http://www.spasmodicdysphonia.us ZHT and Spasmodic Dysphonia |
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| ZHT and Spasmodic Dysphonia A Potentially Revolutionary Model for Voice Disorders by Rick Lehtinen, April 18, 2006 This article is an introduction to Zhou's Hypoxicology Therapy (ZHT) that describes the possible mechanism by which ZHT may ease the suffering of patients with Spasmodic Dysphonia (SD). Helping patients with SD is one of many potential beneficial side effects of ZHT. This therapy was initially developed as a non-drug, non-surgical intervention for Sleep Apnea and other hypoxia-related (oxygen depriving) conditions. The response of SD patients to ZHT has been so positive, however, that we may eventually study these mechanisms in greater detail and more formally. For now, it seems apparent that ZHT is an excellent alternative therapy for SD, and is also one that can be adjunctive to other concurrent therapies. This is because ZHT does not appear to negatively impact other therapies for SD, yet still provides unique benefits to the patient. What is Spasmodic Dysphonia? We will not here clinically define SD, but merely state for readers a common definition found on an acknowledged information source: "Spasmodic dysphonia ... is a neurological voice disorder that involves involuntary "spasms" of the vocal cords causing interruptions of speech and affecting the voice quality. SD can cause the voice to break up or to have a tight, strained, or strangled quality." National Spasmodic Dysphonia Association website homepage ( http://www.dysphonia.org ) Researchers generally distinguish between spasms involving the set of muscles that close the vocal folds, the adductors, from spasms involving the muscles that open the vocal folds, the abductors. Adductor spasmodic dysphonia is the most common, and produces a straining or strangled voice. Abductor spasmodic dysphonia leads to an involuntary whisper, or "cutting-out" of the voice. Spasms that occur while breathing as opposed to speaking, resulting in noisy and struggling breathing, usually involve the adductor group. This latter can often be considered a pseudo -asthma. The etiology of SD is uncertain. Historically it was considered to be psychological rather than physical in nature. Regarding SD, this source continues, "Onset is usually gradual with no obvious explanation. Symptoms usually occur in absence of any structural abnormality of the larynx, such as nodules, polyps, carcinogens, or inflammation. " While we do not dispute this neurological observation for dystonias in general, we believe that time will tell that SD may prove to be a special case for which we can offer a different explanation. We feel that the model that we propose to explain some forms of sleep apnea, and the reason ZHT is curative for them, may shed new light on SD. If this model is correct, the cause of much of what is called SD may be attributed to physical rather than neurological conditions, and can be easily corrected, or at least alleviated, without drugs or surgery, via ZHT. What is ZHT? Zhou's Hypoxicology Therapy (ZHT), is a two part system of treatment designed to ease the effects of chronic mild oxygen deprivation, or hypoxia. As sleep apnea is a "royal road" to hypoxia, and apnea is so prevalent a problem today, ZHT is currently promoted as an effective apnea treatment. The two parts of ZHT are: 1) Patient self care, consisting of daily practice of a series of exercises designed to treat what we feel is the underlying cause of hypoxic illness, and; 2) Practitioner guidance and counseling in selecting, from the panel of all ZHT exercises, those that will most benefit the individual patient at the current point in therapy, as well as corrective manipulations and massage required to expedite the restoration process. How does ZHT work? To understand ZHT requires understanding what we feel is the true cause of many hypoxia related illnesses, including sleep apnea. We will first discuss apnea, but as we shall see, the discussion will cover much of spasmodic dysphonia as well. An apnea is a momentary cessation of breathing during slumber. Shortly after the apnea occurs, the brain senses trouble, usually due to falling blood oxygen, and attempts to rouse the sleeper. Once alert, the sleeper gasps and takes a deep breath. This resolves the brain's immediate crisis, and it moves on to other matters, allowing the sleeper to doze once more. This happens periodically to almost everyone, the body arousing to cope with everything from an event of acid reflux, to stirring when a child coughs, or calling out to quiet a pet. There is normally no ill effect. In the case of a person with sleep apnea, however, the process runs amuck. The sleep / rouse cycle can occur hundreds of times an hour, leaving the victim uncontrollably drowsy the following day, and every day, as true, restful sleep is never attained. Although this sleepiness can be attention getting and disabling, recent research has shown that