get into a little bit about how we got into the SIBO arena but you know my wife, I’ve known Belinda since she was 2 months old. We grew up as buds all of our childhood. Got separated and ran back to each other in our thirties. We were really getting ready to get married. I realized that we still loved each other as we did as children when Belinda developed cervical cancer. The treatment involved 40 external treatments, it involved first surger 40 external and 144 hours of internal radiation where they put radioactive pellets inside of her at her cervix and put it her in a lead room It’s dangerous for any of us to be in there for longer than 5 minutes. But it’s ok we’ll keep you drugged. And we are gonna cure that cancer. So they kind of hit it with a hammer.
A year later they said, “Well we cured your cancer.” And Belinda said, “You know yes that’s great but I am in debilitating pain. I can’t walk, move, or breathe without pain. What is this? What can you do about that?”
“Oh,” they said. “That’s adhesions. You get that after surgeries or after any sort of tissue trauma. We can’t really do anything about that. You’ll just have to learn to live with it.” So that was not appropriate for us. Belinda’s Summa Cum Laude of her class graduate of Physical Therapy. Had been for about 20 years at that point and we started studying different methods trying to figure out how we could address and decrease adhesions without surgery as the doctors told us, any surgery is just going to create more adhesions and more pain.
So that’s how we started.
[2:25] REBECCA: What an interesting story and I think we were chatting before we started recording this episode just about literal information were often provided when it comes to having surgeries and I’ve had multiple abdominal surgeries for various reasons like having my appendix rupture and having endometriosis. I’ve had multiple laparoscopies after that and at no point has any surgeon or doctor or specialist for those conditions ever told me that those surgeries would create a risk of adhesions forming.
[3:04] BELINDA: So I mean adhesions they are basically internal scar tissue that forms as a normal part of the healing process after surgery, after trauma such as car accidents or falling down the stairs or infections or inflammatory conditions like endometriosis or Crohn’s. When you are cut open, you want that incision to heal close and don’t see incisions that do that. But the way they form is like a spider web. They start sticking to anything and everything in the vicinity that can cause pain and different kinds of symptoms and adhesions can be very strong. They can have a strength of up to 140 kilos per square centimeters. So they are incredibly strong and can cause significant amounts of pain and cause many different kinds of symptoms. And you are right oncologists or surgeons never mentioned that i might have adhesions after all that radiation therapy.
So the adhesions caused me to become a chronic pain patient and we started to travel over the country getting treated by therapists that did different techniques that I’d read about because there was no internet in the mid-80s trying to figure out how to get out of chronic pain. And the adhesions caused pain with intercourse, abdominal and intestinal problems. I developed SIBO also. I mean that can cause significant abdominal and pelvic and intestinal problems and pain.
[4:48] REBECCA: and are there surgeries that are a bigger risk than others?
[4:53] BELINDA: well all surgeries cause adhesions. Laparoscopies may cause fewer external scarring but if you think about it, it’s sort of rooter. They have to cut through all the layers of skin, of fascia, of connective tissue, of abdominal muscles to get into the organs. All surgeries create adhesions.
[5:26] LARRY: It’s interesting Rebecca because in the US, they did a literature search of over 50 years of surgeries including laparotomies, open surgeries and laparoscopies. And did an assessment to find out how much adhesions formed after a surgery and what they learned was that adhesions form between 55 and 100 after 55 to 100% of all abdominal and pelvic surgeries. And these were studied tens of thousands of surgeries. So surgery is the number 1 cause of small bowel obstructions. That’s when you get adhesions in your abdomen. And by the way, Belinda had a tremendous amount of pain but you don’t always have the pain but often patients with significant adhesions will and they go to the doctor and the doctor said there’s a CAT scan or an MRI or an X-ray. And says, ”yep there’s nothing there. Maybe it’s all in your head. Just learn to live with it. Have a glass of wine.”
Meanwhile these bonds of 140 kilos per square cm are squeezing your guts and squeezing your intestines and pulling on you. They can pull up into your chest down into your pelvis and into your reproductive organs and yet you gotta a physician who is quite frustrating saying there’s nothing there because adhesions don’t show up on diagnostic desks.
[7:03] REBECCA: that was going to be a question that I asked you, “How do you discover if you actually have adhesions?” and I think about my own journey with endometriosis and I had a period of time where I was in so much pain from my… well what my specialist at that time said was perhaps some endo lesions that I could have any sexual intercourse but I couldn’t even have a pap smear because I was in such excruciating pain that even to insert to device they used to give a woman a pap smear was like a hot red poker was being pushed inside of me. It was excruciating and they would just often say , “We can’t see what’s wrong. Are you sure that there is really that much pain?” and there was a lot of kind of accusation that it was psychosomatic, that I was imagining that I was in that much pain and I would say, “Do you think I would imagine this kind of pain? It’s excruciating.”
