A few months ago I wrote a post about the work of physician and fascia researcher, Bruno Bordoni (HERE).  He's back for the attack with a brand new study called Chest Pain in Patients with COPD: The Fascia’s Subtle Silence, published in last month's issue of the International Journal of Chronic Obstructive Pulmonary Disease.  Having written a post on COPD not too long ago, I realized that the numbers of sufferers are not limited only to smokers or ex-smokers, but I had forgotten just how many people are affected by this disease.  "The World Health Organization (WHO) estimated a current mortality rate of at least 64 million people per year, and in 2030 COPD will represent the third leading cause of mortality in the world."  No matter how you slice it, COPD is both serious and common.

People with COPD not only struggle with difficulty breathing, but with pain as well.  This is especially true if the patient also has other diseases such as ANXIETY/DEPRESSION, HIATAL HERNIA, DIABETES, GERD, ARTHRITIS, OSTEOPOROSIS, SYSTEMIC MYOPATHY, or costochondritis (and as you'll see momentarily, Rib Tissue Pain is a huge component as well).  As opposed to "CENTRAL SENSITIZATION," Bordoni and his team reveal that COPD typically starts with, "peripheral sensitization provoked by the constant stimulation of inflammatory mediators."  If you are not sure what "inflammatory mediators" are, be sure to read THIS SHORT POST. 

Even thought the sensitization starts peripherally, it frequently ends centrally (see earlier link) ---- "hyperalgesia and allodynia, with central sensitization caused by the persistent involvement of medullary neurons and cerebral areas, and the subsequent involvement of the psychoneuroimmune system."  Not surprisingly, HYPERALGIA & ALLODYNIA are problems that are frequently associated with fibrotic fascia ("SCAR TISSUE").  Furthermore, the authors went on to discuss this phenomenon in terms of "LEAKY NERVE SYNDROME" ("increased permeability to cations of pain receptors, with the appearance of primary hyperalgesia").

Chronic inflammation becomes a self-potentiating viscous cycle ("This mechanism of inflammation that makes the fascial tissue fibrotic is always bidirectional. The lungs increase the fascial stiffness by releasing pro-inflammatory substances, just as the fascial tissue releases inflammatory substances toward the lung").  The pleura becomes thickened ("The creation of pleural adhesions and scars further reduces the lung expansion in patients with COPD"), the vagus nerve is affected as these people tend toward SYMPATHETIC DOMINANCE, chronic over-inflation of the lung causes the firing of specific kinds of pain receptors.  Furthermore, "the inflammation of bronchial pathways causes the production of free radicals" causing both bronchospasm "and pathological bronchial fibrosis".  What's critical for you to remember here is that fibrosis (Scar Tissue) is not only the world's leading cause of death (HERE), but always occurs as the result of inflammation (HERE, HERE, HERE, HERE, HERE, HERE, HERE, HERE, and HERE).  The authors went on to say....

"Chronic and acute pain can alter the functions of the baroreceptors, just like an altered function and position of the diaphragm can negatively influence the baroreceptorial system. This creates a vicious circle, and it becomes difficult to understand the cause and the effect.  We know that the compression of the vagus nerve can alter its function and ability to transport, just like the dysfunction of a peripheral nerve, mimicking the nerve entrapment syndrome. We can suppose that an anomalous tension of the diaphragm in the area of the vagal passage could induce the compression of the nerve, negatively affecting its anti-nociceptive and anti-inflammatory ability."

Baroreceptors are nerve endings found in the walls of blood vessels that sense pressure, allowing the body to make the proper adjustments in the muscles of the vessel walls to regulate blood pressure.  Nociception is your body's ability to sense noxious stimuli as pain or similar. This is why folks with COPD have a tough time regulating BLOOD PRESSURE.    The vagus nerve is the chief nerve of the parasympathetic side of the nervous system (the feed and breed / rest and digest side) as opposed to the sympathetic system (fight or flight). Foul vagal function and you'll likely end up with the Sympathetic Dominance I showed you earlier.

Although there are any number of other mechanisms of pain and dysfunction with COPD, this study spent a dozen or so paragraphs talking about the various ways that it affects the FASCIA SYSTEM.  After describing the fascial system thusly ("The fascial organization that covers the contractile part of the muscle can be defined as the myofascial system. The fascia allows the muscles to act in synergy, thanks to the fact that the fascial tissues connect all the muscular districts."), Bordoni went on to talk about how this screws up the BIOMECHANICS of the chest wall, the diaphragm, the ribs, as well as the "somatic fascial system (thoracic rib muscles)".  This is what I refer to in my clinic and on my website as "Rib Tissue" and helps explain why my Rib Tissue Pain pages (HERE or HERE) a some of my most popular.

