Hiatal Hernia has been called the "great mimic" because it mimics many disorders. A person with this problem can get such severe pains in their chest that they think they are having a heart attack. They may think they have an over acid stomach because they will regurgitate stomach acid after they eat, or their stomach may hurt so badly they will think they have an ulcer. This is just a sampling of the symptoms that may occur from this disorder.  From Dr. Russ Tannebaum's website (Hiatal Hernia: An Overlooked Cause of Disease)

Hiatal Hernias are common.  Make that dog common.  Depending on whose research you feel is most accurate, statistics show that American adults have about a 50/50 chance of having some degree of Hiatal Hernia (HH), with the chances becoming significantly greater as one gets significantly older.  What is a Hiatal Hernia?   Allow me to explain.

You have two inner cavities in the middle part of your body; the chest or thoracic cavity (the upper cavity where your heart and lungs live) and the abdominal cavity (the lower cavity where your stomach and digestive organs reside). These two cavities are separated by the muscle used for breathing called the diaphragm (to see it in action, CLICK HERE).  Because there are structures that run from the upper cavity to the lower cavity (chiefly the esophagus and aorta), naturally there must be holes in the diaphragm to let them pass through. 

Since the diaphragm moves up and down in order to pull air into the lungs and then push it back out, there is a constant sliding of the diaphragm on these anatomical structures.  For any number of reasons, these holes known hiatus' (Latin: to stand open, to split; opening, aperture, gap; to yawn) can tear and become larger, potentially allowing part (or in some cases, all) of the stomach to be pulled up through the diaphragm and into the thoracic cavity.  As would make sense, the amount of stomach that comes through, depends on the size of the tear (see pic above right). 

The top part of the stomach contains a one way valve (the esophageal sphincter) that excepting extraneous circumstances such as vomiting, only allows food to travel in one direction; down into the stomach.  If the top part of the stomach is pulled up into or through the hiatus, this process can open the esophageal sphincter valve, allowing acid and stomach contents to reflux upward and burn the esophagus. 

Be aware that Hiatal Hernias can actually wax and wane; come and go.  Sometimes part of the stomach is pulled up through the diaphragm, but the hernia can, for various reasons, be reduced and return to normal, at least temporarily.  Below is a short, animated video showing the two kinds of Hiatal Hernias, sliding and rolling.  Statistically, about 95% of all hernias are sliding.

As you might imagine, there are a number of risk factors for developing Hiatal Hernias.  Although the biggest two are probably OBESITY  and SMOKING, there are plenty of others, including ASTHMA (COUGHING), CONSTIPATION (constantly straining at the stool), regular vomiting (such as might be seen in bulimia), trauma, stress (ADRENAL FATIGUE or SYMPATHETIC DOMINANCE), constant bending, PREGNANCY, too much sitting, or heavy lifting.  Let me show you the symptoms of an HH.

• ASYMPTOMATIC:  Remember that only about 10% of of Hiatal Hernias create any symptoms at all --- not a unique situation when  it comes to health and healthcare (HERE).

 

• REFLUX:  Although reflux can be caused by lots of things (TOO LITTLE OR TOO WEAK STOMACH ACID BEING THE MOST COMMON), I've shown you how HH causes reflux.  Thus, if you are constantly experiencing regurgitation, there is a significantly increased chance you have a Hiatal Hernia.

 

• ESOPHAGITIS AND ESOPHAGEAL STRICTURE:  Although HH can cause stomach acid to reflux all the way up into the mouth (I've treated a number of patients who actually have rings of chapped redness around their mouths from being burned by their own acid at night), it's the lower esophagus that bears the brunt of the damage.  Stomach acid where it should not be (where it there is no mucous lining to protect it) can cause the formation of both scar tissue (FIBROSIS) and stricture / constriction / loss of elasticity in the lower esophagus.  It can also cause something called Barrett's Esophagus (precancerous lesions).  As you might suspect, all of these increase the chances of developing full-blown cancer.

 

• MOUTH & THROAT ISSUES:  This could be dry mouth, bad breath, bleeding gums, chronic cough, rough or scratchy voice, hoarseness, and / or trouble swallowing.  Speaking of trouble swallowing....

 

• TROUBLE SWALLOWING:  Known as dysphagia, it's simple to see that with everything we've covered so far, trouble swallowing would be a natural sequelae.  This was shown in a study from last August's issue of Current Gastroenterology Reports (Hiatus Hernia as a Cause of Dysphagia).  "Dysmotility because of impaired contractility and vigor can occur as a consequence of repeated acid exposure from the acid pocket within the hernia, and the resultant poor clearance subsequently worsens this insult. As such, dysphagia appears to be more common with increasing hiatus hernia size. Furthermore, mucosal inflammation can lead to fibrotic stricture formation and in turn obstruction."

 

• DIGESTIVE ISSUES:  These are similar to what you get with other common digestive issues; post-meal bloating, gas, nausea, and even vomiting.  Be aware that vomiting blood is never a good sign (copious amounts of blood in the stool will appear black).  Also be aware that in many cases, indigestion will manifest as chest pain thanks to the stomach encroaching into the thoracic cavity.

 

• TROUBLE BREATHING:  Although it was mentioned as a risk factor, the November issue of the Clinical Respiratory Journal (Contribution of Hiatal Hernia to Asthma in Patients with Gastroesophageal Reflux Disease) concluded that "The patients with GERD with asthma have a high prevalence of Hiatal Hernia."

 

• MIGRAINE HEADACHES:  Although there are about a million potential causes of MIGRAINE HEADACHES, add one more to the list --- Hiatal Hernia.  In a study published in last July's issue of the Middle East Journal of Digestive Diseases (Association of Gastrointestinal Functional Disorders and Migraine Headache: A Population Base Study), a group of physicians from Iran's Shiraz University came to some interesting conclusions after looking at over 1,000 random patients with GI complaints.  "This study revealed an association between migraine and gastrointestinal functional disorders including IBS, reflux and dyspepsia. Hiatal hernia was the only abnormal endoscopic finding in patients with migraine headache."

 

• HEART:  Hiatal Hernias can mimic heart problems by causing chest pain.  A case study from last July's issue of BMJ Case Reports (Hiatal Hernia Mimicking Heart Problems) described heart attack-like symptoms in a 74 year old man whose stomach had worked its way from the abdominal cavity, through the diaphragm's esophageal hiatus, and into the thoracic cavity with the heart.  While not an everyday occurrence, neither are these massive HH's uncommon.

 

• ANEMIA:  Although there are numerous causes of ANEMIA, according to a 2015 study from the International Journal of Gastroenterology and Hepatology, one of them is "underappreciated" (An Underappreciated Cause of Intermittent Chest Pain, Asthma, and Iron Deficiency Anemia).  Peer-review abounds with similar studies --- not surprising considering loss of blood is the most common cause of anemia.

 

• SEIZURES & SYNCOPE (FAINTING):   The more the stomach is pulled upward into the thoracic cavity, the greater the chances it irritates the VAGUS NERVE.  Because of it's heavy parasympathetic action (see my earlier link on Sympathetic Dominance), stimulation of the Vagus can cause dizziness, fainting, and even seizures (or what appear to be seizures --- HERE).  July's issue of the Baylor University Medical Center Proceedings (Deglutition Syncope) carried a case study on this very thing --- "a 48-year-old man presenting with transient syncopal episodes that occurred while eating, caused by an intrathoracic stomach due to a hiatal hernia."  For the record, deglutition = swallowing.

 

• TROUBLE BENDING OVER:  Because bending forward  can cause the stomachs of those with significant Hiatal Hernia to enter the thoracic cavity, it's on the the list as well.

Although you can see how bad things can get, it's actually worse than that.   As crazy as it may seem, Hiatal Hernias can actually kill you.  That's why doing whatever it takes to get better --- hopefully without having to undergo surgery --- is a big deal, and potentially a huge boost to your health.

If you are diagnosed with reflux, whether from Hiatal Hernia or not, the very first thing that will happen is that you will be prescribed an H2 BLOCKER, or far more likely, a PPI (Proton Pump Inhibitor).  All you have to do is follow the links to see that these drugs (especially the latter) have been in the news for the past several years --- and none of it is good.  As far as medical care of an HH is concerned, the other option is surgery to repair the hiatus.  Although it appears that most people do well with the surgery, peer-review abounds with studies dealing with those who don't (so do internet message boards and Facebook groups).  Bottom line, if there are ways to avoid having the surgery, by all means use them. If you have one of those massive Hiatal Hernias where the stomach is in the thoracic cavity, I'm not sure there's really another option.

• DO WHATEVER YOU CAN TO GET OFF PPI'S:  In researching this post, I came across any number of message boards where people were trading information on getting off of PPI drugs, many of whom had been on them for decades (plural).  There is actually a school of thought that PPI's, over time, actually lead to HH.  Regardless, these drugs are bad news because they have a myriad of side effects, are meant to be used no more than six weeks a year, and are extremely hard to get off of (addictive) for people who have been on a long time.

 

• QUIT SMOKING:  Nuff said.  Along these same lines, be aware that alcohol is a common cause of reflux as well.

 

• CHANGE YOUR CRUDDY DIETARY HABITS:  Not surprisingly, Hiatal Hernia is largely a disease of the Westernized world.   Correct eating will not only allow you to reduce what might be the single largest risk factor (obesity) by LOSING WEIGHT, but not eating junk both reduces inflammation and helps with the whole GERD thing.  Bear in mind that the official stance of the medical community (I've seen the studies and GUIDELINES) is that changing one's diet has little to no bearing on a HH.  My stance is that you never go wrong cleaning up your diet. After you've done an ELIMINATION DIET to see what foods you might be reacting to, get them out of your life.  Oh; and for heaven's sake, don't eat shortly before going to sleepytown (within three or four hours of bed or nap time).  And as if I really need to say it; don't overeat. If I have to define "overeating" for you, you may be a bigger problem than your HH.

 

• SLEEP HABITS:  As we've seen, Hiatal Hernias affect breathing.  So does SLEEP APNEA.  The number one risk factor for both is obesity (see previous bullet).  Also, many people with HH will prop the head of their bed up on books or blocks to prevent the stomach from pulling upward into the diaphragm, as well as helping prevent acid from making its way upward as well.

 

• DRINK PLENTY OF WATER:  One of the single best regulators of STOMACH ACID is water.  The average person does not drink nearly enough.

 

• MASSAGE THERAPY, CHIROPRACTIC, AND OSTEOPATHIC MANIPULATION:  There are tricks to manually push the top of the stomach down from the thoracic cavity to it's natural home in the abdominal cavity, many of which can be done on your own (YouTube abounds with such videos)

 

• THE HEEL DROP:  This is my favorite "trick," and involves drinking a significant amount of water quickly (I'll not debate here whether the water needs to be warm or cold), and then rise up on your toes, dropping sharply onto your heels.  Repeat.  The force of the heel strikes cause the stomach that's already been weighted down by water, to "drop" downward out of the diaphragm and into the abdominal cavity.   I've been using this technique for patients for thirty years --- very simple and super effective for many of them.  In similar fashion, I've often wondered if REBOUNDING ON A TRAMPOLINE could accomplish the same thing in healthier individuals (anyone with experience here, feel free to chime in).

 

• DEAL WITH SIBO, LEAKY GUT, DYSBIOSIS, H. PYLORI, AND CANDIDA:  Although I could have covered a number of others here, this should give you a starting point.  Just bear in mind that all of these "GUT ISSUES" (SIBO, LGS, and DYSBIOSIS ---- including but not limited to CANDIDA and H. PYLORI) have the ability to magnify HH symptoms.

 

• CHANGE THE WAY YOU GO #2:  By this I mean that some of you might benefit from a squatty potty.  There is a fantastic article over at Nature's Platform on the subject, called Health Benefits of the Natural Squatting Position (the back half of the article has some very cool material from peer-review).

 

• LOOK AT YOUR MEDICATIONS:   Be aware that there are any number of PRESCRIPTION DRUGS that are known to cause reflux. 

In some cases, surgery to reduce the Hiatal Hernia and repair the torn hiatus is inevitable --- almost always the case with huge HH's.  For those of you who have tried everything else, it is something to at least look into.  Bear in mind, however, that according to a large study published just a few months ago in the Journal of the Society of Laproendoscopic Surgeons (Long-Term Patient-Reported Outcomes of Paraesophageal Hernia Repair), five thoracic surgeons from Cambridge and Tufts concluded that "Long-term patient-specific outcomes showed comparable, encouraging results between open and laparoscopic repair of PEH without mesh reinforcement. However, half of those undergoing laparoscopic repair required the use of medication for symptom control."  Did you catch that?  Having your HH repaired only reduces your chances of needing ongoing GERD meds by 50%.

In another study, this one from the Annals of Surgery (Paraesophageal Hernias: Operation or Observation?), researchers and physicians answer the question of whether people would be better off to just go ahead and have the HH surgery and get it over with.  After comparing "watchful waiting" (WW) to "elective laparoscopic paraesophageal hernia repair" (ELHR), the authors, three surgeons from Harvard University, concluded that "The mortality rate of ELHR was 1.4%. The annual probability of developing acute symptoms requiring emergency surgery with the WW strategy was 1.1%.  If ELHR is routinely recommended, it would be more beneficial than WW in fewer than one of five patients. WW is a reasonable alternative for the initial management of patients with asymptomatic or minimally symptomatic paraesophageal hernias, and even if an emergency operation is required, the burden of the procedure is not as severe as was thought in the past."

In most cases, following a WHOLE-BODY HEALTH PROTOCOL is going to help with the chief symptom of Hiatal Hernia; GERD or acid reflux.  If you do end up needing a surgery, always go into that surgery PREPPED AND READY.

This email is from "Suzie" who came to see me for neurological TOS a few years ago.  My treatment helped somewhat, but certainly not enough to call it successful.  With her permission, I am answering this for everyone to see because I know that lots of people are in similar situations.  To see other CASE HISTORIES just follow the link.

Dr. Russ,
I had the first rib resection for my NTOS on August 22nd. It is better but not 100% - wasn't expecting 100% anyway I guess.

I was off work for four months. For two of those months I did an elimination diet w/ no gluten, no dairy, no added sugar, etc. - I followed the Vital Mind Reset Diet by Dr. Kelly Brogan.  The first month I still ate white potatoes but she asks you to eliminate potatoes, rice, and legumes so on the second month when her program started I eliminated them. So, I was basically eating paleo - meats, veggies, and good fats! As an example, for breakfast I usually ate her KB Smoothie - I used collagen, nut butter, cocoa powder, coconut oil, and sometimes a raw egg yolk or two. Yes, she called it a fat bomb and the intent was to get your blood sugar stabilized. She stressed eating organic and grass fed & finished meats and non-GMO fed animals that need more than just grass like pigs or chickens.

Sounds good so far Suzie.  Remember that rice and white potatoes are both high glycemic (especially the potatoes) as well as being potential GLUTEN CROSS-REACTORS.  And while some people can eat BEANS AND / OR LEGUMES, not everyone can handle them.  BTW, I am a big fan of PALEO and / or HFLC (KETOGENIC) for people trying to deal with underlying or occult inflammation (there is also some crazy amazing information on scientists using Keto diets to address cancer -- HERE).

