RSD: Living With A New Kind Of Pain

Sara was the busy mother of two young daughters.  Besides working full time for her husband’s company, she was active in her girl’s sports and scouting activities.  One afternoon Sara dropped a box of books on her foot and fractured it.  Instead of getting better, the foot got worse.  It turned blue, was swollen, and she experienced the worst pain of her life.  She visited three physicians, one of whom suggested that Sara was exaggerating her pain for attention.  Although she tried to keep her former routine, Sara could not do it.

Finally, she was diagnosed with CRPS.  Her physician prescribed medication to alleviate the pain, began a series of nerve blocks and had Sara work with a physical therapist to help her regain function in her foot.  Sara still suffers pain and has had to curtail some of her activities, however with appropriate treatment, she is able to work and take part in her family activities.

What is RSD or CRPS?

RSD also known as Reflex Sympathetic Dystrophy is a chronic neurological syndrome characterized by severe persistent burning pain, abnormal skin color changes, skin temperature, excessive sweating, tissue swelling, limited range of motion and extreme sensitivity to touch.  Although it can be classified as a rare disorder a newer epidemiological study reported that there may be up to 50,000 new cases annually in the United States.  It is a malfunction of part of the nervous system.  Nerves misfire, sending constant pain signals to the brain.  There are two types of CRPS:  Type I (RSD) and Type II (Causalgia)  which has definite nerve damage.  CRPS is two to three times more frequent in females than males.  There has been a recent increase in the number of cases diagnosed among adolescents and children.  It has not been unusual for medical professionals to suggest that people with CRPS exaggerate their pain, however research has proven that CRPS is a very real condition.  More than 140 years ago Dr. Silas Weir Mitchell, a Union Army surgeon first described the excruciating pain that we know as CRPS.  Physicians do not know why it develops or what causes it, however it usually occurs after a traumatic injury, surgery, sprain, fracture or period of immobilization.

Diagnosis

Early diagnosis and appropriate treatment offer the highest probability of remission of CRPS.  A physician must make a clinical diagnosis of CRPS using a patient history, a thorough examination, and the results of numerous tests.  There is no single test for CRPS.

Treatment

Treatment may include a wide variety of medication, nerve blocks, physical therapy and psychological support for the people with CRPS and their friends and families.  Occasionally surgical procedures may be used to control pain.  Treatment is individualized-each person should have a treatment plan that includes pain control, psychological support, and physical and occupational therapy.

If you think you have CRPS?

If you have an injury that isn’t healing as it should, or if the pain or swelling is more severe than you expect for such an injury:

•    Ask your physician if this could be CRPS
•    Make sure that you are getting treatment for the pain
•    Try to keep the affected area moving
•    Get another medical opinion if you feel that your physician isn’t taking  your complaints seriously

Is there a cure?

No, but there is hope!  Advances in research on pain and CRPS have helped find some new and effective treatments.  More funds and research are needed to understand the causes of CRPS, find effective treatments for those living with CRPS, and prevent the development of CRPS after injury and tissue damage.

Do I Have CRPS?

•    I may look “healthy” but I often suffer unbearable, unrelenting, and burning nerve pain.
•    My skin may swell, sweat, change colors, change temperature, or hurt to the slightest touch.
•    CRPS can spread.
•    Often it is difficult for me to sleep so I may have trouble with attention and concentration.
•    I am frequently following a prescribed medication regime that usually involves powerful drugs with many side effects that may affect my alertness or attentiveness.
•    It is often hard to move easily or keep my body steady.
•    Chronic Pain, like that caused by CRPS, often leads to depression because we undergo significant and often negative, lifestyle changes.
•    I have good and bad days; even hours.  Stress increases my pain.
•    Please believe that my pain is real even though it is invisible and may not be readily apparent in my demeanor or activities.
•    Sometimes it hurts to be touched anywhere so please ask before you touch me.
•    It is okay to ask me about CRPS,  Better yet visit www.rsds.org and learn all you can.

Reflex Sympathetic Dystrophy Association of America

•    Promotes public and professional awareness of CRPS
•    Educates those afflicted with the syndrome, their families, friends, insurance companies,  healthcare providers, and others.
•    Encourages those with CRPS to offer emotional support to others through affiliated support groups in your state.
•    Supports research and has funded $1,243,371 in fellowships and research grants since 1992

For more information on CRPS, joining RSDSA, making a donation, please contact our office or visit our website.
RSDSA
info@rsds.org
www.rsds.org
Toll-free: (877) 662-7737

Provided by the Reflex Sympathetic Dystrophy Syndrome Association of America (RSDSA)

Nutrition: Reconnect with Food

Are you having a difficult time shedding those last ten pounds? Have you tried every diet with no avail…even after following it to the letter? Do you ever wake up with swollen joints, headache, brain fog, gastric distress or overwhelming fatigue?

