• 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.

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

As a surgeon who has spent a lifetime dealing with patients with chronic pain, including me, have come to see that the MUS diagnosis is wholly inaccurate and should be immediately discarded. Every bodily symptom you experience results from an identifiable structural problem or from your body’s physiological response to  your surroundings. Symptoms don’t just happen. The correct diagnosis is MES (Medically Explained Symptoms).

Physiology

Physiology is the term that describes how the body functions. We stay alive because living creatures can maintain an incredibly delicate balance of the body’s acid/ base balance, electrolytes, blood pressure, temperature, heart rate, and the list is long. It is a dynamic process that changes by the second in response to input from your surroundings.

We require safety (rest and relaxation) to regenerate and build up our reserves. When we are under any stress (threat), the body responds with elevated activity in multiple different organ systems to increase the chances of survival. Fuel stores are depleted, and reserves are lowered as energy is shunted to muscles in the event of fast action is required.

Our bodies are intended to be mostly in “neutral” or what is called homeostasis. When you are going about your daily business without noticing how you are feeling, you are in homeostasis. It can be maintained for long periods of time because reserves are being replenished commensurate with your needs.

Any time your body is under any kind of mental or physical threat, your body’s physiology will react in a manner to bring you back into balance. There are three contributors of this scenario 1) your circumstances (input) 2) the state of your nervous system (coping capacity) 3) output (body’s total neurochemical response).

By definition, anytime your senses any level of danger from any source, you are under threat – even if it lasts for just a few seconds. When you are in homeostasis, your body responds so quickly, you won’t notice the changes. However, when the threats begin to overwhelm your nervous system’s coping capacity, you’ll experience unpleasant symptoms.

The threats can be mental or physical and there are almost always multiple physical and mental responses. The physiological manifestations include:

1. Changes in your immune system with increased inflammation.
2. Your body’s metabolism (the rate you burn fuel). You are either storing fuel (anabolic state) or consuming it (catabolic state).
3. Nervous system activity – you are designed to become more sensitized and alert when there is potential danger.

These are broad categories of the effects of threat. But, since there are so many organ systems required to keep you alive, numerous physical and mental symptoms are created. Every symptom that is not from an obvious anatomical problem is a result of this interaction of your body responding to sensory input from your surroundings that is interpreted as potentially dangerous. How else could you stay alive?

Defining threat

Examples of physical threats include viruses, bacteria, being attacked by a predator – human or animal, hunger, lack of shelter, poverty, lack of opportunity, being bullied at work or school, racism, authoritarianism, trapped in a difficult living or family situation, and physical maladies.

Mental threats are processed in a similar manner as physical ones with the same physiological response. (2). They are more problematic in that humans have consciousness and many of our thoughts and emotions are unpleasant, and unlike visible threats like tigers or a severe storm, we cannot escape our thoughts. Repressed thoughts and emotions are even more impactable on your body’s neurochemical state. Many of our unpleasant thoughts are based on cognitive distortions or “stories” about our lives. Unfortunately, whether the threat is real or perceived it has the same deleterious effect.

Physiologically explained symptoms

Unpleasant sensory input progressively impacts your body at three levels.

• Response
• Symptoms
• Illness/ Disease

When the threat is short-lived your response will be appropriate to the situation and quickly disappears when it has passed or resolved. Almost every internal and external action of your body is directing you in a manner, so you don’t feel unpleasant sensations. If you do sense danger, you are programmed to resolve it immediately. Examples are looking away from the sun, spitting out rancid food, pulling your bare foot back from hot pavement, frequently shifting in your chair to avoid skin breakdown, and avoiding an aggressive dog.

When threats are more prolonged, you will begin to suffer symptoms such as back pain, tension headaches, anxiety, poor appetite, nausea, urge to urinate, sexual dysfunction, burning sensations, skin rashes, dizziness, ringing in your ears, and insomnia. There are over 30 different physical symptoms that can occur. (3)

But when threats are sustained, you have a significant chance of becoming seriously ill or developing a disease. It is well-documented that stress kills people and unfortunately the symptoms of a chronic illness also add to the threat load. This is particularly true in chronic pain. (4)

The nature of your body’s physiology under threat

Environmental cues of threat set off a defensive response. Immediately, before you are even aware, your immune system girds for the possibility of injury by initiating inflammation (to protect cells against bacterial or other invasion), elevates metabolism to provide fuel for defense, increases the speed of nerve conduction–which increases your alertness but also your pain sensitivity, and elevates the levels stress hormones (cortisol, adrenaline, noradrenaline, histamines). Much of this defensive state is modulated by small signaling proteins called inflammatory cytokines.