Honestly, I don't feel as though my depression improved. I lost weight. The pain in my feet subsided mostly and the tingling in my feet did as well for the most part. It was close to Thanksgiving when her program ended and I DID NOT reintroduce food as I should have. I went back to eating some bad food - I didn't go strictly back to bad food but I did throw it back in my diet. Sometimes I would eat pizza, or a PB&J sandwich with white bread, or a bakery pastry, etc. I would say I was doing 50/50 - 50% paleo and 50% crap. 

According to the peer-reviewed literature, DEPRESSION is one of the myriad of problems that fall under the category of "CAUSED BY INFLAMMATION".  Don't think I'm picking on you, but the whole point of putting in the time and effort to do an ELIMINATION DIET is to at some future time, "reintroduce" foods back so that you can figure out which one(s) you might be reacting against immunologically.  The thing to remember about food sensitivities (I'll use GLUTEN as an example since it's common), is that you have to go off of reactive foods totally.  It's why there is no such thing as a "low gluten" diet --- it's GLUTEN FREE.  And if you click the link, you'll see why I'm not a fan of most "GF" programs or foods. 

Because I myself am sensitive (whether it's actually a gluten issue or a FODMAP issue, I'm not totally sure --- functionally it doesn't matter), I have figured out that if I do a cheat day I pay for it.  Severely!  I took a big-time cheat day over this past Christmas break, and it took me a month to get my Gut straight afterwards.  That's why CHEAT DAYS for people whose only issue is their weight are usually not a big deal, but if you have sensitivities or serious underlying illnesses, you are much more likely to cause yourself extended grief each and every time you cheat.  This is the voice of experience speaking.  Every person has to ask themselves if it's worth it.  And this doesn't even begin to address the issue of potentially re-firing addictions (HERE).

I noticed stuff when I went back to foods I hadn't been eating for the 2 months. I couldn't always figure out which food it was but sometimes I could. Symptoms I started having were itchy skin, congested nose, watery eyes, sneezing (I have never been a sneezer - in the past if I sneezed I was coming down with a bug). I tried to have chili once - used soaked kidney beans instead of canned - terrible bloating. Potatoes and rice definitely cause runny nose, sneezing, etc. When I would eat pizza or a sandwich it felt heavy in my belly and my guts would just feel off. Sometimes my mouth will hurt on the inside or my lips will hurt. Other than the beans, which causes bloating fairly quickly, it will take a few hours for the runny nose, eyes, sneezing to start. Food intolerances or food allergies??? I have never had seasonal allergies in my life but now when I eat certain things that is exactly what I think people who have seasonal allergies suffer from.

It almost sounds like a histamine thing, but GRAINS and potatoes actually have low histamine levels.  However, they are both on the cross-reactivity list above, meaning your body reacting against them could potentially cause excess production of histamine.  Also be aware that SIBO (Small Intestinal Bacterial Overgrowth), which is intimately related to FODMAPS (HERE), can cause increased Mast Cell activity (high histamine levels).  But then again, so can both LEAKY GUT SYNDROME and ALLERGIES.  Although there is a specific enzyme (HMT) for breaking down histamine in the CNS, histamine in the gut is broken down by the enzyme 'diamine oxidase' or DAO.   What causes diminished levels of DAO?  The very things mentioned in this paragraph, plus certain medications, chiefly ANTI-DEPRESSANTS and the non-PPI drugs used to treat GERD --- H2 blockers aka "Histamine Blockers" such as Pepcid, Tagamet and Zantec. 

Other drugs that affect histamine levels via decreasing your body's production of DAO include BETA BLOCKERS, NSAIDS, and the "biologics" people take for various AUTOIMMUNE DISEASES.  Oh; and yes, antihistamines as well (which I have seen cause back pain in a number of patients).  For the record, among the foods that are high in histamine, many are "healthy".  These include about anything fermented (including not only alcohol and vinegar, but various probiotic concoctions such as the KKK -- Kombucha, Kefier, and Kraut.  Furthermore, healthy green tea acts as a blocker of DAO.

The last month before I went back to work I was eating 50/50 and wanted to lower my dose of cymbalta. I want off thse antidepressants that I have been on for over 20 years. I was on a low dose but it was very hard coming off of this drug. I am no stranger to trying to get off antidepressants. I have been through hell coming off them in the past. I have finally been free of taking cymbalta for about 2 months now but initially I was extremely angry and wanted to be violent. I had a lot of trouble keeping myself in check. The rage from Cymbalta withdrawal has subsided but, as I'll explain in the next paragraph, I am still very depressed and angry. I am lowering my Burpropion dosage now but I have been on this before and never noticed major withdrawals from this drug.

The problem with antidepressants is that no matter what anyone tells you, they create a reliance on, or addiction to them.  Why?  It all has to do with negative feedback loops. Cymbalta is a SSRI ANTIDEPRESSANT with an added component that also blocks the reuptake of norepinephrine, officially making it an SNRI (Serotonin and Norepinephrine Reuptake Inhibitors).  In my humble opinion as the 'Village Idiot,' these are terrible drugs that should probably never have gained FDA APPROVAL. 

Although I am not an expert on the subject in any sense of the word, the internet abounds with horror stories of coming off of SNRI's.  When you block the body's "reuptake" of various neurotransmitters with SNRI's, you create artificially high levels of said neurotransmitters at the synapses.  The increased levels of neurotransmitters are supposed to, among other things, improve mood and energy levels.  The problem is that when you stop blocking the reuptake of any neurotransmitter, levels of said transmitters plummet.  The result can be a wide array of potentially severe (and in many cases 'bizarre') side effects. 

I am honestly not sure of the best way for people to come off of these drugs, although the web abounds with such articles.  For the record, Burpropion (Wellbutrin) is a drug used to treat depression, anxiety, and is used extensively in smoking cessation.  It is known to react with lots of drugs, including antihistamines and antidepressants, not to mention H2 Blockers.

The night before I went back to work I had horrible pain just below my sternum. I debated going to the ER a couple of times that night but didn't. I did not go to work the next day and the pain subsided after awhile. I hate work. I've hated it for a long time. I always hated school. I was not looking forward to going back. Within the first couple of weeks of work I started having bad heartburn although it took me a week to figure out what it was because I've only had heartburn a couple of times in my life. I was also getting pretty severe lower belly bloating. Some days I feel like I have a stomach full of acid and others I have pretty constant heartburn. Not every day is the same and some days are worse than others. I started drinking just smoothies - blend of lettuce, carrots, coconut oil, and sometimes beats, in the mornings and also sometimes at nights. Sometimes I feel like I can't eat anything or have no idea what to eat because everything seems to exacerbate my symptoms. I have had some pretty significant lower back pain start since going back to work too. At first I thought it was from sitting again a lot but I am wondering if it isn't related to whatever is going on.

Heartburn is usually the result of LOW STOMACH ACID (not high stomach acid), and among other things, can be brought on by various forms of stress (which when maxed, can cause ADRENAL FATIGUE), which also happens to be intimately related to SYMPATHETIC DOMINANCE.  Be aware that the medical community's solution for GERD is always H2 Blockers or more commonly, the even more dangerous PPI's I mentioned earlier.  Neither solves the problem, and in truth, frequently causes the problem to become virtually self-perpetuating to the point people cannot live without them.  And not that I need to tell you this Suzie, but going through life hating what you do for a living makes everything --- including healing your body and mind --- difficult, to say the least.  Unfortunately, I don't have a simple answer for this.

I had an ultrasound done of my gallbladder and kidneys, etc. and nothing abnormal was found. I met with a gastroenterologist last week who did not impress me, but no conventional doctor has other than the doctor I had in Boston for my TOS. I went educated into the appointment with the gastro and asked for tests. He said he thinks it is IBS w/ constipation. I don't accept it - I want to know why? (I have always been constipated. I didn't know that because I didn't realize going to the bathroom once every 3-4 days wasn't normal). I learned a few years ago after trying to figure out what was wrong with my arm that this isn't normal. I'd say for the last 4-6 weeksI have only pooped once on my own. The other times I have either done a coffee enema (I know they are not specifically for this) or just a water colonic to go to the bathroom) He also said, "since when is gluten related to depression?" when I mentioned the diet.

I had started taking some digestive enzymes, Duozyme, that Kelly Brogran recommends, but they hadn't helped. He took one look at them and told me to stop taking them. He ordered an Upper GI and Small Bowel Barium test which I had today. The doctor today that did the initial part of the test when you swallow the barium and he takes the x-rays told me right away that I had significant reflux - the tech said she could see it too - you could see me swallow the liquid and it go down but come right back up. The doctor today told me 2x that he saw major reflux. The gastro doc also ordered a comprehensive metabolic panel and a calprotectin fecal test because my sister has crohns. I insisted on an H. Pylori test. He said they don't test for SIBO which I think is absolutely ridiculous! I don't think I would have gotten these tests had I not been persistent. I didn't like the man. After he suggested it, I told him I had no intention of going on a PPI and he looked at me, shrugged his shoulders, and said, "that's what we do here". He told me at around the 30 minute mark in the appointment that he had to go because he had other patients waiting.

Be aware that tests like upper GI, lower GI, ultrasounds, MRI's, etc, etc, are looking for gross pathology, and not subtle or "functional" problems.  First, there is an intimate relationship between IBS --- a known autoimmune disease --- and SIBO (HERE).   You can purchase good DIY tests for both SIBO and H. PYLORI (not to mention several labs that do incredible COMPLETE STOOL ANALYSIS).  It's interesting about the "gluten" comment, because I hear patients complaining of it all the time.  Just yesterday I had a patient with an extremely rare issue (Tarlov Cysts) that she told her doctor that her symptoms improve when she stays away from gluten and sugar.  Her doctor dismissed it out of hand as stupid.  This is the norm because the system of healthcare we've created under our current insurance system cannot tell the difference between FUNCTIONAL PROBLEMS & GROSS PATHOLOGY!  I'll get to the CONSTIPATION momentarily, but isn't it fascinating that after all this song and dance, "what we do here," is put everyone on a PPI?

Since I have gone back to work my depression has gotten very bad. Most days I don't know how I make it through the day. I typically go in the bathroom to sit there and cry at least once a day. I can barely keep it together. My rage during Cymbalta withdrawal HAD subsided but as more stomach symptoms keep coming I have found myself angry/depressed almost all of the time now. I basically hate everyone and have nothing nice to say about anyone. I go from being so mad to bawling. I feel like I am about to explode any minute. I worry that I will lose it and keeping it in check is a full time job that is killing me. I want to snap. I have worked myself up into a mess writing all of this because I am at my wits end about everything...AGAIN...for the millionth time in my life.

I am utterly exhausted with myself and my issues. It took me 4 years to figure out what was wrong with my shoulder and have two surgeries because no doctor would/could help me. I was hoping for a better year - a new start - and the first day of the new year brought the beginning of more problems. I don't want to spend the money - it terrifies me to now have to spend even more money to try to fix whatever is going on now. I'm still paying for last years surgeries. I am utterly fed up with myself. I feel like I don't deserve this help - I don't deserve to spend more of our money to figure out what's wrong with me.  I hate myself for being sick. I just simply hate myself.

I wish I had all the answers for you Suzie, but I don't.  What I can tell you for sure is that you've got some issues going on with your GUT (probably both LGS and DYSBIOSIS).  Beyond the links I've provided today, be sure and look at THIS POST as well as our articles on FMT.   Bear in mind Suzie that you'll probably need some specialized FUNCTIONAL MEDICINE TESTING as well.  However, for most of you reading this, you can't really go wrong by starting to tackle your health on your own (HERE).   As is always the case, even though your doctor will probably disagree with you and think you are loony tunes, be sure not to do anything without their express written consent.

Although first touted by DR ANDREW TAYLOR STILL, there is a growing number of elite scientists researchers, and physicians, who believe the solution to many --- some would say most --- chronic illness and chronic pain is in the fascia (HERE).  We could definitely add one more to this list; Italy's Bruno Bordoni.  Dr. Bordoni (a physician, physical therapist, professor, and researcher at Rome's TorVergata University and Milan's Don Carlo Gnocchi Foundation) is in rarefied air when it comes to researching fascia.  Today I want to briefly take you through some of his studies on FASCIA, showing you how it really is related to everything that goes on in the body (for the record, many of Bordoni's studies are co-authored by Dr. Emiliano Zanier --- another Italian).

The first study we'll discuss today is from a 2014 issue of the Journal of Multidisciplinary Healthcare (Clinical and Symptomatological Reflections: The Fascial System),  The authors, Drs. B & Z, reveal that "Every body structure is wrapped in connective tissue, or fascia, creating a structural continuity that gives form and function to every tissue and organ. The human body must be considered as a functional unit, where every area is in communication with another through the fascial continuum, consequently originating perfect tensegritive equilibrium."  Right away the authors reveal that fascia is not only a mechanical continuum / structural continuum (TENSEGRITY), but is intimately involved in communication as well (FASCIA IS ITS OWN NERVOUS SYSTEM).

They went on to talk about the importance of both fibroblasts (which we will discuss later) and the ECM (fascia's "gelatinous substance known as extracellular matrix, where numerous molecules (ie, glycosaminoglycans, proteoglycans and polysaccharides such as hyaluronic acid) can be found").  They then discussed the way that the layers of fascia glide on each other ("The superficial fascia is made up of different layers, whose formation facilitates the sliding of one layer over another").  If you want to see what this looks like, one of the coolest things on my site is THIS TWO PARAGRAPH POST showing a side-by-side comparison (10 second videos) of the difference in the gliding ability of the low back fascia of people with low back pain, and people without.

For those of you fascinated by fascia as related to the LYMPHATICS, "according to some texts, within the superficial fascia there is a vascular network independent of the lymphatic and blood pathways. It is called the Bonghan duct system."  This is part of what allows fascia to act not only in a physical and neurological manner, but in a neurochemical manner as well --- it actually acts as a separate endocrine system (HERE).  Furthermore, fascia is its own PROPRIOCEPTIVE SYSTEM as well, likely containing as much proprioceptive power as any other single tissue.

"The deep fascia is the last connective layer before coming in contact with bones, muscles, and the visceral [organs], and vascular systems. Its vascular and lymphatic system is well developed, with numerous corpuscles in charge of proprioception....  The fascial continuum can be considered a sense organ of human mechanics...."

When proprioceptors / mechanoreceptors are not fired off to the brain (the most obvious reason for this would losses of motion, both SECTIONAL & SEGMENTAL), it's been said that every message that's prevented from going up to the brain (sensory messages are otherwise known as "afferent"), inhibits thirty responses coming back down on the motor ("efferent") side.  This is at least part of the reason that decreased function of fascia, and the abnormal firing of mechanoreceptors / proprioceptors that follows, is increasingly being associated with various disease states in the peer-reviewed literature.

