December 2001 Newsletter

FHN Complementary Medicine Monthly Newsletter December 2001

Holidays

As we approach the holiday season we thought we would take some time to express our thankfulness and gratitude. We understand that it is a busy time of year in which it seems there is not enough time for everything. We also understand that there are many who get depressed at this time of year.

So with an attitude of gratitude we share the following.

"Gratitude unlocks the fullness of life.

It turns what we have into enough, and more.

It turns denial into acceptance, chaos to order, confusion to clarity.

It can turn a meal into a feast, a house into a home, a stranger into a friend.

Gratitude makes sense of our past, brings peace for today, and creates a vision for tomorrow."
Melody Beattie

Be Thankful

Be thankful that you don't already have everything you desire.
If you did, what would there be to look forward to?
Be thankful when you don't know something,
for it gives you the opportunity to learn.

Be thankful for the difficult times. During those times you grow.
Be thankful for your limitations,
because they give you opportunities for improvement.
Be thankful for each new challenge,
because it will build your strength and character.

Be thankful for your mistakes. They will teach you valuable lessons.
Be thankful when you're tired and weary,
because it means you've made an effort.

It's easy to be thankful for the good things.
A life of rich fulfillment comes to those who
are also thankful for the setbacks.
Gratitude can turn a negative into a positive.
Find a way to be thankful for your troubles,
and they can become your blessings.

--- Author Unknown

We are grateful for becoming part of the network and the opportunity to serve you.

Share with us that which you are grateful.

We wish you a Merry Christmas!!

May God bless you!

May God bless America!

Drs. Glenn and Julie Smith and staff

Complementary Medicine

November 2001 Newsletter

FHN Complementary Medicine Monthly Newsletter November 2001

Probiotics and Antibiotics

The human body is a walking ecosystem. Although we do not usually think of ourselves in this way, the fact is that we are "home" to trillions of microorganisms that live on and inside us. We are actually made up of 90% bacteria cells (100 trillion) and only 10% animal cells (10 trillion). Every person harbors more microorganisms in their gastrointestinal tract than there are people in the world, or have been in all of history. The gums, teeth, hair, and skin are also richly populated with many types of microorganisms.

Although some of the microorganisms inside us may be harmful, the vast majority are not. In fact, they are necessary for good health. Human beings have developed a symbiotic relationship with these microorganism. For instance, beneficial bacteria in the intestines help digest foods, create vitamins (such as B-12 and K), and inhibit the growth of disease-promoting pathogenic bacteria. Without these beneficial or probiotic microorganisms, as they have now come to be called, we could not survive.

Throughout history many peoples have traditionally eaten certain cultured and fermented foods that are rich in beneficial microorganisms and can increase digestive strength and general health. For instance, fermentation with lactic-acid forming bacteria, including Lactobacillus acidophilus, is one of the oldest methods of making cultured foods such as yogurt and sauerkraut.

Many scientific studies over the last 50 years have shown that probiotic organisms can improve the nutritional quality of foods, as well as produce antibiotics, anticarcinogens, anticholesteremic substances, and substances that break down and recycle toxins for their human host.

Negative Side Effects of Antibiotics
There is no question that antibiotics are invaluable medicines. In emergency situations--such as in the case of a child on the verge of death from meningitis--antibiotics are literally life-savers. Even in many less extreme situations, they can be extremely valuable. Nonetheless, antibiotics are too often overused in current medical practice--with marked negative side effects, one of the greatest being damage to the intestinal microflora.

Once probiotic organisms have been destabilized and stripped off the walls of the intestines, potentially pathogenic organisms such as Candida albicans, Staphylococci, and Clostridium difficile have much more opportunity to proliferate. This can lead to infection, sepsis, diarrhea, and colitis. Significantly, these conditions usually coincide with a reduction in the number of L. acidophilus in the intestines. One side effect of antibiotic therapy is diarrhea. This is often called antibiotic-associated diarrhea. Other names for this condition are antibiotic-associated colitis, pseudomembranous colitis, or Clostridium difficile colitis. This infection is caused by a disruption of the normal bacterial content of the large intestine resulting in a loss of the normal healthy bacteria. Most cases follow a course of antibiotic therapy, but sproradic cases can occur. In either event, this disruption allows an overgrowth of the Clostridium difficle bacteria which produces a toxin. This toxin damages the lining of the large intestine causing the symptoms. These symptoms include diarrhea with many loose watery bowel movements during the day and often at night. Some cases are more severe with fever abdominal pain, nausea and vomiting.

