POTS (postural orthostatic tachycardia syndrome).

I see the Daily Mail ran a story recently saying that POTS could be the 'cause' for 1 in 3 people with CFS. Having heard the woman who heads the research team at Newcastle university talk a couple of years ago I remember thinking at the time she is never going to work out the neurology of this because she's too narrow in her focus. She spent the first 20 mins of the talk (to University Researchers) justifying that CFS is a real disease and not just malingering (presumably the medics that she normally lectures to have that belief). Then when she got to the heart of her presentation and described how they put people on a 'tilt' table to measure their responses (this apparently is how they diagnose it). sounded barbaric and very unpleasant! However, my main bone of contention and one that has been repeated by the Daily Mail is that this is somehow the 'cause' of CFS when clearly it is just another result of autonomic dysregulation (mediated by the limbic system). A client of mine has pointed me to a training programme called DNRS (Dynamic Neural Retraining System) which she uses - I noted they had an article on POTS too. http://www.dnrsystem.com/POTS.html. They say;

Symptoms can include but are not limited to:

• Increase in heart rate, dizziness, fainting, headache, sweating, shakiness, nausea -  mostly worse with standing
• Poor concentration and memory
• Discoloured hands and feet
• Sense of anxiety
• Chest pains
• Nerve pain
• Hyperacusis (sensitivity to noise)
• Photophobia (pain/relapse on exposure to light)
• Changes in taste and smell

I can remember having most of these symptoms when I was ill 15 years ago - however, no-one seemed to be able to link all of these symptoms - they were all treated separately. The first thing I was given was tablets for the dizziness which made no difference at all. However, had I been diagnosed with CFS or POTS for that matter it wouldn't have helped as it is still a descriptive diagnosis of exclusion (i.e we don't know what it is but it's not something neurological/structural, it's characterised by these things so we'll call it CFS/POTS, etc). So, given a diagnosis like that people are left to manage the symptoms with no idea that the limbic system controls all of these things and that ongoing subconscious stress is triggering the limbic system into sympathetic dominance or vagal freeze. Without understanding what is behind it all people are left powerless and controlled by a medical system that then feeds them expensive drugs and surgery as the answer. It would be quite criminal if it wasn't legal...

Polyvagal Theory and the origins of Chronic Fatigue

My recent reading has led me to discover a theory first identified by Stephen Porges on Polyvagal theory of development. This states that there are three levels of the autonomic nervous system which relate to which era of our evolutionary development they originated in.

1. The unmyelinated vagus nerve which developed 500 million years ago in the fish. Myelin is the covering or sheath around nerve fibres which makes them insulated and able to transfer nerve impulses very fast so without it the messages are necessarily slower. 
2. The sympathetic nervous system (or fight' and flight' system as many know it) which is based on basal ganglia from the spinal cord - this comes from our mammalian past.
3. The myelenated vagus belonging to the parasympathetic system which is the opposite to fight and flight in that it is responsible for calming us down and giving us time to relax and enjoy interaction with others (the social bonding system).

If this is down-regulated as it often is with chronic stress we will be forced into the level below (i.e. sympathetic dominance) where we are ready to 'fight the tiger', our heart rate will be high, and our gut unable to function as blood is diverted away from it - hence churning and IBS symptoms. If our systems are even more exhausted (as they are with years of chronic pain in for instance chronic fatigue syndrome) then the other two levels are hijacked and we operate in the 'freeze' mode of the unmyelinated vagal system (freeze state) whereby nothing works. Our energy levels are so low we cannot function, even the most moderate tasks exhaust us. Our mitochondria are getting the signal to 'go slow'.. It down-regulates all metabolic activity. We are operating at the level of a reptile.

The next question is why and this is where my researches and experience working with people suffering from chronic fatigue shows me that subconscious trauma (perhaps more accurately termed unresolved emotion) seems to be the key here. If, in early life, the person suffers a traumatic experience and interprets that they are worthless or dangerous, then any subsequent event which plays into this subconscious belief system will trigger the body to go into a meltdown freeze state. The earlier the traumatic event in the person's life the more likely this is. Women also seem to be more biologically prone to this as men are more likely to go into fight and flight.

