In 2003, a neurosurgeon performed a laminectomy of his neck. That’s an operation where the lamina or the bone over the back of the spinal cord is removed to relieve pressure. He seemed to improve for a little while. In 2005, his symptoms worsened, and in 2009, he underwent a fusion through the front of his neck between his 5^th and 6^th vertebrae. Again there was a slight improvement but two years later he was in my office with crippling pain throughout his whole body.

Normal studies

As I talked to him, I could see how desperate he was for relief. He also wasn’t sleeping and his anxiety and frustration were a 10/10 on my spine intake questionnaire. I couldn’t find any neurological problems on my physical exam. When I looked at his neck MRI, I could see where the two prior surgeries had been performed, but there were no pinched nerves. The alignment and stability of the vertebrae were also fine. He also had undergone several workups of his brain and the rest of his nervous system. Everything was normal.

When I explained to him that I did not see a structural problem that was amenable to surgery he became understandably upset.  He was stuck on the idea that the prior surgeries had helped and that I was missing something. It didn’t matter what I said or how I explained the situation to him. He wasn’t buying it.

What I didn’t tell him was that I had also looked at his scans he had prior to undergoing each surgery. Telling a patient that they did not really need a prior surgery is a very unproductive, unpleasant interaction; I didn’t see why this patient’s prior surgeries were performed. On the first MRI of his neck, there were no bone spurs and the spinal cord was completely free. There wasn’t a structural problem that could have been corrected by surgery. On the scan before the second operation, there also wasn’t a hint of anything that could be causing any symptoms of any type.

The power of placebo

What’s difficult for patients (and physicians) to realize is that the placebo rate for any medical or surgical treatment is between 25-30% or even higher. The response and improvement is not only real but is powerful. It is the result of your body’s own healing capacity. It is a desired response, and you feel less pain.

The pain-killing effects of a placebo are reversed with Narcan, which is the drug used to reverse the effect of narcotics. There is a part of the frontal lobe of your brain that shuts off pain pathways for short periods of time. Another example is the placebo effect of cardiac medications causes the heart rhythms to actually change. Just because a prior surgery or procedure on normal age-appropriate anatomy might have been temporarily effective is irrelevant. It should have nothing to do with current decision-making. I tell my patients “If I can see it, I can fix it” and  “If I can’t see it, I can’t surgically correct it.” It’s critical to have a specific structural problem with matching symptoms before surgery becomes an option. Surgery: The Ultimate Placebo

I suggested that he take a look at the DOC website and I would be happy to explain the whole program to him in as much detail as needed. He was so angry that I didn’t think I’d hear from him again.

Early engagement

Over the next couple of months, I received a couple of emails and had a telephone conversation that seemed to go pretty well.  He was willing to engage in the DOC protocol and began some of the writing exercises. I had a second phone conversation with him a couple of weeks later that seemed to go even better. He was able to recognize that his thought of me “missing something that needed to be fixed” was an obsessive thinking pattern. I was encouraged and thought that maybe I had been able to break through his “story.”

Time went by and our third and final conversation was dismal. He couldn’t let go of the thought that “something was being missed” and that his seventh cervical vertebra was “out of alignment.” I assured him it was OK. As a surgeon, I am also quite obsessive about not missing problems that I can fix. At this point, it didn’t matter. He’d found a surgeon who was going to fuse his neck.

Injury conviction

Physicians use the term “injury conviction” to describe this phenomenon. It is the relentless pursuit of a cause for your symptoms that is well beyond reason. My concept has changed in that I feel this pattern of thinking becomes its own irrational set of neurological circuits. It is similar to phantom limb pain and my term is “phantom brain pain.” Regardless of whether the original source of pain is there, the symptoms are the same. Rational arguments have absolutely no effect.

Hell

I wrote a post Anxiety and Anger: The Highway to Hell. Unfortunately, if you’re in this pattern, you’re in Hell, and the only way out is through you. The deep tragedy is that if you don’t realize you’re in Hell, you’ll remain there. I never give up, but I have learned to let go when I can’t penetrate that firewall of obsessive thinking. For those of you that have let yourself out this hole, I am open to suggestions as to what gave you the insight to move forward. Awareness is the basis of the entire DOC process and is always the first step.