So I had experienced that myself were doctors said, “Well we can’t see anything so we are not really sure that it’s there.” How does one discover that they do in fact have adhesions?
[8:09] BELINDA: Well if anyone has ever had any kind of surgery or trauma or infection or inflammatory conditions such as endometriosis. When you have endo, you have these implants on the different organs. So every month when you have a period and you bleed vaginally, the endometrial implants also swell which pulls on the organs they are attached to which causes pain. And you know endometriosis very frequently… a frequent site of endometrial implants is between the bladder and the uterus and between the uterus and the rectum, they can affect the cervix. So of course having the speculum put in, if you have adhesions affecting your cervix can cause excruciating pain when you go to get your gynecological exam.
And adhesion formation is the first step in the healing process after any of the 4 or 5 major things. So if anyone has had either surgery or trauma or infection or endo or Crohn’s or radiation therapy, they definitely have adhesions because it’s the first step of the healing process.
[9:34] LARRY: Here’s another thing for you Rebecca and for your audience, the medical establishment is pretty good at diagnosing medical that is disease and hormonal conditions. If you have pain or have dysfunction, gee I am bloating all the time or I am having constipation and diarrhea and nobody is ever able to find anything, let’s look back into your history and see have you had any cervix surgery? Have you had any sort of trauma? Incidentally we all can always look for surgeries and traumas and endometriosis. Adhesions frequently form in endometrial sites. They are like brother and sister. They are together so much but one of the most adhered patients we ever had and we have noticed just recently, we started seeing SIBO patients. Well maybe a couple of years ago had never had any surgery, any trauma, anything like that but she had been diagnosed with SIBO and had had SIBO for 13 years. So the SIBO and she was so adhered, she was like you could… her abdomen was so hard and tight with these adhesive bonds when we were palpating her. And we said, “Oh my God we never even realized that SIBO itself can cause the inflammatory process that happens with SIBO is as Belinda said adhesions form it’s the first step of the healing process. So you have inflammation, these tiny little bonds come rushing in to help surround the area so your body can start healing. Once you have healed, if you heal, those bonds remain and they remain with you for life.
[11:22] REBECCA: That’s fascinating. Given that so many of my listeners have SIBO, I am sure that they are listening to this thinking, “Oh my gosh!” Wow, this is answering some questions.
One of the things I was wondering is that can adhesions be picked up on things like MRI scans? Can you do abdominal scans with imaging to determine whether they actually exist in your or not?
[11:53] BELINDA: No, all the adhesions are soft tissue. So they do not show up in any kind of radiologic diagnostic testing. Those tests show up solid things like fibroids or tubers or cysts. You can get all the expensive diagnostic testing possible but they will not show up adhesions.
[12:19] LARRY: Here’s another part of that, adhesions are made of collagen and collagen covers virtually every structural cell in the body, every muscle, every cell and every organ of the body is covered with collagen. So those don’t show up on diagnostic test. They can imply adhesions if you have had a barium pass through were you swallow this material that shows up on x-rays and they can see, “Oh yes that barium comes through and look here it kind of stops it looks like an hourglass here. There’s a stricture. I am gonna assume that those are adhesions there.” Certainly if they do it under general anesthesia, if they do something like that under general anesthesia, oh they can’t just be spasm. That must be adhesions. So with women with history or salpingograms where they have blocked fallopian tubes, they see the dye going through the tube. They won’t see the actual adhesions itself but the dye doesn’t go through. So in that way a physician may tell you, oh yeah we can tell they are adhesions by a test but they can’t actually see adhesions.
So in the intestines if you have adhesions that are narrowing your intestines or kinking them like a garden hose, so the foods just not going through very easily or with SIBO, the area has been treated in response to antibiotics but only temporarily and then the SIBO comes right back in a few days or a few weeks. That’s kind of how we got into. The doctors in Portland at the naturopathic college there said, “Well we actually kind of have a fascinating case but we think that when you are treating the adhesions the antibiotics will work whether they are pharmaceutical or naturoceutical because you freed the adhesions then the patient can expel the last of that treated bacteria.
[14:#0] REBECCA: that’s interesting. And in terms of SIBO one of the things that happens for people quite commonly is chronic constipation. And I am wondering whether you see, given that you’ve had one of the most adhered patients you’ve ever seen just recently whose only issue was that they had SIBO for 13 years, I am wondering if something like chronic constipation or chronic diarrhea in itself could possibly cause adhesions.
