Over the past few days, three papers have come out proving what I have been saying all along --- that mandatory flu vaccines for healthcare workers are not in any way, shape, or form, "EVIDENCE-BASED".  Even just a little bit.  And never have been. 

The first is a study from PLoS One (Influenza Vaccination of Healthcare Workers: Critical Analysis of the Evidence for Patient Benefit Underpinning Policies of Enforcement), the second is by Helen Branswell writing for the medical daily, STAT (Contentious Flu Vaccine Policies at Hospitals Are based on Flawed Research...), and the last is by Dr Mike Edmond, writing for his blog, Controversies in Hospital Infection Prevention --- the post itself is called It's Really Time to Fix This.  I would agree with Edmond's assessment. It really is time to fix this debacle.  And for those of you who may not realize how severely and unfairly many HEALTHCARE WORKERS have been affected by this law (HERE is an example from someone I know personally), we can only hope that this situation is rectified soon.

The PLoS One study is something we've seen before.  The authors (nine Canadians and one French researcher) looked at four large trials that had all come to the conclusion that vaccinating healthcare workers against influenza provided great benefit to patients in the form of less flu.  In Cherry-picked fashion (my usual modus oporandi), we see that the authors of today's study thought otherwise. "Realistic recalibration based on actual patient data shows that at least 6,000 to 32,000 hospital workers would need to be vaccinated before a single patient death could potentially [emphasis on potentially] be averted.  The impression that unvaccinated healthcare workers place their patients at great influenza peril is exaggerated.  Current scientific data are inadequate to support the ethical implementation of enforced healthcare worker influenza vaccination."  Again, nothing new, although it's vindicating to see it coming up in the medical community again and again and again.  Of the three papers being discussed today, the best by far comes from Dr. Edmond.

Edmond is, by any measure, a sharp guy.  He's authored over 350 papers, abstracts, and book chapters.  He is an MD with masters degrees in both public health (MPH) and public affairs (MPA).  And according to his bio he is currently Chief Quality Officer and Associate Chief Medical Officer for University of Iowa Health Care as well as being the Clinical Professor of Infectious Diseases at the University of Iowa Carver College of Medicine.  Not surprisingly, he's held a whole bunch of prestigious positions in other states he's lived in (Virginia and Pennsylvania) as well.  Like I said, sharp guy.

What he discusses in HIS SHORT BLOG POST is similar to what I have shown you over and over again on my site. Seven years ago, SHEA (the Society for Healthcare Epidemiology of America) proposed new guidelines "suggesting" that if you want to work in a healthcare facility, either get vaccinated against the flu or get out.  CMS (Centers for Medicare & Medicaid) took this paper and ran with it in ways that look rather foolish in light of what peer-review actually says on the matter. 

Much of it has to do with the fact that some of the people who created these guidelines stood to profit handsomely from a flu vaccine mandate.  Edmond wrote about this back in 2010 saying, "If you are a guideline author recommending a vaccine and have received money from a vaccine maker, that IS a conflict of interest, not a potential COI or the appearance of COI.  Other sources define COI differently, but I do agree that the conflict clearly exists in the case of the vaccine guideline. Whether it had impact is a different question. I do think it looks bad, and gives the anti-vaccine crowd ammunition.  By the way, I think the guideline is based more on emotional arguments than real data."

We see a couple of things in Edmond's quote.  The first is that he is definitely not one of those evil "ANTI-VAXXERS" like many would call me.  He is actually a very pro-vaccination physician who is, unlike most, being honest about the science.  And secondly, we can't trust guidelines that authors are making money off of --- potentially huge money --- even when they TRY AND CLAIM the money does not influence their decisions, which they always do.  In fact, on many different occasions I've dealt with the crazy number of financial conflicts of interest that can be found in our NATION'S NUMEROUS MEDICAL GUIDELINES --- Guidelines that are all too often for sale to the highest bidder. 

The rest of his paper discusses the PLoS One study, showing that the data SHEA originally used for their recommendations had been cooked.  And here's the thing folks; when it comes to research, cooking the books is simple, with ANY NUMBER OF WAYS to get results to come out exactly how you want them to, which is exactly what SHEA did (and if they don't come out as planned, HERE'S WHAT BIG PHARMA DOES WITH THEM).  Remember the stats I showed you a few paragraphs ago showing how many people would need to be vaccinated to "potentially" prevent a single death from influenza?  Dr E shows how bad things are.

"Estimates of numbers needed to vaccinate were so flawed (off by as much as 4,000-fold) that if extrapolated to all healthcare workers in the US, more deaths would be averted than occurred in the 1918 influenza pandemic.  Here's the bottom line per the authors: 'Each of the four cluster RCTs used to champion compulsory healthcare workers influenza vaccination policies reports benefits that are mathematically impossible under any reasonable hypothesis of indirect vaccine effect. It's hard to imagine a stronger conclusion'.   As I see it, unless SHEA cites alternative facts, it has three choices: change its position to recommending (not mandating) annual influenza vaccine for healthcare workers, articulate a damn good reason to support its current policy despite the evidence (hard to imagine what that would be), or simply retire the guideline (as it has quietly done for the 2003 highly controversial MRSA/VRE search and destroy recommendation)."

Next comes Branswell's piece in STAT.  The best part of her article is definitely the comment section, where one individual chimed in with a long list of the studies showing flu vaccine to be ineffective.  She did, however, shed some light on a point brought up by Dr. Edmond.  Branswell provides a first-hand glimpse of how the evidence was "cooked" for this particular study, and how far from the truth their results really were.

"One the studies, from Britain, calculated that one influenza death would be averted for every eight staff members vaccinated. But if that were correct, vaccinating the estimated 1.7 million health care workers employed in long-term care [nursing homes] in the United States should prevent 212,500 flu deaths a year among residents. There’s an obvious problem though, the paper noted. Nowhere near that many people die from flu in the US [HERE].  If the calculation is applied to the 5.5 million hospital workers, mandatory flu shots should avert 687,500 deaths each year — more than the number of Americans who died in the 1918 Spanish flu..."

Today you get a bonus fourth paper.  The same issue of PLoS One carried a misguided defense of their work by one of the authors of one of the original nursing home studies that was being attacked by all comers.  Other than admitting that nursing home studies cannot be extrapolated to healthcare settings like clinics or hospitals, the author desperately clung to his refuted research, saying that, "Influenza vaccine is effective at preventing influenza in healthy young adults. The strategy to encourage influenza vaccination for health care workers is partly based on the simple notion that this can reduce the risk of staff acquiring and transmitting influenza to vulnerable patients and thereby reduce associated morbidity and mortality.  Despite high levels of resident vaccination, low vaccine efficacy in the elderly means that they remain vulnerable to influenza and its complications. Residents have very high rates of mortality and hospitalization especially during periods of influenza circulation."  Want to see how false this simple cherry-picked paragraph really is?

First, according to the gold standard of gleaning the main conclusions from lots of studies and data, then crunching it into something usable --- COCHRANE --- it takes seventy one "healthy" people being vaccinated to prevent a single case of flu (HERE).  Secondly, when we factor in the elderly and most particularly the "frail elderly," although their rate of vaccination is relatively high compared to the rest of the population, the rate of vaccine efficacy hovers around the level of placebo / sugar pills --- just slightly better than zero (HERE).  In other words, vaccine efficacy for the elderly is admittedly far worse than for healthy adults.

Thus, you can see how adding these two facts together could not possible bring anyone with even an iota of intelligence to the conclusion that vaccinating healthcare workers could somehow prevent flu in the elderly. In fact, every single metric available shows how futile it really is to vaccinate any group against the flu (CHILDREN, healthcare workers, PREGNANT WOMEN, etc).  For the studies backing this up, you can either click these links, read through my FLU VACCINE POSTS one at a time, or you can see them altogether, crunched into my FLU VACCINE SUPER-POST.

On occasion I take a few minutes, head over to PubMed, comb through the latest research on any given topic, and then give you a synopsis of what's relevant as far as solving chronic conditions (pain included) is concerned.  Today I'm doing that with FASCIA.   Let's get right down to business and see what the experts have to say about Fascia over the course of the past few months.

• When I treat people with FACE OR SKULL PAIN, they have often been written off as "crazy".  Although there are any number of reasons for this (remember, Fascia does not image with standard medical testing -- HERE), much of it has to do with the way they so often describe their problem.  Invariably, they will use adjectives such as "crinkling or rustling leaves," "the sound of wadding paper into a ball," "a constant, low grade, Rice Krispies crackling, with each and every movement," or like Brenda described YESTERDAY, "eyebrows so tight on my face you couldn't pull them away."   I have talked about these sounds before (HERE), but it's not so much the sounds people hear that I am interested in, as much as what's causing them.  Last month's issue of Anatomical Record published a study pertaining to this topic called The Mobility of the Human Face: More than Just the Musculature, whose authors concluded, "The human face has the greatest mobility and facial display repertoire among all primates. However, the variables that account for this are not clear. Humans and other anthropoids have remarkably similar mimetic musculature. This suggests that differences among the mimetic muscles alone may not account for the increased mobility and facial display repertoire seen in humans.  This study was undertaken to clarify the morphological underpinnings of the increased mobility and display repertoire of the human face by investigating the Superficial Musculo-Aponeurotic System, a connective tissue layer enclosing the mimetic musculature located between the skin and deep fascia / periosteum.  This connective tissue layer may be a factor in the increased facial mobility and facial display repertoire..."  For the record, the PERIOSTEUM is the membranous layer of Fascia that covers bones, while APONEUROSES are flattened tendon-like structures virtually indistinguishable from Fascia.

• A study from last September's issue of Anatomy and Cell Biology (Histological and Biochemical Study of the Superficial Abdominal Fascia and its Implication in Obesity) provides us with a primer on Fascia. "The superficial fascia is formed of collagen fibers, loosely packed and mixed with abundant elastic fibers and adipose tissue.  The collagen fibers have great tensile strength. It can resist considerable tensile forces without significant increase in their length and at the same time they are pliable and can bend easily.  Elastic fibers run singly, branch and anastomose [run together and connect with] with other fibers. They are usually thinner than collagen fibers. Elastic fibers stretch easily with perfect recoil. These fibers are numerous in membranes that stretch periodically. Superficial fascia covering the anterior abdominal wall has high proportions of elastic fibers.  In abdominal obesity, fat cells lie between various layers of multilayered abdominal fascia."  What does this mean to the average American, considering that about 70% of us are overweight or obese?  Only that the more ABDOMINAL OBESITY you have, the greater the chance of stretching your Fascia past the point of no return (HERE).  By the way, this study pertained to PLASTIC SURGERY, which I have numerous times seen mess people up in severe and debilitating ways.

• In a very cool study on CANCER as it relates to Fascia and bodywork, November's Cancer Research (Connecting Tissues and Issues: How Research in Fascia Biology Can Impact Integrative Oncology) dealt with similar subject matter to what DR. INGBER of Harvard has been talking about for years (not to mention DR A.T. STILL) --- the fact that health of your Fascia plays a huge role in your overall health.  "Complementary and integrative treatments, such as massage, acupuncture, and yoga, are used by increasing numbers of cancer patients to manage symptoms and improve their quality of life. In addition, such treatments may have other important and currently overlooked benefits by reducing tissue stiffness and improving mobility. Recent advances in cancer biology are underscoring the importance of connective tissue in the local tumor environment. Inflammation and fibrosis are well-recognized contributors to cancer, and connective tissue stiffness is emerging as a driving factor in tumor growth. Physical-based therapies have been shown to reduce connective tissue inflammation and fibrosis and thus may have direct beneficial effects on cancer spreading and metastasis."  Wow, that doesn't sound like any cancer doctors I know (HERE)!  And this from a mainstream journal.  If you are interested in the relationship between INFLAMMATION & FIBROSIS, just click the link.

• Last October's issue of Manual Therapy (Mechanical Deformation of Posterior Thoracolumbar Fascia After Myofascial Release in Healthy Men: A Study of Dynamic Ultrasound Imaging) showed that after receiving bodywork on their low backs, "The primary finding included a decrease in the stiffness index of the Posterior Thoracolumbar Fascia and a greater difference in deformation of the Posterior Thoracolumbar Fascia between 50% and 100% maximum voluntary contraction."  How big was the difference in the "stiffness" of the THORACOLUMBAR FASCIA from pre-bodywork to post-bodywork?  Almost a quarter.  One more interesting fact in this study; since MRI does not do a good job of imaging Fascia (excepting maybe the PF), the authors used advanced ultrasound technology as seen in the thoracolumbar link (click for a side-by-side comparison of five second videos --- healthy Fascia -vs- damaged Fascia).

• November's issue of the Journal of Sports Sciences (Is Remote Stretching Based on Myofascial Chains as Effective as Local Exercise? A Randomised-Controlled Trial) actually talked about "myofascial chains" (ANATOMY TRAINS) in regards to stretching distant tissues to get local effects.  What do I mean?  "Lower limb stretching based on myofascial chains has been demonstrated to increase cervical range of motion (ROM)...  ....both lower limb stretches and cervical spine stretches increased cervical ROM compared to the control group in all movement planes and at all measurements.  Lower limb stretching based on myofascial chains induces similar acute improvements in cervical ROM as local exercise. Therapists might consequently consider its use in program design."  What does this tell me?  It tells me that a good stretching protocol will address the whole body --- not just the spot you hurt.  Can anyone say YOGA?

• Next month's issue of Insights into Imaging carried a study (Imaging of Plantar Fascia Disorders: Findings on Plain Radiography, Ultrasound and Magnetic Resonance Imaging) that showed that the most common imaging finding for PLANTAR FASCCITIS is a "thickening," which has been referred to elsewhere in the scientific literature as "DENSIFICATION".  I bring this up only because some people want to split hairs and say that densification is different from FIBROSIS or SCAR TISSUE FORMATION.  Call it whatever you want, the October issue of the Journal of Bodywork and Movement Therapies (Long-Term Impact of Ankle Sprains on Postural Control and Fascial Densification) addressed this issue in a study where, "20 young, healthy subjects with a history of significant (Grades 2, 3) lateral ankle sprains and 20 controls with no history of ankle sprains were recruited to cross-sectional case-control study.  The ankle sprain study group -vs- the control group exhibited significant differences... significantly high prevalence of fascial densification for the talus internal rotation, talus retromotion, talus lateral and pes external rotation.  There are long term effects of an ankle sprain on postural control and on the sensitivity and movability of the fascia in the calf and foot."  As a person who suffered for the better part of a decade after roaching my ankle several times playing basketball (at least two Grade III's, with two avulsion fractures), I can attest to this both personally and professionally.  HERE is our ankle sprain page, as well as our page on LIGAMENT INJURIES.  Thanks to Dr. Michael Miller, I also learned the importance of using a drop-table to work through and mobilize each joint in the foot / ankle, through all their different ranges of motion.

• The October issue of the Chinese Journal of Gastrointestinal Surgery carried a fascinating study called The Third Component in Surgical Anatomy and its Impacts.  The first two components of surgery were described by the authors as the organs and their blood vascular supply respectively.  Guess what the third component was?  That's right; Fascia.  "The third component is omitted by surgeons for many years. The omitted reasons are failed recognition and unknown function. Re-understanding of the third component in surgical or local anatomy will make some changes in the local anatomy, tumor pathology, oncology surgery and operations....  Many aspects will change with surgical developments, especially with the membrane anatomy, the third component."  Holy Toledo!  I've been saying for two decades that far too many doctors think of Fascia merely as the 'stuff' that has to be removed in order to get to the goodies --- the organs, muscles, bones, etc (HERE), not fully comprehending the magnitude of what happens when FASCIA GETS INJURED and people subsequently develop FASCIAL ADHESIONS.

• I happen to be the guy who has been talking about RIB TISSUE PAIN (not to be confused with RIB SUBLUXATION) for the better part of the past twenty years.  Why is it such a big deal?  Only because anything wrong with your ribs will literally make you think you are dying (I have seen untold numbers of people air-evac'd because someone confused their rib pain with a heart attack).  A study in last month's issue of Cureus (The Forgotten Lumbocostal Ligament: Anatomical Study with Application to Thoracolumbar Surgery) helped shed some additional light on this issue.  Although the study was aimed at surgeons, this ligament lies underneath the THORACOLUMBAR FASCIA, and is described as a, "constant structure of the thoracolumbar junction."  The authors also said it was a potential factor in 12th Rib Syndrome.  One more reason I always pay close attention to the TL spine when adjusting patients (I thank Dr. Jim Teachworth for that one).

• A study of last month's issue of the Journal of Craniofascial Surgery looked at what the study itself was named for --- the Anatomy of the Platysma Muscle.  Although the PLATYSMA MUSCLE is, as it's name implies, a muscle; in many ways it actually acts more like Fascia.  "The aim of this paper was to review the anatomy the platysma systematically."  But unlike injured Fascia that tends to thicken or "densify," "The most common aging-related change of the platysma was shortening, followed by thinning."  When you start to grasp the relationship of FHP to any number of pain syndromes, including CHRONIC NECK PAIN and HEADACHES, you start to see why a "shortened" Platysma is such a huge deal.  If you'll take a moment to click the first link in this bullet, you can take a look at pics of this muscle you've probably never heard of, and see why it's incredibly important as far as people with WHIPLASH are concerned.  Not as important as the SCM maybe, but important nonetheless.

• The November issue of the European Journal of Histochemistry (Hormone Receptor Expression in Human Fascial Tissue) talked about the ways that hormones affect Fascia --- especially in women.  That's right folks; as I've shown you before, when it comes to almost any sort of ill health, including injuries to the Fascia, women are much more likely to take it on the chin than men --- and this study could shed some light on this part of the puzzle.  Here are some of the cherry-picked findings from this study.  "Many epidemiologic, clinical, and experimental findings point to sex differences in myofascial pain in view of the fact that adult women tend to have more myofascial problems with respect to men.  It is possible that one of the stimuli to sensitization of fascial nociceptors [pain receptors] could come from hormonal factors such as estrogen and relaxin [the hormone that causes pregnant women's ligaments to loosen], that are involved in extracellular matrix and collagen remodeling and thus contribute to functions of myofascial tissue.  We can assume that the two sex hormone receptors analyzed are expressed in all the human fascial districts examined and in fascial fibroblasts....  Our results are the first demonstrating that the fibroblasts located within different districts of the muscular fasciae express sex hormone receptors and can help to explain the link between hormonal factors and myofascial pain. It is known, in fact, that estrogen and relaxin play a key role in extracellular matrix remodeling by inhibiting fibrosis and inflammatory activities, both important factors affecting fascial stiffness and sensitization of fascial nociceptors [pain receptors]."  Although systemic inflammation is bad news, local inflammation (THIS POST explains the difference between the two) supplies the growth factors needed to stimulate FIBROBLASTIC ACTIVITY.  Thus, in the same way that too much estrogen causes something called ESTROGEN DOMINANCE --- extremely common here in America --- too little estrogen can lead to problems as well. "It is well known that relaxin is a multifunctional factor which contributes to collagen tissue remodeling by inhibiting fibrosis and inflammatory activities and that a longer duration of estrogen deficiency is associated with increased fibrosis. In this respect, estrogen inhibits fibrosis, reducing TGFβ expression, connective tissue growth factor production and function, matrix metalloproteinases 2 and 9 expression and activity, the conversion of fibroblasts to myofibroblasts and the production of collagens I and III. All these factors are also important to define fascial remodeling and fascial tension. If fascial stiffness is increased, the nociceptors within the fascia could be sensitized causing the underlying muscles to be stiffer."  By the way, metalloproteinase dysfunction is associated with abnormal scar formation and stretch marks (HERE).
  

If you have struggled with CHRONIC PAIN, addressing the body's Fascia System probably makes as much sense as anything you've heard.  And if you like what you're hearing, feel free to show us some love on FACEBOOK, which actually helps you get this message into the hands of those you love and care most about.

A patient I'll call "Brenda" sent me the following history in response to a recent post on CHRONIC LOW BACK PAIN.  I told her I would answer her publicly so that everyone could read, since what she is dealing with is extremely common (I do this ON OCCASION).  Scenarios like Brenda's are not only dog common, but have the potential to take a person who has worked hard to be active, fit, and healthy, and destroy their life.  Thus, the biggest question on the table is whether there is anything Brenda can do at this point to potentially help her cause?  I guess another way of putting it might be, what would I do if I were in a similar situation? My responses are in between her paragraphs.

"I was in a car accident just short of 2 years ago and I'm still getting treated. I was hit by someone who ran a red light traveling at least 55mph while I was stationary. I was hit on the front passenger side of my vehicle. The whiplash I incurred went sideways.  My accident happened on a Sunday, I was sore afterwards, but on the following Wednesday I woke up in pain from head to toe."