"The muscle system is part of the fascial continuum, and when it is affected by pathologies or systemic disorders such as visceral [organ], genetic, vascular, metabolic, and alimentary [digestive] disorders, its function undergoes a nonphysiological alteration; there are many epigenetic processes that can lead to its adjustment as a response to mechanotransductive stimuli, resulting in further decrease of its function and properties. Once altered, the fascial continuum generates a symptomatology that deteriorates the health condition of the patient, very often developing symptoms that are more significant than the clinical parameters diagnosed through medical diagnostic devices.  The nociceptive afferent inputs [pain or similar] from the fascial system can modulate the afferent response from the central nervous system. If the afferent is not physiological, the efferent will be in dysfunction and in pathology.  An increased level of circulating cytokines originating in the connective system, due to systemic pathologies, could develop neuropathic pain."

Pay attention to what this is saying.  When MECHANOTRANSDUCTION (the ability to convert mechanical energy into electrical messages) is altered by faulty or "altered" BIOMECHANICS, there is a loss of function that goes far beyond anything we can see with current technology (CT, MRI, X-rays, etc).  The symptoms that develop as the result of said biomechanical dysfunction may not only be severe, they are also not nearly as controlled by genetics as they are by "epigenetics" (HERE).  When this cycle gets going, it can become "vicious," feeding itself.  Furthermore, when you add circulating CYTOKINES (INFLAMMATION) to the mix, the result can be the neuropathic pain we refer to as CENTRAL SENSITIZATION (in many of his studis he talks about ALLODYNIA & HYPERALGIA), with the paper's next several paragraphs talking about fascia's relationship to "normal" pain.  When I say 'normal' I mean the everyday chronic, severe, pain that's caused by SCAR TISSUE (fascia that has become FIBROTIC and THICKENED, or "DENSIFIED").

"The loss of a correct sliding of the layers is demonstrated by an increased density of the fascial thickness... termed... fascial densification. Defective sliding, for instance due to a scar, generates tension, which then affects the fascial continuum, developing painful symptoms. Tensional alterations can derive from the contractile property of fibroblasts, creating a fascial tonus that is independent of neurological intervention. A nonphysiological [pathological] mechanical environment stimulates an inflammatory environment, with resultant fibroblasts’ hyperplasia and further fascial densification, which then develops into chronic inflammation and into the sensitization of nociceptors."

Because I am running out of time, let me give you an overview of the rest of the paper.  The authors speak at length about the relationship between OSTEOPOROSIS & INFLAMMATION, saying "The fibroblasts (the foundations of the fascial system) affect the immune system, and as a consequence bone tissue; this phenomenon is called osteoimmunology," and then going on to mention that the same phenomenon is likely present in RA.  Not surprisingly, they talk about some of the principles mentioned in Meyer's ANATOMY TRAINS ("The fascial continuum can also develop symptoms in areas which are far from the original dysfunctional point") as well as discussing CHRONIC NECK PAIN caused by dysfunciton of the CERVICAL FASCIA ("an alteration in the thickness of the fascial layers has been verified, with consequent altered spinal mobility and pain").  Beyond pain, said dysfunction also causes many of the mechanics of vision to be abnormal, as well as gait and balance issues. The authors end by spending a number of paragraphs showing how fascia is an organ of special senses that have been referred to as "interoception".  Interoception?

Mechanoreception, mentioned earlier, deals with your body's ability to sense "mechanical" entities like stretch, pressure, movement, vibration, etc.  Interoception is a bit different. In a study probably not named after Ric Ocasek's 1986 hit (HERE), last year, Complimentary Medicine Research carried a study called Emotions in Motion that dealt with something known as the Body / Mind (aka the Mind / Body Connection).  Dr. B kicked things off by talking about some of the "pioneers of psychotherapy," and the way they connected the psyche to the body in a single "mind-body functional unit".  Bordoni went on to talk about the ways that some of the same receptors that sense mechanical activities (the mechanoreceptors that allow for proprioception) have the ability to act in terms of interoception.  While Oxford's Reference Guide defines 'interoceptor' thusly ("any receptor organ composed of sensory nerve cells that respond to and monitor changes within the body, such as the stretching of muscles or the acidity of the blood"), Bordoni himself says.....

Interoception is the awareness of the bodily condition based on the information derived directly from the body. The pathways pertaining to interoception project towards the autonomic and medullar homoeostatic centers and the brainstem, where they are routed to the frontal cingulate cortex and the dorsal posterior insula, by the thalamocortical circuit. Interoception can modulate the exteroceptive representation of the body, as well as pain tolerance; dysregulation of the pathways that manage or stimulate interoception could cause a distortion of one's own body image, influencing emotionality.

The authors went on to discuss how different kinds of bodyworkers, PT,s chiros, osteopaths, etc, etc, are able to stimulate these areas of the brain by stimulating the interoceptors found in fascia, thereby affecting the body "emotionally".  They then discussed various pathways and mechanisms, specifically addressing the way that "skeletal muscle tensional load" along with "fascial deformation" (HERE is a link to fascial deformation) are able to increase blood flow via sympathetic response, which triggers certain responses in the brain ("Scientific research has proven that the fascial continuum is innervated by the autonomic sympathetic system").  This is why HOMEOSTASIS is critical in the autonomic nervous system, and why SYMPATHETIC DOMINANCE can cause problems in the body, the mind, and the emotions.  As crazy as it may sound to those within the mainstream, "A disorder involving the myofascial system will have repercussions on the emotional state. There is a strong relationship between the myofascial structure and the emotions."  Bordoni goes on to say...

"We can say that the presence of a disorder of the myofascial continuum, during everyday movements and activities, can alter the emotional state of the person, as studies reveal in the presence of fibromyalgia and in other pathological situations. It is possible to suppose that an emotional allodynia could be established originating from constant myofascial non-physiological afferents, which would bring the emotional state and the myofascial pathology to the same level. In fact, the very position of the body stimulates the areas of emotionality, and the presence of myofascial alterations leads to postural alterations. A dysfunctional myofascial system alters the posture and the emotional state."

After all, what is FIBROMYALGIA but an extreme state of ADRENAL FATIGUE (some might call it Sympathetic Dominance), many times to the point the body has burned its adrenal glands down to a frazzle (yes, 'frazzle' is a scientific term!).  Think about it like this; I personally periodically deal with TRIGGER POINTS. When they get fired up, you had better believe they effect my emotions. And yes, POOR POSTURE affects the whole thing because trunk flexion (a bent-forward or HEAD-FORWARD POSTURE) aggravates the whole mess.  And while it's easy to dismiss this as a purely mechanical / biochemical phenomenon, Bordoni clearly shows that it is neurological and biochemical as well.

Speaking of neurological, Bordoni and Zanier teamed up yet again for a 2013 study called Cranial Nerves XIII and XIV: Nerves in the Shadows.  If you've ever studied anatomy, the very title of this study will surprise you because there are only 12 Cranial Nerves (always named according to their corresponding Roman numeral --- for instance, THE VAGUS NERVE is CN:X or Cranial Nerve Ten).  There are no such things as CNXIII or CNXIV ---- or are there?  I am not going to dwell on this study, but instead will highlight for you a single paragraph having to do with fascia.

"The current view is that nerve N has the ability to affect sexual behavior... . It is believed to act by stimulating luteinizing hormone-releasing hormone on contact with pheromones, improving olfaction and identifying odors, and this series of events will affect sexual behavior.  Finally, the trigeminal system can be stimulated by odors. If a connection between the cervical sympathetic ganglia, the trigeminal system, and the aforementioned nerve [Nerve N] was confirmed, we might better understand and explain some cervical [neck] disorders, such as those related to the menstrual cycle or chronic rhinitis [chronic sinus]. In addition, we could link certain sexual behavioral disorders to trigeminal pain.  In order for the body to maintain homeostasis, each and every part needs to be in harmonious and tensegritive collaboration, with regard to not only fascial but also immunological, neuroendocrine, and psychological functioning."

Now, we'll take a look at the way that fascia is both affected by and affects movement, as well as it's relationship to the nervous system.

As I said at the beginning of today's post, there are an increasing number of scientists and physicians who strongly believe that the fascia is the key to understanding both health and disease.  Much of this has to do with the way that fascia acts on the nervous system.  The periphrial nerves in your body are surrounded by three layers of fasica --- endoneurium, perineurium, and epineurium (HERE).  When the gliding of these layers on each other is compromised by some sort of adhesion or restriction, Bordoni stated in 2015's Reflections on Osteopathic Fascia Treatment in the Peripheral Nervous System, that "there is an impediment to the sliding of the nerve, [causing] the rigidity of its fascial structures during joint movement to be increased....  All this will lead to fibrous adhesions, decreasing the sliding of the intrafascicular tissue. The fibrosis increases the compression both inside and outside the tissues with a thickening of the nerve. This is even more noticeable when the nerve passes through small areas. The situation described will generate pain symptoms."  This is only one of many reasons its critical to keep your fascia moving.  Speaking of moving fascia....

In my post on TENSEGRITY, I embedded a clip of Dr JC Guimberteau's Strolling Under the Skin.  In it you can see the way that fascia moves, and the fact that each individual strand of connective tissue moves in ways that are almost impossible to believe, and frankly impossible for me to explain.  Last year Bordoni published a study called The Indeterminable Resilience of the Fascial System in which he stated of fascia's structure....

"These microvacuoles (a repetition of polyhedral units of connective fibrils) under internal or external tension change shape and can manage the movement variations, regulating different body functions and ensuring the maintenance of efficiency of the body systems. Their plasticity is based on perfect functional chaos: it is not possible to determine the motion vectors of the different fibrils, which differ in behavior and orientation; this strategy confers to the fascial continuum the maximum level of adaptability in response to the changing internal and external conditions of the cell.  The fascial continuum is like a flock of birds flying together without a predetermined logic and maintaining their individuality at the same time."

So, when fascia is working, it's essentially an elegant "chaos," but what about when it's not?  On my site I frequently discuss "MICROSCOPIC SCAR TISSUE".  Scar tissue is different than normal tissue in in a variety of manner --- it's less elastic, more pain sensitive, weaker, and less vascular, making it prone to diminished vascularization and oxygenation.  And as you might have suspected, the whole mess is prone to both pain and re-injury.  Not a good situation.  Is there a viable solution?  There is, and it has little to do with THE "BIG FIVE".  What it does have to do with is tissue deformation.  Bordoni revealed this in 2015's Understanding Fibroblasts in Order to Comprehend the Osteopathic Treatment of the Fascia.

"The various layers communicate by a microvacuolar system, which is in turn composed of the same structures of the superficial fascia; it is a microscopic web, concerning vessels and nerves, in varying directions, and is highly deformable."

I mentioned tissue deformation earlier and told you that it is accomplished by putting mechanical stress / loads on the connective tissues like fascia.  In many cases, tissue deformation involves varying degrees of "CONTROLLED TRAUMA" to break the adhesion (an "UNTETHERING" if you will) so that said tissue can be progressively loaded (stretched) and untangled, and later on, strengthened. Dr. B went on to talk about the FIBROBLAST as being the, "foundation of the fascial system."  What makes STIMULATIING FIBROBLASTIC ACTIVITY --- stimulating the very cells that make COLLAGEN --- so foundational to the healing process?  Listen to these cherry-picked reasons.

"The fascial system can be plausibly considered a memory organ, because it not only registers the functions of the structures it surrounds and connects, but also memorizes any function or information arriving and departing from the same structures.  The fibroblasts contain receptors for the growth hormone (GH), and depending on the levels of growth hormone circulating they can secrete insulin-like growth factors (IGFs).  The cells of the fibroblasts directly affect contractile tissue repair. They secrete different soluble substances, such as insulin-like growth factors (IGFs), fibroblast growth factors (FGFs), hepatocyte growth factor (HGF), interleukins (ILs), and nitric oxide (NO), as response to mechanical information undergone by the muscles.  The cannabinoid receptor or CB1 can be found in the fascial system and in the fibroblasts as well. This relationship is believed to better manage any inflammation and pain information originating in the fascial tissue, as the fascia undergoes continuous remodeling during the day.  Fibroblasts regulate the pressure of fluids and the flow of liquids that permeate the fascia. When the fibroblast undergoes a strain, the water inside is expelled toward the extracellular matrix.  Every fibroblast is potentially aware of the functional state of the one close to it, as well as those distant from it, ensuring the fascial and mechanical continuity.  They convey tension, dynamically affect mechanical tension, can rapidly remodel their cytoskeletons, When the fascial tissue lengthens, the fibroblasts flatten themselves and expand, increasing their area of action, are capable of metabolic responses....  This mechanism is known as mechanotransduction; tension is the 'language' of cells."

Holy Toledo that's amazing!  You can start to see why I've written OVER 150 ARTICLES ON FASCIA!  Believe me when I say that the quote above could have been longer (I cherry-pick everything due to constraints on time and space).  One other thing the fibroblasts do is help the fascia align itself so as to direct muscle fibers in the optimal direction / vectors, which creates both power and ease of motion.  But what happens when something goes wrong, when the fascia is not "aligned" properly, and motion becomes anything but easy? 

Although there are an endless number of ways to therapeutically affect the fascia, the goal is fairly universal.  Increase function, while decreasing pain.  Bordoni talks about "altering the mechanical properties of fascia, such as density, stiffness, and viscosity, so that the fascia can more readily adapt to physical stresses."  Some of this you can do yourself (STRETCHING, EXERCISE, FOAM ROLLERS, STEEL ROLLERS, "FUNKY GIZMOS," TRAMPOLINES, WHOLE BODY VIBRATION THERAPY, all sorts of FUNCTIONAL TRAINING, EXTENSION THERAPY, THE DAKOTA DEVICE, YOGA, PILATES, etc, etc, etc).  Some of it you'll have to have someone do for you / to you (HERE'S ONE).  The bottom line is that there must be "breaking of the fascial cross-links" --- the fibers that act like extra fibers in a net (HERE is a picture).

When treatment is done properly (note that this is more than a mechanical issue --- stick around to the end), "Fibroblasts are able to change their orientation and probably their mechanical behavior."  The end result is an "improved sliding of the various fascial layers, allowing resetting the afferent of the free nerve endings, resulting in physiologic response of the efferent."  In English this means that when you take abnormal pressure off of the sensory side of the nervous system, it allows the motor side of the system to function better, with the end result being better function and less pain.
But what about scar tissue that is stubborn or too deep to access easily?

It was Donnie Iris who famously stated in 1981's hit single, LOVE IS LIKE A ROCK, that, "you can't depend on your doctor."  Although some might debate the veracity of his statement, when it comes to effectively dealing with health problems related to fascia, it's not only true, with the average doctor it's doubly true.   I've given you a small taste of how bad scar tissue can be, but we're going to let Dr. Bordoni (along with Dr. Zanier) give us the bigger picture. 

The duo kicked things off in their 2013 study (Skin, Fascias, and Scars: Symptoms and Systemic Connections) by saying, "There are four main stages in skin healing: hemostasis, inflammation, proliferation, and remodeling."  Although I've talked about these in the past using slightly different names (HERE), allow me to take just a second to cover them for you again.

• HEMOSTASIS:  Hemostasis is when the heme (the blood) becomes stagnant (stasis).  This is the formation of the "clot" that contains all of the growth factors, platelet factors, and other anticoagulants, that begin the process of shoring up a "hole" (injury) in the tissue.
  