[14:59] LARRY: well it’s more like the adhesions would be the contributors to the chronic constipation or diarrhea. Certainly you can understand mechanically how adhesions could cause constipation or contribute to constipation. The diarrhea we believe with SIBO patients is still coming from the bacteria but as we freed the adhesions and those bacteria can be expelled then we have a better chance of turning around and curing that SIBO. And a lot of patients who have SIBO or constipation and they haven’t had a surgery, we always dig deeper. It’s like, “Ok were you a cheerleader? Did you fall in your but a lot during sports and different activities? Did you slip and fall on ice? Did you snow ski and fall a lot?”
Almost always they figure, “Oh yeah I didn’t even that that might have been a problem.” Because they didn’t have to get treated for it.”
[16:09] LARRY: fell of a bicycle or a horse or…
[16:13] BELINDA: Or abuse. Physical or sexual abuse or huge causes of adhesions in the pelvic area.
[16:20] REBECCA: That’s really interesting and I think most people at some point in their life fell off of something. It’s almost part and parcel with childhood isn’t it? and doing any form of recreational sport, you are generally getting bumped and falling over and doing those kinds of things. So even something just a simple, well what we would consider as simple and benign as coming off your bike, that could be a contributing factor for adhesions forming could it?
[16:50] BELINDA: Yeah absolutely.
LARRY: falling on your tailbone when you are roller-skating, you’re ice skating.
[16:58] REBECCA: Wow! Interesting. And we will dive into SIBO itself but one of the other things I am wondering is especially for people that are listening right now, is there any way that you can feel or stretch or move to get a sense whether you might be constricted? Are there particular movements you can do? Like if you try to touch your toes and you can’t. Is that a sign of perhaps adhesions being in your abdominal area?
[17:23] LARRY: As far as touching your toes, that’s tells so much as trying to bend backwards or stand up straight. If you try to stand up straight and you feel like, “Something’s always pulling me forward.” You are pretty sure to be adhered in your abdomen and that happens a lot with SIBO patients. The other thing if you want to palpate yourself would be to lay die on the bed, bring your knees up so that you are taking, think of yourself as three dimensional swatter. If you bring your knees up, that takes the pressure off of your gut and then let your hand sink in all from under your ribs down to your belly button. Feel one side. Feel the other side. Do they feel the same or does one feel like, “You know there is something harder here on the left. It feels like the texture of a head of broccoli maybe. You know on the other side I sink right in and you go all the way down.” If you’ve had a laparoscopy you may notice a little donut around your belly button where, “Oh wow that’s really hard there.”
Any scars that you have at the top of an iceberg. You may notice scarring down there. Really for most of you got when you are relaxed on your knees and you are up, you should be able to sink right in and if you can’t and you are on soft tissue, you are not on the bones, then that’s an indication of, “Wow that place is probably adhered.”
Now put your knees down and say, “Does that hurt there? Is that similar to a pain that I get?” As I said not all SIBO patients get pain but those are a few points for you.
[19:10] REBECCA: Wow, that’s great. And are there common symptoms that people feel when it comes to having adhesions?
[19:19] LARRY: Generally…usually it’s unexplained pain. If they are gonna have symptoms it’s gonna be unexplained pain. I mean we see a lot of women with totally blocked fallopian tubes and we’ve come up with several studies about opening blocked tubes that are in the National Library of Medicine here. But in a lot of those patients, there are not many nerve endings at the end of your fallopian tubes or the beginning. They don’t have pain. But if you have pain or dysfunction and you are hearing from your doctor, there’s nothing there or you are currently being shoved from specialist to specialist and then being told, “You know I think maybe it’s al in your head. You should see a psychologist or psychiatrist.” Those would be…you’ve been checked out medically. You’ve been checked for disease or for hormonal conditions and they just can’t find anything.
I’ve just got this ache here. You know when I tried to stretch my right side it does seem stressed. My left side stretched seems easy but my right side doesn’t. Those kinds of things.
[20:25] REBECCA: That’s great advice for people who are listening. Now moving on to SIBO and the association with SIBO and adhesions I would love to talk about… and I think if we can start right at the start as to how SIBO and adhesions are interlinked because I know with my own journey with SIBO there was an enormous focus on my diet and the actual treatment which I decide to go with the herbal antibiotic route rather than the pharmaceutical antibiotics. There was no discussion at any point about adhesions. And I think that it’s often quite a missing piece. So if we can talk about how adhesions and SIBO really often go hand in hand and why adhesions can be so problematic when it comes to the long term successful treatment of SIBO.