The first thing I want you to understand is that every study that comes out, shows that healing takes longer than the study that came out before it.  Although insurance companies love to tell their insured that "research says" healing of soft tissues takes no more than 4-6 weeks, this is patently untrue as seen in the latter part of THIS LINK.  Although the FIBROSIS (the medical word for SCAR TISSUE) is laid down in that amount of time, your body must remodel said tissue into something functional, which takes much longer --- current research says as long as two years or more.  Furthermore, Brenda has at least two of the biggest factors that potentially make WHIPLASH INJURIES worse working against her --- she's female and her impact was from the side as opposed to coming from either the front or the back (both found HERE).  On top of everything else, having pain show up days or even weeks after the accident is not at all an uncommon phenomenon (HERE).

"I suffered from daily migraines, blurred vision, sensitivity to light, could not sit, stand or lay comfortably. My whole body felt like I was plugged into an electrical outlet. The immediate care doctor I saw the day after my accident prescribed muscle relaxants and ibuprofen. By Friday I was at my doctors office. He is an integrative medicine doctor, therefore no more muscle relaxants, no pain meds prescribed. As much as I laid wishing I had them, I'm grateful I did not. The amount of pain I was in I'm sure I would have become addicted. I saw a chiropractor 3 times a week for 3.5 months with a 1/2 hour massage once a week. My eyebrows were so tight on my face you couldn't pull them away. I was told the muscles in my back were like ropes with knots underneath. I have bulging discs from T4-5 to T10 and broad base to moderate disc bulges in my lumbar/sac."

The first sentence tells me that you had a MTBI / TBI, as all symptoms you list --- including MIGRAINES --- are well known sequelae of such.  It is extremely common for people who are in these sorts of accidents become heat-intolerant as well.  Typical pharmacological fare for these sorts of injuries includes THE BIG FIVE (with the ANTI-DEPRESSANTS usually coming a bit later).  In the acute part of the injury, you'll need lots of care, including massage.  As for your "tight eyebrows," make sure you look at my articles on FACIAL FASCIA.  As for the discs, some of these may or may not be a source of your pain.  And as to the argument that they were pre-existing (invariably this is what the insurance company will say), how can this be proven one way or another without a previous MRI?  Even if these disc injuries were pre-existing, the accident took a stable situation (HERE) and destabilized it (HERE).

"Still to this day my legs still buzz. I can feel it in the back of my upper legs and then it encompasses both lower legs from the knee to my toes with my left side worse. Sometimes I also have tingling on the back of my left arm and into my last 2 fingers. I also have issues with my left knee that comes from my tight hip flexors. After seeing the chiropractor for so long and eventually being told, "I can't fix you (and it's not because he didn't give it 125%) I saw a myofascial release therapist. I finally starting getting some relief. The treatments were painful; I screamed at times, had tears from the pain but the next day I felt relief."

Let me take this time to address your low back pain.  Many insurance companies will tell you that low back pain after motor vehicle accidents is rare.  Hogwash!  According to any number of studies (not to mention notes from Dr. Dan Murphy's 24 hr Whiplash Seminar), it's the third leading symptom of these sorts of accidents, just behind NECK PAIN and HEADACHES.  Also, RADICULAR PAIN and SCIATICA can take on many forms, often leading to paresthesias ("abnormal nerve sensations").  As for the tight HIP FLEXORS, adjustments, while extremely important, don't, in and of themselves, have the ability to solve this or any of the other major "SOFT TISSUE" components of the injury.  The soft tissue parts of the injury will almost always require some sort of bodywork. 

When it comes to bodywork, there are two different kinds.  There is what I call rub-a-dub, which is the feel-good stuff you can get at the spa to help you relax.  This is great for people not experiencing any majorly painful problems.  However, as I have talked about previously (HERE, HERE, HERE, and HERE), bodywork often needs to be harsh, because if it's not, the threshold for breaking the adhesed fascia is not being met.  Thus, sub-threshold treatment is not breaking down the Fibrosis / Scar Tissue, which is why I sometimes say of this sort of treatment, 'a whole lot of nothing is still nothing' (see links).

"I tried working for the 1st three months after my accident, but sitting all day (and trying to learn a new job), I eventually had to go on Medical Leave for six months, or risk losing my job due to call offs. Since I had no pain meds prescribed, I would take 3 ibuprofen upon waking, then 2 extra strength Tylenol at noon, followed by 3 more ibuprofen early evening and then 2 Tylenol pm's to fall asleep. I did this for 9 months, before I said enough."

In many cases, especially cases where you are able to constantly move around without having to do heavy or repetitive jobs (especially on CONCRETE), the best thing you can do is go back to work. However, so many jobs require people to spend their days hunched over a desk or computer screen (or an assembly line) that it creates it's own set of problems (CHRONIC TRUNK FLEXION and FORWARD HEAD POSTURE).  And as for the TYLENOL and NSAIDS (Ibuprofen), clicking on the links reveals their own unique sets of associated problems, many of which can be deadly or at least debilitating.

"The myofascial release was helping until insurance said no more visits. What do they know?  And how could they judge me and my condition sitting at desk wherever they are?  I eventually ended up back with my myofascial therapist a few months later for another 12 visits they OK'd. Once again, I was getting better, then insurance stopped it. I tried going back to the activities I enjoyed prior to my accident. Aquatic exercises. Tried riding my bike, and would have mid back spasms later in the day. I have a horse and have enjoyed riding for 45 years. I got back to the barn again to enjoy everything that comes with caring for a horse, mucking stall, brushing, riding and once again back spasms and soreness. I love hiking/walking. I'm a photographer."

What do they know?  Insurance is evil.  In our society it's a necessary evil, but an evil nonetheless, whether run by private enterprise or our government (a government that has proved time and time again that they are incapable of most of what they are charged with --- HERE for instance).  Sounds like there was a huge amount of ADHESED FASCIA created by this accident.  This is a good time to mention that as unfortunate as it is, a significant number of those injured in MVA's (some studies actually say as great as 25%) never fully recover, being left to deal with varying degrees of CHRONIC (TYPE III) PAIN. My goal is always to keep my patients from falling over that precipice into the pit of despair.

"I now felt as if my ovaries hurt, my left knee was bothering me, I would get up all stiff and sore and limp for several steps. I saw my PCP and asked him should my ovaries hurt if I'm in menopause? My left knee is bothering me too and I still have the buzz in my legs. He has me get up on the table and raises my legs up and down. The left leg was turned "on" I experienced a large electrical current throughout my whole leg with buzzing, pins & needles and tingling all the way to my big toe. He said you might have piriformis syndrome. That leg raise must of woke up a nerve somewhere. Within a couple of days I experienced daily headaches again, culminating into a migraine, my knee hurt worse and the buzzing was worse. I ended up seeing a different chiropractor that specializes in Active Release Technique (ART). It's working and I'm getting a full body deep tissue massage weekly. I'm feeling better but still have the same issues."

Depending on how much nerve irritation you have (PIRIFORMIS SYNDROME can certainly be a factor), this could not only cause the radicular symptoms, but the abdominal pain as well since nerves from your LOW BACK control your sex organs (HERE).  Also be aware that right along with the hip flexor issue, it's not uncommon to end up with FASCIAL ADHESIONS of the lower abdomen (HERE).  By the way, ART is fantastic stuff for lots and lots of people.

"The buzzing in the legs to my toes is still here but my knee does feel better most of the time. Forgot to mention along with the knee pain I was also experiencing plantar fasciatis too. My chiro thinks I should get an EMG. I go to a 3rd neurologist and he tells me he thinks my issues go deeper than any of the medical equipment locally could read and suggests I try a university setting. Do I need a referral? No; well yes I do, or insurance will not pay. Three weeks later I'm still waiting on the referral."

Your neurologist is probably a fantastic individual.  He / she is also likely leading you on about your local university having "special" equipment that is going to show this problem.  Unfortunately, the most abundant, pain-sensitive, and commonly injured tissue in the body does not show up with standard imaging, including MRI (HERE).  And as for an EMG providing an "ah ha" moment.... Not to be a party-pooper, but after 25 years of practice, I would go "all in" betting against it.  As far as a neurologist is concerned, because you are so close to Chicago, you should have no problem finding a Functional Neurologist trained by DR. TED CARRICK to at least evaluate you.  DR. JAY ROHLEDER is in your state and I would consider him to be tops in his field.  I've sent patients to him with great results, and know him personally as he was the Valedictorian of our chiropractic class of 1991.  Great guy; great doctor.

"The last couple of my massage visits she could feel my knots or lumps whatever you call them. She tried working them out, and it was painful. My right side of my back still has the stringy rope going down it and I could feel it all the way into my elbow. The lump of tissue on the left side of thoracic is still here 2 years later and is very stubborn. I would really like to get to the root of these problems, I don't want a doctor to tell me 10 years from now, that you should have done this or that. Is there any hope for me? By chance do you have any insight on what I should do next?  I'm going to be 57 in a couple of months, prior to my MVA I was very active, limber, felt as if I could do anything I wanted. I wanted to go into my senior life with a younger body. You know the saying "move it or lose it"."

The knots you are referring to Brenda are called TRIGGER POINTS and are miserable by anyone's definition.  I commend you for wanting to get to the root of the situation.  However, it can be tough to do --- even if you know exactly what's wrong.  Which brings me to the next part of this post; what would I do if I were in your shoes?

Firstly, because head injuries are associated with crazy things like LEAKY BRAIN SYNDROME, INFLAMMATION, and autoimmunity (HERE), I would take a long hard look at doing an ELIMINATION DIET, which I think is far more accurate than any sort of sensitivity testing.  Secondly, a middle-of-the-road WBV MACHINE might prove invaluable as far as a way to both exercise and stretch (it actually provides exercise to your brain).  Thirdly, because the cost of virtually all technology continues to plummet, a LASER for home use might prove invaluable for you.  Otherwise, I would read THIS POST (as well as looking at the links I provided for you today).  Certainly, not everything I've included is going to pertain to you, but some of it will.  If you can possibly find a hidden source of inflammation, it could prove highly beneficial as far as getting to that "root cause" of your problem.

Because I have family members and friends who are MD's, I have some idea of the bureaucratic BS they are forced to go through all day long with each and every patient.  Why does it matter to you?  Mainly because not only is EVERYONE BEING AFFECTED BY A SIMILAR PHENOMENON, but how much does it affect your care knowing that national polls have repeatedly shown that over fifty percent of physicians hate their job and dread going to work? 

Writing for the blog over at Kevin MD, Dr. Jordan Grumet, an internist doing a guest column (Why This Doctor no Longer Loves Being a Physician) stated, "I no longer love being a physician.  I suppose the change happened sometime after we started using electronic medical records. It happened with meaningful use. And MACRA. And Medicare audits. And ICD-10. And face-to-face encounters. And attestations. And PQRS. And QAPI. And the ACA. And MOC. And on and on.  What I do today is no longer practicing medicine. Instead it’s like dancing the waltz, tango and salsa simultaneously to a double-timed techno beat. It’s sloppy, rushed, unpleasant to look at and often leaves my partner more confused and anxious than when we started.  I have become ineffective. Not by the weight of ever expanding medical knowledge or even the complexity of the human body. Instead, my hard drive is being spammed by thousands of outside servers."

If you want to get an idea of what your doctors are going through every time they come in the room to examine or treat you, you can read THIS POST.  And if you think that it's not affecting the quality of your care (or the quality of the research coming out of the field), I've got some ocean front property in Arizona you just might be interested in.  I would suggest you take one minute to read Dr. Grumet's short article (that's all it will take).  As is frequently the case, the comment section is better (and more telling) than the post itself.

That bastion of truth and knowledge, Wikipedia, says of NIGHTSHADES, "The Solanaceae, or nightshade family, are made up of over two thousand different species of flowering plants, herbs, vines, lianas, epiphytes, shrubs, and trees, and includes important agricultural crops, medicinal plants, spices, weeds, and ornamentals. Many members of the family contain potent alkaloids, and some are highly toxic, but many cultures eat nightshades, in some cases as staple foods."  The first thing I want to get across to my patients and readers is that the vast majority of you reading this have no problem whatsoever ingesting foods from the Nightshade family.  But.... For some of you, Nightshades can be a continual source of occult (hidden) inflammation.  Which begs the question, what edible plants are from the family of Nightshades?

• Tomatoes (including Ashwagandha, Tomatillos, and Tamarillos)
• Potatoes (but not Sweet Potatoes)
• Peppers (both sweet and hot, as well as black pepper, whose active ingredient, Piperine, has actually been used as an insecticide)
• Eggplant
• Paprika
• Okra
• Certain Kinds of Berries (Goji, Garden Huckleberries, Cape Gooseberries, and to a small -- small --- extent, blueberries)
• Poke (around here it grows everywhere and is considered a weed; people call it "ink berry plant," and although the purple berries are toxic, the leaves are less so and can be eaten early in the Spring --- as long as you boil them twice and pour off the water)
• Tobacco
• Others (although there are any number of others, most are relatively uncommon in the US)

The best way to determine whether or not you are sensitive to Nightshades?  An Elimination Diet of course.  When doing an ELIMINATION DIET, I not only urge you to cut out GLUTEN CROSS-REACTORS, but Nightshades as well.  The cross-reactors are self-explanatory if you look at the provided link, but why Nightshades?  Simply because some people are sensitive to them --- especially people whose biggest problem happens to be JOINT PAIN & ARTHRITIS.  They've also been shown to cause intestinal inflammation (HERE), which invariably leads to a "LEAKY GUT" and fouled up MICROBIOME (aka "DYSBIOSIS") --- two hallmarks of chronic illness,  This can be highly problematic considering that 80% of your body's total immune system is found in the Gut (HERE).  From my experiences, I would say that the second most common symptom of Nightshade Sensitivity would be IBS.

But again, why are Nightshades so potentially toxic to certain people?  It has to do with the fact that they all contain chemical compounds known as alkaloids.  Wiki says of this class of compounds; "they are known to have an intense physiological action on animals even at low doses.  Solanaceae are known for having a diverse range of alkaloids. To humans, these alkaloids can be desirable, toxic, or both."  Some of the alkaloids you have quite possibly heard of include Nicotine (the active ingredient in Tobacco), Scopolamine (a plant-based motion sickness and anti-nausea compound), Atropine (highly toxic, but used in the medication "BELLADONNA" at extremely low doses), Solanine (found in both potatoes and tomatoes, especially when unripe or green --- extremely toxic; actually deadly at as little as 2mg per kg of body weight), Capsaicin (not as toxic as the others; is what gives hot peppers their 'heat'), Quinine (the most famous of the anti-malarial drugs, from the bark of the cinchona tree), Morphine (from opium poppies), Ephedrine (part of any number of medications as well as being used to manufacture METH; known as Ma Huang in Chinese Medicine), Cocaine (from the leaves of the coca bush), Caffeine (from coffee and tea) and any number of others.

Once more; the point is not to suggest that most people --- or even a significant minority --- are sensitive to Nightshade edibles.  Just be aware that there is a mountain of evidence, both anecdotal and empirical, showing that for some people --- most of whom have no idea --- this is a legitimate and potentially severe problem.  And for the rest of us......?  Nightshades can actually have some pretty good health benefits.  In fact, when I went to PubMed to research the topic, I found just as many or more studies touting the benefits of Nightshades as I found touting their inflammatory properties.  But.....

If you are one of the tens of millions of Americans struggling with CHRONIC INFLAMMATORY DEGENERATIVE DISEASES, AUTOIMMUNITY, or CHRONIC PAIN, it would serve you well to read THIS POST, and strongly consider doing an Elimination Diet (ED).  A well-done ED allows you to pluck the low-hanging fruit as far as your health troubles are concerned.  In other words, there will be some of you reading this who end up needing some sort of Functional Testing to figure out what's wrong with you.  But for the rest --- the vast majority --- you can actually solve many of your health-related problems on your own by following some of the simple steps outlined on this site (HERE).

The large red "X" above is at the IVF of the fifth lumbar disc --- the lowest disc in the spine.  Although this disc should be the thickest disc in the spine, after 25 years of practice I can authoritatively say that in people with any degree of low back issues, this is rarely the case.  In fact, I would dare say that in most of the over-40 crowd, the fifth lumbar disc (the lowest disc in the low back) is the thinnest disc as opposed to the thickest.  Although I was taught and used to believe this thinning was purely a mechanical phenomenon caused by the immense stresses and loads the spine is under so much of the time (every time you bend forward the movement mostly occurs at the fifth lumbar disc), I've come to realize that this is not completely true.

Much of this has to do with studies showing OSTEOARTHRITIS or "Degenerative Arthritis" (in the extremities this is called DJD or Degenerative Joint Disease, while in the spine it's referred to as DDD or Degenerative Disc Disease) is largely a function of inflammation.  This is the biggest reason that study after study after study has shown that whether we are talking about disc herniations, degenerative discs, or deterioration of joints elsewhere in the body (HERE and HERE), there is little correlation between the amount of pain a person is having and the severity of findings as seen on their x-rays and MRI's.  The silver lining is that you can use this information to your advantage when dealing with chronic low back pain. 

When the medical community treats people with chronic low back issues, they address it three different ways.  Firstly, they deal with the pain by prescribing various sorts of PAIN MEDS.  While there is certainly nothing wrong with this approach for the short haul --- especially if the person is in horrendous pain --- it's never a good thing, and especially not for more than a few weeks at the most.  Secondly, they deal with inflammation --- kind of.  I say "kind of" only because what they are doing is masking inflammation as opposed to actually stopping it at the source (EXPLAINED WELL HERE). And thirdly, they (including alternative practitioners) are attacking these sorts of problems mechanically (CHIROPRACTIC ADJUSTMENTS, THERAPY, EXERCISE, STRETCHES, VARIOUS SORTS OF BODYWORK, SPINAL DECOMPRESSION THERAPY, INVERSION, WBV, etc, etc).  For the record, BACK SURGERY is also a form of mechanical intervention, albeit an invasive one.

Don't get me wrong; this approach has proven successful for many individuals.  However, for many it misses the mark --- sometimes miserably. While the three steps mentioned above might be necessary, they all fail in one critically important area --- stopping the inflammation unrelated to the injured or degenerative disc itself.  You see, while a certain amount of INFLAMMATION is required to heal damaged tissues, too much leads to a variety of serious serious and systemic problems, including chronic pain.  The problem is that tissue damage can occur via any number of reasons, including things such as your DIET and your level of GUT HEALTH.  There are many other possibilities. 

The really cool thing about dealing with your chronic back pain in this manner, is that it's the best way to deal with almost any health problem you can imagine (I'll show you why in a moment).  When Larry thought he was going to have to have back surgery because of the severe low back pain he had dealt with for half a year, it was dealing with systemic inflammation that "cured" him (HERE).  And love him or hate him (did you watch last evening's game?), it's no coincidence why TOM BRADY continues to play at a level rarely seen by anyone, let alone by someone approaching their 40th birthday.  Both these cases have one thing in common --- going all out to control inflammation.  Which leads us to something really amazing for those of you struggling with chronic health issues, including low back pain.

Whether you have CHRONIC BACK PAIN, CHRONIC INFLAMMATORY DISEASES, or any of the AUTOIMMUNE DISEASES on this list (click the link), you can address them in an almost identical fashion.  And you don't have to wait to get your doctor's permission to start much of what's found on this protocol (HERE).  People are using the information on this site to create their own EXIT STRATEGIES to get off the MEDICAL MERRY-GO-ROUND.  HERE it is, and it's totally free.  It might not solve each and every health issue you are dealing with (including your back problem), but it will at least give you a fighting chance as well as a starting point.  Click the links to see why.

When it comes to embryological development, the first thing to form is your nervous system --- brain and spinal cord.  It's so important that it ends up encased in protective bone.  The skull is essentially a fixed structure (no offense to the craniosacral people here), while the spinal column is made up of 24 moveable vertebrae.  In between most of these vertebrae are spinal discs, which act as cushions or bushings.  The nerves travel throughout the body after exiting the spinal cord through small "windows" along either side of the spinal column.

The discs are of critical importance for any number of reasons, with one of the biggest being that the height of the window (known as the IVF or Intervertebral Foramen) where the nerves exit the spinal column, is directly proportional to the height of the disc (see picture below).  This means that things that cause disc thinning in any capacity have the propensity to diminish the size of the IVF.  Considering that this is where the nerve roots live, you can guess how big a problem this presents.

