Have you noticed swelling in your lower legs? Puffy feet or ankles. Dents in the skin when you press against the bone?

That’s called pedal edema. The swelling can be a serious sign of heart disease, kidney, or liver. Please consult your healthcare provider.

It can also be from stress, for instance, if there is heat stress, the legs swell, usually the limbic system that then sends out a hormone called anti-diuretic hormone. ADH. This can also occur with emotional stress. The fingers and even the face can swell when the alarm center of the brain is sending out hormones to raise blood pressure. Water retention is made worse with salt.

Make sure you have your provider exclude serious conditions. But work on your alarm system. Lower inflammation.

Good luck

Judy

Today I have a patient with pain in his shoulder. He swears the pain is coming from his shoulder. He can feel and hear the crackling – which is of course fascia – but our bodies deceive us.

Think of a heart attack. People older than 65, especially women, especially diabetics, they often don’t have chest pain when they have a heart attack. They can get left (even right) arm and shoulder pain. When you have shoulder pain – check to see if the pain is worse when you are exerting yourself. If the pain comes when you exert yourself and then stops when you rest, then consider your heart.

Think about your gall bladder. If you have right shoulder pain – especially the tip of the shoulder, you could actually have gall bladder stones or inflammation.

My patient’s pain is with raising the arm. When he puts the left hand on his right shoulder and raises the elbow – he gets pain in the left shoulder. Typical of rotator cuff tendinosis. Sick fascia around tendons and muscles of the rotator cuff.

He also has pain moving the arm so that the humerus moves inside his joint. Maybe a bit of osteoarthritis.

Actually, when it comes to rotator cuff and osteoarthritis, really, exercising and stretching so that the fascia loosens up is what is really important. When you are afraid of pain, this makes every condition worse. Our bodies heal. We have forgotten how to move past pain. We are so busy relying on tests and doctors and physios to heal, we have forgotten that most injuries will heal if we can stop being afraid of pain.

If the shoulder exercises are not working – you probably also have problems elsewhere. Look to the neck and back as well. Don’t just exercise your shoulder. So do the stretches for Neck Pain and Upper Back pain and also do the Lower Inflammation exercises to reset your alarm in the brain.

Chronic pain is different to Acute Pain. We have to treat the tissues and the brain.

Take care

Judy

Unfortunately, in any situation in any place, you will always find bullies.

Bullies feed off reactions from their victims. They practice their bullying from childhood – all bullies have been taught their techniques from their caregivers or other older people in their families. They are experts.

We can’t change bullies. They are usually narcissists. The best revenge you can have on a narcissist is not to care. Why am I caring? Why do I react when I know the person is unfair and their behavior unacceptable?

The bully is sensing insecurity. Our insecurities usually come from early childhood shame. When was the first time that you felt “not good enough?” What age? If you had difficulties in childhood – check out Complex PTSD.

If you are lucky, this may have only happened when you entered the workplace. Perhaps you had a good childhood and are unprepared for people who are so mean.

Perhaps it’s more than that. Some men will use these bullying tactics as a form of sexual assault.

Explore all the options. Seek counselling. If you are being attacked, this is a serious cause for concern.

Stress causes 70% of chronic disease and early death. Use every technique you can to calm your body and your mind so that you can appear immune to the threat.

Take care.

Judy

Cannabis

Cannabis can seem like a harmless drug, but like any substance, it needs to be used with caution. I remember a professor telling me, if a drug doesn’t have a side effect, it doesn’t have an effect, and that is certainly true of cannabis. It has many side effects and the overall value of cannabis as a chronic pain management tool is still unproven by decent drug trials.

The risk of cannabis may outweigh the benefit. Adolescents in particular are at risk when they use cannabis. They are two to four times as likely to develop a substance use disorder and have an increased risk of mental health or neurological problems.

The elderly are also at risk. Is cannabis worth the risk of a lower IQ? Learning difficulties, earlier onset dementia, falls, psychosis, anxiety, and increased suicide risk are all side effects that occur with cannabis use.

Withdrawal symptoms after regular cannabis use include irritability, anger, aggression, anxiety, weight loss, restlessness, depressed mood, abdominal pain, tremors, fevers, chills, and headache.

Please speak to your healthcare provider about alternative management tools. I have had patients self-medicate their chronic pain with alcohol. Alcohol silently attacks muscles, including the heart, and the brain, kidneys, liver, and other organs. By the time alcohol damage shows itself, it is usually too late.

If you are using cannabis or alcohol to cope with your chronic pain, consider speaking to your doctor about other drugs. Opioids may be necessary in cases of overwhelming pain. They have significant side effects, especially in the elderly, and should be used to assist in the use of other chronic pain tools, like those in Step 2, Step 3, Step 5, Step 6, and Lower Inflammation.

It can be helpful to have someone with you to help you communicate your pain to your doctor/healthcare provider. Have the conversations necessary to make reasonable choices.

Unfortunately, there are too many patients without physicians. I believe healthcare needs to be changed. There are many patients who have incredible knowledge and resources – those who have learned to manage their pain. If only we could find a forum where these patients become the leaders helping others to heal. In the future, I see nurses and physician assistants working with patients in group settings for education and working individually with patients to tailor safe chronic pain management.