the real horror of this situation is actually due to the long term effect of the chronic lack of oxygen, due to interrupted breathing. The list of hypoxia-related illnesses extends far beyond daytime sleepiness, and could include cardiovascular diseases, hypertension, obesity, and even certain cancers. Apnea generally takes two forms: In central apnea , the brain simply forgets to breathe, or alternatively some muscle, the diaphragm, for instance, becomes ineffective at interpreting the brain's signals for action. In obstructive apnea , tissue from some point in the airway somehow relaxes and slips into the respiratory pathway. An example would be the common case in which the uvula or soft palate falls back against the back of the windpipe while sleeping on the back, often due to a backwards motion of the lower jaw as it totally relaxes. The obvious and common dental solution for a collapsed jaw over the past years is the use of an oral appliance at night (known as a Snore Guard). Such an oral device can keep the jaw in the forward position during sleep, and has been helpful to many patients. The common surgical treatment for obstructive sleep apnea is to remove some of the tissue around the airway, or to stiffen it with surgical implants. The current popular non-surgical treatment is to use a small machine to gently force air into airway, using just enough pressure to keep it from collapsing (Continuous Positive Airway Pressure, or CPAP). Central apneas may not be curable using conventional means. ZHT works to alleviate obstructive apnea by recognizing what we feel is the true or primary cause of airway obstruction, and then addressing that cause rather than treating its symptoms. Once the obstructive apnea is relieved, allowing the brain and breathing muscles to function normally and re-educate themselves, central apnea may improve as well. ZHT may also alleviate the central apnea by stimulating the neural pathways that control and fire the breathing muscles. About Tracheal Caudal Displacement (TCD) The connection between ZHT and SD becomes obvious when we examine what our model projects as being the true cause of obstructive apnea. According to the ZHT model, the reason that tissues in the throat become obstructive and plug up the airway is because the throat itself is sliding down into the chest. The name for this condition is tracheal caudal displacement, or "tracheal downward movement." As TCD occurs, the throat (trachea) moves gradually down into the chest (thorax), squeezing together all the tissues and muscles in the throat, and significantly reducing the diameter and effectiveness of the airway. The vocal cords are located in the throat, and could thus be affected by this TCD process. The cause of TCD is unknown, but the aging process and the effects of gravity would be obvious suspects. Fortunately, by rehabilitating the muscles involved, the impact of TCD can be reversed, or at least mitigated. This is the end to which the ZHT exercises were created. If treatment with ZHT can reduce TCD-induced effects on the vocal cords, then it would follow that SD may be improved by ZHT. This is in fact, what we have observed. That TCD and apnea are related is without much doubt. This can be confirmed by a few simple measurements. In fact, physical measurements and surveys are the primary instruments for diagnosing sleep apnea in many poorer nations. These measurements can be illustrated by imagining a young person in superlative condition, say a ballerina. The first measurement would be to determine the body mass index using an ordinary cloth measuring tape placed first around the hips and then around the waist. Any number of on-line resources can convert the resulting ratio into empirical assessment as to whether the subject is "fat" or not. Obesity tends often to be associated with sleep apnea, although recent research has made it difficult to determine whether this is a cause or an effect . The second measurement is easy to imagine, but harder to perform . Standing with the subject's shoulder to one's chest, instruct the subject to tilt the head neither up nor down, but straight ahead (anatomically normal position). Drop the tape from the bottom front of the chin down to the level of the sternal notch, which is the downward indentation in the center of the collarbone, just below where the Adam's Apple would be if the subject was a male. If the distance from the chin to sternal notch is great, the neck is long, and TCD is not likely present. If the distance between chin and sternal notch is short or zero, the neck is short, and the trachea may be intruding into the thorax. The chances of apnea are increased. ZHT will usually restore the neck length, which results in immediate cessation of apnea in many patients, and subsidence of symptoms in most others. A variation of this second measurement is to describe the path that would be drawn by a crayon tracing the line from the chin to the sternal notch. If the crayon forms a line that goes more