• INFLAMMATION: Inflammation (see my earlier link) is neither swelling nor infection.  It is a group of chemical messengers that allows the body's cells to communicate with each other.  Just remember that in the correct dose, local inflammation is vital for the healing process.  When there is too much however --- especially when it is coursing throughout the whole body --- it is the chief driver of most disease processes; even those that most people have been led to believe are "genetic".
  
• PROLIFERATION: Proliferation is exactly what it sounds like --- a proliferation of the collagenous tissue.  "Within 8–14 days from the injury, the third healing stage begins, involving the migration of the fibroblasts toward the provisional extracellular matrix made of fibrin and collagen.  The fibroblasts, which are stimulated by the different growth factors, are divided into myofibroblasts comparable with smooth muscle cells (they hold a protein, which is the alpha smooth muscle actin). These cells can increase the traction force, and thus they contract and reduce the open area of the lesion."  This is the phase that lasts up to six weeks, which is why insurance companies like to hound those who have been in WHIPLASH ACCIDENTS that the "science" says that treatment beyond a couple months post-accident is not warranted because all the healing that's going to take place has already taken place.
  
• REMODELING: Up to this point the scar is a jumbled mess --- a wad of fibrous tissue that is functionally similar to a hairball (HERE).  "Remodeling" simply takes the scar and makes it more functional --- hopefully more like well-combed hair.   "Remodeling can last for years and depends on the size and nature of the wound. In this phase, type 3 collagen is replaced by a stronger fiber such as type 1 collagen, but it is lined up without a specific order and is smaller than the collagen of an undamaged skin surface. This results in more strength but less elasticity."
  

The question now becomes, what causes scar tissue to go haywire, and what can be done to get the healing process back on track?  Let's talk about what we know --- things mentioned in the study.  Firstly, inflammation always leads to fibrosis (HERE).  So, if at any point in the process, you can control "SYSTEMIC INFLAMMATION," you've helped control the amount of "fibrosis" the body is laying down.  When talking about Sympathetic Dominance and increased inflammatory response (something I mention HERE), the authors mentioned that "We can logically assume that in the presence of a scar, these receptors may experience an alteration, resulting in transmitting nonphysiological signals and creating a pathological reflex arc."  This would account for the Central Sensitization and Complex Regional Pain Syndrome (it used to be called Reflex Sympathetic Dystrophy) mentioned earlier in the post.

Drs. B & Z also discussed people who genetically build great deals of scar tissue (HERE), as well as the direction of the injury and subsequent scar tissue (LANGERS LINES).  Not surprisingly both mechanoreceptors and nociceptors are affected by scar tissue, particularly if it's being exposed to chronic inflammation (HERE). 

"We can logically assume that in the presence of a scar, these receptors may experience an alteration, resulting in transmitting nonphysiological signals and creating a pathological reflex arc. It is worth remembering that the language of the cell is, precisely, the tension, which activates the mechanotransduction (ie, the chemicobiological and metabolic response to the tension). This response will be different depending on how the tension emerges and depending on different parameters. However, it is usually ignored that if the tissue where the tension is observable is in an unbalanced condition, as in the case when a scar is present, the cells cannot properly interpret the message, giving consequent anomalous responses.  Fascial tissue is made of contractile fibers, which may possibly produce spasms and consequential dysfunction and pain"

The authors go on to talk even more about the relationship of fascia to the sympathetic nervous system, once more providing a glimpse at potential mechanisms of Sympathetic Dominance and whole body symptoms (make sure to see my suggestions for toning down the sympathetic response --- HERE).   And this is where things start to get wild.  Bordoni talked about the fact that both sensory and motor nerves carry things other than electrical impulses ("chemicobiological, neurotrophic, and at the same time, immune substances"), potentially causing scar tissue to transmit a wide variety of aberrant messages to the brain and various parts of the body. This is at least part of what creates such a wild array of the bizarre and seemingly unrelated symptoms seen with chronic soft tissue injuries --- especially when the HEAD is involved (these people are often labeled by their doctors as "crazy").

"When there is a fascial injury, there is a fascial dysfunction.  A physiological alteration in any part of the body will affect, as a result, everything that is covered by the connective sheet: the symptom will arise in the area concerned with the alteration or, in contrast, in a distal [distant] area, when this is not capable of adapting to the new stressor."

Bordoni goes on to compare / contrast ankle injuries to spinal injuries, talking about how one can affect the other on numerous levels (mechanical, biochemical, neurological, etc).  Pay attention to this direct quote.

"We can then assume that if a scar on the ankle creates an adhesion, this unusual tension will also be recorded by the thoracolumbar fascia, with the consequent appearance of back pain or dysfunctions in the shoulders. It is acknowledged that the thoracolumbar fascia can cause lower back pain or anomalies in the arthrokinematics of the shoulders. Furthermore, when the fascial surface is not in its normal physiological condition, the normal fascial receptors can develop into nociceptors, with a more complex symptomatology.  The sympathetic nervous system is connected to the emotions, and we can assume an emotional alteration resulting from nonphysiological information arising from the periphery. We can still hypothesize the presence of thalamic and hypothalamic dysfunctions because of relations with the sympathetic system and skin.  We can also logically theorize that in time, a scar on the ankle might generate a visceral dysfunction."

Allow me to summarize.  A high-flying basketball player roaches his ankles several times, causing fascial and TENDINOUS dysfunctions.  Coupled with systemic inflammation from living the HIGH CARB LIFESTYLE (it's what "healthy" people were doing in the 1980's), he develops problems in the THRORACOLUMBAR FASCIA that creates a degree of chronic low back pain as well as LEVATOR TRIGGER POINTS behind the shoulders.  The mechanoreceptors found in fascia are actually converted to nociceptors (pain sensors), that ratchet up the sympathetic side of the ANS (autonomic nervous system).  This can actually lead not only to chronic pain but to problems in the viscera (the organs).  It also, as I showed you earlier, changes ones emotions.  How do I know this?  After three separate avulsion fractures of my ankles (right twice, left once), I was at one time ready to have my right ankle amputated until THIS HAPPENED.  Through changing my diet, methods of exercise, and improving the ways I treat myself, I am about 90% better than I was 12 or 14 years ago.  Although I never want to go back there again, the experience undoubtedly led to a better understanding and dogged determinedness to help those suffering with their unique problem(s).

As for surgeries, Bordoni and Zanier went on to talk about SPINAL SURGERY, ABDOMINAL SURGERY, KNEE SURGERY, and several others.  They also talked extensively about the potential problems associated with said surgeries --- adhesions, scar tissue, chronic pain, pathological biomechanics, muscle spasms, visceral dysfunction, ABNORMAL PROPRIOCEPTION, along with dozens of others.  It's why I always suggest conservative methods before trying surgery.  Listen to what they say about the potential far-reaching effects of a surgery on the low back, including its ability to adversely affect the Cervical Fascia and / or cause TOS.

"A lumbar scar could increase the tension of the deep fascia of the neck, pulling the stellate ganglion. This event may cause symptoms at the level of the cervical and thoracic outlet and negatively affect all the neural structures related to it. To exclusively treat the joint negatively involved will not solve the problem."

What does solve the problem?  Although there are many thought processes, Bordoni and Zanier discuss solutions in another 2015 study called A Multidisciplinary Approach to Scars: A Narrative Review.  Here are some of the methods they mention in their study.  Clear the HPA-AXIS, control inflammation, make sure your body is dealing with OXIDATION, HYPERBARIC O2, OT, PT, DO, CHIRO, MASSAGE, BODY WORK, NEEDLING, CUPPING, HERBAL, Ayurvedic, homeopathic, or naturopathic remedies, NUTRITIONAL SUPPORT, along with several others.  But what happens when these approaches fail and you are forced to have surgery?

In 2016, Bordoni came back with a study called Failed Back Surgery Syndrome: Review and New Hypotheses.  What's interesting to me is how he shows studies on back surgery are literally all over the place.  "The percentage of pain detected after spinal surgery varies ranging from a low of 5% to a high of 74.6%, and the percentage of need for re-operation ranging from 13.4% to 35%." This is yet another example of NOT BEING ABLE TO TRUST STATISTICS. 

Because we've covered most of the basics of why a back surgery might fail, I am going to mention the one that most people are totally unfamiliar with, the diaphragm.  "One component that is not even considered when trying to understand the reasons for failed back surgery syndrome is dysfunction of the diaphragm muscle, which is not referred to in the literature. The diaphragm is involved in chronic lower back and sacroiliac pain and plays an important role in the management of pain perception."  Which brings us to our next section......

If you click on the pics above, you can blow them up and take a look at the relationship between the muscle we call the diaphragm, the abdominal cavity, THE RIBS, and the spine.  Although Bordoni is one of the world's foremost experts on fascia, his niche would have to be the diaphragm.  In 2013, Bordoni and Zanier published a study on this topic called Anatomic Connections of the Diaphragm: Influence of Respiration on the Body System.

"From a functional perspective, two areas can be recognized in the diaphragm, ie, the crural region and the costal region. The former is responsible for correct breathing, whereas the latter prevents gastroesophageal reflux. This separation has an anatomic function, because during deglutition [swallowing], esophageal distention, and vomiting, these diaphragmatic areas must work at different times and with different innervations [nerves]."

This brief video shows the bony attachment points of the diaphragm.  Notice how when it contracts it pulls downward, causing negative pressure in the thoracic cavity to "draw" air in, while when it relaxes, it pushes air upward and out.

Listen to what the authors say about the pelvic diaphragm (pelvic floor) in relation to breathing.  "The pelvic diaphragm not only has a significant role in supporting the pelvic organs and in resisting increasing pressure, but also affects respiratory function."  And while I will not cover it here, the authors dealt at length with the diaphrgm's numerous neurological connections (including the phrenic nerve), saying "It is important to emphasize that when an organ such as the liver or the gallbladder does not function properly, the phrenic nerve will be affected."  Yet another example of everything affecting everything (and be honest; how crazy common are LIVER / GALL BLADDER issues in the Westernized world?).  Speaking of EVERYTHING BEING CONNECTED ("the deep cervical fascia reaches the pubis via the fascia transversalis"), let's take a look at the study's section called Fascial Connections.

"It is important to consider the fascial and connective links between the diaphragm and the pelvic floor, and the rest of the body. First, the abdominal muscles are related to the costal, lumbar, and pubic iliac regions of the body, ie, rectus abdominis, the internal and external oblique muscles, pyramidalis, cremaster, transversus abdominis, great psoas, quadratus lumborum, sacrospinalis, and transversus spinalis (where the multifidus spinae is distinguishable). Further, the fascial tissue possesses fibers capable of contracting, probably causing spasms, followed by dysfunction and pain.  When there is a problem in the diaphragm or in any of the structures belonging to this fascia, there will be dysfunction.  A physiologic alteration in any part of the body will affect everything that is covered by this connective sheet: the symptom will arise in the area concerned with the alteration or in a distal area, when this is not capable of adapting to the new stressor.  If handling of these forces is restrained, postural and visceral equilibrium will become dysfunctional. We can assume that the phrenic nerve passes through the deep fascia and media, and be indirectly affected by the superficial fascia of the neck."

Interestingly enough, Bordini not only talked about reflux and PPI drugs in this study, just last month he published a study called Low Back Pain and Gastroesophageal Reflux in Patients with COPD: The Disease in the Breath.  I've talked to you about GERD and the dangers of PPI's (Proton Pump Inhibitors --- aka "acid blockers"), as well as giving you a posts on both CHRONIC LOW BACK PAIN and COPD.  Bordoni and his team put the whole thing together, showing you not only how common all of them are in our society, but just how intimately related to each other they are as well.  Although I have dealt with it on my site, the question now becomes, how do you successfully address the issue without drugs?

In 2016, Bordoni published a study on this very topic called A Review of Analgesic and Emotive Breathing: A Multidisciplinary Approach, in which his team stated "The diaphragm is the primary muscle involved in breathing and other non-primarily respiratory functions such as the maintenance of correct posture and lumbar and sacroiliac movement. It intervenes to facilitate cleaning of the upper airways through coughing, facilitates the evacuation of the intestines, and promotes the redistribution of the body’s blood. The diaphragm also has the ability to affect the perception of pain and the emotional state of the patient."  After going on to talk about the many neurological and mechanical connections between breathing, the diaphragm, and the problems mentioned above, he suggests the solution.

"It is undeniable that a respiratory disorder can alter the emotional picture, similar to depression and anxiety, and it is equally true that an altered emotional state worsens the respiratory function. Considering also the emotional side during manual treatment, such as manual therapy or an osteopathic treatment, would probably be more helpful for the patient."

I would add to that, learning how to breathe properly.  While I will not go into this topic in depth, realize that there are different schools of thought on exactly what "proper breathing" should look like.  A number of years ago I met a gentleman from Switzerland (actually this guy was in his 60's and looked and sounded like a smaller version of Arnold in his prime), who had cured (his word, not mine) a number of major health problems using the Buteyko Method of breathing, developed by a Russian MD, Konstantin Pavlovich Buteyko, back in the 1950's.  He gave me a couple of E-books on the subject, which are fascinating to say the least, the premise being that controlling your CO2 levels is far more important for all aspects of breathing and health that O2 levels.

There is one more study I need to mention before heading to the final section --- last year's The Five Diaphragms in Patients Following Cardiac Surgery in Sternotomy: An Observational Study.  The authors, led by Dr. B, looked at and examined 300 patients that had been cut from stem to stern during open-heart surgery.   The study had a great deal to say about the fascial system as related to the body's five different diaphragms ---- the respiratory diaphragm, pelvic floor, buccal diaphragm (the cheek), the thoracic outlet (where TOS occurs), and the tentorial diaphragm (made up of the tentorim cerebelli or membrane that separates the brain / cerebrum from the cerebellum).

"The fascial continuum creates a structural continuity that  gives form and function to every tissue and organ. The human body must be considered as a functional unit, where every area  is in communication with another through the fascial continuum, consequently originating perfect tensegritive equilibrium.  The dural fascia system of the skull continues, coming into contact  with  the  deep  cervical  fascia,  continuing  with  the  endothoracic  fascia  anteriorly  and  the  thoracolumbar  fascia  posteriorly;  the   first  continues  with  the  transversalis  fascia  until  the  pubis,  while  the  second  involves  the  whole  of  the  posterior  area  of  the   body. This fascia system involves all the bodily diaphragms,  including the respiratory diaphragm. Trauma following a  cardiac  surgery  with  a  sternotomy  will  affect  all  the  diaphragms  as a result of the anatomic and neurological continuity.  The evaluation has  highlighted  the  structure  of  fascia  restrictions  and   the preferential positioning of such structures.  The diaphragms of the body are  considered a pivotal point in the interpretation of the patient’s clinical status and treatment."

Just last month Bordini published a study in Future Cardiology called Depression and Anxiety in Patients with Chronic Heart Failure.  I've shown you in the past how DEPRESSION is linked to any number of health-related problems (including heart problems), via INFLAMMATION.  This latest study strengthens this link.  His study, of course, has a strong emphasis on the diaphragm, but goes beyond that.  After talking about the sheer numbers of people as well as the astronomical costs associated with caring for said people, Bordini got down to the brass tacks of the study.  In a phrase that could have easily gone in the section above....