So how do you think you feel when you are in this physiological state? Your heart is racing, you are sweaty, tired, anxious, overwhelmed, nervous, stomach feels tight, blood pressure is elevated, pain is worse, and your breathing is rapid. The bottom line is that you don’t feel great when your body is in this heightened neurochemical state. Are these symptoms imaginary? Not a chance. None of them.

The consequences

This is a list of some of the symptoms and illnesses that are connected with your body’s physiology being in a prolonged heightened state:

Symptoms

• Irritable Bowel syndrome
• Irritable Bladder syndrome (interstitial nephritis)
• Migratory skin rashes
• Tinnitus
• Burning sensations
• Migraine headaches
• Pelvic, neck, thoracic, and low back pain
• Insomnia
• Tendonitis

Illness

• Anxiety
  • Depression
  • OCD
  • Bipolar
  • Schizophrenia
• PTSD
• Fibromyalgia
• Chronic fatigue

Disease

• Autoimmune diseases
  • Colitis/ Crohn’s disease
  • Ankylosing spondylitis
  • Rheumatoid arthritis
  • Multiple Sclerosis
• Cancer
• Coronary artery disease
• Alzheimer’s disease/ Dementia
• Early death
• Suicide
• Addictions
• Parkinson’s disease
• Obesity
• Liver disease
• Osteoporosis

There is a wide range of “Medically Unexplained Symptoms/ Illnesses/ Diseases” that are created by your body’s  survival response. Dr. Stephen Porges has eloquently explained how the autonomic nervous system through the vagus nerve, modulates these various physiological states. (5)

Why is MUS such a deadly diagnosis?

The worst aspect of the diagnosis of MUS is that it creates despair; it takes away hope. Research has shown that hope, optimism, and a sense of purpose are anti-inflammatory and allow your body to regenerate. (6)  So, the diagnosis itself is inflammatory and adds to threat. Do not accept it at any level. The correct diagnosis is MES.

Any major reason MUS is so damaging is that many physicians assume it is untreatable, there is nothing more that can be done, and refer you to a psychologist for any number of reasons that most of you are familiar with. “It is in your head.” You don’t have much of a pain tolerance.” “You are just looking for drugs.” You have “secondary gain issues and don’t really want to work.” The labels keep piling on and none of them are helpful to your healing and they are just wrong. But MUS has a certain finality to it, and it is crushing. It is tragic because physicians have not been taught the link between mental/ physical threats to the physiological changes that cause physical symptoms. I feel the ultimate tragedy is that with the correct understanding, MES is one of the most treatable diagnoses with minimal costs and risks.

Beware of IES (Incorrectly Explained Symptoms)

When there is an obvious anatomical abnormality and the symptoms exactly match the lesion, that would be considered a structural identifiable source of pain. An example would be a painful inflamed tooth. It is a straightforward process to diagnose it by testing with hot and cold or pressure. A root canal or pulling the tool will quickly solve the problem.

But this discussion is complicated by the fact that there is an emphasis in modern medicine to explain reasons for pain from a structural problem when the anatomical abnormality is not actually the cause of it. Many symptoms are attributed to normally aging anatomy and the cause and effect are not supported by medical research.

For example, pain is commonly attributed to scoliosis and there has never been a research paper documenting that it even contributes to back pain unless the deformity is severe and unbalanced (your head is not directly center over your pelvis).

Degenerative disc disease, bone spurs, arthritis, ruptured discs, bulging disc, and spinal arthritis have all been documented in multiple research papers that none of these “diagnoses” are the cause of chronic neck or back pain. (7)

There is marked debate about small tears of the structures around the hip and shoulder. Even severe hip, knee, and shoulder bone-on-bone arthritis has little correlation with pain. There is actually more of a relationsip to stress. (8)

How can you figure this out?

First, it is always important to undergo a medical workup to make sure there is not a structural issue such as vascular disease, pinched nerve, tumor, or an infection.

