• Anti-depressants
• Sound generators
• Hearing aids
• Cochlear implants
• Behavioral therapy
• Transcranial magnetic stimulation (2)

Much to my surprise (and shock), my tinnitus of over 25 years resolved as I went through my own healing process. It has been gone for over 20 years.

My Experience

The old saying, “Youth is wasted on the young,” is true—especially in my case. Many of the physical issues of my adulthood resulted from a perceived invincibility during my teenage years, combined with my refusal to heed adult advice. Protecting my ears was one of those cautions that I cavalierly ignored.

The Destruction of My Hearing

I worked as a carpenter and hod carrier from the time I was 14 years old and into medical school. Every summer and most college vacations, you could find me building houses. The summer before medical school began, I built my parents’ home. Although I was involved in many aspects of construction, my most frequent task was framing and pouring concrete slabs, which entailed using a Skilsaw much of the day. I never gave a thought to decibel levels, even when I was using the tools close to my ears.

Fellow workers mentioned ear protection, but I just did not see the need. To further punish my ears, I used a nail gun to shoot nails through two-by-four floor plates into concrete. I would load a 16-penny nail (3.5 inches long) into the gun, position it over the 2 by 4, and pull the trigger. To make matters worse, the sound was magnified when I performed this work in basements. Still, the suggestion of using ear protection didn’t seem important.

The Ringing Begins

When I was about 32, I began to notice a strange sound in my ears, like a bell ringing, all the time. It started during a time when I was recovering from low back surgery that had gotten infected. I wasn’t sleeping well, and my stress levels were extremely high.

At first, I didn’t think much about the ringing—until I realized that it wasn’t going to stop. First, I tried to ignore the ringing, which didn’t work. Every time I heard it, I became increasingly frustrated. My attempts to cope with it began to drive me slightly crazy. The problem grew larger and larger. One day I read about a former TV star who had committed suicide because of his tinnitus. This was not reassuring.

No Answers

I saw several ear-nose-and-throat (ENT) physicians, whose exams revealed that I had suffered some high-frequency hearing loss. When I asked about the ringing, they shrugged their shoulders and said it was nerve damage, and nothing could be done. Loud environments aggravated the condition, so I avoided them. Even eating in restaurants would exacerbate it. Earplugs were somewhat helpful.

The Ringing Stops

The tinnitus ceased along with 16 other chronic symptoms around 2003. I could not understand why I could have been so miserable and then have so many divergent symptoms resolve. I heard a lecture by Dr. Howard Schubiner, author of Unlearn Your Pain, where he listed over 30 symptoms that are caused by your body being under sustained stress.(3) Essentially, all chronic mental and physical symptoms, illnesses, and diseases are caused by sustained flight or fight physiology. The effects occur at the mitochondrial (energy producers in each cell) level, and your DNA directs the production of inflammatory cells. The solution lies in calming your stress response to safety (rest and digest) where your body can refuel and regenerate.

Hearing loss is common as we age and permanent. It includes a diminished capacity to discriminate. For example, I could not hear you well if you talked to me in a noisy restaurant. Today I regret the folly of my youth, knowing that much of my hearing disability was self-inflicted. The exact link between hearing loss and tinnitus is unclear.

Calming Down Your Body’s Chemistry

The process of lowering your stress chemistry is called “Dynamic Healing.” You can regulate your body’s stress physiology by:

1. Processing the input in a manner that is less impactful to your nervous system.
2. Increasing the resiliency of the nervous system.
3. Using tools to directly lower your stress physiology. The speed of nerve conduction slows down, and your inflamed brain calms down.

I don’t know the numbers, but numerous people who have learned and used these concepts have reported that their tinnitus diminished or disappeared. I talked to a radio show host who inadvertently used these principles and noted his tinnitus resolved.

The tinnitus still returns when I am in noisy environments, if I am sleep deprived, or if my stress-coping skills are especially challenged. But if I am careful, the ringing is minimal to non-existent. It has been an incredible relief to escape that endless, irritating sound.

Conclusion

There are various types and causes of tinnitus. Not all of them will respond to these concepts, but there is no way of knowing without learning to calm yourself and see what happens. There is no downside, and you may be pleasantly surprised. no longer have to endure tinnitus.

References

1. National Institute of Health. Tinnitus. Available online: https://www.nidcd.nih.gov/health/tinnitus (accessed on 17 September 2021).
2. Denton, AJ, et al. Implications of transcranial magnetic stimulation as a treatment modality for tinnitus. J. Clin. Med (2021); 10:5422. https://doi.org/10.3390/jcm10225422
3. Schubiner H and M Betzold. Unlearn Your Pain, third edition, Mind Body Publishing, Pleasant Ridge, MI, 2016.

The post Solving Tinnitus – The Ringing in My Ears first appeared on Back in Control.

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My first year in training

I will never forget my first holiday season as an internal medicine resident in Spokane, WA. I learned that the holidays are a nightmare for the medicine service, especially the GI service. Diabetics don’t take their insulin and their sugars go out of control. Cardiac patients don’t take their meds and are admitted for chest pain and abnormal rhythms. The GI service is the worst in that patients with liver disease drink more and develop major bleeding in their gut. People are depressed and the stress of the holidays puts them over the edge.