"Although the cause of increased prevalence of wheat sensitivity over the last several decades remains unknown, modern wheat processing techniques may have increased consumer exposure to immunoreactive compounds."  From the February 1015 issue of Comprehensive Reviews in Food Science and Food Safety (A Grounded Guide to Gluten: How Modern Genotypes and Processing Impact Wheat Sensitivity)

"One of the issues of whole wheat flour production is the lack of well-established milling procedures. Whole grain flours are produced by a variety of techniques and result in flours with widely different particle sizes and functionalities.  Another issue with whole wheat flour utilization is shelf-life.  Whole wheat flour is highly susceptible to rancidity due to the presence of lipolytic enzymes."  Andres F Doblado-Maldonado from his 2012 Masters Thesis at the University of Nebraska, New Technologies for Whole Wheat Processing Addressing Milling and Storage Issues

I already know that this post is going to create a firestorm of controversy.  That's OK.  Understand that it's not geared towards everyone --- only those who are chronically ill (HERE), chronically overweight (about 80% of the US population when you factor in the 8-10% who are "SKINNY FAT"), or dealing with CHRONIC PAIN --- according to estimates, as many as 100 million Americans.  The fact that people question that grains could be part of their health problem(s) is legitimate --- I've asked some of the same questions myself.  For instance, how can common grains from the Bible (wheat, corn, barley, rye, oats, millet, emmer, etc) somehow be bad?  I will get to that, but for the time being, realize that the grains we are consuming today are radically different from the grains your grandparents were consuming --- let alone Moses or Jesus.

The first thing I want everyone to realize is that not everyone is sensitive to GLUTEN or other grains, which, by the way, are virtually all GLUTEN CROSS-REACTORS.  Some of you can handle these with no apparent problems.  But also understand that just because a problem is not "apparent" does not necessarily mean it doesn't exist.  This is especially important one you realize that when it comes to NON-CELIAC GLUTEN SENSITIVITY (NCGS), the majority of the symptoms don't manifest like we've always been taught they do --- bloating, gas, CONSTIPATION, DIARRHEA, IBS, etc, etc).  They manifest "extra-intestinally" or outside of the Gut.  For example, numerous studies show that over half of all NCGS manifests neurologically (HERE and HERE).  But Gluten is only part of what makes grain a potential Burmese Tiger Pit waiting to destroy unwary (or uneducated) victims. 

Grains can be divided into two large categories; these are legumes, which include all types of BEANS (UNFORTUNATELY, SOY) and the cereal grains (wheat, rye, barely, corn, etc, etc, etc).  All have three main parts; the bran, the germ, and the endosperm.  The bran, or "husk" of each kernel, is where MOST OF THE FIBER is found. It's also where part of the B-VITAMINS and most of the minerals are found, as well as the majority of the oils (it's the oils that tend to go rancid fairly quickly once the grain is milled).  The bran also happens to be where the phytates, one of the "ANTI-NUTRIENTS" found in many grains, are found (other anti-nutrients that may or may not stimulate health problems such as LEAKY GUT include Lectins, Saponins, Oxolates, Lippopolysacharides, and potentially several others).

The germ is the part of the grain that actually sprouts and becomes a new plant.  The rest of the B-Vitamins are found here, as well as ANTIOXIDANTS and the rest of the oils.  It contains several vitamins and minerals, as well as being made up of about one third protein.  The endosperm is not only the by far the biggest part of the grain, it's where the majority of the starchy carbohydrate meant to feed the "germinated" seed is found.  When compared to the rest of the grain, the endosperm has little nutritional value other than providing a source of simple carbohydrate.

The USDA, which as I have told you previously, is an organization whose chief concerns have little to do with health, but rather the promotion of US agriculture both domestically and around the world, says on their website (Choose My Plate) that, "Most Americans consume enough grains, but few are whole grains."  What's the difference?  "Whole grains contain the entire grain kernel ― the bran, germ, and endosperm.  Refined grains have been milled via a special process that removes the bran and germ. This is done to give grains a finer texture and improve their shelf life, but it also removes dietary fiber, iron, and many B vitamins.   Most refined grains are enriched."   Once the grain has been refined, chemicals, including bleach, are used, not to whiten the flour or to kill bugs as most people believe, but to destroy any living part of the grain remaining from the milling process.  This is because in virtually all cases, manufactures need dead flour made from dead starch. You'll see why this is so important in a moment.

First and foremost, the quote above shows that most Americans are not eating whole grains (and when they do, they are largely being duped as you'll also see shortly).  Secondly, the grain-based products they are eating are usually highly refined (the bran and germ are removed).  Why?  Because flour that is not heavily refined not only spoils and goes rancid quickly, it tends to attract weevils and other critters (those of you who are old enough know what I am talking about).  By removing or killing the vital, living, and nutrient-rich part of the grain, food manufacturers can provide retailers and consumers flours and products that in many cases have an almost unlimited shelf-life.  For instance, breakfast cereal might get a bit stale once the bag has been opened, but left in your pantry for a decade, it will not spoil or rot. And what about the whole "enrichment" thing I mentioned earlier?

Enrichment is what politicians do at the expense of the citizens they are supposed to represent.  It's also one of the many ways food manufactures dupe people who don't know better.  I have a friend who is in the pet food manufacturing industry.  He tells me that synthetic vitamins & minerals are not only widely available, but dirt cheap.  This is why manufacturers can advertise that radically unhealthy breakfast cereals such as Count Chocula, Coco Puffs, Donutz, Captain Crunch, Golden Grahams, Froot Loops, Trix, Super Sugar Crisp, Apple Jacks, Honey Smacks, METH & CRACK, and a myriad of others, are "fortified" with the whole day's supply of a dozen or so essential vitamins and minerals.  If you aren't familiar with the difference between nutrition that comes from food and the synthetic garbage added to these products so industry can make absurd claims about nutrition (for instance, Total Cereal claims to supply, "100% of the Daily Value of 11 vitamins and minerals"), then you need to read THIS.

I think that our "smoking guns" can be boiled down to three main categories, hybridization / GMO, modern milling methods, and chemical saturation. How big a deal has hybridization and GMO been as far as health problems are concerned?  Despite what we keep hearing from our government; huge for susceptible individuals.  This is mostly due to the fact that modern hybrids and GMO's (or funky combinations of the two) can not only contain larger amounts of certain proteins than older (ancient) varieties of grain did, but in some cases, have been shown to contain proteins that did not used to exist at all.  Either way you slice it, people's bodies are reacting to these as foreign and then mounting immune system attacks against them, which as strange as it may seem, is a known trigger for the body mounting immune system attacks against itself in the form of autoimmunity.  This is not a new or novel concept, having been known since the 1930's --- HERE & HERE.  What are some of America's leading authorities saying on the subject?

Renowned Naples neurologist, DR. DAVID PERLMUTTER of NYT bestseller Grain Brain fame, stated that, "The problem with gluten is far more serious than anyone ever imagined. Modern…structurally modified, hybridized grains contain gluten that’s less tolerable than the gluten that was found in grains cultivated just a few decades ago."  FUNCTIONAL MEDICINE expert, Dr. Mark Hyman (MD) says of these modern grains, "This new modern wheat may look like wheat, but it is different in three important ways that all drive obesity, diabetes, heart disease, cancer, dementia and more. It contains a super starch, amylopectin A, that is super fattening, a form of super gluten that is super inflammatory, and acts like a super drug that is super addictive and makes you crave and eat more." Can anyone say GLUTOMORPHIN?  Dr William Davis (MD) who wrote the legendary book Wheat Belly stated that, "This stocky little high-yield plant, a distant relative of the wheat our mothers used to bake muffins, biochemically light-years removed from the wheat of just 40 years ago."

And to top it all off, my mom's first cousin, DR. JAMES BRALY, a nationally respected expert on the immune system and natural allergy relief (not to mention, long-time physician to the rich and famous) was lecturing and writing about the health problems associated with grains clear back in 2002.  In his hit book, Dangerous Grains, he lists on the back jacket some of the health problems connected with the consumption of modern grains via peer-review.... 

• CANCER
• AUTOIMMUNE DISEASES (A list of the more common ones can be found HERE.)
• BRAIN DISORDERS
• OSTEOPOROSIS
  
• INTESTINAL DISEASE (This covers a lot of ground, including not only pathological issues such as IBS and IBD, but "FUNCTIONAL ISSUES" such as LEAKY GUT and the screwed up MICROBIOMES we collectively refer to as "DYSBIOSIS".  For those of you with IBS, it is critical you understand FODMAPS.) 
  
• DIGESTIVE DISORDERS (One that's been related to grain that plagues a huge segment of our population is something called HYPOCHLORHYDRIA.  If you are on ACID BLOCKING DRUGS you really need to understand this bullet.)
  
• CHRONIC PAIN
  
• INFERTILITY & PROBLEM PREGNANCIES

"Even orthodox nutritionists now recognize that white flour is an empty food, supplying calories for energy but none of the bodybuilding materials that abound in the germ and the bran of whole grains.  Problems occur when we are cruel to our grains—when we fractionate them into bran, germ and naked starch; when we mill them at high temperatures; when we extrude them to make crunchy breakfast cereals; and when we consume them without careful preparation.  Grains require careful preparation because they contain a number of antinutrients that can cause serious health problems. Phytic acid, for example, is an organic acid in which phosphorus is bound. It is mostly found in the bran or outer hull of seeds. Untreated phytic acid can combine with calcium, magnesium, copper, iron and especially zinc in the intestinal tract and block their absorption. This is why a diet high in improperly prepared whole grains may lead to serious mineral deficiencies and bone loss. The modern misguided practice of consuming large amounts of unprocessed bran often improves colon transit time at first but may lead to irritable bowel syndrome and, in the long term, many other adverse effects." Sally Fallon and Mary Enrig from the WESTON PRICE FOUNDATION (Be Kind to Your Grains And Your Grains Will Be Kind To You)

"Our rallying cry is 'Bake Like it’s 1869'. That's because, in the 1870’s, the invention of the modern steel roller mill revolutionized grain milling.  Instead of just mashing it all together, one could separate the component parts...  And, beyond being cheap and wildly popular, this new type of flour shipped and stored better, allowing for a long distribution chain. In fact, it kept almost indefinitely. Pest problems were eliminated because pests didn’t want it. Of course, we now know that the reason it keeps so well is that it has been stripped of vital nutrients.  The steel roller mill became so popular, so fast, that within 10 years nearly all stone mills in the western world had been replaced. And thus was born the first processed food and the beginning of our industrial food system: where vast quantities of shelf-stable 'food' are produced in large factories, many months and many miles from the point of consumption."  Fron Zivot's GrainStorm site (the article mentioned earlier)

"Stone mills are the oldest attrition mills used for making whole grain flours, which simultaneously use compression, shear, and abrasion to grind wheat kernels between two stones and produce a theoretical extraction rate of 100%. Modern stone mills are metal plates with composition stones attached and generate considerable heat due to friction. This can result in considerable damage to starch, protein, and unsaturated fatty acids in comparison with other milling techniques.  Furthermore, in large, continuous milling operations, heat generated from stone milling can pose a fire risk.  Interestingly, there appears to be a marketing advantage by using the term 'stone ground' with consumers."  From Andres F Doblado-Maldonado's 2012 Masters Thesis, New Technologies for Whole Wheat Processing Addressing Milling and Storage Issues at the University of Nebraska

"A report written under the guidance of the American Association of Cereal Chemists International Whole Grain Working Group (WGWG) asserted existing data comparing the two principal means of manufacturing whole wheat flours and meals — single-stream milling and multiple-stream milling with recombination — do not show any strong advantage for either milling method with regard to maintaining the nutritional value of the whole grain. Whole grain.. meals and flours mostly were manufactured by mills using a multiple-stream with recombination process.   Some sources have voiced concerns that milling processes that separate and combine millstreams may capture fewer whole grain components and their nutrients, fiber and micro-constituents than milling processes that never separate millstreams.  In multiple-stream milling with recombination, the grain is crushed, and different grain fractions are channeled into separate millstreams. When crushed and separated products of milling, specifically the bran, germ, endosperm, and minor milling fractions (from the same grain), are reunited at the point of use by the food manufacturer, the process is called reconstitution.  The contribution of single-stream milling to whole grain foods in Western diets is minimal...   Manufacturers reconstituting whole grain flour in the manufacture of their whole grain food products must exercise diligence to ensure that the proportions of the various components meet the standards set by the AACCI whole grain definition."  Cherry-picked from a 2015 paper by Josh Sosland on World-Grain (Comparing Whole Grain Milling Methods)

The second "smoking gun" has to do with the way that our modern grains are milled.  For thousands of years grains were milled between pieces of wood, stones, or both.  The nature of this flour was that it was coarse --- often times very coarse.  It was also common to soak grains, sprout grains, and sour the dough; all processes that made digesting them easier.  Today we take grains that have often times been stored in bins or grain elevators with an array of seriously toxic chemicals (next smoking gun), and then we mill it at extremely high speeds (I've seen some that claim tens of thousands of RPMs).  Not only is this product not being mixed with beans, nuts, and other grains, it is frequently being ground to the consistency of talc. Understand that none of this guarantees you are going to have health problems because of the grain, but numerous experts believe it dramatically increases your chances.  This increased probability that grains are problematic is a combination of individual genetic makeup and the way they are affected by their environment.

Why do some people have such serious trouble digesting and assimilating grain while others remain --- at least seemingly so --- unfazed?  Much of it has to do with something called epigenetics.  Interestingly enough, I showed you this back when I showed you how Gluten Sensitivities (CELIAC DISEASE Included) start (HERE).  It seems that Sayer Ji, author of The Dark Side of Wheat would agree.  Pay attention to the fact that EPIGENETIC FACTORS far outweigh the genetic factors when it comes to developing grain sensitivities (as I've told you over and over again on this site, you can no longer blame mom or dad for your health problems, even though Big Pharma wants you to believe otherwise (HERE)).

"It Is Not In the Genes, But What We Expose Them To.  Despite common misconceptions, monogenic diseases, or diseases that result from errors in the nucleotide sequence of a single gene are exceedingly rare. Perhaps only 1% of all diseases fall within this category, and Celiac disease is not one of them.  The "blueprint" model of genetics: one gene → one protein → one cellular behavior, which was once the holy grail of biology, has now been supplanted by a model of the cell where epigenetic factors (literally: "beyond the control of the gene") are primary in determining how DNA will be interpreted, translated and expressed. It is the epigenetic factors, e.g. regulatory proteins and post-translational modifications, that make the determination as to which genes to turn on and which to silence, resulting in each cell’s unique phenotype. Moreover, epigenetic factors are directly and indirectly influenced by the presence or absence of key nutrients in the diet, as well as exposures to chemicals, pathogens and other environmental influences. In a nutshell, what we eat and what we are exposed to in our environment directly affects our DNA and its expression.  The implications of these findings are rather extraordinary: epigenetic and not genetic factors are primary in determining disease outcome. Even if we exclude the possibility of reversing certain monogenic diseases, the basic lesson from the post-Genomic era is that we can’t blame our DNA for causing disease. Rather, it may have more to do with what we choose to expose our DNA to."

Industry will, for the most part, tell you that none of this really matters, trying to convince you that the power is all in the gene; all the while pumping out studies showing their products in a favorable light.  In lots of ways it's almost identical to the phenomenon of "HOMEGROWN RESEARCH" coming out of the sugar industry; or the tainted studies being pumped out by the PHARMACEUTICAL INDUSTRY.  As I've shown you time and time again (HERE), trust peer-review at your own peril.   Which brings us to that final smoking gun.

Although a case could be made for several more, my third and final smoking gun has to do with the CHEMICALS, HERBICIDES, AND PESTICIDES that all modern grain production requires (can anyone say GLYPHOSATE?).  Modern grains are hit with NASTY CHEMICALS a minimum of twice; once in the field and again during storage.  I'll not spend time on this as most of you are aware that exposure to synthetic chemicals is bad for you --- it's one of those rare things in healthcare that we can all agree on (not sure why that doesn't seem to translate over to DRUGS and VACCINES?).  And not only are these chemicals carcinogenic, most have the ability to act as XENO-HORMONES, feminizing the males of every species (HERE), while causing something called ESTROGEN DOMINANCE not only in women, but in men as well.

What should you do?  Like I said, grains are not a significant health issue for some people.  However, if you are one of the people I mentioned at the beginning of today's post (or have a strong family history of certain chronic diseases), I would strongly suggest you do an ELIMINATION DIET, which will entail cutting grains out of your diet for at least a month.  An Elimination Diet is the most accurate way to determine what foods you might have problems with, including grains.

Let me leave you something to think about while contemplating today's post.  When I was growing up in the FLINT HILLS of extremely rural Kansas, ranchers whose beef grazed the prairie would take their livestock to the feedlots in the western part of the state to be "finished".  This is where the beef is given copious amounts of grain the last couple months of their lives.  Why?  Sure, everyone raves about the taste of grain-fed beef ---- after all, it's the fat that largely gives meat it's flavor.  But where's all that fat come from? Largely from the grain --- I'll not even go into the whole LOW-DOSE-ANTIBIOTICS-FOR-FATTENING-YOUR-LIVESTOCK thing here).   It's important for you to be aware that commercially-raised, grain-fed beef is often referred to in peer-review as "obese".

Although there are literally dozens of reasons that a grain-based diet might not be in your best interest if you have chronic health issues OR A FAMILY HISTORY OF SUCH (HERE, HERE, HERE, HERE, HERE, HERE, and HERE are some reasons, as well as hundreds you can look up yourself on the sites of ROBB WOLF, MARKS SISSON, ART AYERS, or any number of others), the biggest has to be that modern grains are inflammatory as opposed to anti-inflammatory (HERE).  Why is this a big deal?

OBESITY is one of the numerous health problems caused by inflammation (HERE), which in turn causes inflammation.  And the doubly crazy thing is that excessive adipose tissue (PARTICULARLY IN THE FORM OF BELLY FAT) is not only itself inflammatory, it actually creates estrogen (HERE), which is the hormone commercial livestock producers give animals to make them fatter (click the link found in the paragraph underneath the pic above).  It's a big round-robin of inflammation, obesity, and increasing ENDOCRINE FUBAR (CARDIOMETABOLIC SYNDROME, ADRENAL FATIGUE / FIBROMYALGIA, LOW T --- or for you women, HIGH T --- THYROID ISSUES, all sorts of "LEAKIES", etc, etc, etc, etc) that may or may not be a culprit in your chronic health conditions.

"Renowned gluten intolerance researcher, Dr. Kenneth Fine, believes 1 in 3 Americans are gluten intolerant and 8 in 10 has the genetic wiring to develop it."  Mike Sheridan's article (Grains – What’s the Upside?) From Robb Wolf's website.  BTW, Dr. Fine is an MD who founded Enterolab.  For the record, I think Cyrex is significantly better than Enterolab.

"Cows naturally do not have so much fat, but in the USA most are fattened before slaughter. They are placed in feed lots their last 4 to 6 months of life and fed 20 to 25 pounds of various grains and soybeans every day, and the result is a huge increase in body fat. Cows slaughtered directly from pasture have far less fat between their muscle fibers and that overlying them."  From Baylor University Medical School Proceedings (Twenty Questions on Atherosclerosis)

Not only does the OZARKS have an overabundance of DEER (these are acorn-fed as we do not have grain in these parts), fortunately there are any number of ranchers in this neck of the woods getting with the program by raising beef (or chicken) that is healthy and delicious in every sense of the word.  In our neighborhood, make sure to talk to FRESCOLN RANCH or CLUCK RANCH about their beef (the Clucks have sheep and goats as well).   Speaking of farm animals, let's talk for a moment about the effects that grains have on them.  It's really quite simple, feed a ruminant copious amounts of grain, and they gain copious amounts of weight.  While the same thing is true of people, what I want to discuss today is what it does to Gut Health.   Because your health starts in your Gut, anything that fouls Gut Health is going to foul your overall health (HERE).

According to the Alabama Cooperative Extension System (Digestive System of Goats), "Mature goats are herbivorous ruminant animals. Their digestive tracts, which are similar to those of cattle, sheep, deer, elk, bison, and giraffes, consist of the mouth, esophagus, four stomach compartments, small intestine, cecum, and large intestine."  What I want to discuss is what happens when herbivores (animals designed to eat foliage, vegetation, plants, etc; not grains) are instead fed large amounts of grains (60-65% grains).