There may be periods of remission where the person has a reasonable ability to function but the next event which triggers these subconscious beliefs they will go downhill again. Thus it explains both the metabolic fatigue and the relapse and remission cycle common to all fatigue syndromes (ME, CFS, Fibromyalgia). Remember these events are recorded in the emotional brain or limbic system with the sensations and emotions that they first caused. They are processed differently from normal memories and may get 'stuck' in the emotional brain/limbic system where they continue to dictate behaviour and  symptoms.

I want to present this theory to the chronic fatigue community - including other clinical professionals at a webinar specifically set up so that we can understand why tinkering at the top level i.e. with diet and pacing can seldom work, if it doesn't approach the real underlying causes of the subconscious neural processing. Thus in summary, we are emotional beings with three increasingly sophisticated nervous systems overlaid on top of eachother (note also this occurs in the brain as well - see the Triune brain theory) - the final one belonging to a reptilian past. If, due to life circumstances this one becomes dominant as the others are suppressed, then our life becomes severely and devastatingly limited. In the next blog I'll be talking about how we can reverse this suppression with various tools from energy psychology.

With thanks to the writing of Peter Levine for these insights and my clients for their practical application.

August musings on mindbody medicine and trauma

August the month of holidays... someone said on the radio today that August is the 'Sunday' of the months and I agree. It feels like a last-ditch effort to enjoy the sun and note how the nights are drawing in. And yet it's just part of the cycle of life really.

Interesting how in having 'down-time' the mind will remember other times you had that response. I had a client in recently who was about to go on holiday but was having very mixed feelings as she has lost her father recently and she was about to return to his former home in Italy. This manifested though as odd sensations and aches in her back and down her legs. Now, you will know if you have read anything I've written before that I am very much a believer in the mindbody connection. I told her it was very likely that these odd pains were linked to her imminent departure but that she should get checked at the doctors just in case. The doctor gave her a clean bill of health so we were left to work on the symptoms from a mindbody perspective.

According to my experience and the work of Dr. John Sarno, it seems that the mind will create aches and pains to distract you from the more painful and serious emotional pain that you are trying to avoid confronting. I know if you haven't come across this idea before it may sound strange but time and time again I have proved this. Anyhow, it seemed a classic case to me as these pains had come on suddenly a few days before her intended departure.. In our therapy session we started with EFT (emotional freedom technique or tapping) which allows you to both own the symptom but also release it. As we worked together I saw a wave of emotion appear to come from her stomach (where she had located the current pain) and wash over her face - tears soon followed. There was a tremendous amount of grief pent up in this person, which she hadn't really dealt with.

Leaving to go away was both pleasurable (it was a holiday after all) and painful as it was the place she had last seen her father AND in order to go she had to leave her elderly cat who was also very dear to her and who is on borrowed time already. This is a classic case of internal conflict; you both want to do something and you don't want to. The guilt and conflicted feelings come out with back-ache or sciatica or whatever. How can you tell if what you have is a true pathology (i.e structural problem) or a mind-body issue? Chase the pain. What I mean by this is use the EFT protocol (detailed and described in detail on my website www.alchemytherapies.co.uk/eft.htm) to apply the tapping protocol and see if the pain moves. it usually changes in some fundamental way pretty quickly.

For my client, I had instructed her to do this the night before she came to see me as it would give me a strong clue as to whether to treat the pain with physical or mindbody therapy. She reported that it went from her legs to her stomach. So, I had a pretty good idea we were dealing with a mindbody problem. In the therapy we did together the pain moved again from a tightness in the stomach to a constriction in the throat (interesting as this often reflects something unspoken). As we continued this developed into a full blown panic attack so I asked her to move to the table and we worked on calming the autonomic nervous system with belly breathing (which helps to break the shallow breathing- oxygen deprivation cycle triggering panic in the brain) and then I helped her speak her pain and then we shook her limbs to release the pent up emotion  (this last approach has been detailed in Peter Levine's work - Waking the Tiger and Healing Trauma). I find it helps people to experience their emotion through their body which is where it resides. There is much theory around how the mind and subconscious process interact. Again, see the information on my website.