He died?

We had a resident’s clinic once a week. One of my favorite patients was an 80 year-old gentleman, who was as nice of a person as you could meet. He had some moderate lung disease but otherwise was fairly healthy. He was admitted to the hospital on Christmas Eve with respiratory failure. It didn’t make sense to any of us, as his lung disease wasn’t that severe. We had a whole team working intensely to solve the puzzle. It didn’t matter. He died two days later. During the course of the hospitalization I found out that his son who lived in Seattle had not invited him over for Christmas and he had become despondent. I have since learned that the will to die is as strong as the will to live.

My descent into loneliness

I could not figure  this increase in illness and depression over the holidays for many years – until I descended into my own anxiety-driven depression and chronic pain. There were many unpleasant (terrible) aspects of being in the abyss, but maybe the worst one was feeling alone. I am an extremely social person. As I became progressively more anxious and reactive I began to feel isolated. In retrospect I realize that a lot of this was occurring in my own head. My friends were not avoiding me. I was not interacting with them. While I was trying to survive the terror of raw anxiety I was not able to reach out to others. I became more withdrawn and felt uncomfortable even talking to people. Discovering I had NPD

Obsessive thought patterns

What began to happen is that I developed what I now recognize as an obsessive thought pattern (classic symptom of the Neurophysiologic Disorder) that everyone else had a better life than I did. It did not matter what the evidence was to the contrary. I could not shake that thought. The holiday season made it much worse. First, it reminded me of times that were much better and I felt even more sorry for myself. Secondly, people really seemed like they were having a better time than I was. (jealous/angry). Finally it seemed like the merriment around me was almost mocking my plight. For over 10 years I would become dark around the holidays.

I became socially isolated. I imagined that people just didn’t want to be around me and the story in my head became strong and convincing. Fortunately, I had a few people that I connected with that could see through the storm of my thoughts. It was that human connection that kept me going. But the feeling of loneliness was one of the worst aspects of my descent into chronic pain.

Social exclusion and the ACC

A study published in 2003 (1) looked at the brains of volunteers who were hooked up to a functional MRI scanner (fMRI) which highlights metabolic activity of the brain in response to different stimuli. The volunteers were visually involved in a computer game of “three way catch”. They were not told that the other two “players” were just the computer. At a certain point they were suddenly excluded from the game while the other two “players” threw the ball back and forth another 45 times. The volunteer would consistently feel excluded and experience emotional distress. Interestingly, a part of the frontal lobe, the ACC, would light up. This part of the brain is “the neural alarm system.” It lights up when something in the environment is not right or threatening. Not surprisingly pain is a basic signal that also lights up this area. This study documented that emotional pain lights up the same area.

So chronic pain creates yet another vicious loop. Pain lights up the ACC (anterior cingulate cortex). While in pain you feel much less inclined to be social, which then reinforces the stimulation of the ACC. You now have added emotional pain to the physical pain.

Where does chronic pain begin?

People need people. People need to connect first with themselves and then with others. There are many societal factors, in addition to chronic pain, that create social isolation. It is unclear whether the social isolation that stimulates this “neuro warning center” could be the starting point of chronic pain.

Omega

My wife, Dr. Fred Luskin, and I put on a five-day seminar at the Omega Institute last summer. There were 11 participants who experienced a significant shift in their mood and pain during the week. As they went back to their home environment some had their pain return and many remained relatively pain free. The essence of the week was that we were able to relax and connect with one another. My impression was that the environment allowed us to open up and share. The capacity of people to heal each other was powerful. (The workshop was July 19-24, 2015.) “The Cup Song??”

The holiday season during my burnout was the equivalent of being excluded from the computer game. I’m sure that if I was placed into a fMRI during that period my ACC would have lit up like a small nuclear reactor. The sense of social exclusion was crushing. My Battle With NPD

I was very fortunate to not only escape from the abyss, but thrive. I wish the same for you in 2016.

1. Eisenberger, Naomi, et al. “Does Rejection Hurt? An fMRI Study of Social Exclusion”. Science, 2003, pp. 290 – 292.

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The same process occurs with thought patterns, which are also embedded and permanent. It is how we navigate life. You don’t have to learn to touch a hot stove every time you pass it or purposely put yourself in an emotionally abusive situation.

Your body’s response to sustained stress is the root cause of chronic mental and physical diseases. Your body is flooded with inflammatory molecules called cytokines and your stress hormones including adrenaline, cortisol, and histamines keep your body on high alert. This “threat physiology” translates into multiple physical and mental symptoms.They resolve as you learn to regulate your own body’s chemistry. Many of them are physical. The most difficult concept for many patients to grasp is that since the symptoms are physically experienced then there must be some structural source. It does not matter how many different ways I explain it or how many negative tests that have been done. They just will not believe that physical symptoms can be generated from the brain and body’s stress chemistry. YOUR BRAIN IS CONNECTED TO EVERY ONE OF THE 30 TRILLION CELLS IN YOUR BODY either chemically or by nerves. The only way that physical sensations can be experienced is by being processed and interpreted in your brain. BTW, there is something terribly wrong. Your body’s physiology is way out of balance.