Unfortunately, about 20% of patients with C. difficile infection have a reccurence of the infection after they finish a course of appropriate treatment - even if they are not exposed to more antibiotic therapy. There does not appear to be any relationship between recurrence and the severity of the original infection or the treatment used. It does seem that recurrent disease is slightly more common in older women, kidney disease, and chemotherapy. Of course, taking antibiotics for another infection will increase the risk of reccurence. Most affected are adults, but recurrent C. difficile has been reported in children. We have talked only about diarrhea as a side effect of decreased flora, however there is growing evidence that more far reaching side effects, such systemic candidiasis, asthma, allergies,etc., may occur.

Probiotic therapy is a treatment of recurrent C. difficile. Preliminary clinical studies suggest that these agents may help restore the normal healthy intestinal bacteria and increase resistance to the growth of C. difficile and other flora a imbalances. Several agents have been studied including Saccharomyces boulardii(SB), a non-disease yeast that inhibits the growth of C. difficile and may help inactivate its toxin. Saccharomyces boulardii is a live yeast packaged in capsules and sold over the counter to treat diarrhea; millions of doses are sold each year. SB does not remain in the intestine and is eliminated from the body within several days. SB is a different yeast than candida, which causes oral and vaginal yeast infections, or thrush. Saccharomyces boulardii does not increase thrush and in fact may lessen or prevent thrush infections.

Another helpful probiotic organism is Lactobacillus. Patients to can eat yogurt with an active lactobaccilus culture during and after their course of therapy, however most of the time this is not nearly strong enough to counter act the strength of the antibiotic used. A more effective form of lactobacillus is a concentrated pill or powder form.

The Benefits of Maintaining a Healthy Indigenous Microflora or Probiotic Supplementation

1. Boosting the Immune System

2. Inhibiting the Growth of Pathogenic Organisms

3. Prevention of Diarrhea from Various Causes

4. Cancer Prevention

5. Reduced Risk of Inflammatory Bowel Disease

6. Improved Digestion of Proteins and Fats

7. Vitamin Synthesis

8. Detoxification and Protection from Toxins

If you are on or have been on (in your life time) antibiotics you need to be on probiotics.

We use Saccharomyces boulardii during therapy and acidopholus after therapy. Try it…it just may save you from further complications.

Sincerely,

Dr. Glenn and Julie Smith

Complementary Medicine

October 2001 Newsletter

FHN Complementary Medicine Monthly Newsletter October 2001

An alternative look at PMS

Premenstrual syndrome (PMS) is defined as a recurrent cyclical set of physical and behavioral symptoms that occur 7 to 14 days before the menstrual cycle, and are troublesome enough to interfere with some aspect of a woman’s life. PMS affects up to 40% of menstruating women. More than 150 symptoms have been associated with PMS. The most common include nervousness, anxiety, irritability, fatigue, lethargy, depression, mood swings, water retention, abdominal bloating, tender breasts, headache, change in appetite, back pain, acne, sugar cravings, diarrhea, low libido, constipation, clumsiness, dizziness, low self-esteem, social isolation, insomnia, and joint pain.

The causes of PMS are many and varied. In some cases not well understood. To get a better handle on causes….and therefore treatment, Dr. Guy Abraham categorized PMS into 4 subgroups.

1. PMS-A (anxiety) believed to be related to high estrogen and low progesterone.

2. PMS-C ( carbohydrate craving) there is a increased sensitivity to insulin during the luteal phase , causing in some woman hypoglycemia ( low blood sugar).

3. PMS-D (depression) May be due to low levels of estrogen leading to the breakdown of neurotransmitters. ( ie seratonin)

4. PMS-H ( hyperhydration) Another hormone aldosterone elevates leading to increased estrogen , increased salt intake ( salt stimulates the adrenal gland) ,and a magnesium deficiency.

It is interesting to note that in Chinese medicine gynecology, developed several thousand years ago ,PMS symptoms were divided into these types:

1. Excess syndrome due to liver stagnation ( the liver is where estrogen production starts)

2. Deficient syndrome due to lack of qi and blood ( symptoms are similar to PMS-D )

3. Spleen qi deficiency ( in Chinese medicine the spleen deals with control of digestion. ie Carbohydrates)

4. Heat in the blood ( which has similar symptoms to PMS-H)

It is important to have a thorough evaluation that includes a careful history including nature, timing, severity, diet, exercise, drug ,and alcohol use. Obviously a complete physical and pelvic exam and lab test to rule out anemia and hypothyroidism need to be done. In addition to those we might run additional tests to evaluate adrenal stress ( a saliva or urine test) ,or a 28 day salivary hormone analysis.

Natural Treatment Options

Obviously treatment options depend on specific causes….the more we know the more refined the treatment.

Exercise

Regular , REASONABLE, physical exercise improve all symptoms of PMS!