Suffice to say I was successful in this treatment and my client left -shaken obviously but no longer having the trauma in her body. Her pain disappeared immediately and she has recently sent me a text from holiday saying how much she is enjoying herself. (though it's worth noting for accuracy that she did experience another panic attack at a subsequent time - one session is not going to undo 40/50 years of trauma!).

If any of this sounds interesting or you have anything to add please contact me through my website or facebook pages.

The unspeakable Speakmans

Someone in the clinic where I worked asked me if I'd seen this TV show 'The Speakman's' yet.. I hadn't even heard of it (I don't watch live TV- takes up too much time) but am always interested in catching something that's been recommended. I was told 'they do amazing things like cure phobias' - really fast!' I was intrigued.

I watched the show on itvplayer - with my mouth open most of the time. The programme is very much in the shlock reality TV mould with frequent add breaks and reminders after of what you've just viewed (in case you've forgotten!). My first reaction, I'll admit was one of horror. These people look like your worst idea of celebrity chasers. He (the husband of the man and woman duo) looks like a middle aged man trying to look young - hideous haircut, and his wife is the blond bimbette type. They have a 'fabulous' house in Rochdale, several ridiculously expensive cars, surrounded by the obvious trappings of wealth, but with no taste. Never mind. I got that bit out the way and then I tried to concentrate on their methods...

Hard to decipher as in fact, the TV format doesn't really go into detail - they have a conversation, they isolate the causative event in the persons life and then they do basic NLP manoeuvres on those memories. They also aren't afraid to humiliate the client if that is what it takes. They call it 'schema reconditioning'. So, they use eye movements, sometimes body movements, freeze framing and running the story backwards, etc to break the link between the memory and the disabling beliefs that surround it.. Fascinating. Now, it's difficult to know exactly how much of what you see is edited out from what actually happened but, on the surface at least, it gets results.

And, in time I must admit I began to think well they're onto something here. So, then I began to think about how I run the 'fast phobia cure' which is an established hypnotherapy technique - it's not dissimilar. What, works for them I think is the expectation ('therapists to the stars!' is how they're billed). As we know, in treatment setting up a positive expectation is 3/4 of treatment. But as for the rest, I don't quite  know how to explain their success. He, certainly seems to know his stuff, she is probably the bubbly, bright eye candy component but you can't fail after a while to start to like them in all their exuberant awfulness. They LOVE their life as they keep telling you and want to spread their joy around. As Nik Speakman says - you're only born with 2 phobias naturally - fear of confined spaces and fear of loud noises (he's not quite right there there's a couple more) - everything else is learned behaviour and can therefore be unlearned.

So, that, my friends and followers concurs with my attitude to life. We deserve more than to be stuck. We deserve to live life in joy and health. I can't quite agree with his saying 'what do you want qualifications or results?' - because  ideally you'd have both. You'd want your therapist to be accredited, to really know their stuff, and to be effective. That's my aim anyhow. Go Speakmans!

The downward spiral

I went to visit an elderly friend in hospital this week and was aghast to see how several weeks in hospital has rendered her. This once independent, feisty woman is reduced to as shadow of herself - literally and metaphorically. the most noticeable difference is the amount of weight she has lost. Now down to less than 5 stone. The cause of this? she broke her hip 3 months ago in a fall at home. She was admitted to hospital and has had numerous operations to try to mend it but she is now so weak she cannot stand. now hospital is obviously the place to be when you have a broken bone, and particularly when you are 95 and live alone. But I really take issue with the type of care she has received. The nursing staff for the most part are lovely, but the problem seems to be with they system.