We are far from where we need to be to provide those in pain with relief. In BC, we are trying with Pain BC and Self Management BC to find help, but we have a long road ahead of us.

Take care all.

Judy

First rule out biology -BIO – there are many reasons for pain. Far too many of them are not detected through blood tests or imaging. Too often, we doctors miss the diagnosis. Then by the time the diagnosis is made, the acute pain has become chronic.

Tissue damage, inflammation, nerve damage – they are really hard to treat when there is chronic pain. Especially nerve pain is hard to treat. From the age of thirty, most of us have some form  of osteoarthritis. Unfortunately – the only treatment for that is exercise, stretching and surgeries – like back surgery or joint replacements. Surgeries usually help, but they don’t always help.

The biological part of pain is very complex. Severe tissue damage leads to scarring and nerve inflammation. The nerves and surrounding tissue change. Changes that are meant to help healing – inflammation – can eventually cause toxicity in the cells if the problem is present for more than a certain time (this can vary from injury to injury and person to person). So pain messages continue to flood the brain due to these changes.

Say you have a severe accident or even an accident which causes a feeling of great threat (like a car accident where you could have died or domestic violence), then the alarm center is altered. Central sensitization happens if the injuries are not immediately ‘fixed’ – which seldom happens if there is severe tissue damage or when you can’t escape a ‘bad’ situation at home.

Once we have exhausted the biological part – we’re stretching, we’re moving, we’re taking the medications that we can, and still there is not relief, then we really have to concentrate on the other areas of pain. BIO-PSYCHO-SOCIAL.

PSYCHO – TRAUMA – physical trauma, illness, environment, toxins and past childhood and adult trauma. Chronic pain is a trauma in itself. It robs you of power.

SOCIAL – Pain makes it almost impossible to use your energy to spend time with others. There is sometimes only enough energy to get through the day. It can cut you off from everyone.

Dealing with the biological part means that the nerve inflammation and tissue damage needs to be sorted. Use cold for swelling – 10 minutes on 10 minutes off; heat for comfort and soothing, stretching the fascia gently, and ventral vagal breath.

When the pain hits, if possible, immediately relax (very hard to do in pain) speak to the limbic system and say “you’re safe” then take ventral vagal breaths. It sounds so silly, but if you pull a face, or wince, or scrunch up, the alarm center is reinforced that there is danger and the pain pathway gets harder, stronger, more set in your brain.

Start with work on the alarm system. It is broken if you have chronic pain. It is very important to recognize that the pain messages you are receiving are false alarms. They do matter! They are causing your pain. But they are causing too much pain for the tissue damage that is present. You can’t trust your pain signal.

Start with making sure you get up every day at the same time. Get dressed, no matter how hard this is. Do your make up if that is what you used to do before you became ill. It is important to make these steps to normal.

I now the breathing. Judy and her bloody breathing. People don’t know how to breathe to lower alarm. Step 2.

I know you want to work. I know you link the work with your self image. And work at least gives you power and social connection. It gives you self respect. Work if that is what you need, but the most important is load! Pacing. If you have chronic pain, you have to take every 20 minutes off for at least 10 minutes to practice breathing and something like super brain yoga. You can do this in the chair. See this and the breathing in LOWER INFLAMMATION. 

Start:

Every 20 minutes – 5-4-3-2-1, superbrain yoga and a deep breath.

Chair yoga 3 times a week. Even if all you do is sit and watch the videos. Eventually do a few movements. Eventually you WILL complete the program. Commit to 3x a week chair yoga.

More to follow

Judy

Is this JUST anxiety. Oh No! Not Just. Stress and Anxiety affect every part of your life – your biology – inflammation, high blood pressure, high blood sugar, the list goes on and on.  Affects psychology – how you think about yourself. Affects you spiritually – how you see the world and what is perhaps beyond what we see in this world.

Shame is a response to not feeling good enough. How do you see yourself? Do you feel capable? Capable enough? Always consider the word enough. In a broken world with broken systems, we try to compensate for things we have no control over. People pleasers and perfectionists cause themselves enormous stress and body ills. Not just your body. Also affects those around you. Affects communities.

Notice shame responses. Where do you feel it in your body? Are you fiddling more than usual – fingers and hands moving. Foot can’t stop bouncing? How does your gut feel? Are you getting headaches? Is your blood pressure going up? Sweating from too high adrenaline. Hormones are running amuck.

Be curious – Ah. I’m having a shame response.

Next step – calm the limbic system – the alarm center of your brain. I do 5-4-3-2-1 grounding techniques. I am an Olympic breather. Gold medals all around. Super brain yoga takes a minute – all on Lower Inflammation.

Take the time

Take care

Judy

Anxiety can stop you from healing. Fear often causes you to not want to try new things. Always speak to your healthcare professional about medications and treatment.

Healing requires learning  tools and accepting many different ways to improve your life. The page, Lower Inflammation, has tools to lower inflammation in the brain and body and by doing that lowering stress. Medications can also be very helpful when you have anxiety.