or less horizontally along the bottom of the chin to the neck, and then turns sharply down towards the sternal notch, sort of like an upside down letter "L", the subject's neck is upright and extended, and in most cases apnea symptoms will not be present. If however the line is a straight, angular shot from the chin to the sternal notch, like the hypotenuse of a triangle if the chin and neck form its legs, then it is likely that the head is being carried forward. In the ZHT model, this is a posture adjustment that the body makes in order to maintain the effective diameter of the airway, which would narrow as the trachea falls. Apnea symptoms are highly likely to be present. Again, ZHT can usually do much to restore the neck to its normal, youthful, extended position, and it is our experience that once this is accomplished the apnea symptoms, and presumably those of SD as well, will subside. Who can practice ZHT? ZHT can be administered by any practitioner licensed to manipulate the soft tissues of the neck and throat, and who can occasionally touch or support a patient that is sitting or standing. Any professionals who have an interest in the nerves and muscles ( neuro muscular specialists) would be suitable ZHT practitioners. A partial list of these potential practitioners could likely include:
The question arises, could a vocal coach, an athletic trainer, or a parent learn the ZHT techniques and apply them to someone for whom it would be reasonable and customary to engage in limited physical contact as part of providing care or instruction? We believe so. The "massage" portion of ZHT, if it can be called that, is highly localized to specific musculature in the throat and jaw. It is not intensive or lengthy, does not require disrobing, and in fact is not always necessary. At this time, however, our effort at disseminating ZHT information and training ZHT practitioners is focused on those whose licensure would allow them to receive payment for their services, and who are likely to maintain a high standard of care and professional record keeping. It is occasionally heard that ZHT is a "Chiropractic treatment." This is not the case, nor is it our goal. By historical coincidence, the first one hundred trained ZHT practitioners included only two or three non-chiropractors; but this was more a function of our ability to communicate well to this group than it was to any preference for one type of practitioner over another. Chiropractors, generally speaking, tend to be interested in non-drug, non-surgery, physical or exercise-based treatments, and ZHT certainly fits this model. However, any practitioner who is interested is welcome to attend ZHT training. Functionally, chiropractors and their patients also tend to accept a process, which could take a little more time and office visits, to accomplish a treatment goal. Accepting this process as a rational trade-off (or hold-off) for non-reversible (i.e., surgical) alterations to the body, or the introduction of chemical agents (i.e., pharmaceuticals). These later interventions could be appropriate, if the simple and natural ZHT methods don't work on some patients. Interestingly, such patience has not proven to be a requirement for ZHT. It tends to work rather quickly. What actually happens during a ZHT session? This depends on the personality and practice style of the practitioner. Generally speaking, a brief medical history will be taken, followed by some questions designed to screen for sleep apnea, which is still our primary focus due to the dangerous nature of hypoxia. The measurements described above may be taken, although in practice ZHT practitioners no longer use a cloth tape to determine the chin-to- sternal notch distance, having found a more accurate way. The patient will then be guided by the ZHT practitioner through a series of exercises designed to coax the trachea back up to its rightful and more normal position. The patient will then be given a carefully chosen list of exercises to perform several times daily at home to help keep it there. Follow-up visits will likely be scheduled. The whole process takes about an hour the first time, and much less on subsequent visits. In addition to individual sessions for actual treatment, some practitioners do their ZHT care training in a group setting for patient education and teaching the exercises. What is ZHT self care like? We describe ZHT self care as being comparable to brushing and flossing between trips to the dentist. Most patients receive a pick-me-up or boost of energy when they do their exercises, which usually take five to ten minutes, four to seven times a day, depending on what the practitioner suggests. Some of the exercises involve sticking out the tongue and stretching it by swallowing, laughing, or coughing in a way the patient will be shown. Other ZHT exercises are designed to increase the amount of oxygen in the patient's system using nature's own processes. In some cases, we measure this using a finger pulse oximeter .