[21:21] LARRY: I guess I am gonna take this one too and then we’ll give it back to Belinda. But I think a good example would be our first patient. You know we knew very little to nothing about SIBO. We have seen long lines of gastroenterologists when we were presenting at a digestive conferences listening to the people talk about SIBO. We really did not know what it was and then a patient of Dr. Gurevich came to us and she came to one of our clinics and this patient is one for whom medications were working for a certain period of time and then they stopped working. In her case, this lady in her young 30s was down to 85 pounds which I don’t know how many kilos that is, 40 kilos or her weight was. And it happened that she came to one of our clinics.
[22:22] BELINDA: for endo
LARRY: For endometriosis?
BELINDA: Uhuh. She had a resection
LARRY: Uhuh. So she came for endometriosis and a bowel resection. But in any rate we were thinking about anything about SIBO. We were treating her for that. she goes back to Dr. Gurevich and suddenly she starts getting her weight back and she went back up to a normal weight 135 pounds. I am not sure again what that would be… 50, 60 kilos. So it really saved her life and sort of the buzz got around on naturopath… we didn’t know anything about SIBO as I said. But it’s got around naturopathic circles and Dr. Siebecker called us and said, “What did you do with this patient?” Dr. Sandberg Lewis came 3000 miles, 3500 miles about 5000 kilometers to Florida to say, “What did you do to those patients? Why is she getting so much better? And why is she better? What is it that you did?” and we said, “What’s SIBO?” It was really kind of a very neat coming together and I had to complement the naturopaths. They are so bright and so inquisitive and so in the afternoon instead of thinking about going out and having a round of golf we are thinking about what else can I do for my patients.
So we got the chief of staff at our hospital here who is our medical director and our double PhD who is an expert on disease modeling and between them and Dr. Sandberg Lewis they discussed it and decided – Well I think what happened was Dr. Gurevich is treating this patient. The meds were doing well. But they would knock down the bacteria but the bacteria would come right back because adhesions in her intestines and you have about 7 meters of intestines were preventing the bacteria from leaving the body. Once we treated because we are just really mechanics in this, once we treated and decreased or eliminated her adhesions and she is still at a normal weight now, then 3, 4 years later then the antibiotics could work and she could flush out those proliferation of bacteria of the SIBO.
[24:44] REBECCA: I hear from a lot of people… every day I am hearing from people and quite often I hear from people that are really from a pretty poor state and there are often been rounds and rounds of treatment for months if not years. Their food is becoming more and more restricted. They are losing weight or they are gaining quite a lot of weight. People seem to fall into any of those categories. And they are at their wits end. They are just thinking nobody is working. What do I do? And I do wonder how much, if there are any discussions happening with these patients about adhesions being potentially what’s keeping them quite sick. And I suspect that there aren’t enough conversations being had around this.
So in a very basic term and obviously, the listeners don’t have anything to look at when we described this, can you describe how adhesions can form around the small intestine and thus either create SIBO or prevent it from being reduced or actually repairing it completely.
[25:51] BELINDA: Again the adhesions form after surgery, trauma, infection, endometriosis, radiation and you have to picture the body as being knit like a sweater. A lot of the adhesions are affecting the fascia which is the body’s connective tissue. And it’s a continuous 3 dimensional weave of collagen and elastin that runs from head to toe, front to back. So the way the adhesions form is sort of like a spider web. So just like when you kink a hose, it decreases how much water can come out. It doesn’t take much crimping or kinking or twisting of any of the loops of small intestine to prevent the bacterial overgrowth from being able to get out of the small intestine. The adhesions can also cause partial or total bowel obstructions.
So if you picture chewing up some chewing gum and sticking the chewing gum in your gut as you move around and do your daily activities and as the organs function depending on what body system they are in, bits start sticking to many different organs that can cause pain and different kinds of symptoms such as bloating, distention, constipation, pain with intercourse, sever pain with periods. They can cause many many different kinds of symptoms.
[2:13] REBECCA: And then with the adhesions being present then obviously that natural flow through the intestinal system, that motility that movement with the waves passing through pushing through it along would be impaired I would imagine which is why the bacteria can then stay present and form in large numbers and develop SIBO.
[27:37] BELINDA: yeah absolutely. The adhesions not only affect mobility of the organs but absolutely affect the motility.
[27:46] REBECCA: and I think mobility is actually an interesting one and I remember Larry you talking about this at the SIBO symposium last year around I think you talked about it actually now… about the organs moving around with each other. I never thought about my organs moving. We see these images of your organs and you just think they are fixed but they are actually supposed to move around a bit aren’t they?
[28:14] BELINDA: All the organs in the abdomen and pelvis absolutely need to be free to slide and glide over and around each other as they function depending on what body system they are in. but also as you do your daily activities and when all these things get tethered and glued down, it can cause all sorts of pain and many different kinds of symptoms.
[28:35] REBECCA: yeah I remember being fascinated by that. I thought I have never thought about my organs moving around and I needing the freedom to move around each other. It was really eye opening for me.