"There are different muscles that operate on the ribs and that take part in the respiratory acts, whose behavior is not always easy to determine. Externally, the intercostal muscles are covered by the deep fascia originating from the deep cervical fascia, while, internally, they are covered by the endothoracic fascia.  Costal (rib) position changes in patients with COPD.  The muscular respiratory disadvantage increases the risk of hospitalization. Costal muscles work harder, and weakness, fatigue and inflammation appear. The level of inflammatory cytokines found in costal muscles is linked to the seriousness of COPD. Muscles suffer from hypotrophy with an increase in the amount of fat inside contractile fibers. Costal muscles can be a source of chronic pain."

Although I CHERRY PICKED the quotes from today's study, leaving out mass quantities of highly technical information, the point I wish to make here is that these rib tissues, as Bordoni says, "can be a source of chronic pain".  Another point is that hypertrophy and "thickening" (it was mentioned earlier) are frequently the result of problems with the fascial system (HERE & HERE).  In the paragraph below his team talks about the importance of hydration and HYALURONIC ACID as well as the inability of the various layers of pathologically adhesed fascia to slide on each other (HERE are two 7 second videos side by side, normal fascia -vs- adhesed fascia).  Oh; I almost forgot --- his study reveals that fascia acts not only as an ORGAN OF PROPRIOCEPTION, but as it's own nervous system as well (HERE).  It's a long (also cherry-picked) quote, but it contains ENOUGH MEAT to live on for a month!

"We know that the rib cage suffers from a biomechanical limitation and that costal muscles tend to become fibrotic. We know that the fascial tissue is in close proximity to the muscles (deep fascia and epimysium) and that it can suffer from the same non-physiologic adaptation of the contractile districts (and vice versa). We know that the nociceptors that are in the fascia have a lower threshold of activation if the fascial tissue is less compliant (greater stiffness).  We can suppose that the deep fascia covering externally the ribs is one of the causes of thoracic pain.  The fascia influences the function of the viscera (organ) it wraps around and vice versa. The fibrosis of the muscles, the fascia or the visceral tissues is similar to the wound-healing mechanism, which modifies the mechanical abilities, without necessarily altering their shape. The deep fascia, like the endothoracic fascia, is made up of several layers that slide over one another. The different layers will lose the ability to slide if they lose water and hyaluronic acid (like in fibroses), creating greater stiffness and density of the tissue. This happens in the fascial tissue of many anatomic areas where there is chronic pain (back, neck) or in pathologies (diabetes, trauma and surgery and hormonal variations) and aging. The fascial tissue that loses part of its ability to slide could create adhesions to the tissues it comes into contact with, further stimulating the nociceptive fascial afferences.  The different organs of the mediastinum communicate with one another, thanks to visceral fascial relations. This scenario could be one of the reasons for the lack of motor coordination found in patients with COPD.  The pain coming from the viscera, caused by the stiffness of the visceral fascia, could not only be one of the causes of perceived pain but also contribute to the patients’ lack of neuromotor coordination [since] the visceral fascial system could be considered as a proprioceptive organ."

No matter what sort of problem you may have, it is important to treat it as though it were systemic (the topic of tomorrow's post).  If you found this post relevant or interesting, please get this information into the hands of those that need it.  The easiest way to reach those you love and care about most is by liking, sharing, or following on FACEBOOK.

We all know that SMOKING is bad for us.  Most of us are even aware that second-hand smoke --- other's smoke that we inhale from the air around us --- can be equally bad.  But what about third-hand smoke?  I find that most people have never even heard of third-hand smoke even though it can be just as serious a problem as the others --- or as some studies are saying; even more so.  Here is the abstract of one such study by over twenty doctors and researchers from the University of California, Riverside (Cigarette Smoke Toxins Deposited on Surfaces: Implications for Human Health) from the January issue of the medical journal, PLoS ONE.

"Scientists do know that babies, toddlers, and children are most vulnerable to the toxic effects of tobacco smoke residue. They crawl on rugs, fall asleep on carpets, and teethe on furniture, all of which could be saturated with third-hand smoke."  From the March 20, 2014 issue of the National Geographic Daily News.

Amazing!  If you are still smoking in your house or in a vehicle --- especially if you have children or babies around, you may as well just give the kid a cigarette and be done with it (HERE). Notice the highlighted portion above talking about "fibrosis".  I've probably beat this horse to death already, but I'll take another crack at it if it will help you understand.  FIBROSIS = SCAR TISSUE = DEGENERATION. Period.