I don’t know how many more tests and surgeries he’ll undergo over the next 30 years. The personal cost to him and society will be enormous.

What’s puzzling is that if any of the surgeons who’d chosen to operate on this man’s essentially normal anatomy were examined by a board examiner about their indications for his surgeries, they’d be failed immediately for giving a “dangerous answer.” It’s our medical responsibility to you to not offer risky procedures that have been documented to be ineffective.

Video: “Get it Right the First Time”

The post How Many More Neck Surgeries? first appeared on Back in Control.

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Safety

With cues of safety from your environment, your response will consist of hormones such as serotonin (anti-depressant), dopamine (rewards), oxytocin (bonding), growth hormone (regeneration), and GABA chemicals (calming, anti-anxiety). The immune response stimulates anti-inflammatory cytokines. Metabolism will be lower and the whole scenario allows the body to rest and regenerate.

Physically, the result is feeling relaxed, slower heart rate and breathing, muscle relaxation, and reduced speed of nerve conduction, which decreases pain. The more time that can be spent in this regenerative state the better.

Most of the time, your body’s goal is to maintain equilibrium (homeostasis) and keep your range of behaviors and chemistry in a stable zone. For example, the nociceptive (pain) system unconsciously guides you to avoid actions that would cause harm. When you experience an uncomfortable or unpleasant sensation from any source, it is simply signaling danger and then you are compelled to take action to remain safe.

Threat

Environmental cues of threat are met with mobilization of all of your body’s resources in order to defend yourself. It includes your immune system with elevations of inflammatory cytokines, elevated metabolism to provide fuel, and the secretion of stress hormones such as cortisol, adrenaline, noradrenaline, histamines, and endorphins.

Physically and mentally, you are on “high alert” with numerous bodily responses. The basic ones include an increased heart rate, rapid breathing, increased speed of nerve conduction (increases pain), elevated blood pressure, sweating, muscle tension, and a sense of danger that we call anxiety. There also numerous symptoms created by this physiological state. They include tension and migraine headaches, neck and low back pain, skin rashes, stomach cramps, depression, bipolar, burning sensations in various parts of your body, and over 30 additional responses. Although the chemical environment encompasses your whole body, each organ and organ system will manifest its unique response.

Symptoms, illness, and disease

Balance is needed between your stresses and your capacity to deal with them. When you processing your circumstances well, you’ll feel connected to what you are doing and often will feel contented and safe. When your coping mechanisms are overwhelmed, your whole body will rise to the occasion to defend you, and every cell in your body goes into different levels of high alert. You will experience the above-mentioned threat symptoms.

When the threat is transient or resolvable, the symptoms will quickly abate. When it is more prolonged, you may develop an illness(es) that are reversible with appropriate treatments or when the stress has been resolved. When threat is sustained, people will eventually develop serious illness and diseases that cause permanent tissue damage and create mental havoc. Diseases don’t “just happen.” What would happen to your car if you were driving a long distance down the freeway at 70 mph in second gear. The engine would be running at a very high speed and will break down quickly.

There are two aspects of the situation that affect the quality of your life.

• The state of your nervous system:
  • Your inherent coping skills
  • Your current degree of neurological reactivity
• Your circumstances including:
  • The magnitude and duration of mental and/or physical threat
    • Note the human inability to escape from unpleasant thoughts and emotions.

Solving/ Preventing chronic disease

The core principles in solving/preventing chronic diseases with chronic pain being just one of many, are centered around the following 1) developing and nurturing a more resilient nervous system (processing center) 2) learning methods to process your stressors so they have less of an impact on your nervous system.