The April 2013 issue of Anerobe (Grain-Rich Diets Differently Alter Ruminal and Colonic Abundance of Microbial Populations and Lipopolysaccharide in Goats) said that, "High grain feeding has been associated with ruminal pH depression and microbial dysbiosis in cattle."  This dysbiosis is likely due to increased lipopolysaccharide concentrations in the Gut.  What are lipopolysaccharides (LPS) and why does it matter?  LPS are found on the membrane of gram negative bacteria and frequently lead to serious immune system reactivity.  They act as endotoxins, not only causing the release of pro-inflammatory cytokines, but inducing "superoxide / hyperoxide" production (high-powered, cancer-causing Free Radicals).  Furthermore, because parts of these LPS look similar enough to human cellular molecules, having large amounts of them running around your system tends to cause two distinct problems.  They can hide and not be properly dealt with by your immune system.  Or the immune system starts attacking them, and accidentally starts attacking self because of the similarities (autoimmunity).

A study published four months later in the August issue of the American Journal of Physiology: Regulatory, Integrative, and Comparative Physiology had a "massively" interesting title ---- A High-Grain Diet Causes Massive Disruption of Ruminal Epithelial Tight Junctions in Goats.  How massive is the Leaky Gut issue here?  After seven weeks of feeding goats a high grain diet, "free LPS in the peripheral blood was detectable, while not detectable in the control, suggesting a leakage of LPS into the blood in the high grain group. Correspondingly, the high grain goats showed profound alterations in ruminal epithelial structure and tight junction proteins, depicted by marked epithelial cellular damage and intercellular junction erosion, down-regulation of tight junction proteins.  These results demonstrated for the first time that the high grain diet caused disruption of ruminal epithelial tight junctions was associated with a local inflammatory response in the rumen epithelium."  When tight cellular junctions become loose, the corresponding "leakiness" allows particles of God-knows-what to freely move from the Gut to the circulating blood where they become immuno-reactive.  There were so many studies on this topic I could have written a book.  Allow me to hit you with one more that was published in August of 2017.

The journal Applied Microbiology and Biotechnology (High-Grain Diets Altered Rumen Fermentation and Epithelial Bacterial Community and Resulted in Rumen Epithelial Injuries of Goats) looked as seven weeks of high grain diet and concluded that, "levels of volatile fatty acids and lipopolysaccharides were higher in the high grain group than those in the hay group."  To see how severely this affected inflammatory response in an epigenetic manner, take a gander at this.  Along with the dysbiosis, "the high grain group had a higher relative abundance of gene families related to energy metabolism [potential weight gain]; folding, sorting, and degradation; translation; metabolic diseases; and immune system [making them more prone to autoimmunity]. Furthermore, high grain feeding resulted in epithelial injury and upregulated the gene expressions of IL-1β and IL-6, and the upregulations were closely related to the rumen pH, LPS level, and rumen epithelial bacteria abundance."  In other words, grain was the trigger for leaky epithelial barriers, which led to rampant inflammation.

The bottom line is that today's grains are nothing like yesterday's grains.  And furthermore, consuming these grains has great potential (key word here is potential) to put you on what I call THE UNIVERSAL CYCLE OF SICKNESS, PAIN, AND DISEASE (click and scroll to circular diagram).  If you are struggling with chronic pain or chronic conditions, an important part of your recovery will be getting off grains.  Period.

Dr. Horst Conrad, in chapter 123 (Vertigo and Associated Symptoms) of his text, Clinical Methods: The History, Physical, and Laboratory Examinations, describes Vertigo thusly, "an abnormal sensation of motion. It can occur in the absence of motion or when a motion is sensed inaccurately. Spinning vertigo is usually of inner ear origin. Disequilibrium is a sensation of impending fall or of the need to obtain external assistance for proper locomotion. It is sometimes described as a feeling of improper tilt of the floor, or as a sense of floating. This sensation can originate in the inner ear or other motion sensors, or in the central nervous system. Positional vertigo is a sensation of spinning that occurs after the patient's head has moved to a new position with respect to gravity." Furthermore, as stated by Britain's public health system (NHS), Vertigo is, "a symptom, rather than a condition itself."   Seeing people diagnosed with Vertigo kind of reminds me of people being diagnosed with "SCIATICA" or "HEADACHES".  Great, but since it they are symptoms rather than problems unto themselves, the question that must always be answered pertains to cause? 

According to Mayo Clinic, the difference between Vertigo and "dizziness" has to do with levels of specificity.  For instance, "Dizziness is a term used to describe a range of sensations, such as feeling faint, woozy, weak or unsteady.  Dizziness is one of the more common reasons adults visit their doctors. Frequent dizzy spells or constant dizziness can significantly affect your life. But dizziness rarely signals a life-threatening condition."   In other words, dizziness is an extremely vague definition, meaning something --- could be anything --- that is affecting equilibrium or balance. Experts tend to agree that most (emphasis on most) actual Vertigo comes from the inner ear.  Although they list a number of potential causes of Vertigo, the Mayo Clinic states, "BPPV (Benign Paroxysmal Positional Vertigo) is the most common cause of vertigo."  Which begs another question.  What the heck is BPPV?  Johns Hopkins states on their website that,

"Benign Paroxysmal Positional Vertigo (BPPV) is the most common of vestibular disorders and the most easily treated. In most patients, it can be cured with a simple physical therapy maneuver.  BPPV occurs when small, microsized calcium crystals called otoconia become dislodged from their normal location on the utricle, one of the inner ear sensory organs. These otoconia are usually embedded in a gelatin like material on top of the utricle. If the otoconia become detached, they are free to flow in the fluid filled spaces of the inner ear, including the semicircular canals which sense the rotation of the head. If there are enough otoconia floating around, they can aggregate into a larger clump. Because they are heavy, they migrate into the lowest part of the inner ear, the posterior semicircular canal. Once in the semicircular canal, they may still move when the head changes position, such as looking up or down, over the shoulder, or when rolling over in bed. It is the movement of these stones that causes an unwanted flow of fluid in the semicircular canal even after the head has stopped moving. This leads to a false sense that the head and body are spinning around or that the world around you is spinning around."

The "maneuver" Mayo speaks of is called the Epley Maneuver.  Be aware that if you look up the Epley Maneuver on YouTube, you'll find dozens of slight variations on how it's done.  Naturally, people have sought to find or create a DIY version of the Epley.   Here's an interesting example from 25 years ago. My first year in practice I had a woman come see me who had already seen a neurologist for her Vertigo.  His suggestion? She was told to sit on the bed and throw herself violently onto her bed to both the left and the right, over and over again, as fast as she could do it until the symptoms cleared or she vomited.   A few years ago, Dr. Carolyn Foster came up with a better way.

Dr. Foster is the Director of the Balance Laboratory at the University of Colorado Hospital in Denver, where she is also a professor.  Having been severely affected by dizziness herself (first Ménière's Disease ---- a combination of Vertigo, Tinnitus (ringing), hearing loss, and the feeling of the ear being full of fluid --- and then BPPV), she had more at stake than most others in her field.  The Ménière's Disease was so bad she had a surgery for it, which took care of her Vertigo until she came down with BPPV, for which she developed her now famous DIY HALF SOMERSAULT MANEUVER, which she successfully used to cure herself.  But what if your Vertigo has nothing to do with tiny stones in your inner ear?

The truth is, there are lots of potential causes of Vertigo, with BPPV believed to account for between 70 and 80%.  While that covers a lot of people, it still means that there are huge numbers of individuals who have Vertigo of other origins.  Frankly, the raw numbers are astonishing.  MedScape has a two month old article on their site by a pair of MD / Ph.D's from Egypt's Balance Clinic, called Dizziness, Vertigo, and Imbalance.  The authors state....

"The overall incidence of dizziness, vertigo, and imbalance is 5-10%, and it reaches 40% in patients older than 40 years. The incidence of falling is 25% in subjects older than 65 years. A report reviewing presentation to US emergency departments (EDs) from 1995 through 2004 indicated that vertigo and dizziness accounted for 2.5% of presentations. The estimated number of 2011 US ED visits for dizziness or vertigo was 3.9 million.  Migraine is more prevalent (10%) than Ménière disease. About 40% of patients with migraine have vertigo, motion sickness, and mild hearing loss."

Besides migraines which we'll talk about in a moment, some of the more common causes of non-BPPV Vertigo include ......

• BRAIN DYSFUNCTIONS (There are a wide array of potential culprits here --- frequently in the brainstem and CEREBELLUM.  You may need to see a FUNCTIONAL NEUROLOGIST trained by Ted Carrick's organization to get things figured out.)
• CERVICAL SPINE DYSFUNCTIONS (DEGENERATION or SUBLUXATION has the potential to cause Vertigo as verified by 25 years of practice, as well as peer-review.  Upper cervical techniques can sometimes be very effective in this class, particularly when coupled with POSTURAL RETRAINING)
• MULTIPLE SCLEROSIS & PARKINSON'S
• CERTAIN KINDS OF EAR INFECTIONS (For instance, Labyrinthitis -- also called Vestibular Neuritis --- is an INFLAMMATION of the inner ear caused mostly by viral infections, but by ALLERGIES as well)
• POST-STROKE SYNDROME & CERTAIN KINDS OF TUMORS
• OTHERS (The list is almost unlimited)
• REACTIONS TO MEDICATIONS

How common are reactions to medications?  The part of the iceberg that we actually see --- the part above the water --- shows that they are crazy common.  According to DrugWatch (Prescription Drug Side Effects), "With record numbers of patients suffering or dying as a result of prescription drug side effects, many wonder why medications that are considered dangerous are allowed on the market.  Each year, about 4.5 million Americans visit their doctor’s office or the emergency room because of adverse prescription drug side effects. A startling 2 million other patients who are already hospitalized suffer the ill effects of prescription medications annually."  One of the most common of these side effects happens to be dizziness.  But you have to remember that the vast majority of the iceberg lies unseen below the water's surface.

Because Vertigo is so widespread, and because only about 1% of drug Adverse Events (AE's) are ever reported (HERE & HERE), this Adverse Drug Reactions are by far the most overlooked of the list above.  In 2013 a group of eight MD / PH.D researchers published a study the Journal of Pharmacology and Pharmacotherapeutics (Vertigo/Dizziness as a Drug's Adverse Reaction) agreeing with this assessment and then going farther.  "Spontaneous reports of vertigo or dizziness, as side-effect of certain drugs, received at our Pharmacovigilance Center, represented the 5% of all reports in 2012. Considering the high incidence of this ADR for several drugs’ classes, it can be speculated that under-reporting also affect vertigo and dizziness."  Although they essentially said that dizziness can be problematic with almost any class of drug, the ones they mentioned by name as part of this "impressive list" were "anti-convulsants, anesthetics, anti-depressants, analgesics, anti-diabetics, contraceptives, anti-inflammatory drugs, cardiovascular drugs, sedatives, tranquillizers, cytotoxic agents, and anti-hypertensive agents."   I have any number of articles about each of these classes (HERE).  By the way, the authors said of the anticonvulsants that, "half of these reports comes from the use of anti-epileptic drugs."  This provides a perfect segue in to the final section of today's post.

Getting AN ACCURATE DIAGNOSIS is great, but as with any health problem, the question that requires needs answering is what can be done about it.  Non-BPPV Vertigo is no different.  What can be done about some, if any, of these various non-BPPV cases of Vertigo?  The truth; for most of them, probably far more than you have been led to believe.  for starters, under its listing for 'Vertigo,' Wikipedia says, "The characteristics of an episodic onset vertigo is indicated by symptoms lasting for a smaller, more memorable amount of time, typically lasting for only seconds to minutes. Typically, episodic vertigo is correlated with peripheral symptoms and can be the result of but not limited to diabetic neuropathy or autoimmune disease."  I would argue that this is at least partly true for most neurological problems (HERE) as blood sugar dysregulation is a common starting point for all manner of chronic illness (DIABETES / NEUROPATHY).

Were you aware that when it comes to seizure-disorders such as Epilepsy, one of the single most effective ways of treating it happens to use the same method that was used 120 years ago ---- THE KETOGENIC DIET?  The truth is, when you can control carbs and blood sugar, you will solve lots and lots of health problems (click the link to see just how many).  While this might be true of at least some cases of Vertigo, we still have to contend with GLUTEN. 

We've known for decades that Gluten is associated with Autoimmune Diseases --- that would be all Autoimmune Diseases (HERE).  We also know that Gluten is heavily associated with MIGRAINE HEADACHES --- a major factor in non-BPPV Vertigo.  For example, head injuries (TBI / MTBI) are linked to autoimmunity, which is linked to both Gluten and Vertigo (click the links).  I am not going to get into it due to lack of time, but I would challenge you to simply Google, Gluten Vertigo and see what comes up.

Add this to the fact that numerous medical researchers and practitioners are coming to the conclusion that Gluten is heavily linked to any number of hardcore neurological problems (HERE, HERE, and HERE), and it's no wonder people are looking to diet as a potential solution to a wide array of health issues, including Vertigo. Here's the really cool thing about any or all of this; you can quite possibly kill multiple birds with one stone by going PALEO.  Why does the Paleo Diet work for so many different problems?  Because it does an amazing job of solving the blood sugar conundrum, while simultaneously cutting the most potentially reactive (inflammatory) foods from your diet (HERE).

According to Webster's 1928 edition, 'Filthy' is defined as, "Dirty; foul; unclean; nasty.  Polluted; defiled by sinful practices; morally impure.  Obtained by base and dishonest means; as filthy lucre."  While certainly a start, this definition barely begins to scratch the surface when it comes to the filth being revealed in BIG PHARMA as shown by brand new studies from one of the most prestigious medical journals on the planet, BMJ (the British Medical Journal), one of the many publications of the AMERICAN MEDICAL ASSOCIATION (JAMA Internal Medicine), and that pinnacle of truth and honesty, the American Diabetes Association.  Let's see what these have to say about the FINANCIAL COI (Conflict-of-Interest) going on in the biomedical field.

The BMJ study that came out only yesterday (Financial Ties of Principal Investigators and Randomized Controlled Trial Outcomes: Cross Sectional Study) looked at almost 200 randomly chosen RCT's (Randomized Controlled Trials) ---- the epitome of the gold standard of medical research --- concluding that, "Financial ties between principal investigators and the pharmaceutical industry were present in 67.7% of the studies. Of 397 principal investigators, 58% had financial ties, 39% reported advisor/consultancy payments, 20% reported speakers’ fees, 20% reported unspecified financial ties, 13% reported honorariums, 13% reported employee relationships, 13% reported travel fees, 10% reported stock ownership, and 5% reported having a patent related to the study drug. The prevalence of financial ties of principal investigators was 76% among positive studies and 49% among negative studies.  Financial ties of principal investigators were independently associated with positive clinical trial results. These findings may be suggestive of bias in the evidence base."  Gulp!

In other words, if the research they happened to be working on showed the drug they were studying in a favorable light, they were 27% more likely to be cashing in.  Cha Ching!  The JAMA IM study (Patient Advocacy Organizations, Industry Funding, and Conflicts of Interest), which also came out yesterday, came to similar conclusions concerning a slightly different area.  "This study found that 67% of a national sample of patient advocacy organizations, virtually all of which were not for profit, reported receiving funding from for-profit companies. Twelve percent received more than half of their funding from industry; a median proportion of 45% of industry funding was derived from the pharmaceutical, device, and/or biotechnology sectors."  In English this means that.....

"Patient advocacy organizations (PAOs), such as the American Cancer Society, the American Heart Association, and the National Organization of Rare Disorders, are influential stakeholders in health and health care. In addition to intervening at the individual level, many PAOs fund or conduct medical and health services research, influence national policy, and play key roles in allocation decisions made by legislatures and government agencies. Patient advocacy organizations need to secure financial support, which may come from many sources, including for-profit entities. However, relationships between PAOs and industry might influence PAOs’ activities in ways that might not align with the interests of the constituencies they represent. There is increasing evidence that financial relationships can create bias in medical research and physicians, and PAOs may be subject to the same concerns."

Not to be outdone, the medial daily STAT ran a piece by Sheila Kaplan yesterday called Behind Patient Advocacy Groups, Donors are Exerting a Powerful Force.  In it she mentioned something I have been hollering about for a very long time --- the fact that sugar industry and JUNK FOOD manufactures are actually supporting and funding research coming out of the American Diabetes Association (HERE). Funny enough, it was only YESTERDAY I mentioned a doctor who was talking about all the "fake news" coming out of the medical community, much of it having to do with the lies perpetrated by the ADA as far as effective treatment of Diabetes is concerned. 

All three of these papers mentioned can be found in their entirety online.  The problem is, it's more of the exact same problem(s) I've been showing you for years (HERE), and instead of getting better, it's becoming exponentially worse.  Oh; in case you actually decide to read these studies, make sure you have a trash can nearby so as not to mess up the floor when you invariably sicken yourself.

I just happened to catch KEVIN M.D.'s post by guest blogger Dr. Matthew Anderson a couple days ago called If You Think Fake News is Bad for Politics, You Should Try Being a Physician.  Some of the things the good doctor specifically mentioned as being a big deal in the "Fake News" scene included NUTRITIONAL SUPPLEMENTS (he talked about Ginko and Vanadyl Sulfate by name), APPLE CIDER VINEGAR, and vaccines --- especially VACCINES as related to AUTISM ("A quick look at Twitter for #vaccines, and the news of vaccination harms is overwhelming." --- I wonder why?).  Anderson went on to tell his readers how he combats this disgusting problem.  "As a physician, I try to be a steward of medical information.  I want my patients to seek out good quality medical information on their own.  I steer them to reputable websites..."  Which begs the question --- what constitutes a "reputable" website?  WebMD?  Yeahright.

We could spend a day answering the previous question, but I want you to forget about it for now --- it's not important to the real topic at hand.  Like so many articles on the web, the best part of Dr. Anderson's article was the comments.  It's uncanny how his readers --- most of which are obviously doctors or at least work in the medical community --- brought up some of the very same things that I've brought up on numerous occasions in the EVIDENCE-BASED MEDICINE (EBM) section of my site. For fun, just click the link and skim the titles.  The comments pertained to....

• There were several sarcastic / frustrated comments pertaining to EHR's (Electronic Health Records) as well as MARCA & MIPS.
• Doctors are so buried in said paperwork they can't even look at their patients for the crazy amount of typing they are doing to document a routine office visit (HERE).
• Professor "BigDwag" (probably a researcher of some sort) ripped the entire medical system every which way but loose (HERE).
• The fact that most medical news is itself fake (start thumbing titles of my posts on EBM as I couldn't possibly list them all).  In fact one poster who identified himself as an MD stated, "According to Ionaddis, almost everything you read in journals is fake news too. I expect patients to be misinformed, I used to not expect academics and publishers to constantly lie, fudge and misrepresent to advance their careers. It is very hard for the average doctor to differentiate between medical research, and crazy nonsense. The doctor in practice should not read any original research. Odds are it will lead to mistakes."  For the articles I've written about Drs. IOANNIDIS and ANGELL, click the links.
• The FDA doesn't follow their own rules and regs.
• Drug companies are frequently a huge scam (the commenters mentioned PFIZER by name, but could have mentioned ANY NUMBER of others).
• The fact that Diabetes care is not in any way, shape, or form, "evidence-based" (HERE, HERE, or HERE).
• Mercola (a DO) and Axe (a DC) are, "dangerous crackpots".  I suppose I would fall into that category as well.
• One commenter thanked the author for "educating" her about Vandyl Sulfate so that she could start taking it for her DIABETES.
• The fact that studies reveal that many, if not most, doctors are so BURNED OUT by all this daily crap they would quit tomorrow and retire if they were financially able.
• And finally, the author himself admitted that, "I agree, we as physicians do not self-police well enough. That includes healthcare policy as well."  Judging from the comments, I would say this is probably an understatement.  Truthfully, this author was barking up the wrong tree for the substance of this article.   His patients using vinegar or Ginko is the last thing in the world he needs to worry about.

The bottom line is this folks; as the government tries harder and harder to put the practice of medicine under its thumb via any and all means possible, the quality of your care will continue to erode.  It has to.  If your doctor wakes up every morning dreading his / her job, they might be able to fake fake that smile for a while, but it won't be very long before the apathy starts shining through and the quality of their work goes south.  It's a bad enough scenario for anyone and any job, but if you are putting people's lives in your hands as a treating physician, it's downright dangerous.

When I see patients, whether local or LONG DISTANCE, who have struggled with CHRONIC PAIN (some of them for decades), they often wonder what led to them develop FASCIAL ADHESIONS. Sometimes, these people know exactly what caused their problem.  But in many cases they have no idea, which can be extremely frustrating, particularly for people who take care of themselves and look like they could go out and win a CrossFit competition at a moment's notice.  Below is a list of the most common reasons I find for Adhesed Fascia.