Tell me about Dr. Zhou. Dr. Zhou (pronounced "Joe") is a small, thin, forty- ish ball of energy who happens to be extremely intelligent, and who is also a gifted clinician. As a student at the Jiangxi University of Traditional Chinese Medicine, in Nanchang, the capital of Jiangxi province, China, Zhou would habitually read all the class texts as well as one or two other books on each subject before the term started. This allowed Zhou to be a terror to his professors, while greatly increasing his learning. It should be understood that in China, Traditional Chinese Medicine (TCM) is taught in modern campuses, as is Western medicine, and that there is a strong degree of cross training among practitioners. It would therefore not be unusual for a talented TCM student to become an expert not only in herbology and acupuncture, but to go on to lecture on abdominal surgery upon graduation, as Zhou did. It would also not be unusual for such a student to perform national service at a military hospital, which Zhou did, as an orthopedic surgeon. Typically, other Jiangxi graduates who have come to the United States have ended up doing medical research. A few may have served residencies and began practicing medicine here. Zhou reasoned that Chiropractic would put him into a clinical setting in the shortest time, so he enrolled in Palmer Chiropractic College in Davenport, Iowa, becoming licensed in July 1991, after graduating in June of that year. From July 1991 through October 1994, Zhou worked as an associate doctor with Birdsell Chiropractic & Acupuncture Clinic in Moline, Illinois. In March 1995, Dr. Jin Zhou established Century Chiropractic & Acupuncture Clinic. Today, in addition to his busy practice and work in developing ZHT, Zhou researches and lectures on the topic of healthcare reimbursement. How did ZHT come about? Like many important discoveries, ZHT developed gradually. The initial research was an unspecified project studying the effects of oxygen-lean environments on decision making, and specifically on whether or not a technology that was new at that time, finger pulse oximetry , could serve to alert a person at altitude that their judgment may be impaired. An extensive literature search exposed the truly frightful nature of hypoxia, and how many diseases and illness it was a factor in. This led to attempts to provide natural interventions. ZHT is the result. The connection between ZHT and SD was a predictable link, but not until sufficient data was obtained from the field could it be evaluated as it is now. Are there "clinical trials" to back ZHT up? Not really, but we are in the process of establishing such formal clinical trials. With ZHT, there are no devices or medicines or drugs to sell, and no surgeries to perform. There is not a great deal of profit potential to be had, other than that what a trained practitioner can charge for his/her professional time. Obviously, this has not led to rapid acceptance or demand by a healthcare industry that is fixed on products. Before formal "clinical trials" can be performed, clinical cases need to be gathered as the foundation for such trials. This is known as the pre-clinical trial era. Significantly, the subject of oxygen deprivation is rapidly becoming a topic of discussion and research. The word "Hypoxemia", although it appeared in medical dictionaries for years, was only recently recognized as an official diagnosis. It was introduced into the medical community in October of 2005, when it appeared for the first time in the International Classification of Diseases-9 th Edition-Clinical Modification (ICD-9-CM). This is the coding standard used by all healthcare in the USA. The new code number assigned to Hypoxemia is 799.02. Use of this new code will facilitate the proper reporting of this important diagnosis for evaluation, payment, and research. By accepting ZHT treatment as a step in overcoming their vocal problems, SD sufferers can play a valuable role in this pre-clinical trial era. Where can I learn more? Edison Health Innovations sponsors two web sites for this emerging therapy, www.ZHTCare.com and www.ZHTDoc.com , which explains the current state of ZHT development. We list on these sites current research from respected authorities regarding hypoxia-related illnesses. Included in these sites is a list of ZHT trained practitioners who wish to be known as ZHT providers. The doctors on this list will be more than happy to explain ZHT. In addition, we offer a forum for patients to exchange their experiences with ZHT. We also have an on-line store in which we offer books and other information regarding ZHT and good health in general. |
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