Medical Research has shown that food, and food additives, can be involved in a wide array of painful symptoms and chronic health problems, along with ideal weight attainment and maintenance.

A look at food sensitivities

Food sensitivities are a common cause of many chronic conditions and affect approximately 15-20% of the population. Symptoms provoked by food sensitivities occur when your immune system begins perceiving foods in the same way it perceives bacteria and viruses. There are many reasons why the body reacts in such a way, but this “mistaken identity” causes the immune system to release chemicals called “mediators” such as histamine, cytokines, and prostaglandins. The release of these mediators starts the inflammatory processes which result in painful symptoms.

Why do food sensitivities make it difficult to lose weight? The inflammatory processes cause your cells to retain water along with slowing your metabolism. Other chronic conditions resulting from food sensitivities may include:

• Depression

• Heartburn

• Muscle weakness and fatigue

• ADHD

• Insomnia

• Brain fog

How are food sensitivities different than food allergies?

Although food allergies can affect the gastrointestinal system just like food sensitivities, food allergies generally affect skin and the respiratory tract. Some individuals are born with food allergies and eventually outgrow them, while others develop food allergies over time. In some cases, when you are exposed to certain foods over and over again, your body eventually rejects these foods and you can develop an allergic reaction. In addition, a weak immune system can be the cause of many food allergies or intolerances. Common allergens include wheat, milk, corn, soy, yeast and mold, as these are foods that are commonly used in our food supply. It is important to strengthen the immune system through proper diet, exercise and stress management in order to avoid reactions to common foods.

Wheat –An allergy or intolerance to wheat can develop when you eat the same types of foods day in and day out. In this country, we overuse wheat, which is commonly found in breads, cereals and pastas. We ignore all the other grains, such as quinoa, barley, spelt, millet, amaranth and kamut that are rich in B-vitamins, protein, fiber and trace minerals.

Milk – Many children are born with a milk-protein allergy, which can cause severe intestinal problems. If left untreated, permanent damage to the intestinal lining as well as lactose intolerance can occur.

If a soy allergy is not a concern, try soy milk, soy cheese (including soy cream cheese), soy sour cream and soy yogurt. If a soy allergy is a concern, rice milks, cheeses, desserts and other rice products are available. Major grocery store chains are now carrying soy and rice products.

Corn and Soy – Have you taken a quick tour of your grocery store or food pantry? Many processed foods contain corn or soy-based additives such as high fructose corn syrup and hydrolyzed vegetable protein, respectively. Read your labels carefully or start shopping at a natural foods/organic market.

Yeast and Mold – Leavened breads and cake mixes contain yeast. Mushrooms, vinegar and vinegar-containing condiments, soured dairy products, alcohol, and aged foods contain yeast-like substances as well as mold. You may think of mold as being an environmental problem only. However, mold-containing foods also include dried fruits, cheeses, and pickled foods.

People who are allergic to yeast and molds often develop chronic sinus infections and tend to be treated with antibiotics. The overuse of antibiotics can cause an even greater weakening of the immune system along with build up of yeast growth and chemical sensitivity, commonly known as Candida Albicans generally found in chronic fatigue syndrome. In addition, recent studies have shown that individuals who have a mold allergy or sensitivity and are repeatedly exposed to offensive foods/ environmental conditions have a tendency to suffer from depression.

Testing for Food Allergies and Food Sensitivities

Food allergies may be tested by serum radioallergosorbent testing (RAST), where a blood sample is placed on an absorbent disc that contains specific food proteins. Immunoglobulin level determination, allergy serum injections or scratch testing also assesses food allergies and their extent.

Mediator Release Test© (MRT©) is used to assess food sensitivities in order to isolate safe foods for individuals. Although MRT eliminates the guesswork to give you definitive answers, it can be expensive and many health plans do not cover this test. Once this test is performed, an eating plan can be developed and tailored to the needs of the individual.

Often, an individual’s innate wisdom can determine his or her food sensitivities upon working with a specialized registered dietitian. A registered dietitian, trained in food allergy and food sensitivity management, can help an individual hone in on offending foods, develop a proper elimination and rotation plan, and help the individual feel better once and for all.

Acupuncture & Mainstream Medicine

With Beth Kohn, LAc

For thousands of years, the ancient practice of acupuncture has been a mainstay of traditional Chinese medicine. It is one of the oldest healing techniques in the world, and until recently has been niched for those practicing holistic medicine.

However, over the past several years, it has found its way into modern day medicine. Once taboo with many medical physicians, acupuncture is now being used as complementary treatment in areas such as cancer pain, infertility, dentistry and other areas.