My clinical work revolves around solving problems created by SCAR TISSUE & FIBROSIS.  It's what I do all day, every day (HERE and HERE).   However, if you get Scar Tissue in your lungs, you're up a creek (HERE).  The only thing I can promise is a slow, painful death, gasping for air like a fish out of water.  When it comes to third-hand smoke, I could have given you several dozen studies on the topic.  Just trust me when I tell you that research on this topic is abundant, and each published study is scarier than the one that came out before it.

Although I have seen numerous definitions of what we call "Gross Obesity" or MORBID OBESITY (50% or more over your ideal weight is a common one, as is 100 lbs over your ideal weight), this study defined you as "Morbidly Obese" if you were over 40 on a BMI CHART.  And I probably do not need to remind you just how bad SMOKING is for your health.  The latest issue of the medical journal PLOS Medicine puts it in perspective.

The study, which is actually a meta-analysis of 20 similar studies, compared 10,000 people who were Grossly Obese, but had no history of heart disease, cancer, diabetes, smoking, etc, to over 300,000 people of normal weight with no history of the same things.  The Obese group died anywhere from 6 to 14 years sooner than the normal weight group, depending on how obese they actually were.  They died mostly of Heart Disease, DIABETES, and CANCER.   By the way, this study was funded and completed by our National Cancer Institute.

According to the latest governmental statistics, one of six American adults is Grossly Obese.  Another three out of that same six are considered overweight or Obese.  Add in the fact that our children are getting larger and larger by the year (HERE) to the statistics on something called MONW ("Skinny Fat" --- approximately 7% of our population would fall into this category), and you can see that the Westernized World has a serious problem on its hands.  If you are interested in losing weight, HERE are a number of articles to help get you started.

Marijuana has been a significant part of the American counter-culture since the 1960's.  With the recent legalization of both "Medical and Recreational Marijuana" (see picture), counter-culture has made its way into the mainstream.  Just how mainstream is pot these days?  Our most recent presidents have all admitted to imbibing in the weed (Bill claimed that he "did not inhale", Obama admits that, "I inhaled frequently --- that was the point", while George W. simply refused to answer the question). 

The truth is, I get it.  For those who are struggling with severe, debilitating CHRONIC PAIN, pot is probably a much better / safer option than Prescription Pain Meds (HERE, HERE, and HERE). However, smoking weed (whether for medical or recreational reasons) does not come without its own unique set of consequences.

The last time I was in Idaho Springs getting some work done on my feet (HERE), Shawn told me that their little town of about 1,800 people had six (6) Medical Marijuana dispensaries in it --- one for every 300 people in the city limits.  Dang; for a little skiing town in a state that ranks so high on the "healthy" chart, that's a lot of sick people! But I regress. One of the well-known effects of regular marijuana use is that regular use tends to create a lack of motivation --- a trait that was recently studied at Mount Sinai School of Medicine in New York City.  If you are a regular smoker, this study should at least raise some eyebrows ---- particularly if you plan on having children.

The effects of pot were looked at across multiple generations.  Interestingly enough, the effects of THC (the active ingredient in marijuana) were passed on to the grandsons (3rd generations) of rats, even though neither dad (the second generation) or Junior (the third) consumed the THC themselves.  The offspring of the THC rats were less motivated to seek out tasty food (reduced interest in chocolate) than were their peers who never smoked, and as seen in the quote at the top of the page, they had a much greater affinity for Heroin (probably why MJ is often times referred to as a "Gateway Drug").  Many will argue, but this did not seem like a good combination to me.  The study was presented by Dr. Yasmin Hurd at the annual meeting of the Society for Neuroscience.

The Tobacco Industry is evil.  They hooked millions of soldiers by giving out free or nearly free cigarettes during WWII.  They ran all sorts of ads telling the public how smoking was good for them, and that more doctors chose Camel than any other brand.  They chemically altered the nicotine (HERE) to make it even more addictive.  In fact, cigarettes were regularly touted for health benefits up until the 1950's, with Camel, Lucky Strike, and Chesterfield duking it out for the title of most healthy smokes (the cigarette most associated with weight loss, increased energy, better sex, etc, etc).  Then in the 1920's, we saw the advent of the "Menthol Cigarette".

By the early 1930's, the "Kool" brand had become the only major player selling menthols, which were among other things, being touted in OLD ADVERTISEMENTS for their health benefits --- particularly pertaining to respiratory health (ASTHMA, ALLERGIES, COUGHS, SORE THROATS, etc, etc).  Did the American public buy this?  Many must have, as I have seen that many prominent singers, including Nat King Cole, chain smoked Kools for their supposed benefits to the throat (could be why he died of CANCER at age 45). 