"The inspiratory dysfunction of the diaphragm is a key element in patients with chronic heart failure, influencing mortality and morbidity rates. The breath becomes more superficial, with increase of the sympathetic activity; the sympathetic nervous system stimulates the phrenic afferents, which in turn stimulate the sympathetic fibers, in a vicious circle. This pathological condition predisposes the patient to arrhythmias and higher risk of sudden death."

The authors went on to discuss the VAGUS NERVE (use it to your advantage to counteract Sympathetic Dominance), and the way it can become compromised......

Emotional conditions such as anxiety and depression can negatively affect the baroreceptors’ response [pressure receptors in blood vessels used to adjust B], as well as they can produce an altered function on the diaphragm. The action of the diaphragm is not only controlled by metabolic factors, but also by emotional states such as sadness, fear, anxiety and anger. The interaction between the breath and the emotions involves a complex interaction between the brainstem and a few brain centers...   The breath stimulates the mechanoreceptors of the diaphragm and the visceroceptors of the viscera [organs] moving during the respiration, which constitute the interoception mechanism.   A dysregulation in the interoceptive pathways could cause a distortion of the body image, affecting the emotional condition. Anxiety can alter a few afferent pathways related to breathing, amplifying one or more receptor pathways related to the respiration.  The phrenic and vagus nerves provide visceral information.

The authors went on to talk about the way that abnormal stretching of peripheral nerves affect the ability of the fascial sheaths of said nerves to slide on each other properly.  This is a big deal because the sliding of the fascial layers is a huge source of PROPRIOCEPTION / MECHANORECEPTION, which, as you already know if you've seen the post that has over 50K likes on Facebook, is responsible for everything that occurs in the body (and one of the reasons that growing numbers of scientists and physicians feel that fascia holds the key to solving most disease processes).  In fact, these authors discussed the ways that functional problems in this system cause (I am loosely quoting here) 'pain, anxiety, depression, intense emotions, neurogenic neuroinflammation, trouble breathing, functional impairment of the muscle tissue, further destabilizing the function of the diaphragm, as well as problems in the hormonal system and brain itself (the hypothalamus–pituitary axis),' affect the rest of the body.  Even for you Yoga Masters out there, who knew that breathing was this big a deal? BTW, the next logical question is how to successfully affect the fascia to improve cardiovascular function and breathing?

Although I've already touched on this, in a study from October of 2015, Bordoni answered this question via a study titled The Fascial System and Exercise Intolerance in Patients with Chronic Heart Failure....  After talking about the relationship between inflammation, Sympathetic Dominance, OXIDATIVE STRESS, and heart failure, Dr. Bordoni went on to say...

"The literature, however, recognizes fascial dysfunction as a cause in many pathological situations. The fascial system, if altered, generates a symptomatology that deteriorates the health condition of the patient, who very often develops symptoms that are more significant than the clinical parameters diagnosed through medical diagnostic devices."

These are the same tests and parameters that frequently tell doctors that there is nothing wrong with you.

"Chronic fatigue, for instance, can be associated with the fascial system, particularly when the pathological disorder has persisted for several years. A recent experimental study has shown that common physiological mechanisms may be involved in the causation of muscle pain and fatigue; the nociceptive afferent [pain] inputs from the fascial system can modulate the afferent response from the central nervous system. If the afferent is not physiological, the efferent [motor side of the nervous system] will be in dysfunction and pathology."

Affect the motor portion of the nerve and you affect everything.  That would be everything with a capital "E".  "Muscle fatigue is associated with a decline in motor coordination and performance. The fascial continuum is essential for transmitting the muscle force and for correct motor coordination: the fascia is a vital instrument that enables the individual to communicate and live independently. The transmission of the force is ensured by the fascial integrity, which is expressed by the motor activity produced." In other words, FASCIAL ADHESIONS are going to adversely affect the way your body's various parts communicate with and respond to each other, in turn affecting your bodies ability to function as normal on almost any plane you care to discuss.  This is why dealing with said adhesions is a big deal. Here is a loosely quoted list of the benefits of manual therapies. 

"Improve motor coordination, reduce metabolic expenditure, decreased intolerance to exercise, increase proprioception, reduce inflammation and influence anti-inflammatory cytokines, affect the intramuscular pH, modulate acid/base parameters, modulate the temperature of the extracellular matrix, better removal of waste metabolites, favor production of hyaluronic acid, increase fibroblast growth factors (FGFs), hepatocyte growth factor (HGF), ILs, and nitric oxide (NO), improve coordination and posture, improve tone, improve biotensegrity, improve urinary incontinence, and positively affect breathing.   Working on these interconnected parts of the body in terms of fascial and neurological links; it is possible hypothetically to create an improvement in the patient’s symptoms, due to the improvements of the fascial system. Evidence-based medicine is based not only on scientific research highlighted in articles, but also on the patient’s experience of treatment and the clinical experience of the operator."

The end-product, according to a study published last July in the Annals of Thoracic Surgery is that Osteopathic Manipulative Treatment Improves Heart Surgery Outcomes.  In this RCT, eighty post-op heart surgery patients were divided into two groups --- the first getting post-surgical respiratory therapy alone, and the second getting manual therapy along with.  What were the results?  Only that group two had shorter hospital stays, lower pain scores, and better breathing as measured by spirometry. 

When you look at the big picture, Bordoni's work proves not only see how big a deal fascia is, but that it's important to deal with injury or dysfunction ASAP.  That's because in most cases, adhesed, thickened, or densified fascia can be changed ("deformed").  The thing to remember here is that your approach must be multi-faceted.  In other words, don't even think of tackling serious problems solely in a mechanical fashion.

Address adhesed fascia on all levels (including controlling inflammation) and it's more likely to get results LIKE THESE.  But fail to change crappy diets or unhealthy lifestyles means you will probably be working against yourself as you continue to drive fibrosis-causing inflammation.  And as for those things you can do to help your own cause fascia-wise, they are legion and for the most part contained in MY GENERIC POST on "Universal Cures" (the word 'cure' being used figuratively of course).  And the best thing about it for you is that it's completely and 100% free!

"CDC Advisory Committee on Immunization Practices members voted 12-2 to include the live attenuated influenza vaccine (LAIV) as "an option for influenza vaccination for persons for whom it is appropriate" in the 2018-2019 influenza season. The vaccine was also added back to the Vaccines for Children (VFC) program in a 14-0 vote."  From Molly Walker's article for MedPage Today (ACIP Reinstates FluMist for 2018-2019 Flu Season)

I'm almost finished with a massive (and massively cool) post on FASCIA, but the ongoing absurdity by the powers-that-be concerning FLU VACCINES is nothing less than astounding, meaning today you get yet another post on flu. Two or three years ago scientists realized that the FLU MIST was not only barely above zero percent (0%) effective at preventing flu, they realized it had been that way since at least 2013 --- this after telling citizens in 2012 that it was over 80% effective.  So seeing Helen Branswell's new article for STAT (Flu Mist is Back: Vote Opens Way to Wider Use of Popular Drug) was somewhat of a surprise.  What really interested me about her story, however, was that it wasn't so much about how good or bad FluMist works (its V.E. or Vaccine Effectiveness), but about protecting the financial interests of BIG PHARMA. 

"The decision will be a relief for MedImmune, which makes FluMist, and for people in public health who see this vaccine as an important part of the response to both annual flu outbreaks and the rare but often more dangerous flu pandemics. There had been mounting concern the company, a division of AstraZeneca, would abandon the vaccine if it could not find a way back to the U.S. market.  AstraZeneca signaled it will ask CDC if its purchase through its Vaccines for Children Program can be increased to include FluMist for next winter."

Isn't that special!  This way your hard-earned tax dollars get to fund a vaccine that in a group of poorly-functioning vaccines, stands out above the rest for being truly terrible (HERE).  After discussing how tough it is to GUESS WHICH THREE OR FOUR FLU STRAINS of the thousands circulating should go into next year's vaccine, Professor of Pediatrics at Hofstra, Henry Bernstein, was quoted as saying, "I’m a little concerned about whether it would be interpreted that we’re compromising our interpretation of the science.... Branswell showed that at least some of the others believed likewise. "A number of members of the committee expressed concern that restoring FluMist to the recommended vaccines list before there is evidence to prove the problem has been fixed could further undermine the battered reputation of flu vaccines, especially if it turns out that the change MedImmune made did not improve the vaccine’s performance."  Concerned?  Maybe.  But not enough to vote it down.

Although the SCARE TACTICS used to coerce people into receiving annual flu shots continue to work on some level; in similar fashion to "The Boy Who Cried Wolf," people are beginning to see the bigger picture. The result is that the reputation of flu vaccines is taking the kind of beating that makes the word "battered" look to be the week's biggest understatement.  In other words, the fear factor is shrinking.  Throw into the mix that articles like Branswell's, whether knowingly or unknowingly, expose this debate for what it really is --- a debate about dollars.   It's no wonder increasing numbers of people are becoming disenchanted, seeing the shot for the scam it really is.  By the way, this is largely what Cochrane, the most respected and elite of the mainstream medical organizations that meta-analyze medical data and research, believes as well (they published their new recommendations for flu vaccines earlier this month HERE). 

It's also why growing numbers of people are realizing that EVIDENCE-BASED MEDICINE the way it's currently being done cannot be trusted.  And while I did not have time, I promise that if you researched the people on this board who actually voted for FluMist to be reinstated, you would likely find financial COI that looks suspiciously similar to THE COI I showed you a month ago concerning TAMIFLU (for the record, Dr. Bernstien voted not to have FluMist restored to FDA approval).

Flu vaccine efficacy numbers may seem lower than normal, but any flu vaccine is better than no vaccine, says William Schaffner, MD, professor of preventive medicine and infectious diseases at Vanderbilt University....  Schaffner characterizes the current vaccine's efficacy numbers as "not bad," and reiterates that vaccination helps prevent severe flu even if it isn't perfect. He also emphasizes the importance of pediatric immunizations, given the latest CDC data about pediatric deaths, and looks ahead to upcoming flu vaccine research."  MedPage Today's Molly Walker from yesterday's article, Flu Vax Data 'Only Tell Half the Story'

I've shown you time and time again just how easy it is to tinker with numbers or statistics, making them "prove" almost anything you want.  In fact, I just gave you a prime example of not only how this is being done in medicine in general, but particularly in relationship to the various debates swirling around this year's flu season (HERE).  Molly Walker was back for the attack in MedPage Today with yet another article beating the drum for flu vaccines, while simultaneously beating up those of us she would characterize as "ANTIVAXXERS" (Are 'Vaccine Skeptics' Responsible for Flu Deaths?  Some Experts Say Anti-Vaccine Lobby Took Over Messaging About Flu Vaccine).

Look folks; this isn't that tough.  I know very few people who are actually "anti" vaccine.  What thinking-people are is pro-vaccine choice.  Nowhere is this truer than with the ridiculously crappy flu vaccine.  I say crappy because that is exactly what this shot is (and although Cochrane says it a bit nicer, they would agree).  Walker quotes Baylor's Dr. Peter Hotez (MD / PhD) as placing blame for a good percentage of this season's flu death directly at the feet of people like me.  "This current flu epidemic may turn out to be the first major example of how the antivaccine lobby in America was effective in dissuading people not to get vaccinated, and may be responsible for hundreds or more American deaths."  Walker found several other experts to agree with this assessment, somehow managing to get the director of Infectious Disease Epidemiology of an Ivy League school (Columbia's Stephen Morse) to say something totally and utterly scientifically indefensible.

"For flu, even 20% protection can prevent many cases and save many lives directly and indirectly..."

On the surface, this statement makes some modicum of sense.   The thought process is simple --- 20% immunity sucks, but I guess it's better than nothing.  But is this really true?  Let me show you how we've all been hoodwinked by statisticians with Ph.D's in chicanery.   Firstly, I've shown you several times that VE for this year's virulent portion of the flu vaccine (the H3N2 portion) is actually 10% or less (HERE), and not Morse's 20% (the CDC says 17%).  And secondly, in the always-interesting comment section, "Dr. CC" provided one of the singularly clearest explanations of the DIFFERENCE BETWEEN ABSOLUTE AND RELATIVE RISK I have ever seen in regards to VE (Vaccine Effectiveness).  Watch the yellow ball and try to figure out which cup it's really under.

I support appropriate vaccination, but I feel it is irresponsible to label patients exercising their decision for informed consent as being responsible for deaths. Clearly, we as a medical profession have done a poor job of educating the public and gaining their trust, and trying to badger them into compliance only increases the distrust they have in medicine. I have to say I even had to rethink my support of the flu vaccine when I learned that the efficacy numbers used were misleading to the public. Most assume that "20% efficacy" means 1 in 5 people would be protected from the flu ---- as do many of my fellow physicians. It took a colleague of mine to point out that it is a ‘relative’ risk reduction, which means you actually are only reducing the typical estimated 4% risk a person has each year, down to 3.2%. In other words out of 100 vaccinated people, 1 person (0.8%) would be protected from the flu if all 100 were vaccinated.  What is more disheartening, and something patients are becoming increasingly aware of, is the fact that the 'flu deaths' reported are actually 'flu-associated' illnesses.....

Amazing!  And as crazy as it may seem, if you use this year's actual numbers (10% VE instead of 20%), the odds are even worse (.4 instead of .8).  This means that you would have to vaccinate 200 people instead of 100 in order to prevent a single case of flu. Gulp!  And in the same way that a measles vaccine does not protect one from polio, neither does a flu shot protect one from the myriad of diseases that fall under the category of flu-like (or as Dr. CC said, "flu-associated") illnesses.   And as to Dr. CC's statement, I even had to rethink my support of the flu vaccine when I learned that the efficacy numbers used were misleading to the public, as yourself whether the 'misleading' is intentional?  At the very least, BIG PHARMA is gleefully reveling in the error, while doing nothing to correct said misconception (If I had time I could show you how they are actually exploiting it).  Speaking of misconceptions, let's take a moment to discuss a biggie --- the "life saving" effects of the antiviral, Tamiflu.

Gary Schwitzer and his team of 40+ physicians, researchers, epidemiologists, and journalists run the site Health News Review.  Their organization looks at media stories (or PRESS RELEASES) on DRUGS, MEDICAL DEVICES, NUTRITIONAL SUPPLEMENTS, DIAGNOSTIC MEDICAL TESTS, SURGERIES, DIETARY RECOMMENDATIONS, etc, then reviews them, ranking them from 1 to 5 stars based on the amount of truth they contain.  In other words, HNR considers themselves experts at sniffing out FALLACIES IN EVIDENCE-BASED MEDICINE.