The theory behind acupuncture is that the fields of energy within the body can be manipulated using solid, metallic needles, to stimulate healing within the body. This is based on the principle that the body has two opposing and inseparable forces, the yin and yang, that when appropriately balanced can lead to a healthy being. The needles used help connect the disrupted energies within the body and helps them reconnect along the meridians, which are lines between the points within the body.

Several large studies have been carried out over the past decade to understand the effects of acupuncture. The NIH (National Institute of Health) determined that many physicians were beginning to incorporate acupuncture as complementary treatment to certain conditions.

With the increased use of acupuncture, the FDA now regulates the production of acupuncture needles to certified, trained practitioners to ensure safety, sterility and quality of the needles.

“I find that most of my patients are looking for alternatives to pharmaceutical medicines,” says Beth Kohn, is a certified acupuncturist at the Henry Ford Center of Integrated Medicine, in Northville. “They want to find options with fewer side effects.”

The goal for both traditional western medicine and eastern medicine is the same; to help heal a patient’s ailment. Therefore, combining these two differing philosophies can see successful outcomes for many patients. By working in concert, the practitioners can provide quality outcomes for some of the most difficult of patient conditions.

“We try to figure out how we can use these therapies (acupuncture and herbal medicine) wen traditional western medicine and pharmaceuticals don’t work, or people can’t tolerate them,” says Kohn. “We have used traditional eastern medicine on people with neck pain, headaches, menopause and premenstrual syndromes. We work with the (physicians) to determine if it is okay to incorporate this into the patient’s treatment.”

Although there are still some skeptics to using acupuncture as complementary treatment, they are becoming fewer and fewer. In fact, many physicians are learning about these alternative therapies based on the demand from patients.

“Patients are more educated and do more research today. It used to be you would go to the doctor and ask what to do, and the doctor would take care of you. Today, people are doing research and coming to the doctor with alternatives and questions about herbs and other treatments,” says Kohn.

This patient-driven force is part of the reason that many hospitals within metro Detroit are now incorporating this integrative treatment plan in certain disease states.

One example of how the Center for Integrated Medicine worked with a physician involved a patient diagnosed with Hepatitis C, says Kohn. The patient had researched the disease and did not want to receive interferon treatment.

“I talked with the physician and found out where the patient was in the stage of his illness and discussed the patient’s desire to use alternative therapies. We made sure it wouldn’t be dangerous to the patient and the doctor said it was okay. Baseline blood work was done and we set up a three month treatment plan to see where the patient was after that time,” says Kohn. “We made it clear to the patient that if we didn’t see the results we wanted, then he was to move forward with the medical plan.”

Another large area of use of acupuncture and herbal medicine is in patients with cancer or those who have completed treatment, says Kohn. In particular, patients who survived breast cancer or ovarian cancer who can no longer receive estrogenic medications. “These patients want to try alternative therapies so we have the physicians review the herbs and move forward with the treatment,” says Kohn.

Although acupuncture is commonly thought to be used for those who are already sick, there are many people who receive treatments to stave off illness and keep healthy.

“Acupuncture is tapping into our natural ability to relax and heal,” says Kohn. “There is a natural release of endorphins and nerve stimulation. People who get acupuncture consistently report getting sick less and have immune systems that respond well to illness.”

Acupuncture is not covered by all insurances and it is important to consult with your insurance company to see what their policy is on treatment. You should also do your research to make sure that your therapist is certified by a nationally recognized organization before seeking treatment.

Although side effects are rare with acupuncture, there can still be serious consequences if you are not treated by someone who is well-trained.

Beth Kohn, Acupuncturist, L.Ac (CA), MTOM, Dipl. Ac., Dipl. CH is a Staff Acupuncturist at the Henry Ford Center for Integrative Medicine in Novi. She received her Masters Degree Oriental Medicine (MTOM)-Pacific College of Oriental Medicine, in San Diego, and her Bachelors of Science from the University of Maryland. She is California Board Certified in Licensed Acupuncturist & Chinese Herbalist and received her NCCAOM Certification in Acupuncture therapy (Dipl.Ac.), Certification in Chinese Herbal Medicine (Dipl.CH). She is a current member of the Michigan Association for Acupuncture and Oriental Medicine.

Fitness: Let the Good Times Roll

Warning: The techniques being presented here may reveal issues you did not want to know about!

Flexibility is often one of the most neglected areas of fitness. Some find it boring, too time consuming, painful, not worth the effort (after all, you cannot really “see” flexibility in most cases), or ineffective – this is what we are going to talk about.