Second, regardless of the findings of the workup, maintaining your body’s metabolic, immune, and nervous system balance is important. If you require a procedure, your odds of a good outcome will be maximized.

There are many ways to accomplish this. The DOC Journey is one platform that presents proven medical treatments in a way that allows you learn and implement these strategies. All three aspects chronic illness must be addressed.

Output (stimulation of the body’s anti-inflammatory response)

• Breath work
• Mindfulness/ meditation
• Humming
• Vagal stimulation
• Certain pitches of music

State of the nervous system (decreasing sensitivity and stimulating neuroplastic changes in your brain)

• Exercise
• Sleep
• ACT (Acceptance Commitment Therapy)
• Processing prior trauma

Input (what are you uploading into it and what are you holding onto?)

• Forgiveness
• Cognitive Behavioral Therapy
• Expressive writing
• Never discussing your pain or medical care

What really does not work is just “coping”, which is what most of us have been taught to do. It requires specific approaches and tools to effectively create the desired changes. Regardless of what approach you use, the key is to learn how to utilize these tools to consistently process threat in way to keep you in homeostasis or a state of safety.

Finally, you must commit to taking charge of your own body and health. The first step is understanding the nature of chronic disease. The solutions lie in implementing strategies we already know are good for our health–healthy diet, sleep, regular exercise, taking time for yourself, process addictive behaviors, and nurturing close relationships. The common theme with all of these interventions is that they lower inflammation. Ongoing inflammation directly destroys tissues throughout your body.  It sounds daunting but it is more doable than you think. Not taking control may have more severe consequences than you can imagine.

Chronic pain is one of the MUS diagnoses. It is one that is particularly untrue. By understanding the nature of chronic mental/physical pain and the principles behind the solutions, it is a Medically Explained Symptom (MES) and a consistently solvable problem.

MUS must go!

References:

1. Edwards T M, Stern A, Clarke DD, Ivbijaro G, & Kasney LM. (2010). The treatment of patients with medically unexplained symptoms in primary care: A review of the literature. Mental Health and Family Medicine, 7, 209–221.
2. Eisenberger NI, et al. An experimental study of shared sensitivity to physical pain and social rejection. Pain (2006);126:132-138.
3. Schubiner H and M Betzold. Unlearn Your Pain, 3^rdMind Body Publishing, Pleasant Ridge, MI, 2016.
4. Smyth J, et al. Stress and disease: A structural and functional analysis. Social and Personality Psychology Compass (2013);7/4:217-227. 10.1111/spc3.12020
5. Porges Stephen. The Pocket Guide to the Polyvagal Theory: The Transformative Power of Feeling Safe. Norton and Co, New York, NY, 2017.
6. Dantzer R, et al. Resilience and Immunity. Brain Behav Immun (2018);74:28-42. Doi.10.1016.j.bbi2018.08.010
7. Jarvik JG, et al. Three-Year Incidence of Low Back in an Initially Asymptomatic Cohort. Spine (2005); 30:1541-1548.
8. Wise BL, et al. Psychological factors, and their relation to osteoarthritis pain. Osteoarthritis and Cartilage (2010);18:883-887.

The post The Myth of MUS (Medically Unexplained Symptoms) – It’s MES first appeared on Back in Control.

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• Anxiety is at the core of how we evolved and continue to survive. It is a gift.
• It is universal, powerful, automatic, and intentionally unpleasant. There is no reason to take it personally.
• It is not subject to rational interventions and the way to lower it is simply lowering your stress reaction to threats.
• An important and critical step is to separate your “identity” from it and develop a “working relationship” with it.

Every living creature has a threat avoidance response that involves every cell in their bodies. Humans are unique in that we possess language and can name it. Anxiety is a word that describes this intentionally extremely unpleasant sensation that compels us to take action to alleviate it. There are levels of intensity. Here is a word progression that falls under the umbrella term of anxiety.

• Alert
• Nervous
• Afraid
• Angry
• Paranoid
• Terrorized

The neurochemical state that we have labeled as anxiety is an amoral powerful survival reaction in response to stress and is not the cause of it. It is how we evolved, and it also keeps us alive. You can’t and don’t want to get rid of it. It is so powerful you can’t control it by rational means. It is hardwired and automatic. You might as well try to have a conversation with the hard drive of your computer.