• OVERSTRETCHING INJURIES:  These are the sort of injuries that occur in SPORTS and CAR WRECKS.  WHIPLASH INJURIES, PULLED MUSCLES, or SPRAINED ANKLES are great examples of these sorts of injuries.  Tissue is stretched beyond it's normal ability to elast, and something gives in its microscopic structure.  You might not realize it at the moment (or more likely, you might shrug it off as inconsequential), but the resulting damage leads to pain, restriction, LOSS OF PROPRIOCEPTION, and eventually degeneration (HERE).  Although this "overstretching" usually occurs all at once in the form of an injury, it can occur a little bit at a time over the course of years or even decades.  Overstretching tissues can cause problems most people don't think much about until they or someone they love is affected.  For instance, growing too fast can lead to a chronically overstretched quad, which can lead to OSGOOD SCHLATTERS.

 

• REPETITIVE INJURIES:  Many TENDINOUS INJURIES would fall into this category. However, it can often be difficult to differentiate what part of the injury is tendon and what part is fascia.  The great thing is that in most cases it doesn't really matter since both will be treated in a similar fashion (HERE).  There are lots of factors that can come into play here, but realize that poor biomechanics can play a part.  For example, PLANTAR FASCIITIS can be a component of any of these first three bullet points, but is often the result of poor biomechanics over time.

 

• "TOO HEAVY" INJURIES:  These are the injuries that occur from lifting things that are too heavy.  Fascia, which in this case works like a weightlifter's belt to hold things in place, cannot tolerated the load put on it and starts to give / tear.  Although many people associate (sometimes correctly) this injury with HERNIATED DISCS, the truth is that most of these problems can be helped.  Although these sorts of injuries can happen almost any anatomical location, they occur frequently in the THORACOLUMBAR FASCIA.   Lifting things that are too heavy is another common cause of the "Pulled Muscles" I mentioned in the first bullet point.

 

• POSTURAL INJURIES:  Crappy posture not only looks bad, but it is associated with any number of seemingly unrelated health problems (DIABETES for instance), and that's just for starters.  When people end up with FHP (FORWARD HEAD POSTURE), sooner or later they can count on both NECK PAIN and deterioration of the C-spine (not to mention those pesky and sometimes even debilitating Trap / Rhomboid / Levator TRIGGER POINTS).

 

• IMPACT INJURIES:  Have you ever noticed the spider web effect that sometimes occurs when a rock (or hand) hits glass?  There is typically lots of damage at the site of impact, with the damage becoming less and less as you move away from the area, toward the outside edges of the pane or windshield.  This phenomenon is often seen with Fascia as well.  Another impact injury I have noticed in my time in practice is STRETCHMARKS (I'm probably not talking about what you are thinking about here).  The stretchmarks I have seen that actually cause people problems are frequently caused by impacts with objects that are harder and more immovable than they are (railroad tracks or vehicles for instance).
  

 

• POST SURGICAL ADHESIONS:  This is a big one, and with our own government coming to the conclusion that six out of ten surgeries in the United States are unnecessary (HERE), it's bigger still.  The question that must be answered as to whether I can help you or not has to do with the location (depth) of said adhesions (HERE).  HERE are some more posts on post-surgical adhesions.
  

 

• CHRONIC INFLAMMATION:  This one can work against you all by itself, or it can be an ugly component of any of the previous bullets. Even though INFLAMMATION is a necessary part of any healing process, too much of it has the potential to make things worse.  The ultimate problem is that inflammation always causes FIBROSIS --- the medical name for SCAR TISSUE.  While this is part of normal healing, imbalances in this system are not only a leading contributor to Chronic Pain (HERE), but the single leading cause of death in Westernized nations (HERE). 

 

• BURNS:  While burns are a common cause of Chronic Pain and hardcore restricted fascia along with large amounts of visible scar tissue, I realized a long time ago that they do not respond to what I do.
  

If you want to see what it takes to start successfully addressing these sorts of problems, I've created a post that covers (or at least touches on) most bases.  HERE it is.  And for those of you who wonder if it really works or not, take a gander at THESE TESTIMONIALS, some of which are almost too amazing to believe.

When I travel to St. Louis via I-44, just past St. James (which is just past Rolla) sits a business on the south side of the highway called Hi Striker.  From their sign it's easy to tell what sort of equipment they manufacture and sell.  Hi Strikers are the gizmos you find at carnivals and county fairs that require you to hit a lever with a wooden sledgehammer.  If you hit the lever hard enough it rings the bell at the top, and you win a prize.  It's all or nothing. Anything short of the bell, and you won't be bringing home the oversized stuffed gorilla.

When people injure themselves in any number of different ways (SPORTS, CAR WRECKS, REPETITIVE WORK, POOR POSTURE, HORSES, FALLS, ETC, etc, etc) they sometimes end up with ADHESED FASCIA. Fascia is the thin, cellophane-like membrane that covers muscles (in most cases, "MUSCLE INJURIES" are actually injuries to the Fascia).  There are any number of reasons these injuries can be problematic, but try this one on for size.  Fascia --- the most abundant and most pain-sensitive connective tissue in the body --- cannot be seen with advanced imaging techniques such as MRI (HERE). 

This means that lots of you CHRONIC PAIN SUFFERERS who are reading this have been through lots and lots of doctor visits and tests, only to be told there is nothing really wrong with them except MAYBE A LITTLE ARTHRITIS.  Trust me when I tell you that it won't take long for doctors to start mentally labeling you as a (insert one or more of the following here _____________ drug seeker, malingerer, crazy, lazy, disability seeker, etc, etc).  I only know because I have been watching this scenario play out for the past quarter century.

Part of what makes my clinic different is that for most problems (HERNIATED DISCS ARE AN EXCEPTION), I don't set you up on a treatment schedule.  If you feel that what I do was beneficial, give me a call and I'm happy to see you again (HERE IS WHAT IT LOOKS LIKE).  Let me give you a couple of examples from earlier this week.  An unnamed individual who I will call Carl made an appointment to see me. When I walked in my office to sit down and talk to him and look things over, I discovered that this individual had been seeing various chiropractors once a month for the past twenty years (he had just recently moved to this area).  

I'm not against some sort of CHIROPRACTIC MAINTENANCE as long as that's what it really is --- healthy people coming in to "maintain" their health.  Unfortunately, all too often what we see in my profession are people coming in over and over and over again for the exact same problems, simply because they hurt. In many cases (probably most cases) this is not maintenance.  They get adjusted and it helps for a bit, and over the course of a few days or a few weeks they are back in the same boat again.  I talked to Carl, examined him, and brought him to a treatment room.  In 15 minutes, I had his neck and back moving better than they had moved in years --- before I adjusted him.  I did not make an appointment for him, leaving him drop-jaw amazed at the whole experience (HERE is the video of him talking about his experience).

I had another patient this week --- A LONG DISTANCE PATIENT --- who had CONTACTED ME a couple of months ago wanting to know if I worked on X, Y, and Z.  He told me that my site had resonated with him, but that he had been through so much THERAPY and ADJUSTING that he wondered what could possibly make what I do different than what he had already done.  I sent him THIS and he realized immediately that he had not had his SCAR TISSUE dealt with, leaving him perpetually tethered.

You see, breaking the Scar Tissue out of Fascia sometimes requires a certain degree of intensity. Although that intensity is different for each and every individual, their bell must be rung.  Huh? Remember the Hi Striker game?  Failing to ring the bell is failure --- even if you get within an inch.  You either swing the sledge hammer hard enough to ring the bell or you don't.  With Tissue Remodeling, there is a similar principle in play.   You either GET INTENSE ENOUGH to break the tissue or you don't.  And when you do, the results can be nothing short of amazing (HERE).

Lots of people are led to believe that if they will just get enough therapy, adjustments, stretching, exercise, etc, it will eventually break through their adhesion and "UNTETHER" them.  While this is certainly true of most problems --- problems that tend to be relatively minor --- for serious problems that involve hardcore scarring and adhesions, the intensity used for breaking said adhesions may, depending on the situation, need to be ramped up a bit (or maybe even more than a bit).  Just remember that your treatment must ring the bell to be doing you any good.  While the analogy of treatment being like peeling an onion is fine and mostly true, a whole lot of sub-threshold treatment is a whole lot of sub-threshold treatment, just like a whole lot of nothing is still nothing.

A brand new study published in Oxford's Clinical Infectious Diseases (Intraseason waning of influenza vaccine protection: Evidence from the US Influenza Vaccine Effectiveness Network, 2011-12 Through 2014-15) confirmed things we already knew and revealed something we've long suspected.  Seven researchers working for the CDC proved something I wrote about a few months ago (HERE) ---- that, "Decline in vaccine effectiveness was more pronounced among patients with prior seasonal influenza vaccination." In other words, a flu vaccine this year means next year's vaccine's effectiveness will be less.  The CDC's dirty little secret is that according to their own research (shhhhhhhhhhhhhhhh) the flu vaccine is only about 2 or 3% effective in healthy adults to begin with, and even less than that in both children and the elderly (HERE).  But there's more.

According to the authors, "Recent studies suggest that influenza vaccine effectiveness may wane over the course of an influenza season, leading to suboptimal effectiveness during late influenza seasons."  Which, of course, begs the question of just how bad this problem really is --- i.e., how badly is vaccine effectiveness affected over the course of the months that make up flu season? CDC authors concluded that, "We observed decreasing vaccine effectiveness with increasing time. Maximum vaccine effectiveness was observed shortly after vaccination, followed by a decline.....  Vaccine effectiveness remained greater than zero for at least six months for influenza A(H1N1) and influenza B and at least five months for influenza A(H3N2) viruses."  What kind of answer is "greater than zero"?  The question we need to answer now is how rapidly did vaccine effectiveness erode before it effectively became zero?  According to these authors, effectiveness of the vaccine waned at the rate of about 7-11% per month. But this statistic is both misleading and deceptive.  Pay attention to Helen Branswell's recent article (today) from the medical daily STAT (Can A Flu Shot Wear Off If You Get It Too Early?  Perhaps, Scientists Say).

"A flurry of studies have since followed. A big one from Europe, published last April, looked at data from five flu seasons. It saw protection against the influenza A virus H3N2 decline to virtually nothing by four months after vaccination.  The CDC study, which looked at data from four flu seasons, showed a more consistent pattern. Protection against all the two influenza A families and influenza B viruses all declined steadily in the months after vaccination, at a rate of about 7 percent per month. (The decline was a bit steeper for protection against H3N2 viruses.) That might seem small, but people aren’t starting from 100 percent protection. On average, flu vaccine is estimated to cut the risk of flu by about 50 percent or 60 percent — and some years, the protection is less than that, when the strains in the vaccine aren’t well-matched to those making people sick."

Did you catch that?  Even though COCHRANE has told us over and over again that the CDC's starting point of 50 to 60 percent vaccine effectiveness is far too high for the flu shot (they found that vaccine-matched years occur once a decade), the CDC continues to promote fairy tales.  At the end of last year's flu season they admitted that it was something like 14% ---- and then took the flu mist off the market because its effectiveness had been zero for at least three years (HERE).  The study above showed that for all intents and purposes, halfway through flu season the shot's effectiveness had gone to zero anyway.  What does this really mean for those who trust the flu shot to protect them from A DISEASE THAT ISN'T REALLY MUCH OF A DISEASE?  If you get the shot in September, by the first of the year it's not worth a flip even if it were worth a flip to begin with.

But this isn't even the most disgusting part.  In Branswell's article we found out what BIG PHARMA providing Americans with 150 million doses of flu vaccine is really about ---- money.  "Michael Osterholm, director of the Center for Infectious Diseases Research and Policy at the University of Minnesota, said there’s enough evidence now to suggest early vaccination efforts — part of an attempt by commercial pharmacies to capture a bigger piece of the flu vaccine pie — should be discouraged.  'I have been concerned for some time that we have gotten into the marketing of influenza vaccine versus the effective use of influenza vaccine.'"  Isn't that special.  One of the big-wigs telling us what we learned from Randy Newman back in 1988 --- It's Money That Matters."

Let me start by saying that I am not trying to equate the back of the 16 year old male on the left of the 30 year old female on the right to the back of "Gordon" --- the escaped Louisiana slave whose photo was taken at the height of the Civil War in 1863.  In all honesty, the photo on the left does not do justice to what is really going on with this kid, as it is difficult to convey the fact that the stretch marks are 'welted' off of his back about a quarter inch.  As for the scars on the far right; this individual was complaining of chronic low back pain that would not respond to adjustments.  Her scars were completely "invisible" until I started working on her, and her relief was immediate upon breaking the tissue.

There are two kinds of scar tissue that I want to talk about today, Hypertrophic Scars as we see in the pictures on the left and right, and the Keloids seen in the middle pic.  Both involve an overgrowth of something called Granulation Tissue.  Granulation Tissue is part of a normal healing process (see diagram below).  In a normal healing process, INFLAMMATION gets the ball rolling by attracting the chemicals and compounds that will repair the damaged tissue, which is exactly what it is supposed to do.  After the inflammatory phase, the next step is 'Fibroplasia and Granulations Tissue Formation'.  The website Advanced Tissue says of Granulation Tissue....

"Granulating tissue is the new connective tissue that is created when the surface area is healing from an injury or wound. Due to the number of tiny blood vessels that appear at the surface of this new skin, the granulating tissue will be light red or pink in hue, and will be moist. Most is raised higher than the surrounding flesh, and oftentimes, it is bumpy (hence the term, granulating). Some people say it looks very similar to red grapefruit flesh. Despite its bright color, granulating flesh is healthy, and means that your body is working to provide a strong, protective new layer of flesh."

Mere hours after the initial injury, FIBROBLASTS (or HERE) start laying down Granulation Tissue (Type III Collagen --- a weak and inelastic form of Collagen) that will later be replaced by the stronger and more elastic Type I Collagen in a process called 'Remodeling' (SEE OUR COLLAGEN SUPER PAGE for more on the process of Tissue Remodeling).   Not surprisingly, research says that Keloid Scars can cause restriction of joint motion if found around joints.  What you have to remember here is that anything that causes restriction has the potential to cause pain via loss of proprioception (HERE). Please understand that I am not saying that the Keloid itself is necessarily causing the pain, but that the restriction creates an increased potential for causing pain.  This is why the combination of restricted movement and / or unbridled inflammation can be extremely problematic as far as joint health is concerned (HERE). 

A March 2016 Medscape article by Otolaryngologist, Dr. Mimi Kokaska (Hypertrophic Scarring and Keloids) went on to say of Keloids, "they are frequently associated with negative wound healing factors, such as infection, excessive tension, foreign bodies, and repetitive trauma...  Keloids are frequently associated with pruritus [itching] and pain...  The central portion of keloids is severely ischemic [poor blood supply]. The investigators found greater expression of hypoxia-induced factor-1α, as well as less vascular density, in the center of these lesions than on the periphery."  She also talked at length about the over-expression of various inflammatory mediators (IL-6 and IGF-1) that are thought to cause, "microvascular occlusion and subsequent hypoxia."  It's no secret that both hypoxia (poor oxygenation) and ischemia (poor blood supply) are problematic on many levels, including their heightened ability to induce pain.

Hypertrophic Scar Tissue is very similar to a Keloid, only less severe in appearance. Part of the difference between Keloids and Hypertrophic Scars is that the later will sometimes improve in appearance over time, while Keloids can actually get worse --- in some cases MUCH WORSE.  Despite the fact that such scars are supposed to be, according to many sources, non-painful and merely a "cosmetic" issue, it's easy to find sources and studies that say otherwise.  For example, in Dr. Kokaska's above-mentioned article, she says of Hypertrophic Scars; "they are associated with adverse wound healing factors..."   A 2014 study published in the journal Clinics (Update on Hypertrophic Scar Treatment) had this to say of Hypertrophic Scars....

"Hypertrophic scars are pathological scars resulting from abnormal responses to trauma and can be itchy and painful, causing serious functional disability.  These scars are characterized by proliferation of the dermal tissue, with excessive deposition of fibroblast-derived extracellular matrix (ECM) proteins and especially collagen, over long periods and by persistent inflammation and fibrosis."

For those interested, this study contains a great deal more information (much of it extremely detailed) about the physiology and pathophysiology of Hypertrophic Scars. As for what's found in the quote above, my site has copious amounts of information on the ECM, FIBROSIS, and INFLAMMATION, as related to CHRONIC PAIN.  And as for the last sentence that pertains to burn victims, unfortunately my Tissue Remodeling treatment does not work for burn scars (I've tried). 

What does the medical community (AND INSURANCE INDUSTRY) say works for treating Hypertrophic Scars?  The only real consensus is that nothing works very well.  This is due mostly to the fact that surgical treatment almost always results in more of the same, and most of the non-surgical treatments for these types of scars (silicone spray and CORTICOSTEROIDS are both quite popular) cause their own unique problems as well tending to stop working once the treatment is stopped.  What seems to work best?

A three year old study from Seminars in Cutaneous Medicine and Surgery (Low-level Laser (Light) Therapy (LLLT) in Skin: Stimulating, Healing, Restoring) touted some of the same benefits of LOW LEVEL LASER THERAPY that I have been talking about for the past decade.  After discussing its mechanism of action (photobiomodulation --- see link) the group of seven medical doctors and Ph.D researchers stated, "LLLT has beneficial effects on wrinkles, acne scars, hypertrophic scars, and healing of burns.  Inflammatory diseases such as psoriasis and acne can also benefit. The non-invasive nature and almost complete absence of side-effects encourages further testing in dermatology."  

What can I tell you about Hypertrophic Scars as related to Stretchmarks?  Let me first say that I am not an expert on this subject --- all I am giving you is my personal (and limited) experience with Stretchmarks in patients I see with pain.  Secondly, this is not something I see lots of --- in the almost two decades I have been doing Tissue Remodeling, I've probably seen less than 50 cases. Thirdly, for whatever reason, the oldest person I have seen with this sort of thing is about forty, with most being much younger. Fourthly, the cases I have seen are almost always related to a history of severe impact (falling out of trees, off horses, hit by a metal beam, four wheeler accidents, impact with a railroad track, etc, etc, etc).  Some of these led to immediate chronic pain, while with others the pain did not show up until later.  Fifthly, some of these scars are indented into the skin or below the surface like the pic directly above, while some are welted off the surface like the pics at the top.  And lastly, the stretchmarks that I have found thus far have always been located in the area of the THORACOLUMBAR FASCIA and occasionally into the mid back.  TISSUE REMODELING has helped in most of the cases I've treated (the one at the very top of the page left, I just saw yesterday).

Beyond after-the-injury treatment, if you know you are prone to abnormal scarring, what could you do to help prevent it from forming in the first place (or at least slow it down)?  Honestly, I would suggest you do what I recommend for nearly everyone --- live your life in as anti-inflammatory manner as is humanly possible.  Even though these pathological scarring issues have been called genetic; due to something called EPIGENETICS, the anti-inflammatory lifestyle is undoubtedly far more relevant than you ever would have dreamed.  As to what some of this looks like, I would recommend you start by READING THIS POST on the subject.

HERE is a super cool testimonial from a young woman who had Hypertrophic Scarring that I treated, but was obviously not the sole source of her pain --- she did not get relief until she went on a GFD.  As for other hidden causes of inflammation, you might have many.  If this is the case, you won't find real relief from the mechanical issue until you start addressing the underlying chemical issue (inflammation).  It's your lucky day because I show you how to do exactly this (HERE).  And for those of you who are particularly interested in fascia, make sure to check out my post with all 145+ articles on fascia organized into a unified post (HERE).

All of us have been in what we would consider to be "desperate" situations.  Unfortunately, desperation tends to make people gullible --- willing to do things they wouldn't otherwise do or spend money they wouldn't otherwise spend.  As defined by Webster's, the word gullible means, "easily duped or cheated."  Few things make people more desperate than severe health problems.  Before you write me off or insinuate that I am picking on you, please realize that I am not equating gullibility with stupidity --- far from it. It's just that when people get desperate, they are far more likely to act irrationally.  Doubly unfortunately, there are any number of unscrupulous people out there ready and willing to take advantage of the situation by separating desperate people from their hard-earned cash.  Probably the best example of this phenomenon has to do with obesity and weight loss.

Four years ago last week, US News and World Report published an article called The Heavy Price of Losing Weight that stated, "According to data by Marketdata Enterprises, a market research firm that specializes in tracking niche industries, Americans spend north of $60 billion annually to try to lose pounds, on everything from paying for gym memberships and joining weight-loss programs to drinking diet soda."  Firstly, DIET SODA as a weight loss tool is like trying to dig a hole in the sand on the beach near the water --- the harder you dig, the faster the whole thing caves in.  Secondly, a quick peek at America's statistics on obesity shows that most of this sixty billion dollars is an exercise in futility.  But that doesn't stop desperate people from trying every new supplement or gizmo that's advertised. 