Rather than taking on a single article, a week ago, journalist Mary Chris Jaklevic, went off on the coverage of an entire class of drugs (antivirals) in a piece called Stories About Tragic Flu Deaths Wrongly Portray Tamiflu as a Panacea.  I'm not going to spend an inordinate amount of time on TAMIFLU because simply understanding how the FDA approved it (60% of the studies on the drug --- the studies showing how crappy it really is --- were BURIED) provides most of what you need to know.  Furthermore, after crunching the data on dozens of Tamiflu studies of over 24,000 people, Cochrane concluded that if you can get the drug into a person during the first two days of their illness, it will convey "small benefits on symptom relief, namely shortening duration of symptoms by half a day on average." Half a day?  Is this a joke? This is the "life saving" miracle drug that everyone in the media is clamoring about?  You bet your sweet bippy it is.... and they are.  Can anyone say "fake news"?

Jaklevic went on to list a number of media stories with deceptive headlines, as well as a clip from the national news showing how this drug is being represented --- as the "panacea" mentioned in her story's title.  If you want more proof of how bad Tamiflu really is, you can read her article, or you can read my brother's really short article (HERE --- he's an MD).  As my friend DR. ERIC SERRANO so "eloquently" wrote (HERE), you need to realize that this drug does not do even remotely come close to doing what it is represented to do by the media, or those in industry who are pulling their strings.

Although I thought most of Jaklevic's story was spot on, for some reason she felt an obligation to parrot a widely touted CDC statistic that is both wrong and misleading.  "The CDC has estimated U.S. flu deaths this season could be close to their peak in recent years of 56,000, and most deaths occur in the elderly."  Firstly, most of these deaths occur not only in the elderly, but in a sub-group of the geriatric population that scientists and doctors refer to as "the frail elderly".  Secondly, Dr. Ed Yazbak, a pediatrician and professor, showed everyone how ridiculously exaggerated flu mortality stats really are in a story he wrote a number of years ago (HERE).

If you are one of those people who has fallen into the pit of chronic pain and chronic illness, be sure to read my DIY generic protocol that may help you start pulling yourself out of that pit (HERE).

When Gretchen says that back in 1994 she was involved in a MOTOR VEHICLE ACCIDENT, it's quite possibly the understatement of the year (it was a five roll-over crash that killed the vehicle's other occupant).  After being hospitalized with kidney and other injuries, she was released, but like so many others with SOFT TISSUE INJURIES, she struggled to get better, fighting a constant battle with pain --- a battle she frequently felt like she was losing (research says 50% of all women injured in MVA's are never the same --- HERE).  Despite going through LOTS OF THERAPY, LOTS OF CHIROPRACTIC, an array of BIG-FIVE MEDICATIONS, and specialists / procedures of all sorts (including an RFA, where some of the nerves in her spinal column were "cauterized" with a super-heated needle), she had just about given up --- particularly considering the severity of another accident she was in in 2013.  Then she called and made an appointment.

back, but there was not much to do there, since little of the SCARRED FASCIA I dealt with on the previous visit had returned).  Her results AFTER JUST ONE TREATMENT over two years ago --- for an accident that happened almost a quarter century earlier --- were so amazing (not uncommon, although certainly not guaranteed), I asked if she would do a VIDEO TESTIMONIAL for us.  Although a bit reluctant (like many, she didn't particularly relish being in front of a camera), she agreed, realizing the potential to help others in a similar situation she was prior to treatment.

While FASCIAL ADHESIONS are certainly not the only cause of pain that doctors sometimes cannot get a handle on, it is certainly a substantial one.  For those of you coping with chronic pain, chronic sickness, or a chronic inability to do the things you love, I have a NIFTY LITTLE PROTOCOL that might help get you back on track.  It's certainly not a solution for everyone or everything, but at least take a moment or two to glance at it, as it might prove to be a game-changer for you or a loved one (and best of all, it's completely free).

Earlier this week MedPage Today's Molly Walker wrote an article called Public Health Experts Look Ahead to Better Flu Control, taking a peek at what epidemiologists and government officials believe could be done to make next year's FLU VACCINE more effective than this year's vaccine (remember that the H3N2 portion of this year's vaccine --- the more virulent strain of the virus --- provided less than 10% effectiveness -- HERE).  Walker quoted Harvard epidemiologist, Marc Lipsitch, thusly.  "We've become a little bit used to the idea that the flu vaccine is not a great vaccine.  We have to target the right strains, and even when we get it right, it's not always effective."  Allow me to show you just how right Dr. L really is on both counts. 

Just yesterday the CDC's Morbidity and Mortality Weekly Report said that "Most (69%) influenza infections were caused by A(H3N2) viruses."  They then said that vaccine effectiveness (VE) against this strain "was estimated to be 25%."  Is this true?  Firstly, if you click the previous link, you'll see that someone, whether intentionally or unintentionally, is wrong (VE is almost always exaggerated by the CDC before being quietly downgraded in the summer --- HERE).  And secondly, even though Dr. L discussed the importance of targeting the correct strains, he failed to explain how difficult (impossible) it really is, because as I've shown you in the past, "matched years" (correctly guessing which three or four strains should be included in next year's vaccine that's being made this year) occur approximately once a decade.  Not surprising considering there are literally thousands of variant strains of flu virus.

The CDC's Timothy Uyeki was then quoted about his opinion of antivirals --- the drugs many doctors recommend if you get the flu --- the Tamiflu that has been in such a shortage due to this year's panic.  I'll not talk about what he said, but if you're interested in seeing just how badly you've been hoodwinked concerning this all-but-completely ineffective drug, take a look at THIS SHORT POST.  As is is typical, there was the usual whining by government officials about not having enough of your hard-earned tax dollars for research ("this takes a lot more funding").  And as I often do with articles that can only be described as propaganda pieces, I headed directly to the comment section, where Dr. JP chimed in with his two cents.

"Correct that a flu vaccine is 100% ineffective if it is not taken. At present it seems to be 70-83% ineffective if it is taken. (that's 17-30% effective, right?) But the only way you know if a treatment or prophylactic is ineffective is if you get the condition you're trying to prevent. Wow -- 70-83 percent of people who get a flu shot get the flu anyway? That's a pretty useless vaccine.  If you don't receive the treatment and you don't acquire the condition -- that's not ineffective, it is null data -- and who's going to report it anyway!"

Dr. JP went on to describe the science behind VE as "dodgy statistical manipulation".  It is dodgy, considering that the director for the University of Minnesota's Center for Infectious Disease Research and Policy, Dr. Michael Osterholm, recently discussed how inflated CDC VE stats really are. I quote, "The vaccine is, at best, around 10% effective on H3N2."  The words "at best" mean that it's doubtful it's even 10% effective. 

The CDC created a built-in excuse for the future VE downgrade that is sure to come, when they admitted that, "the findings in this report are subject to at least four limitations."  Yes they are, and if people would simply read my posts on FLU VACCINES, they would understand that the "science" behind those limitations is as dodgy as the statistics themselves.  What does the science show?  Follow a few of these links to see just how crappy these vaccines really are, which is creating a huge black eye on the profession.  Think about it this way; if the scientific and medical communities truly believed everything they adoringly tout concerning EVIDENCE-BASED MEDICINE, they would treat the flu like what it really is --- A BAD COLD. 

Notice that I earlier mentioned the word panic.  This was not an oversight nor was it hype.  Governmental organizations and their partners in crime from the private sector (BIG PHARMA),  purposeful create, aggressively cultivate, and then actively promote an environment of fear (panic) surrounding each and every flu season for one reason --- to sell more vaccines.  The same can be said for antivirals such as TAMIFLU, which are themselves no better than about 10% effective.  Helen Branswell's article for Thursday's edition of STAT (Three Quarters of People Who Got Flu Shot This Year Weren't Protected Against Most Common Strain) quoted CDC director, Dr. Anne Schuchat as saying, "We are a bit concerned that the performance of the vaccine right now might reduce interest in getting vaccinated in the future, but we have the other side that flu was just so bad so far this season, so many people have been sick and see how miserable it is."

But was this year's flu really that bad, and could it legitimately be described as "worse" than other recent seasons?  Or, was the media --- a group who is collectively and constantly looking for some "DIRTY LAUNDRY" --- selling fear and panic in order to juice their ratings?  You be the judge after listening to Branswell quote from this week's CDC Morbidity and Mortality Weekly Report (I am cherry-picking a bit here).

"The H3N2 vaccine effectiveness in children 6 months of age to 8 years old was 51 percent. The text of the report did not point out that in children aged 9 to 17, there appeared to be no protection at all against H3N2 viruses.  So far this season 63 children have died from flu.  While tragic, that number is actually low in comparison with other recent seasons.  In older adults, the H3N2 vaccine performance was much less impressive. Seniors aged 65 and older saw their risk of needing medical care for flu cut by 17 percent, and in adults 50 to 64 — an age group with an unusually high hospitalization rate this winter — the H3N2 component’s effectiveness was 10 percent.  Those numbers correspond to what was seen last year in those age groups in the U.S. and also to vaccine effectiveness estimates from Canada that were released earlier this month."

How can you tell this is statistical rubbish?  Ask yourself how in the world Vaccine Effectiveness could be over 50% for children 8 and under, but 0% for those ages 9-17?  This stat alone shows you how bogus the numbers are.  And as for the elderly, the latest Cochrane Review on flu vaccines and the elderly from last week (HERE) showed exactly what the last Cochrane Review for flu vaccines and the elderly showed several years ago; that VE hovers in the nether regions for this age group.  That's not me folks, that's Cochrane; the most prestigious and respected producer of medical meta-analytics on the planet (HERE).  The CDC is MANIPULATING THE DATA (playing statistical games) to try and keep a lid on just how bad things really are with flu vaccines (VE).

Allow me to show you an example of data manipulation concerning the flu vaccine that I stole from the previous link.  "A few days ago I was discussing the brand new Cochrane Review concerning flu shots in healthy adults with my brother (AN ER DOCTOR who has never been a fan of the shots).  He brought up an interesting point.  Even though the data of hundreds of studies since 1965, containing over 80,000 subjects, was crunched to show that the vaccine lowers a healthy adult's chance of contracting flu from 2% to 1% (a whopping 1 percentage point), he rightly predicted that industry would claim that the unvaccinated group had 100% more flu than the vaccinated group (after all, two is 100% greater than one)."

Here's another example of data manipulation concerning flu vaccines that you undoubtedly didn't hear about from the mainstream press.  Enter Dr. De Serres.  Dr. Gaston De Serres biography for CIRN (the Canadian Immunization Research Network) reads thusly.  "Dr. De Serres is a medical epidemiologist at the Institute National de Santé Publique du Québec and a professor of Epidemiology at the Faculty of Medicine at Laval University. Dr. De Serres works in the area of control and prevention of infectious disease with a focus on vaccine-preventable diseases and respiratory infections, vaccine effectiveness and vaccine safety."  His specialty is flu vaccine.  I mention Dr. De Serres only because he was the lead author for a study (Influenza Vaccination of Healthcare Workers: Critical Analysis of the Evidence for Patient Benefit Underpinning Policies of Enforcement) published in last January's issue of PLoS One.  Listen to the conclusions of his team of a dozen medical researchers from facilities around the world.

"Annual influenza vaccination for health care workers (HCWs) is widely endorsed and increasingly enforced on the basis that it will reduce influenza-associated morbidity and mortality in patients.  Two pivotal systematic reviews and meta-analyses have been published summarizing and pooling these four RCT [studies] findings, but reached different conclusions about the strength of that evidence. Whereas the review conducted by investigators of the CDC characterized the overall quality of evidence as moderate, the Cochrane review concluded that the evidence was insufficient to support HCW influenza vaccination as an approach to reduce patient risk. Such uncertainty in the quality of the evidence warrants closer examination. This is particularly important given that compulsory or coercive (e.g. vaccinate-or-mask) policies have been extrapolated in some jurisdictions to not only include HCWs providing direct patient care, but also to include all staff in acute-care hospitals and other healthcare settings."

After making all of their calculations with extremely generous statistics (among other concessions, De Serres' team assumed a flu vaccine VE of 60% --- significantly better than what's seen in a typical year), they concluded that "Through this detailed critique and quantification of the evidence, policies of enforced influenza vaccination of HCWs to reduce patient risk lack a sound empirical basis.  While HCWs have an ethical and professional duty not to place their patients at increased risk, so also have advocates for compulsory vaccination a duty to ensure that the evidence they cite is valid and reliable." 

Because the evidence for MANDATORY FLU VACCINES FOR HEALTHCARE WORKERS is so "unreliable" (some HCW's understand this, therefore there is a significant segment of them who do not want the shots), De Serre's team concluded that the only viable way to protect patients is for all healthcare workers to wear a mask, not just those who declined to be immunized.  "A coherent prevention policy to reduce risk to patients to the extent possible would dictate the wearing of masks by all HCWs, vaccinated or unvaccinated, for the duration of the winter respiratory season. We are unaware of such extreme policies anywhere to date."  So, the only thing that might help stop the spread of flu in institutional settings isn't even being done. 

This is an emotional, hot-button issue.  Make sure to look at it logically, and not based on the fear purposefully created by people who either don't understand the evidence (those who are currently 'drinking the koolaid') or who completely understand it and realize just how crappy it really is.  BTW, the second group is far scarier than the first.

What did you get for / from your valentine this year?  Hopefully not a box of cheap chocolates.  I only bring this up because two days ago the British Medical Journal published a study called Consumption of Ultra-Processed Foods and Cancer Risk....  Although you intuitively knew this, there is some real "meat" (ULTRA-PROCESSED MEAT) in this study that you can take home to your family (and it's all free online).  But the first thing we have to do before proceeding is to create a clear definition of ultra-processed food (UPF).  Most of us know what processed foods are, but what in the heck are "ultra" processed foods?

According to natural health expert, Dr. Adrew Weil (What are Ultra-Processed Foods?), UPF's "include soft drinks, packaged snacks and baked goods, and reconstituted meat products such as chicken and fish nuggets. Instant noodles and commercially produced soups also qualify."  But as you'll soon see, UPF's go far beyond the obvious foods seen on this list.  Another study from BMJ (this one published in 2016 --- Ultra-Processed Foods and Added Sugars in the US Diet...) concluded that......

"Ultra-processed foods were defined as industrial formulations which, besides salt, sugar, oils and fats, include substances not used in culinary preparations, in particular additives used to imitate sensorial qualities of minimally processed foods and their culinary preparations.  Ultra-processed foods comprised 57.9% of energy intake, and contributed 89.7% of the energy intake from added sugars. The content of added sugars in ultra-processed foods was eight-fold higher than in processed foods.  High intake of added sugars increases the risk of weight gain, excess body weight and obesity; type 2 diabetes, higher serum triglycerides and high blood cholesterol; higher blood pressure and hypertension; stroke; coronary heart disease; cancer; and dental caries. Moreover, foods higher in added sugars are often a source of empty calories with minimum essential nutrients or dietary fiber, which displace more nutrient-dense foods and lead, in turn, to simultaneously overfed and undernourished individuals."

Over-fed and under-nourished.  That pretty much sums up a huge and growing segment of Western society (no pun intended).  And even though it's on this two year old list, the latest study is specifically about the relationship between UPF's and CANCER.  Speaking of UPF's and cancer; while most people have at least heard that SUGAR FEEDS CANCER, the medical community has been slow to embrace Dr. Otto Warburg's work --- odd considering he won the Nobel Prize for Medicine back in 1931 (HERE).  Once you realize that added sugar makes up the largest portion of UPF's, it's not difficult to argue that the medical community needs to step up to the plate and change the way they deal with their average patient (HERE).