The “Pain Switch”

Then he or she proceeds to explain to me in detail that since they can push on a certain spot and feel the pain, then how can it be in their brain? How can it not be there? The fact that a simple push can elicit pain means that the threshold for stimulating those pain fibers has been lowered –  often dramatically. Your pain switch is either on or off. The only place these switches exist is in the brain.

Water Torture versus a Rock

Do you think that the pain felt during water torture is imaginary? It is a simple, painless drop of water. There is no reason it should ever cause pain. If water constantly drips on a rock does that cause pain? In fact over years, decades, or centuries the rock will be eroded by the simple repetition of dripping. Why is there not pain in that scenario? Obviously a rock has no nervous system. Repetition of any activity lays down circuits that are repeatable and become increasingly efficient? It is true for musicians, artists, and athletes, and also true for the perception of pain.

Obsessive Thought Patterns

Unfortunately, it is also true for the thought, “My doctor is missing something because I am in pain.” I am repeatedly told that I just don’t understand how they feel. That set of thoughts becomes it’s own set of repeatable circuits that will not shut down. Logic alone will not break them up. The reason why it is such an unfortunate situation is that it also limits treatment. The one variable that predicts success or failure in treating chronic diseases is your willingness to engage in the tools. The problem is that these endlessly repeating circuits also block opens to learning. It is the reason why that The DOC Journey app and course emphasise expressive writing so early in that is the one necessary exercise that begins to break up these endlessly repeating circuits.

My Weekly Battle

I was reminded of the problem several times every week. I had a middle-aged woman who had not really engaged in the DOC project. She had experienced anxiety (another stress symptom) since she was a teen along with chronic LBP. She had ruptured a disc in her back six months earlier and was experiencing screaming leg pain. She did have a large ruptured disc. When I explained the neurological nature of chronic pain, it was an ugly conversation. I asked her to come back when she calmed down. I was surprised that she returned the next week. On the second visit I told her that I seldom operate anymore unless the chronic pain is being actively addressed. That means that the patient is actively reading, writing, learning, and generally taking full responsibility for their care. However this disc was so large that I felt that I had to take it out first. She swore that she would engage.

Guess what? The simple disc excision that took away all of her leg pain, as expected, did not relieve any of her LBP. In spite of at least 10  direct conversations that the operation was only effective in relieving leg pain. I could not convince her that her LBP was coming from the soft tissues around her spine and that spine surgery rarely helps LBP. It is a rehab issue. She was convinced that there was something causing her pain that I was missing.

Doctors do not like to miss anything. We are extremely aware, even paranoid, of overlooking a problem that can and should be fixed. It is one of the reasons why health care costs are so high. We will often order testing when we know that the chance of it being positive is less than one in a thousand.

Another Failure

I did not get through. She thought if we could “fix it” her pain would disappear and her anxiety around it would diminish. I don’t think she will ever engage in any structured rehab program. The tragedy is that both are easily treatable with usual outcome to be pain free with minimal anxiety. The general wisdom in surgery is that if a patient has had the surgical risks explained to them then they must be in enough pain to undergo the operation. What the surgeons don’t understand (historically including me) is that the decision-making has become irrational.

The success of a spine fusion for LBP is less than 30%. (1,2) When the surgery has failed then the surgeon “has done their part” and sends them on their way – to where??

I never again performed elective surgery unless the patient would engage in his or her own care at some level. I felt in every elective case that surgery was only about a third of the solution. Physical conditioning and healing the nervous system are the other two thirds of the picture.

Personal and Societal Costs

I don’t regret performing her surgery, as it was necessary from a perspective of the need to relieve her severe leg discomfort. I am sad and frustrated that only a fraction of the benefit will be realized. Not only is the suffering of truly trapped patients not solved, they are also costing the rest of society untold billions dollars with the relentless pursuit of an answer that does not exist. Obsessive thought patterns, which is one of the symptoms created by stress physiology, both exacerbates pain and blocks effective treatment. It is truly phantom brain pain.

Are You Kidding Me?

1. Franklin, GM et al. “Outcome of lumbar fusion in Washington State Workers’ Compensation.” Spine(1994); 19: 1897 – 1903.
2. Nguyen, TH et al. “Long-term outcomes of lumbar fusion among worker’s compensation subjects.” Spine (2010); 20: 1– 11.

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Sophia relaxed

Like most cats, she is clean and easily learned to use her litter box. About a year after we adopted her, she began to mess on the carpets and sometimes on our bed. We somewhat panicked and called the vet. She didn’t have a lot of suggestions but did point out that cats have strong behavioral patterns and can’t be trained like a dog. The episodes would occur when we were packing for a trip. Then she would pee in the suitcase. We were assuming that she was “angry” and acting out. After we were back home for a few days, things would settle back into a routine.

Last Thanksgiving, we took our usual precautions of locking her out of the bedroom and keeping the suitcases somewhat out of sight. I woke up early and saw that she had thrown up twice and created two unpleasant messes both up and downstairs. I also noticed she was meowing frequently and following my wife everywhere she went. It finally hit me that she wasn’t a malevolent cat with an agenda. She was anxious and it was manifesting in creating physical gastrointestinal (GI) symptoms. She had irritable bowel syndrome (IBS).