Something similar can be said of people struggling with CHRONIC PAIN (or even more so, of people with children or family members dealing with chronic pain).  Because my site is geared toward helping people who have had long-standing problems with various chronic pain syndromes (HERE and HERE), I am literally inundated with EMAILS asking if I can help such-and-such problems (HERE).  Let me give you an example of something that happened just a few weeks ago and unpackage it for you (actually, this is a combination of two different emails).

PROSPECTIVE PATIENT:  I am desperate and would be interested in traveling to come see you to see if you can help me with my pain.  My problems include

• C-spine fusion with neck and trapezius muscles so tight and sensitive they can barely be touched (diagnosed with MPS).
• L5 discectomy with talk of needing a fusion.
• Fibromyalgia and all-over pain.
• TMJ
• Lifelong migraines.
• chronic pelvic pain from interstitial cystitis and endometriosis.
• A recently surgically repaired shoulder (capsular tear) that is not healing properly.
• Chronic plantar fascitis (I had a surgery for it several years ago).

Although I have been through lots of therapy, adjustments, massage, injections, meds, and home ice, heat, stretching, etc, nothing has really helped and often times makes me worse, sometimes much worse.  I pretty much hurt everywhere.  Do you think you can help me?

ME:  Taken as a whole, I have serious doubts of being able to help you with most of these problems. However, on some level I believe that you could help yourself. I would suggest you read everything you can on my site about CENTRAL SENSITIZATION and then take a look at THESE POSTS.  Controlling inflammation is a key part of any healing process.  Maybe down the road we can revisit this conversation.
Sincerely,
Russ Schierling

PROSPECTIVE PATIENT:  I think you are a rip off artisit and your site is a sham.  You should be sued for false advertising for claiming you can help people with chronic pain.  How could you possibly know you can't help me without seeing me???!!!!

After practicing a busy, rural, "see-everything" clinic for two and a half decades; given a decent history I have a pretty good idea of which people I am more likely to help and the people I probably can't. Although I don't have time to answer all the do-you-know-someone-in-my-town-doing-the-same-thing? questions I get each and every day, If you send me a history of your problem (what caused it, how long have you've had it, what makes it worse, what brings you relief, etc, etc, etc) I will let you know whether or not I think I might be able to help you. 

Believe me when I tell you that if I wanted to I could make seven figures annually by taking advantage of those of you desperately trying to find solutions to your CHRONIC, ONGOING, LONG-TERM PAIN. That's not my goal.  Honestly, it's heartbreaking turning desperate patient after desperate patient away, knowing that I don't have the answer to their particular problem (it continues to shock me how many of you there are out there).

While it's true that given the right circumstances, I am able to help people with CHRONIC NECK PAIN, POST SURGICAL PAIN, FIBROMYALGIA, TMJ / TMD, CHRONIC SHOULDER PROBLEMS, INTERSTITIAL CYSTITIS and several other AUTOIMMUNE DISEASES, PLANTAR FASCIITIS, MYOFASCIAL PAIN SYNDROME (Trigger Points) --- and maybe even ENDOMETRIOSIS on some level, when you add it all together this person has a SYSTEMIC PROBLEM and is going to require some time studying the EXIT STRATEGY I provided.

I don't claim to be able to help everyone who struggles with chronic pain --- there are far too many causes, circumstances, and variables.  What I do promise is that if I think I can help you, I will tell you so.  What's really nice about what I do --- what sets me apart from other practitioners --- is that you are going to know in one treatment whether my approach is going to help or not going to help.  If you don't see real, tangible results after a single treatment (DISC HERNIATIONS ASIDE), then more of the same isn't going to help you either.

So don't get upset with me if I tell you I can't help.  I'm just trying to be honest with you and looking out for your best interests by saving you a lot of needless time, effort, and expense. 

Because we are seeing increasing numbers of LONG DISTANCE PATIENTS, allow me to give you some information concerning our location (Tuesday and Thursday mornings are set aside for long distance patients.  The clinic is centrally located in MOUNTAIN VIEW (see the red dot above), in the southern part of Missouri, in the very middle of the state.  We are right next door to West Plains (about a half hour away).  Springfield (the nearest airport) is about an hour and a half drive to our west (BRANSON is just south of Springfield).  Rolla is an hour and a half drive to the north, Poplar Bluff is an hour and a half to the east, and beautiful Mountain Home, Arkansas is an hour and a half to the south. 

The orange circle indicates the distance you can drive in about five hours.  Some of the cities within the circle include, Tulsa OK, Nashville TN, Wichita KS, Kansas City, Columbia, and Little Rock AR.  St Louis is only about 3 hours away.  For more information about what a "Long Distance" visit might look like, simply visit our FAQ PAGE.  Bear in mind that most of you coming from a couple hours away will, depending on your problem, be seen as a regular new patient on a Monday, Wednesday, or Friday.

"Why do I mention autism now twice in this article. Because we have to wake up out of our trance and stop following bad advice. Does the vaccine burden – as has been debated for years – cause autism? I don’t know and will not debate that here. What I will stand up and scream is that newborns without intact immune systems and detoxification systems are being over-burdened with preservatives and adjuvants in the vaccines."  Taken from Dr. Daniel Neides' Friday, January 6 blog post (Make 2017 the Year to Avoid Toxins (Good Luck) and Master Your Domain: Words on Wellness) on the world famous Cleveland Clinic's website (HERE).  If you want to see this, you had better do so quickly as it is likely to be taken down at any moment.

"Cleveland Clinic is fully committed to evidence-based medicine. Harmful myths and untruths about vaccinations have been scientifically debunked in rigorous ways. We completely support vaccinations to protect people, especially children who are particularly vulnerable. Our physician published his statement without authorization from Cleveland Clinic. His views do not reflect the position of Cleveland Clinic and appropriate disciplinary action will be taken."  The statement Cleveland Clinic put out yesterday (Sunday) distanced itself from Neides' views, promising to take him out behind the woodshed ("Daniel; you've been a very naughty boy. Go cut me a switch").

"I apologize and regret publishing a blog that has caused so much concern and confusion for the public and medical community. I fully support vaccinations and my concern was meant to be positive around the safety of them."  Dr. Neide's public apology on the Cleveland Clinic website.  BTW, Neide's was banned from doing interviews concerning this subject.

Apparently a regular on Pat Robertson's 700 Club, Neide's bio states, "Daniel Neides, MD, MBA is the Medical Director and Chief Operating Officer of the Cleveland Clinic Wellness Institute. Dr. Neides is board-certified in Family Medicine and has practiced at The Cleveland Clinic since 1996."  His Cleveland Clinic page shows that he is loved and respected by his patients, with 140 reviews, all 5 out of 5 stars.  But don't be surprised if he is fired, considering he recently found himself in the cross hairs of the notorious "Anti-Vaxxer Bounty Hunters".  You see, over the course of the past three or four years, being labeled an ANTIVAXXER has taken on connotations virtually the equivalent of being labeled a bigot, homophobe, racist, sexist, puppy killer, or my all-time favorite cover-all-your-bases term; "hater". 

The thing that's comical about this whole thing is that as far as I can tell, everything he said is true.  His column was not against vaccines in general, it was against certain common components of vaccines (namely MERCURY & ALUMINUM).  He was writing a post about toxins, and had to mention the toxicity found in vaccines.  And it wasn't necessarily all vaccines, he was talking specifically about the FLU VACCINE.  Listen to what he says...

"I am tired of all the nonsense we as American citizens are being fed while big business - and the government - continue to ignore the health and well-being of the fine people in this country.  Why am I all fired up, you ask?  I, like everyone else, took the advice of the Centers for Disease Control (CDC) - the government - and received a flu shot.  I chose to receive the preservative free vaccine, thinking I did not want any thimerasol (i.e. mercury) that the "regular" flu vaccine contains.  Makes sense, right? Why would any of us want to be injected with mercury if it can potentially cause harm? However, what I did not realize is that the preservative-free vaccine contains formaldehyde.  WHAT? How can you call it preservative-free, yet still put a preservative in it? And worse yet, formaldehyde is a known carcinogen. Yet, here we are, being lined up like cattle and injected with an unsafe product. Within 12 hours of receiving the vaccine, I was in bed feeling miserable and missed two days of work with a terrible cough and body aches."

Firstly Dr Neides, whether or not you "chose" to have a flu shot is a moot point, because as someone working in a clinic or hospital, he was going to get one anyway, whether he wanted it or not (HERE).  Furthermore, the CDC states right on it's website that flu vaccines cannot cause the flu.  "No, a flu shot cannot cause flu illness. The most common side effects from the influenza shot are soreness, redness, tenderness or swelling where the shot was given. Low-grade fever, headache and muscle aches also may occur."  While they are correct that flu shots don't actually cause flu, they do cause flu-like symptoms.  For the record, there's no difference between the two other than the fact that when you actually have the flu, you have a positive blood test.  As for the mercury; why in the name of corn-on-the-cob would we still be making flu vaccines containing the single most toxic non-radioactive element on planet earth (he had to actually request mercury-free)?  I'll not touch on formaldehyde, but suffice it to say that it's really really toxic as well, although not in the same ballpark as mercury.  The problem is, however, they all contain aluminum.

"The adjuvants, like aluminum - used to stimulate the immune system to create antibodies - can be incredibly harmful to the developing nervous system. Some of the vaccines have helped reduce the incidence of childhood communicable diseases, like meningitis and pneumonia. That is great news. But not at the expense of neurological diseases like autism and ADHD increasing at alarming rates."

Two biggies here folks; Dr. Neides admits that we are trading chronic inflammatory and autoimmune diseases (he'll talk about them momentarily) for childhood diseases (SOMETHING I'VE SPOKEN AT LENGTH ABOUT), and that we are loading men, women, children, and newborns with aluminum.  Why is aluminum so bad?  If you want to get the whole scoop, CLICK HERE, as I wrote an entire post on the subject. 

The thing about aluminum that makes it different from the other two nasties we've already discussed, is that its entire purpose in vaccines is to provoke intense immune system (i.e. inflammatory) reactions. INFLAMMATION is the body's response to tissue damage, and is required for healing said tissues. This becomes particularly scary once you realize that the end product of inflammation is always some sort of FIBROSIS (Scar Tissue) and that furthermore, fibrosis just happens to be America's number one cause of death --- just ahead of medical errors (HERE).  But we have not even addressed the biggest problem with this whole conundrum.

The modern catch-phrase for practicing politically correct medicine is "evidence" or more frequently, EVIDENCE-BASED MEDICINE.  In similar fashion to the way one would go after werewolves or vampires with crosses, garlic, wooden stakes and silver bullets, Cleveland Clinic goes after Neides with "best evidence".  The only problem is, whether we are talking children, the elderly, health care practitioners, pregnant women, or any other group you care to mention, the "evidence" for flu shots in the form of hundreds upon hundreds of studies, stinks.  In fact, the group that probably responds best to flu vaccine (healthy adults) requires more than seventy people to be vaccinated in order to prevent a single case of the flu.  And for you older folks lining up and clamoring for your shots, those numbers are far worse (ALL OF THIS FOUND HERE). We shouldn't be surprised considering the devastating amount of fraud taking place in the biomedical research community (see first link in paragraph).

And for all the posturing and pseudo-outrage over Neide's post, who could argue with his statement that, "Toxins accumulate in our fat cells if they are not eliminated and interrupt normal bodily functions. Your body should be a finely tuned machine with all of the organ systems working in concert together. But when toxins disrupt normal function, problems can occur."  Some of the health problems he talks about by name are PARKINSON'S DISEASE, ADHD, ALZHEIMER'S, DIABETES, AUTOIMMUNE DISEASES, and (double gulp!) AUTISM.  Just before mentioning EPIGENETICS, he reveals how autism rates have exploded in America ("1 in 68 children").  Sorry, but he's wrong.  According to our government, they are actually double that (HERE).

This, however, is what happens when the 'Thought Police' start taking over academic medicine --- it eventually filters down to practicing doctors who not only believe what they believe because it is what they were taught --- they believe (or they keep their big traps shut) because dissent means looking for a new job.  Before he passed away a few short years ago, you could have asked DR. HUGH FUDENBERG how well bucking the system worked out. That's the problem here; we can't even have a discussion ---- it's off limits.  Which is the big reasons that vaccine studies tend to skew toward safety. If you do what Dr. Hugh did, prepare to have you life and career destroyed like he did.  Why do you think that more people aren't speaking up like Dr. Neides? 

It's not tough to see that BIG PHARMA has rigged the game.  By and large they not only have the medical community firmly in their pockets, they have most of the press in their pockets as well.  How do you combat this, especially when we know that studies can be set up to prove anything you want them to (HERE, HERE, HERE, or HERE)?  It's exceedingly difficult.  And the studies that can't be fudged to say what Big Pharma wants them to say; they go to their quiet resting place in the company's double-locked vault, where they'll never see the light of day and no one will ever know (HERE).  

Not only have we seen that drug reactions are reported in only about 1 in 100 instances (HERE), we know that in our current environment the reporting for vaccine reactions is surely worse.  Why?  Because how many doctors, professors, or researchers want to be made to look like hacks, quacks, or (triple gulp), antivaxxers?  Bottom line, there are so few physicians reporting to VAERS --- even when protocol requires it --- that the problem of vaccine safety and efficacy can be dressed up in white lace and largely made to look like it doesn't exist.  But exist it does.

Case in point, the nearly 400 page medical text by a group of neurologists / immunologists called Vaccines and Autoimmunity. The publisher, Wiley-Blackwell, describes the book thusly...  "In light of the discovery of Autoimmune Syndrome Induced by Adjuvants, or ASIA, Vaccines and Autoimmunity explores the role of adjuvants – specifically aluminum in different vaccines – and how they can induce diverse autoimmune clinical manifestations in genetically prone individuals." This should not come as a surprise considering that it was only in the last year or so that our body's lymphatic system was discovered to be directly tied to the nervous system (HERE), which is a big enough discovery that it will eventually change our MEDICAL PHYSIOLOGY TEXTBOOKS SUCH AS 'GUYTON'. 

CANCER researchers discovered that thimerosal downregulates an important immune system enzyme (ERAP1), thus potentially leading to autoimmune and neurological disorders.  The May 2016 issue of ACS Medicinal Chemistry Letters (Screening Identifies Thimerosal as a Selective Inhibitor of Endoplasmic Reticulum Aminopeptidase 1) revealed researchers had, "discovered novel inhibitors of ER aminopeptidase 1, an important enzyme for the human adaptive immune response that has emerged as an attractive target for cancer immunotherapy and the control of autoimmunity.... The latter, also known as thimerosal, a common component in vaccines, was found to inhibit ERAP1 in the submicromolar range... Cell-based analysis indicated that thimerosal can effectively reduce ERAP1-dependent cross-presentation by dendritic cells in a dose-dependent manner."  This might not be such a big deal if EARP1 WAS NOT SO CRITICALLY IMPORTANT to so many different areas of physiology and immunity.  I could go on and on, but I need to bring things to a close.

In the same way that Dr. Neides was made to back down, retract, and apologize, so will others trying to do what he did.  This is simple today because most practicing physicians work for "the man" (around here it's either Cox or Mercy).  This essentially squelches free speech --- that is, if you value your career and which side your bread is buttered on.  How do I know this is what's taking place?  Mostly because the MD's that I know that don't vaccinate their children (or themselves) --- or at least don't vaccinate on a schedule even remotely resembling what's recommended by the CDC --- are not promoting the fact.  They are quietly flying under the radar and simply TRYING TO SURVIVE.

Sometimes I get emails that beg to be answered via a posted article so that everyone can learn something (HERE'S ANOTHER ONE).  The question below was sent to me by an individual who will remain anonymous.  Understand that what she is going through is happening all over the country, all day, every day.  In fact, I see similar scenarios so often, I would almost call this the norm.

Dear Dr. Schierling,

I am a female with no history of back or pelvic injury.  About eight months ago, while transporting a patient in the Emergency Department, something happened to the gurney, causing my body to be forcibly twisted.  As I strained to correct the situation (the whole thing lasted just a couple of seconds) I felt a tearing sensation in the upper portion of both buttocks that sort of felt like old elastic giving way. 

After the initial pain during the twist I did not feel any more pain for about 4-5 days. Then I started having shooting pains in my left buttocks and then the right buttock three different times over a two week period. The third time I felt the pain I almost went to the ground it was so severe. It was at this time that I sought medical attention.

After months of tests, injections, and PT I was diagnosed with Myofascial Pain Syndrome (MPS). My question is, can myofascial tissue be torn and there not be pain?  In other words, does the pain have to show up immediately, or can there be a delay in the onset of pain if the injured area is not being stressed by my work?

The Workman's Compensation doctor is saying that the MPS is not from the injury because of the delay time for the pain. The physiatrist that I am seeing only wants to treat the symptoms without finding out the cause.  Since I am an RN, I find this both frustrating and hard to swallow.

Sincerely,
Jane Doe

Hello Jane,

There are several points here that need to be addressed, and I will attempt to tackle them one by one. Also bear in mind that while this is being written in regard to your question, not everything here is going to pertain specifically to you. The first thing I want my readers to understand is that when it comes to Workman's Comp, they are never your friend.  Not sure what state you live in, but it's important to be aware that some are much worse than others.  By the way, the same phenomenon you are going through occurs thousands upon thousands of times a day with INJURIES CAUSED BY MVA'S. 

Because of the way our insurance system is set up, in order to treat people, there has to be a working diagnosis.  Unfortunately, these diagnosis are frequently wrong (MUPS).  Why?  Because so many health problems don't show up on tests the way we have always been taught (HERE).  For instance, you can imagine how big a deal it is that the single most pain-sensitive tissue in the body (FASCIA --- which also happens to be the most abundant connective tissue) does not image well with standard advanced imaging techniques such as MRI (HERE).  On top of this, the NSAIDS and CORTICOSTEROID INJECTIONS so frequently used for treating the sort of injury you received, are not therapeutic (i.e. --- they do not aid the healing process, but actually inhibit it --- HERE). 

Another thing I would like to briefly address is your diagnosis of MPS.  MPS is a diagnosis that is almost always given to those struggling with TRIGGER POINTS.  Understand, however, that when it comes to the sort of injury that it sounds to me like you are dealing with, FASCIAL ADHESIONS are a much more likely choice.  This point might be splitting hairs, as the vast majority of the medical community is going to attack them the same way (HERE), but the reality is that while potentially related, they are two very different problems.  But we still have not answered the main question......

"Nearly 1.7 million traumatic brain injuries (TBI) occur every year in the US, and they have a significant impact on the lives of patients and their families. Headache is the most common complaint, and it can occur after mild, moderate or severe injury.  The International Classification of Headache Disorders (ICHD) includes diagnostic criteria for post-traumatic headache. According to ICHD, post-traumatic headaches must occur within seven days of injury.  The rule that headaches must occur within one week of injury may not reflect reality. Some individuals appear to develop post-traumatic headache in a delayed manner. In the study by Walker about one quarter of the patients without headaches immediately after TBI had 'delayed onset' headaches at six months."  From the American Migraine Foundation's website (Post-Traumatic Headaches)

"Is there really such a big difference between the three day delayed onset so commonly discussed in the literature, and the four day delayed onset being claimed by Jane but being rebutted by Workman's Comp?  To claim that this 24 hour or so difference is somehow a deal-breaker for Jane's claim is absurd."   Dr. Russell S. Schierling

And now for the answer to the question Jane is really looking for --- why does pain sometimes not show up immediately after injury?  Let me start out by saying that delayed onset of pain is, in many instances, more common than the instant onset of pain.  Following a quick Google search for "delayed onset pain" I came up with many many attorneys advertising for injured persons.  They all basically said something like this quote taken from Nolo dot com.  "Soft tissue injuries typically result in pain, swelling, and reduced mobility, but these symptoms may not show up immediately. They can take days, even weeks, to manifest. In addition, soft tissue injuries are not visible on an X-ray. This makes them more challenging to diagnose and document."  None of these attorneys, however, seemed to have good articles on why this is the case. 

The most common reason given for delayed onset of pain was "excitement".  Because there was a good deal of adrenaline surrounding the accident / injury, you didn't realize you were hurt immediately. Sorry, but except for rare exceptions, I am not buying this.  Not to mention, the web is loaded with all sorts of evidence proving Jane's side of things (HERE is a great example, although it really has nothing to do with her specific problem).  The thing is, it's not like this concept of delayed onset of pain after a physical trauma is anything new, or that it's solely related to litigation. 