Can we talk a little bit about how your therapy works and clearly you developed your therapy to support you Belinda with your very chronic pain. But for anybody that is listening, how does that work? What do you actually do?
[29:03] LARRY: Well we’d love to fill this under laparoscopy but to anybody we’ve suggested said, “Why would we get a laparoscopy if you are gonna clear my adhesions. I don’t need the surgery.” So we know that adhesions are composed of thousands of tiny strands of collagen like the strands of a nylon rope but very short little strands, microscopically short.
When you have an injury, your surgery is certainly for you when your appendix bursts and infection goes to the intestines kind of leaks out into the interstitial spaces between your organs. But anywhere that you have an invasion like that or tissue trauma, these tiny strands lay down on top of each other and they come into lay down and attach to whatever they can attach to. They are not thinking I am gonna be in the intestines or I am gonna be in the reproductive structure. I am gonna be on the muscles. They are just forming to help surround the area so that your white blood cells and your immune system can fight off the infection or just to start the process of healing. Once they have formed, they stay there in the body. The body, after 7 to 10 days they are with you for life. There is really not a way that the body has to get rid of them.
I will really get to the edge of the question but it’s kinda like the run in a sweater if you will were things used to be mobile and used to be moving easily and were the tissue got damaged. Scar tissue forms. Internal scar tissue called adhesions made of thousands of little strands and they attach to each other and to anything that is nearby and that’s what you are left with after you heal. We believe that what we are doing and our intent is to pull these strands apart from each other. Strand by strand, little by little will probably do hundreds or thousands at a time but there are tens of thousands or hundreds of thousands in there.
We know that the strands are very strong. We don’t think we are actually breaking the little strands. But there is a molecular chemical bond that attaches each strand to the next one and then the underlying structure. So the intent of our manual therapy is to slowly and steadily detach those bonds, that molecular chemical bond is the vulnerable point we feel like and adhesions. And by doing the work that we do, it’s kind of like pulling out the run in the sweater in very slow motion.
[31:55] REBECCA: and so then once you have kind of undone all of those strands from each other are they then just little free strands still attached or are they breaking apart from the walls that they have attached themselves to?
[32:11] LARRY: We don’t have film of this but it makes sense to us that strands attached at the top and bottom of each strand, the strand probably detaches at one end or the other. The end that is still attached, these are collagen fibers and collagen covers, as I mentioned earlier, every single cell in the human body. So if there is still a strand that is attached to the cell of the bowel. But it’s just collagen, it can lay down on that cell just to become part of the collagen that is already covering that cell wall. The important part is that is not attached to the next one and the next one and the next one.
So we don’t think they break at both sides at the same time and go kind of free in the body. As they detach, they just become part of the collagen that is a natural environment of every cell in the body. But the important part is they are not attached to the next and the next. Just like with the sweater, those strands don’t go anywhere but they detach from each other. Does that make sense?
[33:13] REBECCA: yeah it does and I got this mental image of how these little strands flowing freely in the breeze. Abdominal area…
[33:22] BELINDA: I think they sort of blend with surrounding fibers but they are mobile. Like if you picture the fibers crossing each other, they are no longer stuck where the fibers cross.
[33:33] REBECCA: yeah definitely. And given that these adhesions form because of some kind of either surgery or injury to the area, are they at risk of reforming?
[33:47] BELINDA: well we have developed a home program and self-treatment techniques for patients to do to maintain the improvements that they gain during our treatment. We know that the results of our last just from patient feedback over 27 or so years. But the body doesn’t form adhesions spontaneously. They would form new ones if they had another surgery another trauma, another infection or another infectious process.
[34:23] REBECCA: Okay. Yeah that makes sense.
BELINDA: the self-treatment is an important part to maintain, to keep things as freely mobile as we are able to gain during our treatment.
[34:34] REBECCA: And how long does treatment program generally take? Is there an average length of time? Or is it really a case depending on how bad the adhesions are?
[34:44] LARRY: a little bit of each. Most of our studies are based on 20 hours of treatment. We start Monday morning and are done Friday afternoon. 2 hours in the morning and 2 hours in the afternoon. I f someone has had 7 surgeries, a lot of trauma, they can go longer. Generally we’ll tell patients, “see how that works for you? You can always come back if you feel like you need to.” WE don’t push them into any of that. We do give them a home program so that they can maintain the gains that they got. So it’s usually a 20 hour program but can be as long as 40 or 50 hours.
But again we are not pushing anything. Patients feel like, “Oh man that really helped me. I can really feel that i still got some stuff going on. I would like to come back.”