Examples of approaches to increase your nervous system’s coping capacity:

• Restful sleep
• Exercise
• Acceptance Commitment Therapy (ACT)
  • Learning to feel threatening mental or physical sensations and training yourself “to be with them.”
• Education – understanding the nature of chronic pain allows you to choose your own way of escape.
• Addressing childhood trauma
• Meditation practices

Some methods that lessen the impact of your threat:

• Cognitive behavioral therapy (changing thought patterns)
• Not discussing your pain
• Mindfulness/ active meditation – changes sensory input
• Forgiveness
• Awareness – can be used as its own tool
• Getting organized
• Expressive writing – separates you from your thoughts

Safety vs. threat

Modern medicine has nullified these aspects of care in that we are not given the time nor are we encouraged to talk to our patients. From the beginning, we are not providing cues of safety. Consequently, we don’t know our patients and their coping capacity and really don’t know much about their circumstances. We are given only the time to treat symptoms. We are ignoring the root cause of the problem. It is similar to trying to put out an oil well fire with a garden hose. It can’t and doesn’t work. Indeed, there is an ongoing and growing epidemic of chronic disease – both mental and physical.

A general overview of the mechanisms of how you will effectively be approaching chronic disease involves:

• Lowering inflammation (output) – calming techniques
• Increasing the resiliency of the nervous system – neuroplasticity
• Input – choosing what data to download

There is a marked amount of overlap and these three categories are artificial designations. They are intended to create a framework for discussion around developing and applying various interventions. You will learn tools to stimulate your brain to change and also calm down your nervous system. There will be a major shift in your body’s neurochemical profile. You can program your brain around most anything. Remember, this is not, “mind over matter.” You will lose that battle. Think of it more like a sculpting process and you have the power to create whatever reality you choose. The DOC Journey will guide you through this healing process at whatever pace you are comfortable with.

In summary, the root cause of chronic disease states is unrelenting exposure to threat and the solution is learning methods to create safety.

The post Principles of Solving Chronic Pain first appeared on Back in Control.

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The nature of illness

All physical and mental symptoms are the result of you gathering data from your surroundings from different sensors, your brain interpreting the sum total as safe, neutral, or threatening, and then you automatically responding in a manner to ensure survival. You may or may not be aware of the reactions. They can be dictated by signals from chemicals, small proteins (cytokines) produced from your cells, signalers from the nervous system (neurotransmitters), or signalers from our glands running through our blood (hormones).

The term, “mind body” is not a useful term in that it implies that there is a separation between them. There is actually just you; one system that responds as a unit. Your nervous system, including your brain, is simply one of the many ways your cells communicate to coordinate your functions. The mind and the body are inaccurate constructs and distractions to understanding illness and disease compared to wellness and health.

Safety

With cues of safety from your environment, including your mind, your response will be signalers such as safety cytokines (anti inflammation and pr- anabolism), GABA (calm), acetylcholine (restoration), serotonin (contentment), dopamine (rewards), oxytocin (connection and bonding), growth hormone and growth factors (regeneration). The immune response will be strong yet inflammation low when stimulated by safety cytokines. Clinically the result is feeling less inflamed, less painful, relaxed, composed, present with a slower heart rate, blood pressure and breathing. The more time that can be spent in this regenerative state the better for health and wellness.

Your body’s goal is to survive. Defeating or dissipating threats and discord and maintaining safety and harmony to keep your range of behaviors and chemistry in a stable restorative and regenerative zone is key to thriving. The nociceptive (pain) and the emotion systems, both with and without awareness, guide you to take actions to avoid harm. When you experience an uncomfortable or unpleasant feelings from any source, it is simply signaling danger and then you can take appropriate steps to find safety.

Threat

Environmental cues of threat or internally generated ones are met with a defensive response including stimulation of your immune system with elevations of inflammation, elevated metabolism to provide fuel for defense, and increases in multiple stress signalers including the threat cytokines (IL1, IL6, IL17, TNF), inflammatory chemicals, (histamine, prostaglandins), mobilizing neurotransmitters (glutamate, dopamine, noradrenaline), and stress hormones (adrenaline, cortisol, aldosterone, vasopressin and endorphins).