Back in 1941 (the year Pearl Harbor was attacked by the Japanese), Martin Brazelay graduated from Harvard with a masters degree in engineering.  After working on aircraft design throughout the SECOND WORLD WAR, Brazelay became a Professor of Mechanical and Aerospace Engineering at Syracuse University in 1947.  Upon retirement from teaching and research he became one of the world's foremost experts on accident reconstruction.  In chapter 46 of his 1984 treatise Scientific Automobile Accident Reconstruction (BTW, this thing will cost you over $4,300), Brazelay revealed that, "Whiplash injuries may be present as a result of automobile accidents, even though no physical, radiological or other objective evidence of injury can be found. Sometimes there may be as much as weeks or even months delay between the automobile accident and the experience of symptoms."  He wrote these words as I was graduating from HIGH SCHOOL --- almost 33 years ago.

Let's shift gears for a moment and talk about something known as Delayed Onset Muscle Soreness. According to that pinnacle of truth and veracity, Wikipedia (you can double check their definition by looking at any of dozens of studies on PubMed), "Delayed onset muscle soreness (DOMS) is the pain and stiffness felt in muscles several hours to days after unaccustomed or strenuous exercise.  The soreness is felt most strongly 24 to 72 hours after the exercise and is thought to be caused by microtrauma to the muscle fibers.  Delayed onset muscle soreness is one symptom of exercise-induced muscle damage. The other is acute muscle soreness, which appears during and immediately after exercise."   Now, listen to what Paul Ingram has to say on the subject in this completely cherry-picked quote (as are many quotes I use) from the November 20, 2016 article on his PainScience site (The Biological Mysteries of "Muscle Fever," Nature's Little Tax on Exercise)

"Medical science can barely even explain DOMS, let alone treat it.  [It is caused by] exercise or other physical stresses outside your normal range of intensity — anything you aren’t used to. Even extremely well-conditioned athletes can get DOMS, if they train harder than usual. Eccentric contractions — controlled elongation — cause DOMS far more readily than concentric contractions.  Maybe the worst DOMS I ever had was after a night of dancing and, yes, a little 'head banging.' (I grew up in a Canadian logging town; AC/DC and Metallica were like gods to us.) Even a little head banging can be hard on neck muscles. I could barely lift my head off my pillow for 3 days.

Neurology never comes up when professionals talk DOMS. It’s really not on anyone’s radar, but it should be.  We’ve established that DOMS is obviously more complicated than it seems on the surface, and nothing demonstrates that more clearly than an 2011 study, which showed that it can actually spread — probably via a neurological mechanism — to adjacent muscles groups that were not exercised at all.  Thus DOMS may well often feel much worse and more extensive to some patients than it 'should' feel … and with an explanation that isn’t really on anyone’s radar.  The biology of pain is never really straightforward, even when it appears to be." 

DOMS, however, is not an "injury" as we think of the term; it is due to overworking untrained muscles or really overworking well-trained muscles.  If working out too hard has the ability to cause this sort of pain and stiffness --- pain and stiffness that peer-review commonly describes as showing up 24 to 72 hours after the initial injury, do you think that a real injury --- an injury that physically and mechanically compromises connective tissues --- could manifest somewhat differently and potentially worse?  In light of what we've seen so far, it certainly appears so.  A side note that was doubly interesting about Ingraham's article is that one of two things he mentioned as actually being potentially beneficial for DOMS was CURCUMIN --- the highly anti-inflammatory yellow component of the spice Tumeric --- that just just happened to be the topic of my last blog post (see link).  Let's now move out of DOMS and back into the realm of real injuries.

Medical doctor, surgeon, and medico-legal expert, Dr. Colin Tidy of Oxfordshire, England, writing for Patient dot info (Whiplash and Cervical Spine Injury) states that, "Most cases of whiplash injury occur as the result of rear-end vehicle collisions at speeds of less than 14 miles per hour. Patients present with neck pain and stiffness, occipital headache, thoracic back pain and/or lumbar back pain and upper-limb pain and paraesthesia.  The clinical symptoms of whiplash injury may not develop until 6-12 hours after the injury, or even after a few days."  Dr. Tidy also mentions that the top risk factor for indicating a potentially serious injury is, "immediate onset of neck pain following the event."  He goes on to say that, "studies have shown that the strongest prognostic indicators are factors that are present before impact. Lankester et al found that the factors that showed significant association with poor outcome on both physical and psychological outcome scales were pre-injury back pain, high frequency of GP attendance, evidence of pre-injury depression or anxiety symptoms, front position in the vehicle and pain radiating away from the neck after injury."   Not sure whether or not Jane had DEPRESSION, but as per what little history she sent me, she did not seem to have pre-existing back issues.  Let me show you another area where delayed onset of pain is considered the norm.

Problems with the jaw (TMJ / TMD) don't always show up immediately after injury as shown by a 2007 study (Delayed Temporomandibular Joint Pain and Dysfunction Induced by Whiplash Trauma: A Controlled Prospective Study) from the Journal of the American Dental Association.  "The authors studied 60 consecutive patients who had neck symptoms after whiplash trauma and were seen at a hospital emergency department. They followed up 59 subjects one full year later.  The incidence of new symptoms of TMJ pain, dysfunction or both between the initial examination and follow-up was five times higher in subjects than in control subjects.  Our results suggest that one in three people who are exposed to whiplash trauma is at risk of developing delayed TMJ symptoms that may require clinical management."  And in similar fashion....

The jaw problems might be partially explained by a HEADACHE study published five years earlier in the journal Pain (Antinociceptive Reflex Alteration in Acute Posttraumatic Headache Following Whiplash Injury) due simply to the fact that the temporalis is one of four muscles that allow you to chew (one of the four muscles of mastication).  According to the authors, whiplash injuries lead to, "Brainstem-mediated antinociceptive inhibitory reflexes of the temporalis muscle...."  In English, this means that anti-pain inhibitory reflexes (reflexes from the brainstem that could best be described as anti anti-pain responses) frequently led to --- well, pain, via "reflex abnormalities [which] are considered a neurophysiological correlate of the posttraumatic (cervico)-cephalic pain syndrome [headache]. The authors point to an altered central pain control in acute post-traumatic... following whiplash injury but without neurological deficits, bone injury of the cervical spine, or a combined direct head trauma on average 5 days after the acceleration trauma."  In other words, it took five days for aberrant reflexes from the neck / brainstem to raise their ugly heads and cause headaches after injuries that many doctors would write off as "WHIPLASH" simply because there was no blood, guts, broken bones, or overtly objective physical findings.

A 2001 study from the journal Brain (Delayed Onset and Resolution of Pain: Some Observations and Implications) took things a bit further, opening the door for (delayed) development of more serious complications like possible CENTRAL SENSITIZATION OR CRPS.  "Late-onset pains may develop gradually or suddenly, and may be brief or long standing. Pains which develop after an innocuous insult may be associated with slowly evolving sensory changes. However, even long-standing pains, particularly those of nociceptive origin, may resolve sometimes after many years. Resolution, which again can occur gradually or suddenly, may be spontaneous or follow development of another disorder or after therapeutic intervention. The duration of this pain relief can range from minutes to an indefinite period.  It is postulated that mechanisms implicated in acute pain may not be the same as those that subserve pain that develops after a long interval. Those late-onset pains which develop slowly after innocuous lesions may be associated with a variety of slow anatomical, physiological and biochemical changes."  There is, however, a significant difference between an injury to the NECK / brainstem and / or BRAIN, and an injury to the PELVIS or GLUTEAL MUSCLES.  However, because of Fascia's connection to both scar tissue / fibrosis and chronic pain (HERE), the later can sometimes prove problematic and even debilitating.

This leads to to wonder if the delay of days or weeks might be due to the INFLAMMATORY / FIBROTIC aspect of the healing process itself hypersensitizing nerves and leading to Allodynia or Hyperalgia?  If you scroll down my COLLAGEN SUPER-PAGE, you come to the section titled The Phases / Stages of Tissue Repair & Healing, in which I deal with its four distinct phases.  Remember that SCAR TISSUE was just beginning to be laid down when Jane felt her second buttock pain. 

So, what can I definitively say about delayed onset of pain after an injury?  Nothing really except that it is poorly understood, yet extremely common. Unfortunately, this always works in the favor of the insurance company (and also unfortunately, there seem to be increasing numbers of people being attracted to attorney's TV advertisements).  Ultimately, what all this means that everything under the sun will be used against you -- the injured person.  Previous injuries or pain (none in this case, but if you've ever visited a chiro for any reason, prepare to be accused). Degenerative changes in the spine or joints (almost guaranteed by age 50, but virtually impossible to correlate to present symptoms --- HERE).  Drug seeking (don't be surprised if you are accused of being a closet addict on the prowl for your next fix --- HERE).  Greed (you will be accused of malingering for the sake of collecting a monetary settlement).  Laziness (don't be surprised if you are accused of faking the injury so that you can stay at home collecting Disability).

Because pain --- especially CHRONIC PAIN --- is so poorly understood (and all but impossible to quantify), it is extremely difficult to defend people whose pain started weeks or months after the accident, mostly because these individuals usually have nothing in the way of objective findings (things other than pain) to show for it that can be directly tied back to the original accident / injury (HERE). Jane's situation, however, is different.  Because her severe symptoms happened four to five days after the initial injury, a good attorney should be able to make the case that her problem is legitimate (see my quote from the top of this section).   I also think that Jane's might be the perfect example of ripped out pants.  Ripped out pants... huh?

Let me take you back in time to something that happened to me when I was ten or eleven years old. Back in the day, my "dress clothes" (clothes only worn to church, or for weddings and funerals) consisted of a pair of polyester pants, a polyester button-up shirt, and some doubly cool platform shoes (Jackson Five, eat your heart out!).   One day when I bent over, I felt / heard my pants rip out.  But when I looked in the mirror and tried to figure out what had happened, there was nothing to be seen --- everything looked normal.  But the next time I wore them and bent forward, I had the same experience.  Only this time there was a hole in the seam of the butt about four or five inches long (interestingly enough, Jane described her injury as "old elastic giving way").  I think that sometimes this is sort of what happens with connective tissue injuries.  For example......

Uncle Roger calls up and asks you to help him move his antique upright piano.  You go over and do your part, grunting and straining while in awkward positions.  After it's all over, your back feels a bit "catchy" for a couple minutes and you are relieved the job is finished.  No real pain, and not even anything that could be characterized as soreness; just a catchiness that lasted all of 2 or 3 minutes before you walked it off.  But the next day you bend over to pick up a quarter off the parking lot of your local Mal Wart and bam --- your back grips you so hard that you can barely breathe, let alone stand up. You have all the CLASSIC SIGNS of a disc injury (even though they can prove extremely DIFFICULT TO DIAGNOSE). Just remember it's not that pesky quarter that caused the problem, the quarter was just the final straw after moving the piano.  Best guess is that Jane experienced something similar.  She felt tearing and pain after the initial injury that went away almost immediately.  But the damage from her initial injury was likely hiding just below the surface.

What do I recommend people do to solve their chronic pain issues?  Although there is no such thing as a one-size-fits-all solution, fortunately for my readers there is a one-size-fits most.  The secret is to solve the mechanical issues at hand, deal with the underlying Scar Tissue, and then make good and sure that any and all sources of excess INFLAMMATION are mopped up so as not to be driving FIBROTIC CHANGES and potential hyper-sensitization of the nervous system (HERE).  Although weeks and weeks of visits to a chiropractor or therapist are the norm, these visits are all too often not addressing the underlying cause of said problems --- Scar Tissue (HERE and HERE respectively). That's why I have provided my readers with THIS PROTOCOL.  No; it's not going to fix everything that ails you. What it will do, however, in even the most difficult of cases, is to provide a firm foundation that you can 'scaffold' off of if needed.

Some people might wonder why a person who deals almost exclusively with CHRONIC PAIN SYNDROMES would continue to beat the inflammation drum so loudly.  In all honesty, it's really not that difficult to understand.  Inflammation is everything.  EVERYTHING!  Learn to control it and you will not only extend your life, your life will have less pain and distress (HERE).  It's easy to understand why, once you realize how many different health-related problems are caused by the group of immune system molecules we refer to collectively as "INFLAMMATION". 

The craziest thing is that not only is inflammation being driven by the CRAPPY DIETS eaten by most Americans, but it's being driven by the drugs we take to compensate for said diets.  For instance, SUGAR DRIVES BOTH INFECTION & DYSBIOSIS.  But when we go to the doctor for either, we are given ANTIBIOTICS that cause the very problem(s) we are trying to correct.  This is true of any number of drugs, including many NON-ANTIBIOTICS. 

My goal is to see you get healthy, get to a normal weight, get off your drugs, GET OUT OF PAIN, and get your life back.  It all starts with controlling inflammation.  Not with NSAIDS or CORTICOSTEROIDS mind you, but with tangible lifestyle changes.  Although EXERCISE is important, it is minimally so when compared to what you put in your mouth.  WHAT YOU EAT is critical --- critical for controlling inflammation and feeding a healthy (anti-inflammatory) MICROBIOME.  It's one more reason why figuring out how to get more anti-inflammatory spices into your diet is important for all of us --- especially if we are dealing with CHRONIC INFLAMMATORY DEGENERATIVE DISEASES, CHRONIC PAIN, AUTOIMMUNITY, a bad case of "THE LEAKIES," or any number of others.

TUMERIC / CURCUMIN:  Because it is arguably the most important of the lot, I am going to start with Tumeric (see pic at top and right).  Related to ginger (we'll get there), Tumeric is an Asian / Indian plant whose bright yellow roots are dried and powdered for use as a cooking spice (it is a major ingredient in curries).  Many studies will, instead of referencing Tumeric (Curcuma Longa), talk about something called Curcumin, which is simply the part of Tumeric that gives it it's distinctly yellow color. 

According to a popular online encyclopedia, "Curcumin has been shown to inhibit certain epigenetic enzymes."  Why is this such a big deal?  Because due to EPIGENETICS, you can no longer blame most of your health issues on your genes. Some of the 'enzymes' mentioned are responsible for seriously ugly diseases, while others are simply part of the enzymatic cascade of compounds that make up the inflammatory pathways.  As far as studies are concerned, if you go to PubMed and start looking at how much peer-reviewed (MAINSTREAM) research there is on Tumeric / Curcumin, you'll be amazed.  I've seen reputable sources say that there are nearly 7,000 studies touting the benefits of this yellow spice.  These studies have made it into some doctor's offices.

An email I received just yesterday from the Psychiatric Times carried a PDF Power Point presentation by expert on Bipolar Disorder, Dr. James Phelps (Curcumin: New Use for an Old Spice). Phelps stated that, "Accumulating evidence implicates inflammation as a critical mediator in the pathophysiology of mood disorders."  That's right folks, even Depression is considered to be "inflammatory" (HERE) along with any number of "psych" disorders.  To see a list of health-related issues that have been helped by Curcumin / Tumeric, HERE it is (if the health problem is related to inflammation, I promise that someone somewhere has done or is currently doing research on it with Tumeric / Curcumin). 

One more thing you need to understand about Tumeric / Curcumin is that by itself, it is not absorbed well.  This means that you can eat lots and lots of top quality product and get little or no real health benefit, unless......  Just remember to use it with pepper (black pepper), as this simple spice will dramatically boost Tumeric's bioavailability.  Also remember that for those of you with NIGHTSHADE SENSITIVITIES, this could present a problem (Nightshades come into play with many of these other spices as well).

BERBERE:  Unlike most of the others on this list, which are spices unto themselves, Berbere, like Curry, is a combination of any number of spices.  Berbere includes Chili Peppers (and long peppers), Cumin, Garlic, Coriander, Ginger, Basil, Korarima, Rue, Ajwain, Radhuni, Nigella, and Fenugreek.  Although I'm no expert on Berbere, I know a bit about some of the spices in this mixture.  For instance, Fenugreek (the yellow seeds of a green leafy plant) is itself used to treat people with any number of inflammatory conditions, including DIABETES and ALLERGIES. 

Berbere is a family favorite because of my ETHIOPIAN DAUGHTERS. After making two trips to Ethiopia a bit over five years ago, I came back with a love for Ethiopian food, which is seemingly all spiced up with Berbere, giving it a unique smell and taste.  The way that almost all Ethiopian food is eaten is by using Injera (a spongy sourdough pancake-like bread made from Teff --- a GLUTEN FREE grain) to mop up the vegetable and meat dishes, which are often combined.  If you've never tried Ethiopian cuisine, find a restaurant  and go.  Or better yet, make a friend with someone from Ethiopia (they are some of the most generous, genuine, and caring people I've ever been around) that might eventually be willing to cook you an authentic meal (you buy the food). 

BOSWELLIA:  If you've never had the chance to actually smell Boswellia, you are missing out.  This is because the dried resin from the Boswellia Sacra tree goes by another name you may be more familiar with --- Frankincense (recall that it was one of the three gifts that the "wise men" brought Christ).  This herb is fairly scarce, mainly because the most quality product comes from a narrow geographical zone (the Nejd) that encompasses parts of Yemen, Oman, and Somalia, where the desert butts up to the Dhofar Mountains --- an area known specifically for it's fog.  The trees grow extremely slowly and as you might imagine, over-harvesting has become a problem.  To the best of my knowledge, Boswellia is not used as a cooking spice.  However, it is used for people dealing with the various inflammatory conditions mentioned via links, including a couple we haven't mentioned by name ---  AUTOIMMUNE DISEASES and THE BIG "C".  The best product can be found at Standard Process' sister company, Medi-Herb.

GINGER:  Although fresh Ginger from the store is only slightly yellow, the dried form is much more so (the two have a somewhat different taste).  As you can see, the root itself looks similar to Tumeric, and actually comes from the same family.  Although renowned for its anti-inflammatory properties (especially arthritis), it's commonly used for quieting an upset stomach. For those of you who are interested, Ginger is the base of an anti-inflammatory drink (Green Tea & fresh Ginger, along with whatever else you want to add) that you can make yourself and keep in your fridge (HERE).  You probably will not be surprised to learn that India and China are responsible for about half the worlds Ginger production.

CUMIN:  Cumin, not to be confused with Caraway, which is itself yellow and sometimes called meridian fennel or Persian cumin, is another of the yellow spices that comes largely from India (most of the rest comes from regions near the Mediterranean --- particularly the eastern portion). Cumin literally has dozens of reported health benefits, not surprisingly, most of which have to do with its anti-inflammatory properties.  Cumin is a flavor you would recognize, as it  is often used in chili powders and curries.

MUSTARD SEEDS:  Although they come in many different colors, Mustard Seeds do come in yellow.  Not only do the seeds have any number of anti-inflammatory qualities, mustard greens are considered to be one of the highest nutritional quality greens you can consume.  BTW, much of what we today call 'mustard' (the condiment) used to be colored with Tumeric.

CINNAMON:  Although it tends to be more brown than yellow, we are going to fudge a bit on this one.  Cinnamon is one of the most incredible and healthful spices on the planet, with thousands of references in peer-reviewed journals.  The spice itself comes from the rolled up bark of various kinds of Cinnamon trees, which are found mostly on island nations such as Sri Lanka, Madagascar, Indonesia, and the Seychelles.

Studies have shown that of all the spices we've mentioned thus far, Cinnamon has the highest antioxidant capacity.  And in similar fashion to the other spices we've discussed today, Cinnamon has powerful anti-inflammatory properties as well, which means it can prove helpful when dealing with all sorts of health-related conditions (HERE is a list) as well as helping to lower LDL CHOLESTEROL.  It's also been shown to be a powerful weapon in the war against DYSBIOSIS --- particularly against YEASTS & FUNGUS. You could certainly add a bit of Cinnamon to the drink mentioned earlier, although I would absolutely not recommend that you consume Cinnamon in THIS MANNER, as it can be hazardous to your health.

The thing about all the spices discussed today (as well as any number I did not manage to get to) is that when used with common sense and moderation, you can't really go wrong.  They are spices for Pete's sake, and have been used for millennia both for making food tastier as well as for medicinal purposes. However, if you are on certain drugs --- particularly blood-thinners --- ask your doctor.  Or maybe just go and check online as your doctor is not likely to know (HERE).  The internet is full of great articles about the safety profiles of herbs and spices, finding the best sources for quality products, as well as recipes for using said spices, which can be a helpful part of THIS PROTOCOL.