  Feeling abandoned

IBS

The essence of IBS is the occurrence of multiple disruptive GI symptoms. They are unpredictable in their type and timing. Symptoms include:

• Constipation
• Diarrhea
• Abdominal pain
• Excessive gas
• Bloating/ cramping
• Nausea/ vomiting

The symptoms are more frequent in females and are associated with multiple other physical symptoms. It is one of the most common reasons that people seek medical care. I am going to simplify the cause and effect. Anxiety is the sensation that is experienced when your body is full of stress chemicals such as cortisol, histamines, endorphins and adrenaline. Any mental or physical threat results in different levels of these hormones depending on its severity. Unpleasant mental input (thoughts and concepts) are more problematic because humans can’t escape their thoughts. This results in chronic exposure to an adverse chemical environment and people become ill. The list is almost endless but here are some of the ones listed as being associated with IBS:

• Fibromyalgia
• Chronic fatigue syndrome
• Chronic pelvic pain
• Dyspepsia
• Gastroesophageal reflux
• Major depression
• Panic disorder
• PTSD
• Higher chance of inflammatory bowel diseases such as Crohn’s Disease and Ulcerative colitis.

Physical symptoms

There is a paper out of Sweden (1) that documents a strong association between chronic stress and all autoimmune disorders, including the inflammatory bowel disorders. All these symptoms are included in the list of problems that are associated with chronic pain. The constellation of these symptoms is what I have termed, “Neurophysiologic Disorder” (NPD). Other names include:

• Stress Illness Syndrome
• Mind Body Syndrome (MBS)
• Tension Myoneural Syndrome (TMS)
• Central Sensitization Syndrome (CSS)

The bottom line is that a sustained adverse chemical environment causes physical symptoms. In addition to the above symptoms there is a higher incidence of heart disease, obesity, diabetes and early death. (2) This unconscious survival response is about a million times stronger than the conscious brain and can’t primarily be addressed by psychological means, although it has a role. The key to solving these symptoms is to use techniques to change the body’s chemistry to a more favorable environment. When you are truly relaxed, laughing and at play, your body is full of oxytocin (love drug), serotonin (antidepressant), dopamine (reward drug) and GABA chemicals (similar to Valium). This is a great chemical bath and you will feel relaxed along with a high chance that your physical symptoms will abate.

I thought I was so smart because I figured out that Sophia had IBS. Then I looked it up on the Internet and IBS is an established diagnosis for cats. The symptoms are similar. One of the listed causes is, “separation anxiety.” This is probably what is happening with our cat. At least she isn’t an angry cat that is acting out.

Childhood trauma

There is a high association between childhood trauma and many adult illnesses. This also includes a shortened life span. IBS is one of the problems that is connected with Adverse Childhood experiences (ACE). Reactions to the environment are programmed in by your parents and are the basis for future learning. Early dysfunctional parental patterning will worsen with time. It isn’t possible to see your own dysfunctional reactions because it is your own personal norm. As I was developing many physical and mental symptoms, I thought I was fine. I fancied myself as being somewhat “enlightened” since I had engaged in so much self-exploration. Little did I know I was reinforcing the patterns that were the source of my problems. I had no clue that I was angry. I just had “high standards” of myself and expected others to have the same. So I was constantly judgmental of me and others. I was just “frustrated”.

Sophia was a rescue cat and abandoned by the side of the road before she was weaned. My wife was at a farmer’s market and called me about bringing her home. As she was holding her, Sophia instantly attached herself to her neck and began nursing. Of course, some serious bonding was happening at that moment. We always thought she would stop doing it, but nine years later she hops on the bed every morning and nurses more fervently than ever. If my wife doesn’t let her do her thing, there’s a noticeable difference in her behavior throughout the day.  Early patterns are permanent.

The day she came home

Solution

The DOC process represents a set of concepts that allows you to become aware of when you are triggered and teaches you strategies to alter your body’s chemistry to a more favorable state. Not only will IBS symptoms resolve but so will the multiple other ones. I was experiencing 17 of them simultaneously while I was in the depths of my own Abyss. It is still surprising to see most of these gone. I had migraines, tinnitus, and burning feet for over 25 years. Who would have thought they’d disappear?

1. Song H, et al. Association of stress-related disorders with subsequent autoimmune disease. JAMA (2018); 319: 2388-2400.
2. Faletti VJ and RF Anda. The relationship of adverse childhood experiences to adult medical disease, psychiatric disorder and sexual behavior: implications for healthcare. The Impact of Early Life Trauma on Health and Disease: The Hidden Epidemic – Chapter 8. Editors Ruth A Lanius, Eric Vermetten and Clare Pain. Cambridge University Press, 2018.

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For some, the holidays are synonymous with a strong sense of familial closeness and love. However, this is not the case with many family gatherings, where relatives trigger each other, and chaos quickly ensues. If this describes your experience with the holidays, then this article is for you.