There are many different types of stretching: static, dynamic, ballistic, and PNF (Proprioceptive Neuromuscular Facilitation). There are also many philosophies about how and when to stretch: pre or post workout, hold for 10 seconds or 30 minutes. While there are physiological principles that do determine all the variables of effective stretching, that is not what this article is about. Many people attempt to stretch to increase flexibility, diminish pain, or “warm up” – all to no avail; this is where foam rolling can help.

Foam rollers are tools which help relax muscles to allow proper stretching to occur. If a muscle is too tense and cannot relax it is very difficult to improve the flexibility. Foam rolling will help inhibit these overactive muscles. Conversely, foam rolling can also help stimulate underactive muscles and “wake them up” when they have been inactive due to immobility, injury, or misuse. All of this can help with flexibility, pain, and tissue warm up, as well as strength, speed, power, coordination, and overall performance.

Foam rolling is a fairly simple technique to understand, but more difficult to perform for most people in the beginning. It can be uncomfortable to the point of painful if the muscles are extraordinarily tight. It can be very physically taxing on the arms (they are supporting most of your bodyweight), and it can be time consuming. However, the dedicated addition of foam rolling to your exercise regime can be one of the most beneficial things you can do for your body, regardless of your fitness goals.

The rules are the same for all body parts: 10-20 rolls per part (you may need to build up to this); put as much weight from the chosen body part onto the roller as you can tolerate; avoid bony prominences; and DO NOT AVOID TENDER SPOTS – this is where you need it most. So let’s get to it!

HIPS

Common problems associated with tight hips: back, hip, and knee pain.

Gluteals/Piriformis – Sit on the roller (Fig. 1). Cross one leg over the other. Shift your weight onto the side of the crossed leg. Roll from your butt bone (the one you sit on) to the bone that sticks out just above your butt muscle (in the low back area). You will need to shift from the back of your butt to the outside of it to get the whole area rolled.

THIGHS

Common problems associated with tight thigh muscles: back, hip, knee and ankle pain.

Hamstrings – Roll along the back of the thigh from the butt to the knee. Roll directly on the back (in the middle), then also slightly rotate your leg in and out to get the inside and outsides of your hamstring.

Quadriceps – Roll along the front of the thigh from the hip to the knee (Fig. 2). Roll directly on the front (in the middle), then also slightly rotate your leg in and out to get the inside and outsides of your quads. Try to do one leg at a time.

IT Band – One of the worst exercises (and most needed) for most people. Lay on your side with the top leg crossed over the bottom one and the top foot flat on the floor (Fig. 3). Roll along the outside of your thigh – make sure you are not getting the front muscles (quadriceps) or back (hamstrings). The IT Band runs right along the outside from the side of the hip to the outside of the knee. Many hip, back, and knee problems come from tightness in this area.

Adductors – Lay down like you did for the quadriceps but bring your leg out from your body with the knee bent (Fig. 4). Position the foam roll so it makes a 90 degree angle with your thigh. Roll along the inner thigh from the knee to the groin. This is another “un-fun” exercise, but also another source of many problems.

LOWER LEGS

Common problems associated with tight lower legs: knee and ankle pain, plantar fasciitis, tendonitis.

Gastroc/Soleus (Calf muscle) – Roll along the back of the calf from the knee to the heel (Fig. 5). Roll your leg in and out to get the whole calf muscle.

Peroneals – Lay like you did for the IT band (Fig. 6). Roll along the outside of the lower leg from the knee to the ankle.

TORSO

Common problems associated with tight torso: pain anywhere in the body.

Lumbar/Thoracic Spine – Lay down and roll along the spine, from the low back through the upper back (Fig. 7). This may need to be broken up into two parts (low back, then upper back). Try to position your torso horizontal. Added bonus: your abdominals will get a workout, especially when doing the low back.

Latissimus Dorsi/Posterior Shoulder Muscles – Lay on your side with the bottom arm stretched out (in the direction of your head) (Fig. 8). Roll along the side of your upper back (outside of your shoulder blade) up to the armpit and back of the shoulder.

EVERYTHING ELSE

While foam rolling is certainly easier to apply to some areas than others, it can be done throughout the body in addition to what was presented here. There are other tools on the market that can be used similarly to foam rolls and should also be considered as supplements. Foam rollers can also be used for different training purposes, including balance training (generally done with foam rolls cut in half lengthwise).

Foam rollers can be purchased from $10-25 and range in length from 1-3 feet with diameters of 3-6 inches. Just make sure to use a quality roll that will not break down quickly with use. Quality foam rollers can be purchased at www.performbetter.com and/or www.power-systems.com.

Special thanks to Tara Egli, for subjecting her body to these demonstrations and allowing me to photograph it.

For more information on foam rolling, contact Bob at: bob@functional-strength-training.com, or visit his website at: www.functional-strength-training.com.