Diet and Nutrition

Reducing sugar and simple carbohydrate (pasta, bread, etc.) intake is essential….I know that is what you are craving! Replace them with something that has a lower glycemic index. Such as vegetables or a protein food.

Decrease salt intake at these periods

Decrease caffeine intake, that includes coffee, tea, cocoa, chocolate, pop, caffeine supplements (diet pills)

Shift fat intake to eat more Omega 3 oils (fish ) and reduce both arachadonic acid ( red meat) and omega 6 oils 9 ( corn, soy, palm, etc). Some women can’t convert linoleic to gamma linolenic acid. They may need to use oil of evening primrose.

Increase calcium and magnesium 1000-1500 mg /day

Increase B vitamins especially B6. 50-100mg/day. The active form of B6, P5P is actually better in this instance.

Botanicals

Chasteberry

This herb has been used for centuries for PMS. It helps normalize both LH and progesterone.

Black and Blue cohoshes

These herbs seem to effect both homone and serotonin levels.

St John’s wort

This also seems to effect serotonin levels which can help with some depression and mood swings. Care should be taken if you are already on SSRI medicaton.

Kava

This herb has been used to help alleviate anxiety type symptoms.

Wild Yam creams

Both the progesterone and estrogen type of creams, that are biologically active, ( there are only a few brands that are), can be used effectively. We recommend that we have hormone levels checked with the 28 day saliva test before we use this therapy.

Chinese Medicine

Acupuncture is a wonderful tool to help during the pain and to help to normalize the hormone imbalances.

Chinese botanical medicine has a number of different formulas to treat PMS depending on the symptoms. We have found these to be very effective in restoring normal function.

Sincerely

Dr. Julie and Glenn Smith

PS Past copies of the newsletter can be found on the “P” drive in the Complementary Medicine folder.

September 2001Newsletter

FHN Complementary Medicine Monthly Newsletter September 2001

“WHAT’S IN A BULGE”

This month we will talk about Low Back Pain (LBP). There can be many reasons for LBP , we will look at the bulging intervertebral disc(IVD) as one of the causes.

First we need to look at the anatomy of the IVD to understand its role in back pain. The IVD is composed of an outer layer ( annulus) of tough connective tissue , and an inner layer ( nucleus pulposis) of a jelly like substance. The connective tissue annulus holds the nucleus in place and the nucleus acts as a shock absorber for movement and stress in the spine. The annulus of the disc has been shown by Bogduk and others to be well innervated with both sensory and autonomic/sympathetic fibers of the sinuvertebral nerve. There are mechanoreceptors (stretch), nociceptors (pain), and chemoreceptors that can detect all types of mechanical and biomechanical changes occurring in the periphery of the disc.

A disc bulge is the protrusion of the jelly-like substance into the space where the nerve sits. A disc herniation is when a bulge ruptures. With either of these conditions, you may experience pain or numbness in your back or down your leg. Most commonly, a disc will herniate from repetitive strain over time. A person will bend a certain way with little problems for years. Then, one day, you sneeze and your back is killing you!! The backaches that you get from time to time are giving you a warning signal.

Are disc bulges or central disc herniations clinically significant findings when revealed on anatomical studies such as MRI or CT scanning, when there is clinical correlation on physical examination? While this is a controversy in some circles, clearly the scientific literature supports that central/paracentral disc herniation or bulge without neural impingement as significant when there is clinical correlation. Recent studies with CT/discography have shown that there is an entity of internal disc disruption that can cause the patient pain, prior to a disc protrusion that is evident on MRI or CT scans. Bogduk has published similar work where he describes "internal disc disruption" based on CT discography studies. The symptoms of nerve irritation can also be caused by inflammation from the breakdown products from a degenerate but not bulging disc. So patients may be suffering intense back and leg pain where no protrusion is visible on MRI scans. Disc degeneration is caused by the watertight endplates of the vertebra above and below the disc, squeezing water from within the disc causing it to dry out during the day, when it is under pressure from the upright spine. Consequently the disc contents are less able to conduct oxygen and other nutrients into the disc and this results in the cells dying and disrupting. This destruction liberates acids and enzymes which effectively dissolve the proteins that form the healthy disc material and these breakdown products leak and the disc gradually looses bulk. These chemical irritants affect the surrounding disc and the posterior longitudinal ligament, which are abundantly supplied with nerves (remember?) and as it is linked to the levels above and below the affected disc, the pain is felt over a much wider area than just the level concerned.

So what can you do about that back pain?

First of all determining the extent of the disc involvement / bulge is imperative. CT/MRI, while not perfect , are helpful in this area. If we have a bulge that is causing a space occupying lesion , we need to reduce the bulge! If we have neurological deficits ( weakness, numbness, radiating pain, etc.) That may need a surgical procedure . However if not severe there are some conservative measures that have proven effective. An osteopathic procedure that has been refined by a chiropractor (Cox) called

flexion/ distraction (F&D) has proven very effective in reducing/retracting the disc. ( We have two very special F&D tables exactly for that purpose.)