I want to touch on one thing that Belinda had mentioned. As far as when you asked the adhesions reform, generally speaking they are only formed as a response to the different conditions that Belinda talked about – surgery, trauma, inflammation, endometriosis. We noticed that when we would open women’s blocked fallopian tubes that those tubes would stay open for years and women would have baby after baby after baby. Six, seven years later we open one tube and she still isn’t having children. That was great when we first started treating bowel obstruction which is a very serious, life threatening condition in which the intestines are totally blocked with adhesions.
Patients would come to us and say, “You know I’ve had 7 first ones.” Came to us and say, “I’ve had 7 surgeries in the last 3 years and now the last one was 12 weeks ago and they are planning my 8th surgery. Can you prevent these from happening.” And we did. That was about 9 years ago. She came in. we treated her and she hasn’t had a surgery in that area since. But we did notice that we kind of expected it to work like fallopian tubes and would open them and just be good to go. But where the fallopian tubes are 10 centimeters long, the intestines are 7 meters long. So we find that yeah were are great at clearing adhesions in the bowel in most cases but because of the huge amount of geography compared to the fallopian tubes we do find that it is important that we give patients something to go and give them an education and teach them how to treat themselves at home.
And then the home program is pretty easy. It will just be in about 20 minutes in the evening for about 6 months. And lying on a ball or using your own hands.
[37:58] REBECCA: and 20 minutes isn’t extreme at all when you think about we’ve got maybe 16 hours of waking time during an average day. 20 minutes out of that isn’t laborious.
[38:10] LARRY: That’s right. You can listen to your iPod or watch television or whatever.
[38:14] REBECCA: Or you could be listening to this podcast.
It’s a good way to spend those 20 minutes.
REBECCA: with regards to actually breaking down these adhesions I am thinking it sounds like it could be really painful. When the manual treatment is happening does it hurt when someone is being treated?
[38:39] BELINDA: Well our pressures vary from pretty gentle to pretty firm. The patient is always the boss. They are in control at all times. We are constantly telling them what we are finding, what we are feeling, what we are thinking, what’s going on and asking for their feedback. If at any point any technique is getting to be too intense all they have to do is ask the therapist to ease the pressure up until they say, “Ok I am good with that.”
So I can tell you working on scars is probably the most uncomfortable. It can feel like a burning, stretchy, pinchy situation. But again the patient is totally in control at all times.
[39:16] REBECCA: And I am guessing that would also build up that you may not start at the most intense on the very first session. And I know that… well I wonder if with your patients that come through with SIBO given that the majority of us have been chronically inflamed, chronically in pain, I think that our pain thresholds are often… our pain sensitivity is pretty high because we are so pained all the time and I am wondering whether SIBO patients or those chronically in pain, they need to kind of build up to it because they are already feeling really sore?
[39:54] LARRY: well, most of the time we stay within their tolerance level. We’ll say 0 to 10, what does that feel like. “Oh that is about a 5.” “Ok how’s that?” “Ok so you just let me know if you need me lightening up. I’ll say hey you are hitting an 8 can you lighten up. That’s a 4 that’s good for me.”
So we can start on peripheries. Because when you think about the run in the sweater you don’t always go right into the center of the run. You may start at a distal aspect of it, in an area that is not so adhered. I do find that more often than not our patients are like – Just do it. Just do whatever you need to do. Just give all that stuff
[40:49] REBECCA: Whatever it takes.
LARRY: I kind of wish it did because I love to stay a little bit lighter. So we are super sensitive to what people are feeling and even a very very light touch can be effective. But generally speaking we are working through layers and in way it is kind of like peeling over the course of the week, over the course of 20 hours of treatment. You feel like, wow it’s like you are peeling off layers off an onion in a way as you get deeper and deeper and the deeper you go the quicker things go because there is so much more geography that we are getting through in the beginning of the week than towards the end of the treatment session.
[41:33] REBECCA: Yeah definitely. And now for people like myself who live in places where you guys aren’t yet, hopefully one day you will all have the presence. How do people find a practitioner that can help them with it if they suspect that they have adhesions? What should people do?
[41:51] LARRY: First of all if you have a physiotherapist that has really great skills send her to us. Maybe we can train her especially if she is in the big city where folks come to. But you can look for somebody with either mild fascia release or visual manipulation, someone who works regularly with soft tissues. The visual is very light which is in general, which is probably good because we have 6 pages single space of country indications, things that we are looking at. Does this patient have cysts? Does she have cancer in the last 18 months? Does she have…. we are just looking.. because there are so many things that’s gonna happen in the abdomen. It’s really nice to have clearance from a physician that says oh yeah you can get some deep soft tissue. But start looking around.
I have heard people talking about visceral manipulation. I think Allison Siebecker told me that she saw some good results from patients doing visceral.