I’ll never forget one Christmas break during my second year in medical school. I hadn’t been home for two years because of study and work demands. I was excited to see my family. Within five minutes, my mother launched into a fight that had started two years earlier. She picked it up almost to the sentence. I was both dumbfounded and upset. This wasn’t part of my vacation plans.

This isn’t an uncommon occurrence.  You’ve waited all year to be with those who you love, and people aren’t getting along. It goes both ways in that loneliness is also magnified. The medical wards are usually full because many patients have increased problems around drugs and alcohol. It doesn’t make sense, except it does if you understand the mismatch between the conscious and unconscious brain and the nature of triggers. So what happens?  Happy holidays – not

Triggers

Any time you are anxious or angry, you’ve been triggered. Your nervous system has connected a current situation to a similar unpleasant past event. It doesn’t matter if the present or prior event represented a true threat. It just has to be perceived that way and the body will secrete stress hormones in its effort to resolve the problem. The sensation created by these chemicals is anxiety. Anxiety is the result of the reaction, not the cause. When you can’t solve the issue, more hormones are secreted, and you’ll become angry.

The reason why family dynamics can be so volatile, is that most of your reactions are programmed by your parents during the first 12 years of life, especially the first two. It matters little what your parents teach or preach; it’s their behaviors and attitudes that become embedded in your nervous system. If you have come from an abusive family, your reactions to the present will be intense, although the present “danger” might be minimal. It is well-documented in the ACE (adverse childhood experiences) studies that the incidence of chronic pain, anxiety, depression, obesity, heart disease and suicide are higher than the norm. You needed to be hypervigilant as a child and it doesn’t change as you age. You are and will continue to be hyper-reactive out of proportion to the circumstance. All of this is exacerbated in families dealing with chronic pain.

During the Holidays, you are around the sources of your triggers from your parents, siblings, children and other relatives. No wonder they can be problematic. Landmines are everywhere.

How did this happen? I watch parents with babies and young children laugh, hold and play with them. It’s a precious time and they would do anything for them. Yet by five or six years-old, there is often a lot of arguing and fighting between parents and children. Suffering from chronic pain doesn’t help. I don’t have to detail what frequently happens during the teen years. The household can be a battlefield — a war without any hope of an end. I don’t how common this scenario is, but I am seeing it frequently in my practice. I only need to ask a few questions and be observant. Many family situations are intolerable.

Learned behaviors

The problem is that we program our own triggers into our offspring. They watch their parents become upset with them or each other and they learn their own behaviors in response to similar stressors. Then they become the cause of deep reactions in their parents. Why else would you yell at this person who used to be this incredibly wonderful child you brought into this world? But you are the adult and you are now in the same boxing ring as your 12-year-old. It’s your role and responsibility to provide a safe environment where your family can feel safe and nurtured. Only then can your child connect with his or her creativity and thrive.

You also may be critical of them. Really?? Anytime you are critical of someone, you have projected your view of you onto them. Remember that you are the one who taught them these behaviors that are now upsetting to you. It is remarkable the number of friends we have whose parents continue to be incredibly critical of them well into adulthood. The negativity is often intense and occurs in the face of the son or daughter doing the best they can to help and be supportive. The intensity of the verbal barrage is unbelievable to me and seems to worsen with age.

So, you have planted your own landmines. Would you yell at a stranger with the same intensity that you talk to your child or spouse? How do you think you appear to them when you are upset? Is that what you want your children to see?

Now it’s the Christmas season, and these deep triggers are coming back into your world. You have missed your family and want to be with them. What are you going to do? How are you going to handle being triggered, because it is inevitable you will be set off at some level. The two faces of Christmas

Here are a few suggestions, most of which I have learned the hard way.

• Remember the problem with the strong familial triggers and concentrate on enjoying your family. Play may be challenging, but it’s also the reason you want to be with them.
• Don’t give any unasked-for advice. They have survived the year without you and have you ever heard of a child listening to a parent’s criticism at any age?
• Remember that when you are volunteering advice, you are really saying, “You aren’t good enough the way you are.” That is probably what your parents did to you when you were young. It’s also why most of us have the “not good enough” voice in our heads.
• Visualize yourself being angry and what your family is seeing when you’re in that state. Be the person you want others to be.
• If you get upset, quickly leave the room. Nothing is ever solved in a heated argument.
• Be curious and genuinely interested in what your family is up to.
• Don’t discuss your pain, medical care, politics, religion, or complain – about anything. After all, it is the season of joy regardless of your belief system.
• Read Parent Effectiveness Training by Dr. Thomas Gordon. It is a classic and the most influential book that I have ever read on any topic.

I want to re-emphasize the powerful irrational nature of being triggered. It is only you and not them that is responsible for your anger. (I well-know that it still feels like it is him or her that upset you). Own it. It is yours.

You’re the one who created the behavior in your child that is now upsetting you. Own that too! Remember how excited you were when they came into the world. Remember the good times and don’t spend time on past differences. Why? It’s done.