Clinically, you are on “high alert” and there are numerous bodily responses to threat. The basic ones include an increased heart rate, rapid breathing, increased speed of nerve conduction (increases pain), elevated blood pressure, sweating, muscle tension, and a sense of danger that we call anxiety. There also numerous symptoms created by this physiological state. They include tension and migraine headaches, neck and low back pain, skin rashes, stomach cramps, depression, bipolar, burning sensations in various parts of your body, and there over 30 different responses. Although the chemical environment encompasses your whole body, each organ and organ system will manifest its unique response.

Symptoms, illness, and disease

 When the threat is transient or resolvable, there will be different physiology that will quickly abate the symptoms. When the threat is more prolonged, people will develop illnesses and diseases that, also, are reversible with appropriate treatment including the removal of threats and restoration of safety. When threat is sustained people can develop serious illness and diseases that may cause permanent tissue damage and create physical, mental and social havoc.

 What causes disease? There are two aspects consider.

• Your nervous system/ body
  • Your inherent coping skills
  • Your current state of reactivity influenced by diet, exercise, sleep, meds, etc.
• Your environment or perception of it
  • The magnitude and duration of threat – the inability to find safety

So, it is the interaction of the surrounding stressors with the human organism that determines the manifestation of physical and mental symptoms; illness and disease versus wellness and health.

The current state of “mainstream” medicine

Modern medicine has nullified these aspects of care in that we are not given the time nor are we encouraged to talk to our patients. From the beginning, we are not providing cues of safety. Then, we don’t know our patients and their coping capacity and really don’t know much about their environment. We are given only the time to treat symptoms. We are ignoring the root cause of the problem–total threat load. It is similar to putting out a major fire with a garden hose. It can’t and doesn’t work. Indeed, there is an ongoing and growing epidemic of chronic disease – both mental and physical, social and spiritual.

Solving our medical care crisis

Our medical care crisis could be solved with one simple move – significantly increase the reimbursement for talking to patients. This would allow a sense of safety, allow providers to assess both the patient and his or her surroundings, and direct them to resources to reduce the threats in their lives, improve safety,  coping and connection skills and provide tools to more effectively process their stresses.

The other half of the equation is to quit paying as much for procedures and also not reimburse for interventions that have been proven to be ineffective or damaging.

Addressing  root causes

A basic concept in extinguishing a fire is to deprive it of its fuel. Forest fires are the classic example. Fire breaks eliminate fuel and are only ineffective if the fire is so powerful as to jump over them. Fire retardants cover wood in a manner that it cannot be consumed. If water is used, it may be delivered in a mist, which helps lower the oxygen available. Water also removes heat. A carbon dioxide fire extinguisher displaces oxygen and suffocates it. The bottom line is that to fight a fire you have to address one of the root causes of it – oxygen, heat, or fuel.

Treating only symptoms is not only ineffective, the “fire” will continue to burn causing ongoing tissue damage. Successfully minimizing the impact of chronic illness requires minimizing the multitude of threats and maximizing access and opportunities for safety. coping and connection while also improving skills to better process toxic environmental inputs.

Summary

Every mental and physical symptom is created by the interaction between your surroundings and your body. Your body contains trillions of sensors that collect data that is sent to and processed by your central nervous system. Unpleasant sensations compel you to take action signaled by your brain and local tissues to resolve threat. Pleasant input causes you to take actions that are restful and regenerative.

The two factors creating symptoms and disease are you (and you coping capacity) and your surroundings (stressors). When you stresses overwhelm your coping capacity, you’ll experience symptoms, maybe become ill, or develop a serious disease. The solution lies in 1) increasing your coping capacity and 2) teaching you skills to more effectively process stress so it has less of an impact on your body, health, and sense of well-being. As you learn to regulate your body’s neurochemistry, you’ll have control, a sense of safety, and thrive. The DOC (Direct your Own Care) Journey presents a well-traveled sequence of lessons that will allow you to master these skills.

References

1. O’Neill Hayes, Tara and Serena Gillian. Chronic disease in the United States: A worsening health and economic crisis. Americanactionforum.org; September 10th, 2020.

Plan A–Thrive and Survive COVID-19, 2nd edition; Loving Life Lengthens It

The post Essence of Illness first appeared on Back in Control.

The post Essence of Illness appeared first on Back in Control.