"Overall sales of carbonated soft drinks dropped for the 11th consecutive year in the U.S. Total volume declined 1.2% in 2015, an acceleration from 2014's 0.9% drop, as the biggest three players in the category all reported falling demand, according to a new report from industry tracker Beverage Digest."  Taken from John Kell's March, 2016 article in Fortune called Soda Consumption Falls to 30-Year Low In The U.S.  Wow!  It sort of begs the question of just how little soda American consumers are drinking these days?  "The group reported that annual per capita consumption of carbonated soft drinks dropped to about 650 eight-ounce servings in 2015 – the lowest since 1985."

Holy carbonated beverages Batman.  When we enthusiastically applaud the fact that every man, woman, and child in America is "only" drinking 5,200 ounces of soda per year (81 gallons), something is darn drastically wrong with our society.  Because of the health-related problems associated with consuming this much soda, there have been any number of ideas kicked around to further curb these numbers, including increased taxes.  The thought process behind increasing government taxation on sweetened beverages (mostly this means soda, although it could be your Starbucks, your McDonald's shake, or any of hundreds of other products) is that it's been used with other things like CIGARETTES. In other words, bad behavior will be punished by taxes so high that many Americans (the hope is most Americans) will decide to bail on said habits.  It sounds kind of warm and fuzzy, but government policies seem to have a way of not working out as planned.

When I Googled "have cigarette taxes curbed smoking?," I received a wide array of answers, the majority of which argued that it had not.  In fact, there was even an article in the New York Post from last year (The Great Cigarette Tax Lie) that stated, "On the contrary, in tandem with a tobacco advertising ban, higher taxes have made teen smoking cooler than ever. In fact....."  And let's face it; when the government has taxed other things in similar fashion (gambling for instance) the money rarely ends up going where it was promised (HEALTHCARE, education, law enforcement, etc).  Or if it does so initially, it winds up getting pilfered AS SEEN IN THIS ONE MINUTE VIDEO.

Because the under-25 crowd gets the majority of their calories from soda and other sugary drinks (HERE), the government's desire is to tax said products out of existence (so riddle me this; why can you buy these and similar products with Food Stamps?  ANSWER FOUND HERE). Just two short days ago, the open source medical journal PLoS One published a study by researchers from the University of São Paulo, University of Bristol, Imperial University of London, and St. Louis Missouri's own Washington University School of Medicine, called Artificially Sweetened Beverages and the Response to the Global Obesity Crisis.  After spending time discussing the severity of the obesity and diabetes epidemics as related to "sugary drinks," the authors admitted that as to increasing the taxes on them, "the effectiveness of these interventions is still emerging." Here are the rest of the author's cherry-picked conclusions.

"ASBs (artificially sweetened beverages) are marketed as healthy alternatives to SSBs (sugar-sweetened beverages). The potential benefits from ASBs rely on the assumption that they elicit no energy compensation [zero calories]. However, there are long-standing concerns that ASBs may trigger compensatory mechanisms, which could offset a reduction in energy and sugar intake provided by their replacement of SSBs.  Systematic reviews of observational studies indicate that ASB intake is positively associated with increased body mass index in both children and adults and to cardiometabolic disease risk (e.g., type 2 diabetes and stroke). More recently published data suggest that artificial sweeteners may contribute to the development of glucose intolerance by altering the composition and functions of gut microbiota.  The absence of evidence to support the role of ASBs in preventing weight gain and the lack of studies on other long-term effects on health strengthen the position that ASBs should not be promoted as part of a healthy diet. Far from helping to solve the global obesity crisis, characteristics related to ASB composition makes them a potential risk factor for highly prevalent chronic diseases."

Not surprisingly, the authors went on to talk about study bias, saying that for the most part the numerous studies showing health benefits of swapping out regular soda with diet soda are being done by groups funded by (drum roll please) THE SUGAR INDUSTRY, which is (as stated by the authors) going out of its way to hide this fact.  Furthermore, the paragraph above, both raises and answers some intriguing questions in one fell swoop; the biggest being how can a product that has no sugar and no calories be associated with STROKES, OBESITY, CARDIOMETABOLIC SYNDROME, DIABETES, GLUCOSE INTOLERANCE / INSULIN RESISTANCE, and other "CHRONIC DISEASES"?  The answer, folks, is not only right there in front of your face, it's in your Gut and all over your body as well. As always, it's all about your MICROBIOME. 

If you are interested in at least skimming titles, I have provided you A LINK to the articles I've written on this very topic, with the peer-reviewed studies showing that in many cases, people drinking diet beverages gain as much as twice as much weight (mostly in the form of BELLY FAT) as those drinking sugar-sweetened beverages (Gulp!).

Paul Krugman's Curriculum Vitae reads like a veritable Who's Who of academics.  He holds degrees or professorships at Princeton, Yale, MIT, the City University of New York, and the London School of Economics. He won the Nobel Prize for Economics in 2009 --- the year prior to Obama winning the Nobel Peace Prize. He is not only a self-proclaimed liberal (he has written several books attesting to the fact, including 2007's The Conscience of a Liberal), he proudly touts it in his syndicated column for the New York Times.  It is in this capacity that I introduce to you an article he wrote on New Years Day called Snatching Health From Millions.

As an ardent supporter of both Hillary and Obama, as well as a public reviler of President-Elect Trump, it's not surprising that he is a defender of the ACA, with the general theme of his article being, "the good news about Obamacare."   Krugman goes on to write (cherry-picked for time and space), "More broadly, Obamacare [is] working, showing that government action really can improve people’s lives.  Obamacare has, in fact, been a big success — imperfect, yes, but it has greatly improved (and saved) many lives. And all indications are that this success is sustainable, that the teething problems of health reform weren’t fatal and were well on their way to being solved at the end of 2016."  The point here is not to either pick on or praise the Affordable Care Act; nothing I could possibly say would sway you one way or another.  What I do want to talk about today is one tiny word found in the middle of Krugman's quote --- "sustainable".

For all Krugman's 'brilliance' in other areas, I showed you via a post written almost a year ago that AMERICAN HEALTHCARE HAS BECOME COMPLETELY AND UTTERLY UNSUSTAINABLE. When we try and associate the number of covered lives with health, we are making a grave error.  Ask any doctor; our healthcare system is nothing of the kind.  It's not health..... care.  In other words, for the most part, healthcare is not really caring for health.  The term itself is an oxymoron.  Why?  Because for the most part, caring for your health (healthcare) is something that your doctor cannot do for you. 

Sure, your physician can monitor your vitals, check your BLOOD PRESSURE, put you ON THE SCALE, and test your BLOOD SUGAR and BLOOD CHOLESTEROL levels.  And they can then give you DRUGS.  The problem is, DRUGS DON'T REALLY CHANGE ABERRANT PHYSIOLOGY.  For the most part, they cover symptoms.  In other words, they help 'manage' your diseases --- most of which are self-induced.  And above all, drugs provide patients with a false sense of security (not to mention supplying BIG PHARMA with job security ---- HERE).

Interestingly enough, just yesterday, the Annals of Internal Medicine came out with brand new guidelines for treating TYPE II DIABETES (Oral Pharmacologic Treatment of Type 2 Diabetes Mellitus: A Clinical Practice Guideline Update From the American College of Physicians).  Just a few short weeks ago, I showed you that between one in three and one in four of all Americans is dealing with either Diabetes or pre-Diabetes (HERE).  The Annals authors echoed the problem's severity by revealing that almost 10% of the adult population has FULL-BLOWN DIABETES, going on to say, "Because of the rising obesity rate in the United States, the incidence and prevalence of diabetes mellitus are increasing substantially.  The total direct and indirect costs associated with diabetes in the United States alone reached $245 billion in 2012."  Their solutions?  "Lifestyle modification and pharmacologic therapy."  The question we really need answered is how well is this working out?

According to a brand new study from the American Medical Association's JAMA Network (US Spending on Personal Health Care and Public Health, 1996-2013), not too well.  After telling us that nearly one in five dollars are spent on healthcare, the authors reveal that, "Spending on low back and neck pain and on diabetes increased the most over the 18 years."  Not surprisingly, CHRONIC BACK AND NECK PAIN --- itself one of the many problems considered to be "inflammatory" --- was listed as the third leading cause of healthcare spending in the United States at nearly 90 billion dollars annually.  But moving into the number one spot was (drum roll please), Diabetes.  "Diabetes had the highest health care spending in 2013, with an estimated $101.4 billion in spending, including 57.6% spent on pharmaceuticals and 23.5% spent on ambulatory care."

Despite being told by the authors of the first study discussed that, Oral pharmacologic therapy with metformin is an effective management strategy for Diabetes, I continue to have my doubts (I also have doubts about how hard physicians are pushing LIFESTYLE MODIFICATIONS specifically geared toward diabetics). So do others. There are any number of experts saying that in similar fashion to what we are seeing with STATIN DRUGS, Diabetes Drugs (HERE and HERE) --- while undoubtedly lowering blood sugar numbers --- are not lowering either morbidity or mortality.   On top of this, many continue to say, "BUT DR. RUSS; I DON'T HAVE DIABETES".  While this may be factually true (at least for the time being), you have to remember that if you have PRE-DIABETES (otherwise known as Cardiometabolic Syndrome), for all intents and purposes you are actually a high-functioning diabetic.

Why do I bring this whole issue up on a site that's chiefly dedicated to helping people with CHRONIC PAIN? Because there are lots of you that I treat (not to mention my readers) struggling with BLOOD SUGAR DYSREGULATION ISSUES.  And the brutal truth is that not only is this affecting your ability to get well, it's causing you immense amounts of chronic pain while you die a slow, miserable, and often times painful death --- all while you progressively lose your ability to revel in life's simple pleasures (EXERCISE & PHYSICAL EXERTION, SLEEP, SEX, JOY, TRAVEL, etc, etc, etc. If you are looking to break free from these chains, get out from under your SUGAR ADDICTION, and get off the MEDICAL MERRY-GO-ROUND, the best place to start is HERE.

"All off-label drug uses are not created equal. A study published in November 2015 in JAMA Internal Medicine compared prescription drugs used for off-label indications with and without strong scientific evidence to back the alternative use. When that evidence is lacking, there's a 54 percent increase in adverse drug events."  From Lisa Esposito's April 22, 2016 article in US News called What Patients Should Know About Off-Label Drug Use.  The problem is, according to the November 23 issue of the Wall Street Journal (Risk of Off-Label Uses for Prescription Drugs), "The JAMA Internal Medicine study found that about 80% of off-label prescriptions weren’t supported by strong scientific evidence."

"While there are restrictions on off-label promotion, off-label prescribing by a physician is not illegal. In fact, off-label prescribing is considered both ethical and within the standard of care in appropriate circumstances.  It is also common.  For the 3 leading drugs in each of the 15 leading drug classes, off-label use accounts for approximately 21% of prescriptions. Moreover, off-label uses may be the norm in some areas of practice.  For example, about 80 percent of all drug prescriptions for children are off-label."  Cherry-picked from Jann Bellamy's March 2016 article for the highly anti-alternative medicine website, Science-Based Medicine (Patient Beware: Off-Label Drug Promotion by Pharmaceutical Companies).  Follow along as I show you how the restrictions on off-label drug promotions are going bye-bye.

As I've shown you time and time again, evidence-based medicine is frequently anything but.  However, if Big Pharma can come up with catchy ads and talk a good enough fight to make people think that the thousands of studies they are paying universities, research centers, and think tanks to do each year are unbiased proof that their products are wonderful and effective, they will have fooled the public enough to make billions.  Today's post is going to help burst that bubble and show you the interesting and potentially ugly side of recent changes in the law concerning the promotion of off-label prescriptions.

When medications are prescribed "OFF-LABEL," it simply means they are being prescribed in a manner that has not been studied or approved by the FDA. In other words, if a doctor started prescribing a certain arthritis drug for people with depression, or prescribed it for groups of people (i.e. children / pregnant women) that had not been studied, this would constitute OFF-LABEL PRESCRIPTION.  The biggest official stipulation put on this practice by the government is that drug companies cannot advertise off-label uses of their meds.  All of this begs the question of just how common off-label prescribing may be?

Off-label prescribing is extremely common.  As I showed you a few years ago concerning ANTIDEPRESSANTS, off-label use is arguably the most common way this class of drug is being prescribed.   Despite this, the title of a study published in a May 2016 issue of Medscape (Off-Label Antidepressant Prescribing Increasingly Common) showed us through its title that this practice is getting worse instead of better.  The paper went on to say that, "Investigators at McGill University, in Montreal, Canada, found that 45% of the antidepressants prescribed... in the province of Quebec were for conditions other than depression."  The problem is at least that bad here in the United States.  I could literally write a book on this topic, but that is not the purpose of today's post.  

Today, I want to let my readers know that as of recently, things got much easier for Big Pharma to push their wares on an unwary public in off-label fashion.  On December 29 of last year (less than a week ago), the Managing Editor for MedPage Today (John Gever) published two articles on the same topic --- FDA Concedes Defeat on Off-Label Drug Marketing and Will Off-Label Promotion Become a Fact of Doctors' Life?  As strange as it may sound, this story started five years ago with a drug that's based on Pharmaceutical Grade Fish Oil.

As I've shown you about a million times, INFLAMMATION is the root cause of most diseases.  On the other hand, PHARMACEUTICAL GRADE FISH OIL has been proven effective for helping people with a wide variety of health-related conditions simply because Omega-3's are extremely anti-inflammatory.  Be aware, however, that peer-review is never unanimous in it's assessment of any supplement, fish oil included (HERE, HERE, HERE, HERE, or HERE).  Although there are lots of reasons for this (that's why I provided you a few links), when it comes to fish oil, much of it has to do with the fact that most grocery store or health food store fish oils are rather crappy products (click the PGFO link above to see why), with low levels of EPA and DHA --- the two active ingredients in fish oil, not to mention the fact that most of it is rancid / oxidized.  Enter Amarin Pharma, Inc.

In July of 2012, the FDA cleared Vascepa --- a prescription fish oil product made from highly purified and concentrated EPA --- for use in treating people with high triglycerides (high levels of blood fats aka hypertriglyceridemia).  This categorizes Vascepa as a "Medical Food" (Medical Foods are nutritional products that have been molecularly tweaked enough to be patented, yet still retain their beneficial food-like qualities).  The products I am most familiar with in this class are Deplin and Metanx (for DEPRESSION and DIABETEIC NEUROPATHY respectively).  Effective for some people but very expensive.  Anyway......

Because Big Pharma understands the benefits of using fish oil to treat people with inflammatory conditions, they started pushing the FDA to allow their product to be advertised in an off-label fashion (not prescribed or used off-label mind you --- those are already legal --- but advertised).  As of September of 2014, it wasn't working out so well, as seen by the title of The Street's article called Third Time Was No Charm, FDA Denies Amarin Vascepa SPA Appeal.  But with so much money at stake and lots of attorneys on retainer with nothing better to do, Amarin went after the FDA yet again. 

In May of 2015, the Wall Street Journal wrote an article about this battle called Amarin’s Vascepa Revenue Grows 42%: Small Drug Maker is Suing FDA Over Free Speech Right to Promote Off-Label.  And guess what?  In July of last year, they actually won based on a judge ruling that not allowing off-label prescribing was a violation of the right to free speech.  So instead of our problem with drug advertising getting better, it's about to get worse --- much worse. 

Case in point, Cardio Brief's September 2016 article by Larry Husten titled Amarin Begins Legal Off-Label Promotion Of Vascepa stated that, "Barely a month after a big victory in a federal court over the FDA, Amarin Pharma has started off-label promotion of Vascepa, its much-disputed prescription fish-oil product.  The federal judge ruled that the FDA can’t restrict Amarin’s first amendment right to disseminate off-label information about Vascepa providing that information is neither false nor misleading."  The problem is, both politicians and Big Pharma have different definitions than the general public as to what the words "false," "misleading," and any number of others (including "is") actually mean.  Take, for instance, Vascepa's website.

It is my opinion that their website (you can look it up as I am not going to promote it by providing a link) is an exercise in misrepresentations and half truths (many of the later probably much less than half).  For instance, their website opens up with, "Why should you take Vascepa instead of fish-oil supplements?  Unlike Vascepa, dietary supplements are not approved to treat medical conditions."  They then go on to talk about fish oil supplements as compared to Vascepa. 

Everything they say is mostly or at least partially true (I revealed virtually everything they mention at least a decade ago in a handout that I turned into a web page --- HERE), but much of it is taken way out of context or presented in a very twisted and convoluted manner.  If the problems with Vascepa --- a supplement whose chief side effect is joint pain --- ended there (interestingly enough, the number one reason people in my office take PGFO is to relieve joint pain), it wouldn't be such a big a deal --- after all we are talking about fish oil here.  Unfortunately, the judge's ruling pertained not just to Vascepa, but to pharmaceuticals in general.  Put on your ten-gallon hats and polish your six-shooters --- you are about the experience the pharmaceutical industry Wild West style.

In last week's MedPage article, Gever wrote that Big Pharma can, "now feel free to say anything they like to physicians and consumers about their products, as long as they had some fig leaf in the form of a journal paper or PowerPoint slides from a conference."  If you ever get a chance to look at paintings or engravings of Adam & Eve after their confrontation with God in the Garden, they are usually depicted with A FIG LEAF OR TWO in strategic locations.  When it comes to Eve, the single fig so often depicted in ancient artwork leaves little to the imagination. The point is that when it comes to EVIDENCE-BASED MEDICINE, not only are fig leafs common, they are arguably the norm (click the link and start skimming the dozens of titles).

Firstly, this whole affair begs the question of what really counts as protected speech under the First Amendment.  Can I really tout Chiropractic as a "cure" for deafness (HERE) even though BJ PALMER originally did?  We know that it is clearly illegal to go into the proverbial "crowded theater" and yell 'fire,' or start making insinuations about bombs on public flights.  On the other hand, it's perfectly legal under the First Amendment for producers of porn to use models who, while being of legal age (18), appear to be younger --- some of them much younger (HERE).  Where do we draw the line?  For starters, I would argue that free speech is meant to grant political and personal protection (HERE); commercial protection much less so.

Because of this I would also argue (you'll have a tough time moving me off this point) that free speech and First Amendment protections have nothing whatsoever to do with off-label promotions of prescription drugs.  But let's look at the other side of the coin for a moment.  According to the author who is quoting FDA Commissioner Dr. Robert Califf, "physicians aren't expected to rely solely on FDA-approved communications about available drugs. We know that healthcare providers can already access considerable scientific information about unapproved uses through a variety of sources, including scientific journals, clinical practice guidelines and compendia, or by requesting information from firms." 

Look folks; if everyone was really working toward the common good of the patient, this might (might) be true.  However, with the various ways (HERE and HERE for instance) that Big Pharma is conning and defrauding both the public and the governmental agencies (FDA, NIH, CDC, etc) assigned to police them (INVISIBLE & ABANDONED STUDIES continue to be one of the most common and most effective), Califf's reasoning is not valid.

One of the commenters on Gever's article (Dr. DeeDee) sided with Califf, saying, "Bureaucracies thrive on controls and regulations.  I simply believe that physicians - all properly trained and examined in their profession - remain the best-qualified to decide what is best practice for their patients, and to separate the good from the chaff during promotional meetings with Pharmaceutical Industry Representatives (whose overall contributions to our ongoing knowledge-base remains very significant).  There remains a need for Rules and Regulations dictating a baseline safety level for honesty and propriety in the development and manufacture of medicines, but does this extend beyond the early "learning curve" into the best practices era? I think not, and most certainly believe that I am my own best censor in my professional field of competence - not some unaccountable unknown bureaucrat."  Well spoken, but according to study after study after study, completely untrue.  You are affected by advertising.

If advertising, whether through DRUG REPS, TV COMMERCIALS, PRESS RELEASES, pathetic "FIG TREE" STUDIES and HOMEGROWN RESEARCH, a steady stream of MEALS, continuing education in Aspen or Key West, Clinton-style honorarium for speaking engagements, "consulting" fees, etc, etc, etc, etc, didn't work, BIG PHARMA (watch the humorous "TV commercial" at the end of this link), wouldn't be spending billions and billions of dollars each and every year to peddle their products and influence.  The fact is, BMJ showed us nearly five years ago that for every dollar industry spends on research, they are spending almost twenty times that on advertising.  No one, doctors included, likes to admit they are capable of being played by the pharmaceutical industry's schmooze & schtick.  But being played they are --- over and over and over again (HERE --- the truth is, I could have put dozens of different links in this spot). 

When it comes to the "Bureaucratic BS In Medicine Top Ten List," the the top spots should be held by phenomenon like FINANCIAL CONFLICTS-OF-INTEREST, FAKE "HEALTH CRISIS," and HEATH GUIDELINES that are so bought and paid for no one's even trying to hide it any more.  And to think that Pandora's Box was opened over a drug that is, for all intents and purposes, a nutrient.