Exercise

Research shows that recurrence rates for low back pain soar as high as 50% in the 12 months following the initial episode. And although patients are encouraged to return to normal activities as soon as possible, many fear that movement or activity will only make their pain worse. In July 2000 , the British Medical Journal published a study that evaluated the effectiveness of an exercise program for dealing with back pain. One hundred and eighty-seven patients with low back pain of 1-6 months duration were divided into an exercise group or a control group. The exercise group participated in eight one-hour classes that included muscle strengthening, stretching, relaxation techniques and a brief education on back care. The control group continued under the care of their doctor.

Questionnaires completed six months and one year after the program revealed that patients in the exercise group reported less back pain and associated disability than the control group. The exercise group also took less days off work than the control group in the 12-month follow-up period (378 days by the exercise group vs. 607 days by the control group).

Rest has been standard recommendation for low back pain (LBP) for years . This recommendation persists despite research evidence suggesting that prolonged rest serves no purpose and may delay return to work and resumption of normal activities.

A report from the International Paris Task Force on Back Pain outlines the role of activity in the treatment of back pain. In addition to presenting numerous recommendations and summaries, the authors offer the following key points as summary to their findings:

· Bed rest is contraindicated in subacute and chronic cases of LBP.

· In acute cases, bed rest should neither be enforced nor prescribed.

· If authorized (based on pain indication), bed rest should be for the shortest duration possible.

· Patients whose pain is intense enough to justify bed rest should be referred for a specialized back pain evaluation if daily activities have not been resumed after 10 days of strict bed rest (defined as getting up only to go to the bathroom) and adequate pain therapy.

Acupuncture is a wonderful modality in the treatment of LBP and assist in the healing of the area by increasing blood perfusion, increasing lymph drainage, and helping to shunt prostaglandin( one pain producing hormone) production form the proinflammatory type to the antiinflammatory type.

Nutritional Support for the disc include:

· Hydrolyzed gelatin - Gelatin provides the components of collagen, which is the basis of connective tissue found in skin, ligaments, cartilage, vertebral discs, joint linings, capillary walls, and the bones and teeth.

· Glucosamine sulfate - Glucosamine is a major component of cartilage. It helps the body make synovial fluid—an important joint lubricant—and proteoglycans—the large, shock absorbing molecules found in cartilage.

· Chondroitin sulfate - Chondroitin is a derivative of glucosamine that supports the strength and flexibility of all connective tissues in the body.

· MSM (methylsulfonylmethane) - MSM is a natural, nutritional source of biologically active sulfur. MSM provides the body with the raw materials it requires to remanufacture protein and connective tissues. MSM also has an anti-inflammatory effect on injured joints.

· Vitamin C (ascorbic acid) - Ascorbic acid is essential for the synthesis of collagen and the reconstruction of connective tissues in the body.

. Bromelain, a highly effective anti-inflammatory enzyme from pineapple. This enzyme has been extensively tested and found to have prostaglandin regulating properties. Prostaglandin cascades are centrally involved in inflammation, and by helping to shift the prostaglandin balance away from pro-inflammatory and towards anti-inflammatory, bromelain can moderate the process and speed recovery time.

• N-acetyl glucosamine (NAG), an activated metaboliteof glucosamine..

The enzymes that assemble connective materials from precursors readily utilize NAG “downstream” from glucosamine. NAG bypasses the acetylation of glucosamine that in vivo is known to be sensitive to blockage by aspirin and ethanol. NAG also may help to heal the “leaky gut” that sometimes accompanies connective tissue dysfunctions. NAG has antioxidant efficacy – it is an effective quencher of superoxide, one of the oxygen radicals that are abundantly produced during inflammation. NAG also partially blocks the release of elastase enzyme from immune cells, a phenomenon that normally contributes to spreading inflammation.

• Silicon and boron. These dietarily essential minerals are involved in crosslinking the primary connective strands to generate a final material that has great tensile strength

• Vitamin B6/pyridoxine.

Vitamin B6 helps recycle homocysteine, which when accumulating in excess will

interfere with collagen hydroxylation.

• Magnesium and calcium,

In this “yin-yang”mineral pair, magnesium is involved in connective tissue renewal and calcium if included for balance.

. Manganese is included as a mineral cofactor for SOD.

Molybdenum is another mineral essential for tissue homeostasis.

• Proanthocyanidin flavonoids, standardized.

This class of bioflavonoids is proven to enhance the tonicity of the microcapillaries and other small vessel beds.