[43:02] REBECCA: it’s interesting. Since learning about adhesions I have spoken to any of my practitioners, osteopaths, physiotherapists and all the rest. There aren’t a lot of people I’ve gotta say here in Australia that know much about it. I mean they know the concept but when I say, “Would you feel confident in treating me for adhesions?” generally the answer is, “not so sure about them.” And so I think that fortunately there is not always a great pool of people and yes I would love to be putting a whole bunch of people on a plane and coming and doing some training with you guys. I would love to get some more Australian therapist in training under you.
[43:47] LARRY: yeah London would be the closest for you I guess.
[43:52] REBECCA: Well it’s actually closer for us to jump on a plane from the States than it is to the UK. Yeah you are closer. It seems strange but it’s 24 hours to fly to the UK and it’s only 15 to get to the west coast of the US. So you are a little bit closer.
[44:13] LARRY: Well I was just gonna say we are very picky with our therapists. There are therapists who have 28 years’ experience so we don’t really hire training newbies because we need to know that they are gonna be successful because we are treating…. Bowel obstructions are life threatening and treating it as a very serious condition. So and we do screen everybody really thoroughly. Medical history and history or surgery and traumas and anything that they’ve got going on now. And we do those consults… We don’t charge for those consults if somebody thinks that they seriously may want to come see us. We don’t push anybody at anything. But it’s too bad as you said osteopaths, there are not a lot of people that are really working on adhesions.
[45:11] REBECCA: No, there aren’t and I feel that I have kind of found this missing link in my own health journey. And you know I have been, since June of last year, I have been actively looking for somebody that can do some work on me here in Australia. And I am having a lot of conversations. It’s what I do now with everything, with the Healthy Gut. It’s all about education and sharing knowledge and it does sadden me that there’s just not as many options here in Australia but I am hoping that will change in the very near future.
What is a risk if somebody leaves an adhesion? Can things get worst if you think, “Ah I’ve had it for 10 years.” What else? It can’t get any worse than it already is. Can it actually worsen? Can we get sicker from leaving our adhesions?
[46:06] LARRY: well adhesions either stay the same or grow over the course of life. So the reason that they would grow if you had adhesions in your abdomen is that if every time you reach back and you are stretching and you are kind of feel that pull is creating a little bit of inflammation there and the body goes, “oops. Rebecca’s got some information there let me just send in some cross links. Some adhesive cross links to help start healing that area. I mean really the greatest risk I think for your patients would be bowel obstructions which are life threatening is when the bowels get squeezed. So no food goes through. And when that happens in the US it leaves us a lot of data. The average hospital stay is 14 days. They put a tube down through your nose into your stomach to pump out your stomach. They put intravenous or narcotics into your veins and then they give you intravenous hydration and IV fluids to keep you alive hoping that it will pass. If it passes, nothing has really changed. You still have those adhesions. It may happen again, the physicians tell you. If it does bypass, they have to do surgery, open you up, pull out and usually the tradition is to pull out all of the bowels, let’s find what’s adhered. “Ah, there’s the area that is necrotic, that’s dying or that is squeezed like an hourglass. Let me just cut those two sides, throw away what’s bad, rejoin the two sides that are left, hope to God that not of drop of what’s inside the intestines drips out and it’s on the outside now of the bowel because now I am gonna put that bowel back into this patient.
In about 18%, about 1 out of 5 patients return to the hospital within 30 days for another surgery. And so now we have had that repaired and the doctor will say, “Here’s my card. This is liable to happen again because surgery is well regarded in the literature as the number cause of bowel obstruction.” And we see patients that have had 4 or 5, 6 of these and their doctors says, “I just don’t want to operate anymore on you because I can’t even see where I am going on there. It is so adhered. I am afraid I might cut through something that you don’t want me cutting through.
So that would be the most serious risk I would say of letting them go.
[49:03] BELINDA: Plus with endometriosis, every month when you have a period, you form more adhesions from the endometrial implants on the different organs. They are swelling during the period pulling on the organs. The body lies down more adhesions to protect those organs. So it’s sort of a vicious cycle.
[49:27] REBECCA: for somebody with endometriosis, do they need to be on a very long term kind of treatment plan given that every month when they are having their cycle that their body is in effect causing more adhesions?
[49:44] BELINDA: Well I think with most of our endometriosis patients, however many years they’ve had endo, you know in the 20 hours of treatment, we can free up as much as we can free up and as long as they do their home program we don’t see that many of them back again. Some do. You know we do see many women of pretty severe stage 4 endo. So some of them do come back every few years for a few more days. It varies depending on their history if they’ve had a bunch of surgeries and traumas as well.