A Cigna insurance study in 2018 demonstrated about 40% of Americans feel socially isolated.(1) During my pain experience, loneliness might have been the one most crushing aspect of my ordeal. It was brutal. Connect with gratitude and remember how lucky you are to have friends and family. If you are someone reading this who is socially isolated, work on finding a way to re-connect with someone or give back. I am aware how terrible a feeling this is, and I’m really sorry. The Holidays do make it worse. But by being aware of the impact, you have a higher chance of dealing with it.

Make a commitment to enjoy your holiday season and if you detonate a landmine, use the situation as an opportunity to practice your own tools of staying connected and centered. Become the source of Holiday cheer!

1. Cigna U.S Loneliness Index (2018).

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Conscious vs. unconscious brain

Thoughts are protective mental links to the environment. They cause chemical responses in your body that create anxiety, which enables you to survive. (not thrive).  They are  automatic, unconscious and one million times more powerful than your conscious brain. That is also one of the reasons using rational means to solve problems arising from the unconscious brain is not very effective.

“Recent neurological research has demonstrated that the brain has the capacity of neuroplasticity, or the ability to create new nerve pathways in response to life events. For example, when you learn to play the piano or swing a golf club, your brain cells have developed a new pathway that is connected to your body. These pathways consist of millions of nerve cells.The more that pathway is activated or practiced, the stronger it becomes. What most doctors do not know is that pain can be caused by this type of learned pathways. Even when there’s no tissue damage in the body, such as a tumor, a fracture, or an infection,  a learned pathway can cause real, physical pain.” -Dr. Howard Schubiner-

• Take Dr. Schubiner’s test to see how many NPD symptoms you have. (He uses Mind Body Syndrome – MBS)
• Read “Unlearn Your Pain” by Dr. Howard Schubiner

DOC Principles Address NPD

The DOC model is a framework that organizes well-established spine care concepts. It allows you to organize your thinking and care to enable you to take full charge of your life.  Your providers are resources and coaches. The concepts are the polar opposite of what most of us have been taught regarding how to manage pain and stress.

• Learn the framework of the DOCproject.
• How does it apply to you?
• Use this website as an ongoing resource. It will be updated regularly.

My patients’ success is proportional to the degree of their commitment. I have observed a consistent improvement in my patients’ pain and quality of life. I am guessing that every person has at least three to five other NPD symptoms. I was experiencing 16 of the 33 symptoms during the worst part of my burnout. Most of these will also resolve.

Caring for my patients in chronic pain using the NPD approach has become the most rewarding and enjoyable aspect of my practice. This has been an unexpected development in this phase of my surgical career.

Anxiety, Anger, and Adrenaline

The post Neurophysiologic Disorder first appeared on Back in Control.

The post Neurophysiologic Disorder appeared first on Back in Control.

• Stress Illness Syndrome
• Psychosomatic Disorders
• Central Sensitization Syndrome (CSS)
• Mind Body Syndrome (MBS).

There are several more. They all describe the same constellation of symptoms created by an altered central nervous system and resultant chemical imbalance. For reasons that will become clear as you learn the DOC project I have chosen Neurophysiologic Disorder (NPD) as what I think is the most accurate description of the problem.

Thoughts are protective mental links to the environment. They cause chemical responses in your body that create anxiety, which enables you to survive. (not thrive). They are  automatic, unconscious and hundreds of thousands of times more powerful than your conscious brain. That is the reason using rational means to solve problems arising from the unconscious brain is not effective.

“Recent neurological research has demonstrated that the brain has the capacity of neuroplasticity, or the ability to create new nerve circuits in response to life events.  For example, when you learn to play the piano or swing a golf club, your brain cells have developed new pattens of connections that are manifested in your body. Billions of nerve connections are involved and are reinforced with repetition. What most doctors do not know is that pain can be caused by these types of learned circuits.  Even when there’s no tissue damage in the body, such as a tumor, a fracture, or an infection, a learned set of connections can cause real, physical pain.” -Dr. Howard Schubiner-

• See how many NPD symptoms you have by taking Dr. Schubiner’s test. (He uses the term Mind Body Syndrome – MBS)
• Read Unlearn Your Pain by Dr. Howard Schubiner

DOC Principles Address NPD

The DOC model is a framework that organizes well-established spine care concepts.  It allows you to organize your thinking and care to enable you to take full charge of your life.  Your providers are resources and coaches.  The concepts are the polar opposite of what most of us have been taught regarding how to manage pain and stress.

• Learn the framework of the DOC project.
• How does it apply to you?
• Use this website as an ongoing resource. It will be updated regularly.

My patients’ success is proportional to the degree of their commitment.  I have observed a consistent improvement in my patients’ pain and quality of life. I am guessing that every person has at least three to five other NPD symptoms. I was experiencing 16 of the 33 symptoms during the worst part of my burnout. Most of these will also resolve.

Caring for my patients in chronic pain using the NPD approach has become the most rewarding and enjoyable aspect of my practice. This is a very unexpected development in this phase of my surgical career.

Anxiety, Anger, and Adrenaline

The post C – Neurophysiologic Disorder (NPD) first appeared on Back in Control.

The post C – Neurophysiologic Disorder (NPD) appeared first on Back in Control.