This elderly lady has been moved 11 times in her 3 months stay - both to another hospital and to different wards within the same hospital. She has also been given food she cannot eat, over cooked meat ('which all tastes the same') and ends up bringing it all back up again so she has simply stopped eating it. Nutrition is so key with someone like this. The elderly have very weak digestion and need lots of fluid and dilute protein - so vegetable/ meat broths would be ideal. Her friends have noticed and try to bring things in for her. But all she gets is cake which she doesn't want and won't help her body heal.

I know, she's 95, what can you expect. But if only as much attention and money were paid to the diet of the ill and convalescing as is spent on expensive surgery then people might get better a lot quicker and we'd have less of a crisis in our health system.

The Road less Travelled; natural approaches to health and healing.

I have borrowed the title of the famous book by M Scott Peck not to talk about self improvement, and psychology like he does, but to look at naturopathic approaches to health and healing. I went to
 an interesting talk on Saturday by Naturopathic guru's Joe and Lara Pizzorno (authors of the seminal Textbook of Natural Medicine) about Acidiosis, Mercury toxicity and Osteoporosis and natural approaches to reversing these issues.

The approach is basically one of supporting the body's detoxification systems - specifically the liver - rather than suppressing symptoms with increasingly dangerous drugs. For example in osteoporosis the available pharmaceutical methods are pretty much all very harmful - one class of drugs the bisphosphonates - e.g. Fosamax and other trade names... promotes cancer of the jaw and oespophagus!) In the US, dentists are refusing to treat people on this class of drugs because of potential litigation..

No. 1 recommendation was to alkalise your diet, reduced salt (sodium competes with Calcium in the bones) and stop drinking sodas/fizzy drinks - diet or not, the phosphates in these are very damaging to bone rebuilding activity . If you  mess with this process either by not having enough Calcium to build the bone or having too much toxicity in your blood (heavy metals, persistent organic pollutants - 'POP's' from water, etc) or worse, taking the pharmaceutical medicines !! you will end up with osteoporosis.
Top recommendations are; Add sea-algae to your diet, reduce grains and sugars and supplement Betaine HCl to help your stomach to digest properly (> 40& of postmenopausal women are deficient in this vital stomach acid and Calcium in the diet cannot therefore be absorbed).

Use milk thistle to support the liver, make sure you do de-stressing activities to balance your system and prioritise sleep as this is the time when we do our vital detoxification.
There is so much you CAN do to help yourself. . If anyone is interested in ordering my downloads on various subjects with specific recommendations for different conditions then please see my website www.alchemytherapies.co.uk

Chronic Pain and TMS – the hidden cause

When, in my mid-thirties I became struck by a mystery illness which rendered me incapable of more than 3 hours work a day, I feared the worst. The symptoms were very varied but began with incredible fatigue. Then my joints swelled up so that walking became painful. I had unexplained rashes and itching, dizziness and headaches, it went on and on. I went back and forth from the GP and various hospital and blood tests. They could find nothing organically wrong with me and left me with a 6 months prescription for painkillers telling me it would probably get better of its own accord!

So, I determined I would find out more about chronic pain and fatigue and see if I could unlock whatever it was with alternative methods. I tried acupuncture (which was helpful), homeopathy (which was not – for me anyway). Then I tried massage and chiropractic and finally some Chinese herbs which were incredibly effective as they detoxified my body and enabled it to begin to heal. I started to see that health and wellbeing was more than curing myself of disease. It was about bringing my body back into balance.

Fast forward 15 years and I am now a fully qualified therapist specialising in Chronic pain, specifically TMS or Tension Myositis Syndrome (which is closely related to Chronic Fatigue syndrome although they may manifest differently). It is a stress-related illness – by which I don’t mean necessarily due to an obvious stressor but it can be accumulated, low-level stress like being in the wrong job, relationship for you, or by burying your emotions of loss, grief or anger. Men and women are different in this respect as their emotional landscapes are different which may explain the huge preponderance of women with CFS/ME as compared to men. Men on the other hand may get unexplained back pain, or auto-immune diseases. Modern medicine calls these conditions different illnesses, and attempts to treat them symptomatically. This doesn’t work as the central cause isn’t in the affected part but in the brain.