Sincerely

Dr. Julie and Glenn Smith

PS Past copies of the newsletter can be found on the “P” drive in the Complementary Medicine folder.

August 2001 Newsletter

FHN Complementary Medicine Monthly Newsletter August 2001

This month we will continue our talk about headaches.

Last month we talked about four types of headaches:

Organic

Tension Type

Cervicogenic

Migraine

This month we will continue with:

Cluster

Hormone

Detox

Other Headaches

Whenever we discuss treatment we must have 2 goals.

1. Abortive (pain relief)

2. Preventive

So lets look at these four types of headaches and some alternative treatment strategies.

Cluster Headaches

It is estimated that less than one percent of the population are victims of cluster headaches, thank goodness because they are nick named the suicide headache. They encounter the headache somewhere between the ages of 20 and 45. More men (about five to one) than women suffer from cluster headaches. Cluster headaches frequently surface during the morning or late at night; the cluster cycle can last weeks or months and then can disappear for months or years. Clusters often occur during spring or autumn and, thus, are often incorrectly associated with allergies. Sufferers, however, usually do have a history of chronic smoking, and alcohol frequently triggers a cluster headache.

Traditional Preventive Treatment usually include:
As you review these, remember that all medications have side effects, and you should discuss them with your doctor.

Verapamil
Prednisone
Ergotamine tartrate
Methysergide
Lithium carbonate
Divalproex Sodium
Histamine acid phosphate

Traditional Abortive Treatment include:
Some of these medications come in various formulations, such as nasal sprays, injections and tablets.

Oxygen
Dihydroergotamine
Sumatriptan
Lidocaine

Alternative Therapies

Stress reduction techniques, such as yoga, meditation, and regular exercise.

Vitamin C and the bioflavonoids quercetin and bromelain (pineapple enzyme).

Supplementation with essential fatty acids (EFA) will help decrease any inflammatory response.

Physical medicine therapies such as adjustments of the spine, craniosacral treatment, and massage at the temporomandibular joint (TMJ) can clear blockages.

Acupuncture.

Nervous system relaxant herbs: a few herbs to consider for relaxation are valerian ( Valeriana officinalis ), chamomile ( Matricaria recutita ), rosemary ( Rosemarinus officinalis ), and skullcap ( Scutellaria baicalensis ).

Hormonal Headaches

Although only women suffer from "hormone headache," both men's and women's headaches are prompted by hormones. You would not feel pain without them, because it is the hormones that induce the pain response. Actually, the headache may be protecting you or warning you of something more damaging in the same way that touching a hot stove alerts you to the heat and protects you from burning yourself.

Your endocrine and nervous systems are responsible for the thousands of automatic responses that regulate your bodily functions. They decide, for example, whether you will respond to a potential headache trigger with an actual sensation of pain.

Let’s look at some different types of hormonal headaches.

Menstrual migraines affect 70 percent of women with migraines. They occur before, during or immediately after the period, or during ovulation. Menstrual migraines are primarily caused by estrogen, the female sex hormone that specifically regulates the menstrual cycle fluctuations throughout the cycle. When the levels of estrogen and progesterone change, women will be more vulnerable to headaches.

The PMS headache occurs before your period and is associated with a variety of symptoms that distinguish it from the typical menstrual headache. These symptoms usually disappear when menstruation begins.

Migraine headaches are the most common side effect reported by women taking birth control pills, and many women stop taking them because of the headaches. The birth control pill tends to increase the frequency, duration, severity, and complications of migraine by intensifying the fluctuations of female hormones in the body.

Menopause Headaches: About half of all women do experience slight physical or emotional changes as they progress through menopause. Another 25 percent may suffer irregular heartbeat, joint pains, flushing in the upper torso, and headaches.

Treatment:

All treatment needs to be focused at normalizing hormonal function. As such gynecological problems that effect hormones need to addressed ( ie endometriosis, cysts, tumors, etc.).

Again assessment of hormone levels especially over the whole cycle can help in treatment strategies. We use a saliva test that take samples over the course of the period to help with hormonal assessment and timing. Menopausal women can do a five day test to assess their current hormonal levels.

Alternative preventive treatments include:

Herbal remedies – blue and black cohosh, wild yam creams, licorce , ginsengs , dong quai

Nutritional Support: Calcium /magnesium, adrenal support , Vitamin C

Physical medicine therapies such as adjustments of the spine, craniosacral treatment

Acupuncture

Detox Headaches

We could divide these into withdrawal type headaches and rebound type headaches. Everyone who drinks coffee is familiar with the headache they get if they stop drinking coffee for a day or more. This is your bodies detoxification process in the liver getting rid of metabolic waste it has been storing. The headache can last for hours to days. If you are constantly intoxicating your liver with substances such as caffeine, or alcohol, etc., you may be in a viscous cycle leading to frequent detox type headaches.

