integrative medicine mind – body connections plc or rn november 26, 2010 jeffrey p schaefer msc md...
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Integrative MedicineMind – Body Connections
PLC OR RNNovember 26, 2010
Jeffrey P Schaefer MSc MD FRCPC FACP
website
dr.schaeferville.com
Conflicts of Interest
• none
Objectives
• Session participants will learn that:– the current paradigm is insufficient– a psychobiological framework is useful– there is more to stress than stress– we can reduce the effects of stress
And above all...
Relax Responsibly
Case
• 46 year old educator
total body pain and fatigue x 5 years
assessed by GIM, Neurology, Gastroenterology
investigations normal
Problem List
– daily occipitofrontal headache
– chest pain, episodic, at work
– abdominal pain
– fatigue
– poor concentration & dizziness
– work issues
What’s your diagnosis?
Diagnosis: ______________________
Hopefully, uptodate.comhas something…
Diagnosis Menu
• What’s your diagnosis / diagnoses?– Chronic Fatigue Syndrome / Idiopathic Chronic Fatigue– Fibromyalgia– Tension Headache– Irritable Bowel Syndrome– Multiple Chemical Sensitivity Syndrome– Interstitial Cystitis– Hematuria Loin-pain Syndrome– Depression and Anxiety– Conversion Disorder– Somatization
This is a problem!
One condition or many?
Chronic Fatigue SyndromeFibromyalgia
Irritable Bowel SyndromeMultiple Chem Sensitivity Syndrome
Sick Building SyndromeHypoglycemia
Gulf War Syndrome
Undocumented LabelsHeadache Syndromes
AsthmaPainful Conditions
Various
Bodily Distress Disorder
• Do functional symptoms cluster in a way that support multiple conditions?– Cross sectional survey of patients with
functional symptoms– Screened 2,300 patients 978 were judged
functional
Median Number of SymptomsMen & Women 5
“Bodily Distress Disorder”Fink et al. Psychosom Med
2007
Chest Pain GroupGI Symptoms Group
Musculoskeletal Group
< 3% of patients had symptomsconfined to their predominant group
3 group model explained 36% of the variance
• associated with anxiety • preoccupied with symptoms• preoccupied with illness• low threshold to request consultation• difficult / impossible to reassure
Multiplicity of diagnostic labels is an artifact of
medical specialization.
Psychobiology‘the mind-body connection’
Psychobiological Framework
NO MATTER WHAT ELSE
IS GOING ON!
Talk about Stress...
Acute Stress Response
Fight, Fright, Flight, Frolic Response
Hans Selye (1907-1982)
General Adaptation Response
– Alarm– Failure to adapt– Exhaustion
Recipe for Stress• Novelty
• Unpredictability
• Threat to ego
• Loss of control
Absolute Stress
Relative Stress
Interpretation of the world
stress4 parts
Stress Stimuli
Experience the stimuli
Physiological Response(Body Chemistry Response)
• Hormones
• Neurochemistry
• Immunochemistry
• Energy Metabolism
Experience of thePhysiological Response
Stress Hormones
• Corticosteroids– Cortisol
• Catecholamines– Adrenaline (Epinephrine)– Nor-adrenaline (Nor-epinephrine)
Cortisol
Cortisol Regulation
• Brain– emotion, pain,
memory
• Hypothalamus– autonomic function
• Pituitary– stimulating hormone
• Adrenal Gland– cortex
Left: Areas of the brain that ‘light-up’ during strong emotion.(happy, sad, disgust)
These correlate to Vagus Nerve mediated Heart Rate Variability.
Mind Body Connection: neural and hormonal
Immediate Effects of Cortisol
• Response to Absolute Stress– increase vigilance– respond to emotion don’t think– raise blood sugar– increase psychomotor activity– obtain food
Prolonged Effects of Cortisol• increase appetite• increase blood sugar• increase fat stores• redistribute fat• salt retention BP +• reduce acid barrier• menstrual cycle problems• male impotence
• bone calcium loss• muscle wasting• insomnia• irritability• depressed mood• memory loss*• immune dysfunction
Pituitary Tumor & Cushing’s Disease
Disease States
• Moon facies
Catecholamines• Adrenaline (Epinephrine)
• Nor-adrenaline (Nor-epinephrine)
Effects of Catecholamines
• increase heart rate• increase cardiac force of contraction• narrows blood vessels• increase blood pressure• dilates pupils• dilates airways• reduces flow of blood to GI tract• reduces saliva production• increases platelet adherence ‘stickiness’• increases sweat production
Acute Stress and MI• Mortality in Widowers
– 40% increase within 6 mo of spouses death
• Myocardial Infarction Onset Study– incidence of AMI 14X among recent widows /
widowers
Self-report AMI Trigger412 reports from 849 AMI
Chronic Stress & Immune Dysfunction
• Influenza Vaccination
• Difference between stressed and non-stressed group.
– Lancet 1999
Punch Biopsies• 13 Care Givers vs 13 Controls• Complete wound healing
– Caregivers 48.7 vs 39.3 days (9 day diff)– Age and income did not effect outcome
So now what?
www.calgaryhealthregion.ca/cmbm/
CMBM Approach
• symptoms are psychobiological – real & explainable & diagnosable
• management– cognitive reassurance is insufficient– uncovering a psychological trauma is insufficient– psychotropic medications are counterproductive– success lays in self-regulation
Self-regulation• Somatic Awareness
– experiential– link emotional state with body symptoms– effortless breathing
• Medication Reduction / Elimination
– group therapy– education– heartmath– guided imagery
Don’t forget to breathe…
Breathing... by any other name...
• ‘naked’ woman
• Living with COPD – diaphragmatic breathing
• Living with COPD – relaxing w diaphrag btng
Humor....
• Laughter Therapy
Dr. Sonia Lupien
• Work on yourself– improve problem solving– learn to appreciate others– learn to appreciate yourself– practice goodwill
• Work on your Body– breathe– move– power of laughter and smiles
Goodwill
• Mother Theresa Effect
– improved self-esteem
• 290 patients 2004 - 2009
Objectives
• Session participants will learn that:– the current paradigm is insufficient– a psychobiological framework fits observations– there is more to stress than stress– we can reduce the effects of stress
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