[50:20] REBECCA: I was on a cycle for a period of time where i was having my laparoscopy surgeries every 12 months and the advice I was given by the specialist… this was when I was living in the UK was that expect to be on the operating table every year. Once I started to address my diet and particularly when I addressed my SIBO my endometriosis changed considerably. It is virtually nonexistent for me now which is wonderful. But for people that are in that vicious cycle where they are booked in for surgeries to break down adhesions every 1 to 2 years, what would your advice be to them?
[51:04] BELINDA: Every time they have a surgery they may cut or burn away a certain number of adhesions but they are creating so many more new ones. I mean they really need to get the adhesions addressed nonsurgically if possible to break that cycle.
[51:21] REBECCA: and I think it can be quite a vicious cycle because you think well the surgery needs to be done to break the adhesions but I am sure for anyone listening that it is now understood that surgery is causing more adhesions that they might be thinking, “Oh my gosh, I’ve just been in this really nasty vicious cycle for all these years and no wonder I am so full of adhesions.”
[51:46] LARRY: That’s right. And it’s not that the doctors are mean or cruel and we are not exactly sure why they don’t talk about adhesions that are going to form or that are liable to form and very liable to form other than they’re thinking – there’s nothing else we can do. We don’t want to scare the patients. The fact is that the most brilliant surgeon cannot help but have adhesions form because that’s the first step in healing. It’s the first step in healing from a trauma. And surgery is a trauma where they are cutting through tissues and burning.
I asked the chief of staff at the hospital. He is a surgeon for 35 years and he just got fascinated with us for a lot of that time. I said, “Dr. King do you think that possibly when we are treating we are causing some inflammation. We could be causing more adhesions ourselves.” And he said, “Larry, you know I am an excellent surgeon.” And he really is. He is highly respected here. He said, “But when I go in, after I finish, it looks like a warzone. You know there’s cutting and there burning and there’s smoke and there’s bleeding and I have to stop the bleeding.” And when you are treating it’s kind of like a picnic. The least traumatic thing I can imagine and the fact that you have now published data, you’ve got about a dozen studies and actually about 20 but some are between 12 and 20 depending on. What you are doing is so much less traumatic. He stayed with this for about 30 years just because he was so fascinated. But I am not sure if I wandered off or if that answered your question.
[53:44] REBECCA: so if people want to find out more about you or even to learn where your treatment centers are, what’s the best way for people to get in touch with you?”
[53:56] LARRY: Probably go to www.clearpassage.com It’s our website. It’s got a lot of information. A lot of testimonials, information about how adhesions affect conditions. There’s a little tab where they can fill out and say, “yeah I’d like a phone call. I’d like an email.” If they are thinking seriously that they may want to consider coming, there is a comprehensive medical history form that may take 30 or 40 minutes to complete where we ask all your medical history.
What surgeries have you had? Falls? Any abuse? It’s all quite hipo-compliant that is to say it’s private. And in that case it gives us great information and they can schedule a consultation. There is no charge for that to discuss their case. And we will give them our best advice.
[54:56] REBECCA: That’s great. And I myself am thinking, how can I get myself to the US for a week to do this treatment because just listening to you talking today I can’t not be full of patience after all my surgeries and injuries and endometriosis. And I literally got the gamut. So my suspicions of having adhesions are even more suspicious now after talking to you both because I just think it would be an absolute miracle if I didn’t have adhesions after what I have been through.
[55:31] BELINDA: well we would absolutely love to work with you. It’s a great pleasure.
LARRY: I would say that I think you are probably quite accurate. I mean how could you not…I mean once you’ve had an appendectomy and your appendix bruised and that stuff goes out your system and then the various surgeries that you’ve had and you’ve taken enough traumas, you’ve healed… you’ve created those little straitjackets. In some people they can get those strait jackets where they just don’t even bonded them and they are fine. But if you have persistent SIBO, if you have pain, if you have endometriosis, it’s the great thing to do. somebody with a history like yours, I am sorry to say you are quite accurate my dear lady.
[56:24] BELINDA: You are a very good candidate for the work that we do.
REBECCA: I think I would be. And even just thinking about I remember having falls as a kid. I have come off my bike. I ski. So the number of times I have fallen on the slopes and sometimes quite badly wounded myself. I am literally I have been going through everything thinking that could have caused an adhesion. That could have caused an adhesion. The surgery… everything. It’s been quite eye opening and I am sure it has been for my guest as well. So Larry and Belinda Wurn I would just love to thank you so much for taking some time out of your very busy schedules to come on to the healthy gut podcast today. It has been an absolute pleasure. And for the people that are listening, I have the link to your website in the show notes so that they can connect with you guys very easily.
Thank you once again. It has been a joy to have you here today.
BELINDA: Thank you so much for having us.
LARRY: lovely. Thank you.