Rebound headaches can come from over medicating OTC type analgesics (taking more than recommended) on a regular basis. Many times the therapeutic dose and the toxic dose of these substances are not that far apart, which could lead to the bodies detox mechanism upregulating and causing the viscous cycle to start.

Some prescription medications such as fiornal and ergotamines are well known for their rebound type effects.

So what do you do? If the headaches are due to withdrawal type symptoms STOP the offending substance.

During the withdrawal phase several things may be helpful.

Alkalize yourself with buffered vitamin C (ester C) or bicarbonate of soda (alkaseltzer gold).

Withdraw gradually adding water in place of the coffee or tea or whatever.

Antioxidents especially glutathione and N acetyl cystiene to help the liver detox processes.

Herbs silymarin (milk weed thistle) and bupluerum, again for liver support

If you are over medicating you need to talk to your doctor !

Other type headaches

The majority of headaches that fall into this category are sinus headaches, which will be the subject of another newsletter on sinusitis.

As you can see the causes and treatment of headaches vary greatly. It is a piece of detective work many times. If you are a chronic headache sufferer it may benefit you to look into alternative treatments so that you might be able to reduce frequency, dependence on meds, and intensity of headache.

The feedback on the last newsletter was appreciated. If you give us feedback let us know if we can pass it along to help others. Dr Gaertner and Dr. Hass at Healthworks report excellent results with headaches using acupuncture.

To your health

Dr. Glenn Smith

Dr. Julie Smith

Complementary Medicine

July 2001Newsletter

FHN Complementary Medicine Monthly Newsletter July 2001

This month we will talk about headaches. Almost everyone at some point suffers from headaches. 30-40% of the adult population have headaches at least once per month. 3-5% of the population have “chronic” headaches. Headaches can have many different causes so it is helpful to breakdown headaches into different types. That actually is not as easy as it sounds. Different organizations break them into different categories and your symptoms may fit into several different categories. So categories are some what arbitrary but useful for discussion, diagnosis and treatment.

Headache types:

Tension Type

Cervicogenic

Migraine

Cluster

Hormone

Detox

Organic

Other

Each of these types of headaches may have different causes, requiring different treatment approaches. Some may share some common causes, allowing for common treatment strategies. Whenever we discuss treatment we must have 2 goals.

1. Abortive (pain relief)

2. Preventive

So lets look at some of the types of headaches and some alternative treatment strategies.

Organic Headaches

While this type of headache is one of the smallest in terms of prevalence (<5%) style=""> for any intense or chronic headache. Organic headaches can be from brain tumors, aneurysm, hematoma, meningitis, abscess, infection, hemorrhage, or encephlitis (to name a few). The underlying cause needs to be ascertained by the appropriate diagnostic measure and then dealt with accordingly.

Tension –Type Headaches (TTH)

The most common type of headache is the tension headache. 20-30% of adults have one or more per month. 3% have chronic (15 or more per month ) headaches. Obviously, ‘stress’ plays a roll in these type of headaches, however, it does not explain a good percentage of them. There was a recent discovery (1995) by some dental researchers at the Univ. of Maryland. They discovered a band of connective tissue that connects a small muscle in the back of the head/neck (rectus capitis posterior minor) to the outside of the spinal cord (the dura matter). This happens at the occipital/atlas junction and the atlas/axial junction. This new anatomical understanding can help explain how former head and neck trauma (leading to scar tissue) can be part of the cause of these type of headaches.

Traditional preventive treatment traditionally include:

NSAID’s

Antidepressants

SSRI’s

Etc.

Traditional abortive treatment include:

NAID’s

Muscle Relaxants/analgesics

Some alternative treatments that have been shown to be as effective as amitriptyline include:

Relaxation techniques

Biofeedback

Chiropractic manipulation

(Boline et al 1995)

Chiropractic manipulation additionally had a more sustained benefit in terms of decreasing frequency and intensity.

Additional treatments include:

Acupuncture

Massage

Nutritional/Herbal therapy (ie magnesium, calcium, valerian root, hops, passion flower)

Cervicogenic Headaches (CGH)

This type of headache by definition has a neck (cervical) cause and or component. (We could add TMJ induced headaches in this category.) CGH and Migraines are about equal in prevalence and are the 2^nd most common types of headaches. 17-18% of adults suffer from this type of headache ( 5 or more days per month).

This type of headache is often very resistant to traditional treatment

A study done at Duke University showed that manipulation is the most effective form of treatment for CGH headaches.