An interesting "proof" of a phenomenon routinely found in EVIDENCE-BASED MEDICINE is that less than six months ago the American Journal of Nutrition (Ultra-Processed Foods in Human Health: A Critical Appraisal) said this about the ADDICTIVE NATURE (or non-addictive as their authors determined) of UPF's.  "This commentary challenges many of the basic arguments of [the relationship between] the link between food and health. We believe that there is no evidence to uphold the view that ultra-processed foods and drinks give rise to hyper-palatable foods associated with a quasi-addictive effect."  This statement becomes especially interesting once you realize the study's lead co-author, Dr. Michael J. Gibney, "had primary responsibility for final content... serving on scientific committees for Nestlé and Cereal Partners Worldwide."  Here's an article about NESTLE that will make you puke, and the CPW is a joint effort between Nestle and General Mills to develop BREAKFAST CEREALS.

After looking at 105,000 people without cancer and adjusting for confounders (sociodemographic and lifestyle characteristics, age, sex, occupation, educational level, smoking status, number of children, height, weight, dietary intakes, physical activity, personal and family history of diseases, drug use including use of hormonal treatment for menopause and oral contraceptives, and menopausal status) these authors determined that (quote is somewhat cherry-picked)......

"Main food groups contributing to ultra-processed food intake were sugary products (26%) and drinks (20%), followed by starchy foods and breakfast cereals (16%) and ultra-processed fruits and vegetables (15%).  Ultra-processed food intake was associated with increased risks of overall cancer and breast cancer. The association with overall cancer risk was statistically significant in all strata of the population investigated.  Ultra-processed foods have also been associated with a higher glycemic response and a lower satiety effect [it never makes you "full"].  Excessive energy, fat, and sugar intakes contribute to weight gain and risk of obesity, with obesity recognized as a major risk factor for breast, stomach, liver, colorectal, esophagus, pancreas, kidney, gallbladder, endometrium, ovary, liver, and (advanced) prostate cancers and hematological malignancies [leukemia].  For instance, body fatness in post-menopausal women is estimated to contribute 17% of the breast cancer burden."

And this is just for starters.  The authors went on to talk about the effects of plastics, chemicals, and other "ENDOCRINE DISRUPTING" packaging materials commonly used in UPF's, as well as the effects that additives such as dyes, MSG, ASPARTAME, and several others, have on PHYSIOLOGY / HOMEOSTASIS, particularly when it comes to GUT HEALTH and MICROBIOME (remember that 80% of your immune system is found in the Gut --- HERE).  Although you could correctly guess what the most common UPF's are (see pics at top of page), some might surprise you.  The list included "fried potatoes, biscuits, bread, coffee, sweet pastries, dairy desserts, ice cream, fruit purée, fruit in syrup, fruit and vegetable juices, soups and broths, sandwiches, pizzas, salted pastries [crackers]."  Also mentioned were processed "starchy foods (cereals, legumes, or potatoes)."

What's the solution to this mess?  First, control your BLOOD SUGAR.  This is done via controlling your intake of simple carbohydrates.   Secondly, because generic LOW CARB DIETS can be loaded with all sorts of garbage, including TRANS or other junk fats, I suggest you go PALEO.  Some of you might do great with a KETOGENIC DIET as well (click THIS LINK to watch a cool video by a researcher at Pitt using Ketogenic Diets in his lab to successfully address cancer).  And for those of you struggling with serious chronic health issues and rampant inflammation (HERE), be sure and take a look at THIS POST for a nice little protocol that will at least point the average person in the right direction.

Doc, I have a bone to pick with you and the rest of the medical profession: I am real tired of hearing about pain. I have no pain. I have loss of functionality without pain. I am also real tired of hearing about injury, There is no injury, just a lifetime of assymetrical usage. My mother did the same thing, but much worse. She actually gave herself severe scoliosis without injury, just by bending over her work asymmetrically for 60 years. I'm not that bad yet, but it's real hard to fight alone, ad it's very difficult to find help, because all anyone wants to talk about is pain and injury, whereas all I want is not to end up in a wheelchair (like my mother).  From Suzie via a blog comment (I got this after I put this up today).

Making sure that you do not end up with soft tissue fibrosis is a big deal.  This fact really hits home once you realize what fibrosis really is. Spine Health reveals that, "Fibrosis is the replacement of normal tissue with scar tissue."  News Medical (What is Fibrosis?) describes it thusly. "The term fibrosis describes the development of fibrous connective tissue as a reparative response to injury or damage. Fibrosis may refer to the connective tissue deposition that occurs as part of normal healing or to the excess tissue deposition that occurs as a pathological process. When fibrosis occurs in response to injury, the term “scarring” is used."  Merriam Webster defines fibrosis as "a condition marked by increase of interstitial fibrous tissue."  The Oxford Dictionary says this of fibrosis. "Fibrosis is the thickening and scarring of connective tissue, usually as a result of injury."

I've talked at length on my site about fibrosis, the debate as to whether it's really "scar tissue" or not (HERE), as well as a characteristic mentioned above --- "THICKENING" ("DENSIFICATION"). There is an inaccuracy above that I must clear up as well.  When Oxford says that fibrosis is usually the result of injury, this is simply not true.  Or at least not true in the sense that most people think of an injury as a physical trauma.  Listen to what the authors of a study published earlier this month in Advanced Drug Delivery Reviews (Scarring vs. Functional Healing: Matrix-Based Strategies to Regulate Tissue Repair) showing that fibrosis goes way beyond CONNECTIVE TISSUES.

"All vertebrates possess mechanisms to restore damaged tissues with outcomes ranging from regeneration to scarring. Unfortunately, the mammalian response to tissue injury most often culminates in scar formation. Accounting for nearly 45% of deaths in the developed world, fibrosis is a process that stands diametrically opposed to functional tissue regeneration. Wound healing is guided by precise deposition and remodeling of the extracellular matrix (ECM). The ECM, comprising the non-cellular component of tissues, is a signaling depot that is differentially regulated in scarring and regenerative healing.  Strategies to improve wound healing outcomes therefore require methods to limit fibrosis."

Allow me to take you through this bit by bit.  First off, I've shown you previously that fibrosis is the number one cause of death, not just in America, but worldwide (HERE), directly accounting for almost one death in two.  Secondly, bear in mind that there is a known reason for this --- inflammation always results in fibrosis (HERE).   And while this inflammation can certainly be the result of a physical trauma, it can also be driven by other things, including food sensitivities (HERE is a common one), sugar and junk carbs (HERE), PARASITES, BLACK MOLD, DYSBIOSIS, POLLUTION, TOXIC METALS, OCCULT INFECTIONS, POOR POSTURE, CHEMICAL EXPOSURE, and on, and on, and on.  And ultimately, it all leads to inflammation, which in turn leads to fibrosis (HERE), which itself leads to various sorts of dysfunction(s) depending on where it's found (heart, lungs, liver, kidneys, etc, etc), with the ultimate dysfunction being death.  Today, however, we are going to focus on inflammation and fibrosis of the connective tissue fascia.

FASCIA is the tough membranous cover that permeates muscles (it's also the covering for nerves, blood vessels, bones, etc, etc).  It can become "fibrous" (fibrotic) due to either local inflammation from an injury (HERE) or systemic inflammation from the many causes mentioned earlier (HERE).  Either way, as joints become dysfunctional (even slightly so), BIOMECHANICS can become screwed up enough to start causing degenerative changes. While DEGENERATIVE CHANGES in and of themselves are not typically enough to cause pain in their earlier stages, few would argue that the less degeneration you have, the better.  Enter TISSUE REMODELING.

As you can see from watching a few of our VIDEO TESTIMONIALS, it is important --- scratch that; it's imperative --- to get injured / insulted tissues moving and keep them moving in order to prevent fibrosis and the subsequent problems that follow.  A study from  the Tissue Repair Laboratory of the State University of Rio de Janerio (Mechanical Tension Prevents Fibrosis by Reducing Collagen Deposition After Injury On Subcutaneous Layer In Mice) provided some proof.  Two groups of mice had their THORACOLUMBAR FASCIA "injured" by a microsurgical procedure.  The first group underwent specific stretches, while the second did not.  After later looking at the tissues under a microscope the authors concluded that, "Microinjury resulted  in a significant increase on collagen deposition in the absence of stretch, but not in the presence of stretch. Brief tissue stretch attenuated the collagen deposition following tissue injury. These results have potential relevance to propose treatments of different types of excessive scars."

There are only about a million and one ways to mechanically load your soft tissues, including many that you can do on your own (HERE, HERE, HERE, HERE, or HERE).  What does moving injured or inflamed soft tissues do besides fire off PROPRIOCEPTON?  Let's take a look at an issue of Molecular Basis of Disease (Tissue Mechanics and Fibrosis) that was published 5 years ago this month (everything in today's post is cherry-picked due to restraints on time and space).  The study kicks off with the statement "Mechanical forces are essential to the development and progression of fibrosis."  This means that if you can control (or at least manage) said forces, you will ultimately change the progression of the healing process and control / manage deposition of collagen (fibrosis) that I usually refer to as "SCAR TISSUE FORMATION". 

The authors talked about the many different forces at work in tissue --- pushing forces, pulling forces, hydraulic forces, etc.  What do these forces do and why is it important to learn how to harness them?  "These forces collectively regulate the phenotype and proliferation of myofibroblasts and other cells in damaged tissues, the activation of growth factors, and the structure and mechanics of the matrix – all of which are central to fibrosis."  This is why understanding FIBROBLASTIC ACTIVITY as it related to both normal and abnormal fibroproliferation is a big deal.  And as for the fibroblasts, the authors state "It is important to note that changes in the mechanical properties of tissues can both cause and result from fibrosis."  In other words, biomechanical / biochemical changes cause fibrosis, and fibrosis causes biomechanical / biochemical changes.  And in similar fashion to compound interest, you can either make these changes work for you or they will likely work against you; quite possibly for the rest of your life (can anyone say 'Vicious Cycle'?).  The authors ended by concluding....

"Mechanical forces are increasingly appreciated to play a role in fibrosis on a par with soluble [chemical] factors. Matrix stiffness is so far the best-appreciated mechanical stimulus in fibrosis, and liver and lung are the tissues best studied. Even for these tissues and stimuli, our understanding of forces, their effects, and mechanotransduction in fibrosis is rudimentary."

The first thing I want you to grasp is the concept of MECHANOTRANSDUCTION --- the process of turning mechanical energy into electrical / chemical messages that the body understands.  As you might have guessed, it's compromised in fibrotic tissues.  And as for the "soluble factors," this would not only cover INFLAMMATION (a chemical process that is not synonymous with either swelling or infection), but all sorts of growth factors and enzymes as well.  Speaking of enzymes, thirteen researchers from the surgical departments of Stanford and the Oregon Health and Science University teamed up to publish a study (Focal Adhesion Kinase Links Mechanical Force to Skin Fibrosis via Inflammatory Signaling) in Nature Medicine.

The study kicked things off by saying, "Traditional cytokine-based paradigms for fibrosis largely overlook the role of cell-matrix interactions and physical cues in disease pathogenesis."  In English, this means that although mainstream scientists have known about the effects of CYTOKINES (inflammation) on the development and proliferation of fibrosis for a very long time, only recently are researchers appreciating mechanical effects on the ECM (the gel part of the connective tissue).  Listen as these authors talk about potential causes and solutions for "exuberant fibroproliferation ---- a common complication after injury."

Because inflammatory mechanisms are strongly implicated in fibrosis, we examined whether FAK modulates cytokine/chemokine signaling.  One key component of wound repair that is often overlooked is mechanical force, which regulates cell-matrix interactions through intracellular focal adhesion components, including focal adhesion kinase (FAK). Here we report that FAK is activated after cutaneous injury and that this process is potentiated by mechanical loading. Fibroblast-specific FAK knockout mice have substantially less inflammation and fibrosis than control mice in a model of hypertrophic scar formation.  Inflammatory chemokine pathways are a major mechanism by which FAK mechanotransduction induces fibrosis.

In other words, FAK --- an enzyme that controls, regulates, and essentially causes "focal adhesions" (can anyone say FASCIAL ADHESIONS?) is not only found in great concentrations in said adhesions, but is "activated" by injury, and "potentiated" by loading said tissues in a mechanical fashion (this process is known as TISSUE DEFORMATION).  What does tissue loading entail?  Tissue loading is any sort of mechanical stimulus that pushes or pulls tissue, and is accomplished by the very things mentioned earlier; exercise, stretching, bodywork, etc, etc.   "It is possible that in addition to these chemokine-mediated mechanisms, FAK may also control fibrosis by directly activating fibroblast collagen production... Based on these studies, we propose a model for load-induced fibrosis whereby mechanical force activates both MCP-1 secretion and collagen production through FAK to perpetuate a ‘vicious cycle’ of fibroproliferation after injury."  Stimulating the production of collagen through INCREASING FIBROBLASTIC ACTIVITY is a good thing, but in cases where inflammation (cytokines, chemokines, etc) is rampant or the mechanical loading is "abnormal," the end result can be crazy amounts of Scar Tissue.

When you start studying Scar Tissue, you'll quickly see that there is a great deal of conflicting information about it's potential pain sensitivity and ability to conduct pain impulses.  For instance, I have come across several medical publications saying that scar tissue is not painful (i.e., if there is pain present, it's coming from something else besides the scar).  Let me give you an example of this from the Net Doctor (Very Painful Scar).  After an individual tells an online physician that he has an old appendectomy scar that hurts so bad he cannot stand his shirt to touch it, the good doctor answers....

"It is fairly common for people to have an anesthetic, or numb, area around an operation site owing to inevitable damage to superficial sensory nerves in the skin; this usually recovers in time.  Extreme sensitivity is most unusual. Your GP's reassurance suggests that this condition is not indicative of anything nasty.  However, the pain sounds very unpleasant so do go and impress this on your doctor if the situation is still causing concern.  Yours sincerely, The NetDoctor Medical Team."

Not common?  Most unusual?  Not nasty?  Allow me to show you that if you are struggling with some sort of adhesion-induced pain issue (whether you realize it or not), it's not only common, it's common enough that numerous experts in the field are discussing it in some form or fashion.  Below are some random quotes from the first couple pages of a Google search.