Relentless anxiety is the worst aspect of suffering for many people. So, if rational interventions can’t work, how can you lower your anxiety? Since it simply describes the feelings created by your body’s neurochemistry, the answer is to learn and use approaches that lower your stress hormones, metabolism, and inflammatory proteins. In other words, you can stimulate your body to switch from flight or fight physiology to safety.

Effectively dealing with anxiety

The goal is not to control or “manage” this reaction, but to develop a “working relationship” with it. As you quit fighting anxiety, it will be less disruptive to your quality of life. There are four aspects to consider.

• Separating your identity from it. Anxiety is a gift of survival and life, but not who you are as a conscious human being.
• Using tools to directly lower your stress chemicals (output) through stimulating the parasympathetic nervous system (vagus nerve).
• Increasing the resiliency of your nervous system.
• Becoming aware of the input into your nervous system that creates threat physiology.

Separating your identity from anxiety

These will be discussed further in the next few lessons in this rest stop. But the first step is to separate your conscious identity from this all-encompassing feeling and view it is simply your body’s mechanism of protecting you. It is a gift.

One helpful step is to eliminate the word, “anxiety” and substitute phrases such as, “heightened stress response”, “elevated stress hormones”, or “increased sympathetic tone.” Any words that describe your body’s heightened physiological activity will do. What happens with many people is that they feel badly about these disturbing feelings and impulses. However, they are universal and why would any of us take them personally? It has nothing to do with your identity or value system. In fact, the research shows that the more of a well-intentioned person you are, the more you will fight these deep impulses, which reinforces them. The result can be crippling anxiety.¹

Another separation strategy is to visualize a large thermometer on a wall. As you feel your physiology become more activated, describe the intensity of emotion with one of the above words. Then mentally assess your “temperature” in light of the “thermometer.” Again, the way to lower anxiety is to use tools to shift your physiology from a threat profile to that of safety. In other words, “lower the temperature.” You’ll be using approaches from all three areas:  input, nervous system, and output.

As our challenges keep coming at us, you’ll use these tools multiple times per day. The key is learning to process adversity effectively and efficiently so as to minimize your time in threat and maximize your time in safety. Healing can only occur when you are in safety and not consuming your body’s resources to survive. There will many times when stresses are overwhelming, or you are overtired when you will not do well. That is the norm.

Once you can consistently separate “you” from this physiological reaction, you’ll be free to “observe it” and get on with your day and life. You must break loose in order to move forward into the life you desire.

Recap

Thoughts are what you think, and unpleasant ones can be considered “mental pain.” They are processed in similar brain circuits as physical pain and is why they are so disruptive. They create a flight or fight response with a resultant surge of stress hormones, increased metabolism, and inflammation. Emotions are the feelings caused by these changes in your body’s neurochemical profile. The word that describes this heightened state is anxiety. It is not primarily psychological.

This is a critical concept in that you cannot control these automatic and powerful survival responses with rational means. It is huge mismatch. You cannot outrun your mind.

Anxiety is a universal survival reaction that is your protector. You cannot and don’t want to get rid of it nor do you want to take it personally. There are many ways to develop a “working relationship with it, use it to move forward with your life and heal. The critical first step is to separate your personal identity from it.

 Questions and considerations

1. Every cell in your body is bathed and affected by stress hormones and inflammation when you are in flight or fight. It is the reason people identity with this sensation, when it actually has nothing to do with who are as a person.
2. Carefully consider anxiety for what it is. It describes the feelings generated by your physiological state when your body is in a survival mode. It is critical to understand this situation, as the conscious brain is no match for your unconscious brain.
3. You cannot control the unconscious aspect of your nervous system, but you can reprogram it. It is a step wise process and why The DOC Journey is in the sequence it is.
4. View your unconscious brain as your guardian and learn to develop a “working relationship” with it. As you quite fighting the unwinnable battle with anxiety, you’ll much more energy to live an enjoyable life – and heal.
5. You cannot heal when you are in flight or fight and consuming your body’s resources to survive. Healing can only occur when your physiology is one of safety.

 References

1. Wegner DM. The Seed of Our Undoing. Psychological Science Agenda. Jan/Feb 1999, pp 10-11.

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