Acupuncture, massage, and physiotherapy were also looked at in this study. All were deemed to need more study to show effectiveness.

Dental bite plates additionally have been used for TMJ problems.

Migraine Headaches

Again, the second most common type of the headache (along with CGH). This type of headache is most responsible for job absenteeism and disrupted family life. 28 million americans suffer from migraines, with women have 3 times as many as men (which may suggest a hormonal component to some of the migraines). Part of the problem is that everyone who suffers from them seem to have there own brand of symptoms. Migraines can be with or without ‘auras’. The headaches seem to be vascular in nature. Which leads us to some of the detective work involved with treatment of the headache….finding triggers that precipitate the vasodilatation (blood vessel distension).

Preventive treatment must include understanding those triggers.

Some of those triggers include:

Stress

Fatigue

Hypoglycemia

Caffeine

Chocolate

Alcohol

Hormonal Changes

Candidisis

Food Sensitivities

Additives

Some helpful tools in assessing some these triggers include:

Food allergy testing that includes both immediate (IgE) and delayed mediated sensitivities. We use an ELISA blood test for those purposes.

Hormone testing that looks at hormone levels over a complete 28 day cycle. We use a saliva test that can be done at home. This assesses not alone hormone levels but also hormonal timing which can be as important as levels.

Reactive hypoglycemic testing ( ie 5 hr GGT)

Cellular Energy testing which assesses metabolites of cell energy production. (Krebs cycle intermediates )

Comprehensive Digestive Stool Analysis which not only assesses parasitology, but imbalances in normal flora (helpful in assessing candidiasis) .

Alternative abortive treatment include:

Acupuncture with needles and with microcurrent stimulation to the ear.

Herbs: feverfew, Chinese fumewort, butterburr root , ginger root ( for naseau)

Cranial suture manipulation/pressure.

Cluster Headaches

It is estimated that less than one percent of the population are victims of cluster headaches, thank goodness because they are nick named the suicide headache. They encounter the headache somewhere between the ages of 20 and 45. More men (about five to one) than women suffer from cluster headaches. Cluster headaches frequently surface during the morning or late at night; the cluster cycle can last weeks or months and then can disappear for months or years. Clusters often occur during spring or autumn and, thus, are often incorrectly associated with allergies. Sufferers, however, usually do have a history of chronic smoking, and alcohol frequently triggers a cluster headache.

Traditional Preventive Treatment usually include:
As you review these, remember that all medications have side effects, and you should discuss them with your doctor.

Verapamil
Prednisone
Ergotamine tartrate
Methysergide
Lithium carbonate
Divalproex Sodium
Histamine acid phosphate

Traditional Abortive Treatment include:
Some of these medications come in various formulations, such as nasal sprays, injections and tablets.

Oxygen
Dihydroergotamine
Sumatriptan
Lidocaine

Alternative Therapies

Stress reduction techniques, such as yoga, meditation, and regular exercise.

Vitamin C and the bioflavonoids quercetin and bromelain (pineapple enzyme).

Supplementation with essential fatty acids (EFA) will help decrease any inflammatory response.

Physical medicine therapies such as adjustments of the spine, craniosacral treatment, and massage at the temporomandibular joint (TMJ) can clear blockages.

Acupuncture.

Nervous system relaxant herbs: a few herbs to consider for relaxation are valerian ( Valeriana officinalis ), chamomile ( Matricaria recutita ), rosemary ( Rosemarinus officinalis ), and skullcap ( Scutellaria baicalensis ).

Hormonal Headaches

Although only women suffer from "hormone headache," both men's and women's headaches are prompted by hormones. You would not feel pain without them, because it is the hormones that induce the pain response. Actually, the headache may be protecting you or warning you of something more damaging in the same way that touching a hot stove alerts you to the heat and protects you from burning yourself.

Your endocrine and nervous systems are responsible for the thousands of automatic responses that regulate your bodily functions. They decide, for example, whether you will respond to a potential headache trigger with an actual sensation of pain.

Let’s look at some different types of hormonal headaches.

Menstrual migraines affect 70 percent of women with migraines. They occur before, during or immediately after the period, or during ovulation. Menstrual migraines are primarily caused by estrogen, the female sex hormone that specifically regulates the menstrual cycle fluctuations throughout the cycle. When the levels of estrogen and progesterone change, women will be more vulnerable to headaches.

The PMS headache occurs before your period and is associated with a variety of symptoms that distinguish it from the typical menstrual headache. These symptoms usually disappear when menstruation begins.

Migraine headaches are the most common side effect reported by women taking birth control pills, and many women stop taking them because of the headaches. The birth control pill tends to increase the frequency, duration, severity, and complications of migraine by intensifying the fluctuations of female hormones in the body.