• "Scar tissue pain occurs, for example, after an operation, and can result in chronic pain in and around the scar area.  The cause of scar tissue pain is damage to a small skin nerve, or when a nerve is squeezed by the scar tissue. In scar tissue pain, which can occur after an operation, there sometimes mention of neuroma formation at the end of a damaged skin nerve. After some interventions, such as inguinal hernia, lung, heart, kidney, and shoulder operations, as well as breast amputations, scar tissue pain is more common."  The Maastricht University Pain Centre in the Netherlands (Scar Tissue Pain)

 

• "Every time an injury to the skin penetrates through to the dermis layer, a scar will occur as a result of the healing process, this is the body’s way of naturally repairing itself. In response to a wound, the body produces collagen, a protein of which the rest of our skin is made from. Scar tissue however, looks and feels different – some researchers suggest that this is due to its alignment, which differs from that of normal skin tissue.  Although many scars are trivial, some are extremely unpleasant causing not only aesthetic displeasure but also chronically painful symptoms. Scar pain, whether it be from an operative, or traumatic cause, is very common. The symptoms and signs can be similar to those of Complex Regional Pain Syndrome. They include pain, itching, swelling, tightness, restriction of movement, skin colour changes, allodynia or hypersensitivity to touch, and hyperalgesia or marked pain to deeper palpation.  Scar tissue pain is usually caused by damage to the nerves or when a nerve is compressed by the scar. In some cases..... firing uncontrollable pain signals to the brain."   Dr. Mark Miller, owner of a number of Pain Management clinics in England, from an article called Scar Pain

 

• "Wounds take a variable amount of time to heal. The location of the wound makes a difference, as peripheries like your foot heal slower than your shoulder for example. Other factors such as smoking, using steroids, diabetes or low protein levels also slow wound healing.  Scars are not just skin deep. They may involve several layers beneath the skin which are stuck together."   My Ortho Clinic dot com (Stitches, Wounds & Sensitive Scars)

 

• "Many people have scars as a result of accidents, injuries and surgeries. While scar tissue is extremely helpful at repairing cells quickly to prevent further damage and/or injury, the characteristics of scars and their presence in the body can restrict and inhibit movement. This can lead to myofascial pain, musculoskeletal imbalances and ultimately impede athletic performance.  Since the configuration of scar tissue is not the same as the surrounding muscle fibers it can alter the way these structures work."   From an article on PT On the Net (How Scar Tissue Affects Pain and Performance) by therapist Justin Price

 

• "As of 2012, 33% of births ended in C-section.  A common complaint after a C-section is the sensitivity of the scar itself.  In addition, the scar may cause a slight postural change... that could result in back pain.  But the possible consequences don’t stop there. The scarring can cause the adjacent muscles to develop trigger points that refer pain.... In addition, the adjacent connective tissue can become restricted also causing pain.  Lastly, the scarring can irritate superficial nerves in the area of the scar.  What’s more, the round ligament that attaches from the sides of the uterus to the labia can be caught in scar tissue after a C-section because the incision is also right over the area where the round ligament crosses the pelvic brim.  Another symptom we have seen with our patients who have had C-sections is that they may have issues with lower digestion such as irritable bowel syndrome or constipation. This occurs because of the tightening created by the scar tissue pulls within the abdominal cavity and thus affects the organs."   Cherry-picked from an article called C-Section Scar: Problems and Solutions by the physical therapists at the Pelvic Health and Rehabilitation Centers of California

 

• "After a trauma, a large cut or surgery around the nerves, scar tissue forms. Scar tissue is both good and bad. It helps the nerve attach to nearby structures, but when the patient moves, pressure is placed on the nerve because the scar tissue can pull on the nerve. Even without movement, the scar tissue can reduce the nerve's blood supply. All of this can cause significant nerve pain. The main symptom is constant, unrelenting pain coming from the nerve tissue."  The University of Michigan's Medical School (Scarred Nerves)

 

• "Scars can be a big pain... When there is an initial injury (and yes, a surgical incision is an “injury”), the body goes through three phases of healing: Inflammation, Proliferation and Remodeling. Through this process, the body creates scarring to close up the initial injury. Scars are composed of a fibrous protein (collagen)....  The difference, however, is that scars are not quite organized the same way as the tissues they replace, and they don’t really do the job quite as well.  Scars can form in all tissues of the body.  Scars are not super selective when it comes to tissues they adhere to. So, sometimes, scars will adhere to lots of tissues around them and this pull can lead to discomfort.  Sometimes, small nerves can be pulled on by the scar which can lead to irritation."   From Dr. Jessica Reale's (she's a DPT in Atlanta) article about Painful Scars.... 

In these articles, there's a common thread: injury or insult leads to scarring, which in many cases leads to pain and various sorts of dysfunction.  If you are struggling with CHRONIC PAIN, there were terms used in these articles that you really need to be familiar with.  HYPERAGLIA, ALLODYNIA, CRPS, Hypersensitivity --- uncontrolled firing of pain signals to the brain (CENTRAL SENSITIVITY), are just a few of the more common.  And if you've been following my site(s) for the past decade or so (DCP is where I started), you are already aware of the fact that Scar Tissue is different from normal tissues in any number of ways, including both its physical structure and its increased propensity to act as a pain generator (HERE), via an almost infinite number of causal mechanisms.  And on top of everything else, it's dysfunction is being touted as a "universal" cause of disease (HERE).

For instance, the August 2015 issue of Muscle & Nerve (Comparison of Nerve Growth Factor-Induced Sensitization Pattern in Lumbar and Tibial Muscle and Fascia) concluded, after injecting NGF into various areas of human fascia that, "Nerve growth factor (NGF) induces profound hyperalgesia.  The mechanical hyperalgesia area was larger in tibial fascia than in muscle. Pressure pain thresholds were lower, tonic pressure pain ratings, and citrate buffer evoked pain higher in fascia than in muscle."  This is all well and good, but the next sentence is where the rubber meets the road as far as chronic low back pain is concerned.  "Thoracolumbar fasciae appear more sensitive than tibial fasciae and may be major contributors to low back pain." Once you start to understand the THORACOLUMBAR FASCIA, this all starts making sense.

This is doubly true if you recall that the amount of degenerative change (HERE) or presence of disc herniations (HERE), are poor indicators not only of whether or not a person will have back pain at all, but how severe said back pain may be.  Check out the results of a study from the University of Heidelberg's Dissertaitions Kurzfassung (Pain Sensitivity of Human Fascia and Muscle Sensory Findings After Chemical and Electrical Stimulation).  And if you are one of the millions of Americans suffering from CHRONIC LOW BACK PAIN, be sure and read the paragraph until you understand it.

"ln many patients, chronic low back pain  cannot be explained by abnormalities in the bony structures of  the vertebral column. Due to their dense innervation, fascia and muscles of the lower back are  potential alternative sources of nociceptive input in these patients with "non-specific low back pain".  These studies suggest that the fascia of the lower back might be a key structure in the genesis of nonspecific low back pain, because of its high innervation density, its high pain sensitivity to several  stimuli, and substantial pain amplification after its stimulation. Effects of muscle nerve stimulation in  previous studies may have been at least partly due activation of afferents from the fascia that run through these nerves. Therefore, treatment of the fascia may be an important target for prevention and treatment of back pain."

We are seeing this phenomenon is studies over and over again.  If you want another example, take a look at Dr. Stecco's, The Role of Fascia in Non-Specific Low Back Pain.  And what do we see when we go to current peer review as far as treatment is concerned?  We see that while far from perfect, bodywork of various sorts (stretching, MANIPULATION, exercise, etc --- things that move joints and fascia) is at least as good, or in most cases, better, than other treatments designed to get these people get out of pain and return to function.  And they're certainly better than drugs (HERE).  If you are interested in lowering your level of systemic inflammation and addressing the various roots of many, if not most of your fascial adhesions, I would suggest you take a moment to read THIS SHORT POST.

Don't you find it interesting that numerous drugs pass FDA muster, only to later be removed from the public after experts "discover" how dangerous and/or ineffective they really are?  Today I am going to give you a small taste of exactly how that happens, but before I do, let's take a moment to look at this phenomenon up close and personal.  On Thursday of last week, our government announced, via the Global Defense News (According to VA, Drug Prazosin Fails to Alleviate PTSD in Military Veterans), that........

"About 11 percent to 20 percent of veterans of the Iraq and Afghanistan wars have been diagnosed with PTSD.  The drug prazosin failed to effectively alleviate post-traumatic stress disorder in military veterans, according to a trial conducted by researchers with the Department of Veterans Affairs.  Prazosin, which includes trade names Minipress, Vasoflex, Lentopres, and Hypovase, is also used to treat high blood pressure and anxiety.  Although the drug has been effective in controlling nightmares or improving sleep quality associated with PTSD, the researchers concluded it was no better than a placebo, according to results published in The New England Journal of Medicine."

Riddle me this Batman; how can a drug specifically used by government physicians to treat Combat Veterans diagnosed with PTSD be both "effective in controlling nightmares or improving sleep quality associated with PTSD" and "no better than placebo" at the same time?  This, my friends, is the sort of oxymoronical gibberish today's post is about.  For the record, the study's lead author stated in GDN, "....the trial seemed like a good idea, but you know, live and learn....  I don’t think it should change clinical practice..."  This seems to be a common conclusion in the field of evidence-based medicine.  Don't like the research findings you come up with?  IGNORE THEM until the government finally steps in with a drug ban.  In the meantime, there are plenty of people who need prescriptions, and lots of money to be made.  Here is a list of a few of the neat little tricks regularly employed by Big Pharma to make their products appear better / safer than they really are.

• MAKE THE ISSUE POLITICAL:  Nowhere is it easier to see how industry deflects criticism than the manner in which they politicize VACCINES. And no vaccine is more politicized than the FLU SHOT.  Despite the medical community's battle cry of nothing but "BEST EVIDENCE," the flu vaccine has shown just how hollow this statement really rings.  Not only does the vaccine not work against the more virulent strains of the flu (HERE), the latest COCHRANE REVIEWS on flu shots from just last week showed essentially what they did in the last reviews done five or six years ago --- that the flu vaccine is woefully ineffective in light of the time, energy, and money the government and big pharma spend warning people (FORCING PEOPLE) to get their shots.  Unfortunately, those who use peer review to question the staus quo are labeled as "ANTIVAXXERS," which in today's politicized environment, is similar to being called a neo-nazi.
  

 

• CREATE AN ENVIRONMENT OF DEPENDENCE ON BIG PHARMA:  This is not only true of the general public, the average of whom is exposed to hundreds of thousands of DRUG ADS and PRESS RELEASES before they are out of high school, it's likewise true of doctors.  The brainwashing starts in medical school and continues right on through practice.  Think of it this way; with our university system garnering a significant part of their funding directly from BIG PHARMA, are these institutions really going to bite the hand that feeds them?  Of course not.  Click the link and fast forward the video to the 15:15 mark (you'll laugh your head off and gain a better understanding of yet another way that the system is being gamed).  Dr. Gorski once argued that diet and exercise are not alternatives, but actually part of the "fortress" that makes up mainstream medicine (HERE).  I would argue that you would never have any idea of that from looking at the average doctor visit.  The powers that be want you sick, but living a very long time, T-totally dependent on drugs for your perceived well being.  Thanks to people who refuse to step up and take charge of their own health, they are getting their wish (HERE).
  

 

• HIDE RESEARCH RESULTS YOU DON'T LIKE:  INVISIBLE & ABANDONED research is another drum I've been beating for a very long time.  For instance; how many of you were aware that TAMIFLU received it's FDA approval because 60% of the studies done were never published?  The only reason studies are not completed, or completed and not published, is because the results were not what industry was hoping to see.  Although oversight agencies such as the FDA and CDC are trying to get a handle on this problem, it's recently been estimated that half of all medical studies are I & A.
  

 

• RESEARCH IS NOT REPRODUCIBLE:  What does it mean when scientists cannot reproduce pharmaceutical research --- either their own or someone else's?  In many cases it means we are no longer dealing with science.  This problem is so rife in some fields (CANCER, for instance) that select research teams have not been able to reproduce as much as 90% of the profession's most important experiments (HERE).
  

 

• SET THE STUDIES UP TO PROVE WHAT YOU WANT THEM TO PROVE:  I belong to a group run by a specialist in FUNCTIONAL MEDICINE (he's an MD) that has members from every specialty imaginable, many of them researchers.  What I hear concerning a large portion of studies that are discussed on the board is just how poorly designed many (some would argue most) experiments really are.  There are DOZENS OF TRICKS easily employed to create experiments in such a manner that they can prove anything you want them to.  And no one is shocked by the fact that when industry pays for the study, the results are far more likely to be beneficial to industry than if done by an independent third party.
  

 

• DRAMATICALLY UNDERREPORT DRUG SIDE EFFECTS:  Make sure that drug side effects are rarely reported.  Because if the proper governmental reporting authorities don't get accurate reports on AE's (adverse events), those AE's never make it into the statistical analysis of the drug's safety profile.  Naturally, this makes most drugs appear much safer than they really are.  This problem is so rampant that hundreds of studies have estimated the overall rate of reporting side effects at between 1% and 5%.  In other words, somewhere between 1 in 20 and 1 in 100 serious drug side effects are ever reported to the agencies specifically created to take these reports (HERE). 
  

 

• USE STATISTICAL ANALYSIS TO YOUR ADVANTAGE:   A few days ago I was discussing the brand new Cochrane Review concerning flu shots in healthy adults with my brother (AN ER DOCTOR who has never been a fan of the shots).  He brought up an interesting point.  Even though the data of hundreds of studies since 1965, containing over 80,000 subjects, was crunched to show that the vaccine lowers a healthy adult's chance of contracting flu from 2% to 1% (a whopping 1 percentage point), he rightly predicted that industry would claim that the unvaccinated group had 100% more flu than the vaccinated group (after all, two is 100% greater than one).  It's like Mark Twain once said, figures never lie, but liars figure.  If you get a good enough statistician on your research team, you can prove the moon really is made of green cheese!  This is why everyone should learn the difference between ABSOLUTE & RELATIVE.
  

 

• THE LAB IS DIFFERENT THAN THE REAL WORLD:  This was just dealt with the other day, although the exact post escapes me at the moment.  Variables are far more easy to control in a lab setting, many times giving us experiments that look nothing like real life.  Because of this the results look nothing like real life either.
  

 

• CREATE HYPE & CREATE DISEASES:  Whether talking about ADHD, flu, GERD or a myriad of other health issues, be sure and make things sound far worse (or mysterious) than they really are.  And by all means talk about these problems in terms of "diseases".  You no longer have heartburn, you have Gastro-Esophageal Refulx Disease.  You no longer have OSTEOARTHRITIS, you have DEGENERATIVE JOINT DISEASE.  Tacking the word 'disease' or 'syndrome' onto the end of a descriptive term is a surefire way to create hype and fear, and ultimately sell more drugs.
  

 

• DISCREDIT ANYONE WHO DARES OPPOSE YOU:  My site is littered with names of individuals who have come forward with their discoveries only to be blasted as quacks and crackpots by those in power --- something we routinely see in politics as well (who could forget the number of times that Hillary covered for Bill's sexual "escapades," many of which would now be classified as "assaults," while residing in the Arkansas Governor's Mansion and White House?).  What's cool is that we are seeing more and more people willing to step forward and take a bit of heat for what they are publishing in peer-review (HERE is a recent example).
  

Any one of these bullet points can be a big deal.  But when you dump them all together into a big cauldron and bring the whole sordid mess to a boil, you get a witches brew that skews and distorts truth in a way that creates maximum amounts of fear.  And face it, fear is what sells drugs.   This despite the fact we already know just how dangerous (scratch that, deadly) drugs and surgical interventions can be (HERE).  If you want to see this entire process in action, take a look at this video interview of chemist Boyd Haley on the neurotoxicity of MERCURY.

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