B Blockers lower the alarm in our flight fight freeze area of the brain – the limbic system. Lowering the alarm slows the body down – they slow the heart rate down. They can raise low blood pressure or can drop high blood pressure – the freeze response causes low blood pressure and the fight, flight response raises blood pressure.

If have asthma, then propranolol is not advised. If you have a pulse of under 50, then also not advised. The B blocker also helps slow your breath. Slow abdominal breaths make a humungous improvement on anxiety.

I see the Limbic system as a second brain. The first brain is our thinking brain. B blockers relax the body which then feeds information to your second brain, the limbic system, and it reads lower alarm and relaxes. When the second brain is not wo aroused, the thinking brain is lit up and can do the work to concentrate and learn new things.

Be careful of new medications. B blockers slow reflexes down, so if you are driving, keep long travelling distance between cars.
Always test new drugs out first – take a small dose when you’re at home.

Selective serotonin re-uptake inhibitors, SSRIs, side effects are many. Especially in the beginning. They can make you more anxious, give you gut upsets, dizziness, whooziness and have other side effects.

Unlike b-blockers, they take a while to work, but the side effects start early. After a week or two, the brain adjusts and then the effects of lowering the alarm center is similar to b blockers.

Unlike the b blockers, they work directly on the nervous system. They improve the thinking part of the brain which then gives feedback to the alarm center – this is called downstread regulation of alarm system –second brain. B blockers relax the body and that regulates the alarm center with upstream regulation.

Body and Brain connected!!

The interesting thing about SSRI’s – there are links to improved brain function structurally – not just operating to help you function better. We know the brain is plastic – neuropasticity – so there is proof that it works to improve brain in the long term.
Long term harms – after years and years – they can cause or increase risk of osteoporosis

In terms of doses in SSRI – low doses cause increased anxiety in the beginning. A prof used to say me, the more side effects you have, the more you need the medication. It’s your body resisting change – typical of anxiety. Go low and go slow, but usually someone with anxiety needs higher doses of SSR than people with depression. Having said that, everyone is different. Listen to body.

The SSRIs take usually 6 to 8 weeks to work. Some people actually feel better after two. I find the people using tools for anxiety actually get better faster and I’ve seen improvements in 2 weeks. B blockers work much faster – within about 30 minutes.

Another long term consequence is that people can feel so regulated with the medication, they ignore the most important part of healing – using every tool you can to eventually be free of medications. If possible. No shame if you need meds.

The meds can, however, help give you the energy and motivation to start using these important ways to heal, like the ones found on the Daily Program and Lowering inflammation (and stress).

Good luck

Judy

Today, in the office, I hear a patient explain there are troubles in her relationship. She says “But, I am too sensitive.”

That is a huge red flag that the patient is being gaslighted. 

People pleasers are often attracted to narcissits. When we are hurt in life, we behave sometimes by hurting others, or by hurting ourselves.  Which one are you?

Please take care

Judy

Covid is here to stay. The stress of the pandemic, the division it has caused in families and communities, and the near collapse of health care systems are only some of the long term effects. Another is Long Covid after a Covid infection.

Some long Covid symptoms include fatigue and exhaustion with exertion. After a COVID infection, notice your body’s needs. If you feel fatigue, then a gradual return to activities is necessary. Try the 4 P’s:

Pacing, Prioritizing – choosing the most important tasks, Positioning – modifying activities to make them easier to do, Planning to conserve energy.

 Long COVID causes physical and mental changes – anxiety, depression, PTSD. The viral effects can be compared to myalgic encephalitis, ME syndrome.

Shortness of breath can be helped using Breathing Exercises, Lung exercises – see video below. A pulmonary therapist can help assess for the need for medication or oxygen.

Sleep and Relaxation is very important for healing. 

Body exercises and tools cand be used to Lower Inflammation.

People with long Covid can develop POTS, fluctuations in your heart rate depending on your posture. 

We talk so often about medical care, but the care of family, friends, and community is essential. Reach out to your loved ones – don’t be shy to ask for help.

Take care

Judy

In the day, our brains are occupied with all the things that need to be done and tasks and people – all the distractions. Look at the red arrow – that is pointed towards your frontal cortex. That is the thinking part of the brain. Where you plan. Where you complete tasks.

At night, that part of the brain is less stimulated. Here it is in blue. The blue shows not much glucose is being used – glucose is the only energy source for the brain. (This brain is a brain of someone with PTSD but it sort of highlights what I’m trying to explain.)

At night the Limbic system is awake. This is the part of the brain responsible for controlling pain. Also sleep. And metabolism and blood pressure and all sorts of things. Now at night, this part of the brain is more active than the cortex.

Also, at night, if you lie there thinking and thinking and thinking (that’s anxiety) then the flight fright fight center (Limbic system) is stimulated. See the yellow? That is the area of pain and inflammation.

Obviously, it’s a bit more complicated than that. Everyone is different. General explanation. Have a look at this section to Lower Inflammation and pain. 

Take care

Judy