Although menthol can be made from peppermint or other mint oils, it is made for commercial means synthetically.  One of its unique properties is the ability to stimulate nerves that sense cold without actually changing the temperature of the tissue.   Many muscle rubs as well as "Vick's" have similar properties.

Two days ago, the FDA issued a paper on the effects of menthol in cigarettes (something they also did back in March of 2011).  It finally looks like a ban is coming.  The problem with menthol cigarettes is not that they are somehow more toxic than regular cigarettes, but that the research has shown how many young people begin their smoking habit with menthols or other flavored smokes (these have since been banned).  For some reason, studies have shown that it is harder for people to stop smoking menthol cigarettes than it is for them to stop smoking normal cigarettes.

Interestingly enough, because there is a disproportionate number of blacks and other minorities addicted to menthol cigarettes (80% of those who smoke menthols are black), several organizations (The Congress of Racial Equality, the National Black Chamber of Commerce, the National Organization of Black Law Enforcement Executives, The National Black Police Association, etc) have petitioned the FDA not to ban menthols because doing so might cause a black market to spring up for smuggled menthol smokes.  Oh, by the way, the National Association of Convenience Stores opposes a ban as well.

The bottom line is that I would strongly suggest that if you smoke; QUIT!  I see 18 year old kids looking for anything to help them stop smoking.  They are already deep into the world of hardcore addiction, and they know it.  If you smoke, you are not only likely to die early, but to die a long, drawn-out, and painful death.  Do what it takes to quit the cigarettes today!  And while you are at it, can the SUGAR ADDICTION as well.

No one today is going to argue that tobacco use does not carry some very serious health risks (except maybe the company who used to advertise decades ago that more MD's smoked Camels than any other brand).  We know that smoking is directly responsible for at least one in five deaths in the United States each year, and adds an estimated $200 billion dollars to health care costs --- costs ultimately picked up by the tax-paying public.  The truth is, most people who smoke want nothing more than to quit.  But thanks to chemists working in the Tobacco Industry, the nicotine is today's cigarettes is more addictive than it was in years gone by --- much more addictive.

Amazingly enough, according to the Department of Health and Human Services, 36 percent of the nation's smokers try to quit each year.  But only 3 percent succeed in quitting for even six months (percentages go down from there).  However, this number is said to go up to almost 10% if people use some sort of smoking cessation drug. Whenever you hear the word "drug" just start following the money. Enter the drug companies.

Although a recent scientific study stated that Pfizer's smoking cessation drug Chantix, "carries too many risks" it was still OK'd for public use.  Exactly how bad were these risks ---- risks that PFIZER, the drug's manufacturer, vehemently denied?   Chantix is a whopping eight times more likely to be linked with DEPRESSION and suicidal behavior than other nicotine replacement products (which themselves increase these problems as well).  The findings directly contradict two studies released last month by the Food and Drug Administration that showed Chantix did not increase the risk of being hospitalized for psychiatric problems such as depression. The agency at the time acknowledged that those studies were flawed because they were too small, and they only captured cases that were severe enough to land people in the hospital.

"Our study contradicts the implications of a recent review by the FDA showing no difference in psychiatric hospitalizations.  The FDA hospitalization studies were flawed because they could not capture most of the serious psychiatric side effects, including suicide, depression, aggression and assaults. These can be catastrophic events but do not normally result in hospitalization" said Dr. Curt Furberg, professor of Public Health Sciences at Wake Forest Baptist Medical Center, co-author of the study published online in the Public Library of Science journal PLoS One.  He's right.   How many sucessful suicide attempts are hospitalized?  They're not hospitalized.  They end up in the morgue!

The new study relies on adverse events reported via the FDA's Adverse Event Reporting System from 1998 through September 2010.  They compared 3,249 reports of serious self-injury or depression linked to

• Pfizer's Chantix
• Glaxo Smith Kline's Zyban --- an antidepressant that was approved for smoking cessation
• Nicotine Replacement Products (gum and patches).
  

They found that 2,925 cases, or 90 percent, of suicidal behavior or depression reported to the FDA were related to Chantix, even though the drug was only approved for four of the nearly 13 years of data included in the study.  "We found that Chantix is associated with more suicidal behavior reports than any other smoking-cessation drug on the U.S. market. The risks simply outweigh the benefits".

Although Pfizer has strongly defended its drug, prior studies by Furberg and colleagues have shown Chantix increases the risk of other serious health issues including heart problems, unprovoked aggression, and sudden blackouts.  "There were reports of people driving cars and blacking out," said Furberg. He and fellow researchers were so concerned about this side effect that they took their findings to the Federal Aviation Administration, which banned pilots from using Chantix in 2008.