Now, here’s where this gets tricky as people in pain do not like being told ‘it’s all in the mind’. That isn’t what I’m saying at all. The pain is very real and there is real physical disturbance in the tissue causing that pain. However, the ultimate causation is in the imbalance in the nervous system which comes from undischarged emotion. It is a simple biological fact that we are hardwired for emotion – the two most primitive are fear and defensive anger (rage). In the animal kingdom (of which we are part from an evolutionary perspective) animals will display these emotions as a survival tactic. If we didn’t have fear we would be incautious and perhaps get eaten, if we didn’t have rage we couldn’t stand up to our attackers with the same result. The part of the nervous system that controls this is the autonomic nervous system and it is composed of two parts; the sympathetic and the para-sympathetic. They are like the accelerator and brakes respectively that modulate the body’s responses to outside stimulus. But they also response to internal stimuli – our feelings and emotions.

So, if we are afraid, our heart rate increases, our breathing is rapid, we are geared to the so-called  ‘fight or flight’ response which involves the brain and endocrine (hormone) system. If we have a situation where neither of these is possible we can exhibit a freeze response where our body is in perpetual slow motion – lacking energy and vitality. This is probably the basis for Chronic Fatigue syndromes – much more common in women whose nervous systems tend to freeze more than they fight. [i]That our mind can create this may seem nonsensical until you begin to understand our evolutionary heritage. As animals, our mind is incredibly complex and designed to deal with threat- it cannot differentiate between real threat and perceived threat – perception is everything! So, for instance we can get anxiety because our mind is interpreting a situation as threatening even when it is relatively innocuous. This is because the brain is a pattern recognition machine and it links certain events together by their associated senses or emotions. So, for instance a certain smell will evoke a memory as will feeling fearful – but the associations may be unconscious, so for instance your boss may remind you of someone you once feared so they trigger that response in you causing unconscious stress.

TMS is the physical response of the body to that cumulative, low-grade stress. It inhibits blood flow to the tissues casuing local ischaemia (or oxygen deprivation). The tissues become hypoxic, lactic acid builds up and pain and fatigue is the result – especially in muscles and tendons. There only needs to be a small amount of reduction too to have serious effects. If the nerves are affected then the pain may be accompanied/replaced by tingling or odd feeling sensations. But because the root cause – stress – is never addressed all physical approaches be they massage, physio, pain killers and surgery will never work. It has been noticed of instance that in people with Fibromyalgia most pain killers are ineffective.

There has been a lot of research into TMS but the main author who first coined the term was Dr john Sarno[ii]. He was in rehabilitation medicine for 30+ years and began to notice patterns of trauma in his patients that, if he encourage them to highlight and address their unprocessed emotions, they were able to reduce or remove their pain altogether. He hypothesised that the mind was creating pain as a diversion to these uncomfortable emotions – in the mind’s view physical pain is less damaging! He also noticed  that the pain could shift and move around when these feelings were addressed. Combined with his research into normal pathology of the spine and tissues with ageing, he came to the conclusion that the root cause was not physical but emotional.his work has since been furthered by clinicians such as Dr James Alexander[iii] who being a psychologist, was able to hypothersise how this mechanism might be mediated.

I have written extensively on this in other blogs and won’t repeat here, but mindbody medicine which acknowledges that we are both mind AND body is really the only logical way forward to solve the epidemic of mindbody disorders that we are currently seeing. These include in no particular order; CFS/ME, auto-immune disease, IBS, anxiety/panic disorders, headaches/migraines, insomnia, etc. In my practice I work with people on a mindbody level - we investigate the whole person not just the physical symptoms.  I use massage and Reiki to stimulate the body and rebalance the energy system, and then various psycho-somatic techniques such as EFT (tapping ) and EMDR within a hypnotherapeutic framework (which emphasises safety and self-empowerment).

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[i] Peter Levine:  ‘In unspoken voice- how the body releases trauma

[ii]Dr john Sarno: ‘The Mindbody Prescription’ and ‘Healing Back Pain’

[iii] Dr James Alexander; The hidden Psychology of Pain’