I also remember that there was usually a lag between the end of school and the beginning of my summer job. I was fine for a couple of days but then I would quickly get cabin fever. I could not stand laying around the house and not being productive. I enjoyed getting outside and being with my co-workers.

Abusing my back

Unfortunately, I had little regard for my body with regards to lifting properly. I was continually reminded to use my legs and not my back and arms. I did not have great upper body strength so, of course, I used my back. I had no concept of the consequences and had a perverse sense of pride about how much I could lift and for how long.

The perils of parenting

In March of 1985 I was holding my sleeping one-year old son and placed him over the top of the side rail of the crib. It would have made much more sense to lay him down, lower the side rail and then place him in the crib with a relatively straight spine. I was still bulletproof and why would I change my lifting habits now? Just as I was fully leaned over the top of the rail I felt a snap in my back and a searing pain in my left big toe. That was the beginning of a six-week descent into abject misery of constant severe pain. I had thought (incorrectly) that if pain was very localized, that it would be more tolerable. I could not and did not sleep more than two to four hours a night for over six weeks. I still do not know how that is possible and I never had even one full night’s sleep.

My suffering worsened in that I could not eat,  lost 25 pounds, developed kidney failure from taking too many aspirin, experienced ringing in my ears, and I became increasingly irrational. (at least that is what I am told)

I was only able to work half time as the second partner in a private orthopedic practice. I had only debt after just finishing my residency. I was about to begin my spine fellowship training in Minneapolis in 4 months. I finally elected to do the one thing I swore I would never do and that was to have spine surgery. The simple decompression surgery at L5-S1 went well and my great toe pain was gone. I quickly returned to work and was excited about getting on with my training I was ecstatic – until my wounds began to drain about 10 days later. I developed a deep wound infection from being malnourished after losing so much weight. A second operation and six weeks of antibiotics finally resolved it. My spine surgery – and infection

“You’re fired”

I had been through a lot and fortunately I had a remarkably benevolent partner who continued to pay my salary, although I was only about a third functional. I was dealing with it pretty well until my future fellowship directors found out about my infection and promptly informed me that I had been replaced. They did not think I could do the job and I was also not offered a later position.

Somehow that was it. It was the one part of the situation I could not handle – losing my job. I was devastated. That night I sat alone in my car and completely broke down. I cannot verbalize the depth of despair and helplessness that I experienced. I could not care for my family or even myself. I clearly saw how vulnerable you were not being able to fend for yourself in a capitalistic society. I felt like a medieval warrior going to battle without any weapons or armor. It was one of the most painful and enlightening moments of my life.

The “benefits” of being disabled

Physicians are often given the impression that people are generally looking to get off of work. The answer to disability is to tighten the rules and get tougher. They feel that many injured workers just don’t want to work. They also do not realize the implications of taking people off of work. Once a person loses their job the whole nature of the claim changes. It becomes more difficult to get hired by anyone since you now have a track record of missing work. Here are some of of the other “benefits” of being off of work:

• Your income is at least 25% less and is fixed.
• A claims examiner is in charge of your life instead of you.
• You cannot get through to them to get an update on your progress or status and he or she is in charge of your entire life.
• Your disability check can be taken away from you without notice.
• No one believes you are in pain. My battle with NPD
• Life becomes one of surviving rather than thriving.
• Worker’s comp will not cover stress management treatments or provide resources to help you.
• How do you get out of this situation?
• Your providers are not filling out the paperwork and not getting back to your employer.
• There are endless contradictions regarding your care and diagnosis and you often are given bad news.
• Even without the conflicting medical advice, anxiety and frustration usually continue to rise.
• Pain invades every part of your life including many conversations. It is not that interesting after a while.
• What happened to your dreams?
• Research has shown that being off of work is detrimental to your mental and physical health.
• Many people lose their assets, including their home

I remember a moment about five years into my practice when I realized that my Worker’s Comp patients were not doing well because of lack of motivation. It was because  were justifiably angry. The Worker’s Comp system that they expected to help them and allay their anxiety was mostly harassing them. I didn’t blame them for being upset.

Disabled

Life is not better being disabled. Maybe you have been that way for so long that you can no longer understand or appreciate the alternatives. You are so used to being trapped that anger seems normal. Many people don’t even think they are angry. That included me. No one, and I mean no one, is going to help you out of this hole. It is deep and will keep getting deeper. Many Italians choose suicide – People need to work

The only patients I see succeed are those who have made a decision to live a different life and they are not going to live this way anymore. I have watched hundreds of patients become pain free. It is just much more difficult if it involves Worker’s Comp. How do you want to live your life? I had the smallest taste of what it is like to not be able to work and take care of myself. Not only did I not like it, it was the worst part of my ordeal.

The post The “Benefits” of Becoming Disabled first appeared on Back in Control.

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The post Fighting a Forest Fire – Address All Aspects of Your Pain first appeared on Back in Control.

The post Fighting a Forest Fire – Address All Aspects of Your Pain appeared first on Back in Control.

Consider the following:

Thoughts are the mental link to the environment that allows you to assess your situation second by second in order to make choices that allow you to first survive and then thrive. If our thoughts are pleasant our bodies will secrete chemicals such as oxytocin, growth hormone and dopamine that create a sense of relaxation and well-being.