Menopause Headaches: About half of all women do experience slight physical or emotional changes as they progress through menopause. Another 25 percent may suffer irregular heartbeat, joint pains, flushing in the upper torso, and headaches.

Treatment:

All treatment needs to be focused at normalizing hormonal function. As such gynecological problems that effect hormones need to addressed ( ie endometriosis, cysts, tumors, etc.).

Again assessment of hormone levels especially over the whole cycle can help in treatment strategies. We use a saliva test that take samples over the course of the period to help with hormonal assessment and timing. Menopausal women can do a five day test to assess their current hormonal levels.

Alternative preventive treatments include:

Herbal remedies – blue and black cohosh, wild yam creams, licorce , ginsengs , dong quai

Nutritional Support: Calcium /magnesium, adrenal support , Vitamin C

Physical medicine therapies such as adjustments of the spine, craniosacral treatment

Acupuncture

Detox Headaches

We could divide these into withdrawal type headaches and rebound type headaches. Everyone who drinks coffee is familiar with the headache they get if they stop drinking coffee for a day or more. This is your bodies detoxification process in the liver getting rid of metabolic waste it has been storing. The headache can last for hours to days. If you are constantly intoxicating your liver with substances such as caffeine, or alcohol, etc., you may be in a viscous cycle leading to frequent detox type headaches.

Rebound headaches can come from over medicating OTC type analgesics (taking more than recommended) on a regular basis. Many times the therapeutic dose and the toxic dose of these substances are not that far apart, which could lead to the bodies detox mechanism upregulating and causing the viscous cycle to start.

Some prescription medications such as fiornal and ergotamines are well known for their rebound type effects.

So what do you do? If the headaches are due to withdrawal type symptoms STOP the offending substance.

During the withdrawal phase several things may be helpful.

Alkalize yourself with buffered vitamin C (ester C) or bicarbonate of soda (alkaseltzer gold).

Withdraw gradually adding water in place of the coffee or tea or whatever.

Antioxidents especially glutathione and N acetyl cystiene to help the liver detox processes.

Herbs silymarin (milk weed thistle) and bupluerum, again for liver support

If you are over medicating you need to talk to your doctor !

Other type headaches

The majority of headaches that fall into this category are sinus headaches, which will be the subject of another newsletter on sinusitis.

As you can see the causes and treatment of headaches vary greatly. It is a piece of detective work many times. If you are a chronic headache sufferer it may benefit you to look into alternative treatments so that you might be able to reduce frequency, dependence on meds, and intensity of headache.

Dr. Glenn Smith

Dr. Julie Smith

Complementary Medicine

June 2001 Newsletter

FHN Complementary Medicine Monthly Newsletter June 2001

As a method of informing people in the network more about what Comp. Med. does, we are initiating a monthly newsletter. We hope to inform of different options for different problems. You may not always agree….thats OK, maybe we’ll stimulate a dialogue that will be beneficial to all.

This month we’ll talk about the use of ACUPUNCTURE AND HERBS IN SMOKING CESSATION.

No statistical diatribe is necessary on the dangers and problems with smoking. If you smoke you know the dangers!!!

Let’s first look at the program that we use at Comp. Med.

The program is three fold:

1. Acupuncture (with needles)…they are very small!

2. Herbal/Homeopathic Therapy

3. Behavior Modification

Let’s look at each part individually, it is important to understand what each can and can’t do.

Acupuncture: We do 3 treatments over 7-10 days. We insert the needles in the lower arm and ears and leave them for 10-15 minutes. The first visit we will also insert an ear tac that can stay in the ear for several days to provide additional stimulation.

If you look at the studies on acupuncture and smoking you get a mixed review, however, even the studies that show “no long term “ effect of acupuncture in smoking cessation, show that it does give an increase in short term cessation. Which is exactly how we use acupuncture, as a tool for the physical addiction stage of stopping. It can also help with some of the metabolic changes (ie weight gain) that take place due to the drug withdrawal.

Herbs/Homeopathic: We use an homeopathic product called nico-end. As it is homeopathic it does not have any active nicotine. We use it as a way to help with the initial cravings that some may have. We use this product for approximately two weeks.

Behavior Modification: As the physical addiction to nicotine ends in 3-7 days after stopping the drug, most long term benefits have to come from behavior modification (changing a habit). We’ll discuss different strategies for long term habit formation.

We have set a package price of $200.00 for the three treatments and herbs.

Our network insurance covers this program at 80%.

This is limited two programs per member per lifetime.

The allowed amount will be reimbursed to you after successfully completing the program.

We have found that if we do all three of these strategies YOU can be successful in stopping smoking.

So start enjoying a whole new life!!!!!!

Dr. Julie and Glenn Smith