Conversely, if you feel stressed then your thoughts will create a chemical environment consisting of adrenaline, cortisol and other hormones that create a sense of insecurity and dread. You will be motivated to control you or the situation to alleviate these feelings of anxiety. If you cannot escape or solve it, you will feel trapped and angry. If you are in a constant hyper-vigilant state, then your body will be continually on overdrive. It is like driving your car 70 mph down the freeway in second or third gear. It will break down much sooner than if you were in 5th gear and cruising.  Anxiety, Anger and Adrenaline

I am aware that life is not easy. Very few people can live their lives on “cruise.” Additionally, avoiding stress also becomes its own stress. You cannot run from your thoughts, which can torment you regardless of your environment. In fact, when I was in the most severe period of my Obsessive Compulsive Disorder (OCD) my mental distress was worse when I was less busy. OCD, BTW, is manifested by intrusive thoughts and extreme anxiety. Some day I will write about my battle with it in more detail but the only metaphor I can use to describe the experience is “having a hot branding iron on my brain”. The misery being in that hell of unrelenting anxiety is indescribable. OCD is no fun and not funny – extreme mental pain

Control

One of the main antidotes to anxiety is control. When you lose control your body will kick in more adrenaline to physically help you solve the problem. For example, if you were physically fighting someone for food to feed your family, the adrenaline boost would up your odds of winning. Unfortunately, just thoughts of danger can create the same chemical response even when there is no physical threat. Now you are in trouble because you have no way of physically solving the problem and there is not an endpoint.

Neurophysiologic Disorder (NPD)

There are many terms to describe the physical consequences of sustained levels of stress chemicals in your body. Some of them include Mind Body Syndrome (MBS), Tension Myositis Syndrome (TMS), Central Sensitization Syndrome (CSS), and Stress Illness Disorder. The term I have chosen is “Neurophysiologic Disorder” (NPD). Your thoughts are the neurologic input to your nervous system that creates a physiological response. We are programmed to gravitate towards the reward chemicals and avoid the stress ones. Within a pretty wide range we are able to conduct our lives in a functional and enjoyable manner – except when we can’t. There are solutions to the problem, which are the focus of my book. However, consider the effects of not addressing it.

These next few paragraphs were part of a proposal to address the effects of high ACE (Adverse Childhood Experiences) scores beginning in elementary school that are directly linked to your responses to stress.  Aced Out

Effects of Untreated NPD and Anxiety

There are several ways that untreated Neurophysiologic Disorder (NPD) manifests itself. Remember that the main focus of the school project is to deal with the lifelong impact of adverse childhood events. The worse the ACE load, the higher will be the anxiety a child brings into the classroom. The devastating impact on mental and physical health of a high ACE score is well documented. This does not even take into account the power struggle that occurs amongst these students to deal with unrelenting anxiety. Bullying, at the moment, is not even counted in the ACE score.

First, NPD can directly cause over 33 different physical symptoms. Medicine is focused on treating symptoms instead of the root cause of a fired up nervous system. Many of these conditions will begin in childhood, such as migraine headaches, insomnia, anxiety, eating disorders, stomach pain, etc. My Battle with NPD

Second, anxiety is the result of sensory input also that drives anger. One common cause of anger is loss of control. When you lose your ability to control your anxiety the anger will become intense. Anger is always destructive, including self-destructive. Although it may not become manifested during school years, it eventually results in complete disregard for personal health. This is an addition to the symptoms directly caused by the MBS. My observation is that complete neglect of your health is akin to a “slow suicide.”

Third, anger is abusive. Chronic pain creates and indescribable depth of frustration. When you are angry, it is all about you. It is a survival response and you lose awareness of the needs around you. Lack of awareness is the essence of abuse. Families of patients in chronic pain become the targets of this deep anger, and hence the cycle of adverse childhood events continues. There is a high chance that these children will act out their frustrations at school. Also, their parents have modeled anger as the normal way of dealing with adversity. Pain = anger = abuse

Unrelenting anxiety/anger cause profound physical effects on your body. Another week I will present the data regarding mental health and life span. It is not a pretty picture.

Your Unconscious Brain

I am aware that no one intellectually wants to be sick or unhealthy. The solution lies in addressing pre-programmed behavioral patterns that are part of the unconscious brain. The unconscious brain is much more powerful than the conscious brain. Your conscious brain energies manifesting as “good intentions” or “will power” have no chance of solving the problem. You must utilize strategies that stimulate your brain to rewire. You cannot “fix” yourself because your attention is still on you. Solving the Unsolvable

The DOC project is a framework intended for you to organize your thinking in a manner to connect with your own body’s capacity to heal. Your unconscious brain will resist this process to the max. Just sit down with Stage 1 on this website and start the therapeutic writing as described in Step 2. Your brain will begin to change and you will be able to move forward.

So my feeling is the mental health is the highest priority. Your body’s chemistry is optimized, you are able to enjoy your life with your family and friends, and your capacity and motivation to care for your health will be higher.

Why are New Year’s resolutions so hard to keep?

The post Mental or physical health – Which is more Critical? first appeared on Back in Control.

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