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Transcript of Integrative Medicine Mind – Body Connections PLC OR RN November 26, 2010 Jeffrey P Schaefer MSc MD...
![Page 1: Integrative Medicine Mind – Body Connections PLC OR RN November 26, 2010 Jeffrey P Schaefer MSc MD FRCPC FACP.](https://reader035.fdocuments.net/reader035/viewer/2022062407/56649e895503460f94b8e305/html5/thumbnails/1.jpg)
Integrative MedicineMind – Body Connections
PLC OR RNNovember 26, 2010
Jeffrey P Schaefer MSc MD FRCPC FACP
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website
dr.schaeferville.com
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Conflicts of Interest
• none
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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
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And above all...
Relax Responsibly
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Case
• 46 year old educator
total body pain and fatigue x 5 years
assessed by GIM, Neurology, Gastroenterology
investigations normal
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Problem List
– daily occipitofrontal headache
– chest pain, episodic, at work
– abdominal pain
– fatigue
– poor concentration & dizziness
– work issues
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What’s your diagnosis?
Diagnosis: ______________________
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Hopefully, uptodate.comhas something…
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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
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This is a problem!
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One condition or many?
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Chronic Fatigue SyndromeFibromyalgia
Irritable Bowel SyndromeMultiple Chem Sensitivity Syndrome
Sick Building SyndromeHypoglycemia
Gulf War Syndrome
Undocumented LabelsHeadache Syndromes
AsthmaPainful Conditions
Various
Bodily Distress Disorder
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• 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
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Median Number of SymptomsMen & Women 5
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“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
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• 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.
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Psychobiology‘the mind-body connection’
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Psychobiological Framework
NO MATTER WHAT ELSE
IS GOING ON!
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Talk about Stress...
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Acute Stress Response
Fight, Fright, Flight, Frolic Response
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Hans Selye (1907-1982)
General Adaptation Response
– Alarm– Failure to adapt– Exhaustion
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Recipe for Stress• Novelty
• Unpredictability
• Threat to ego
• Loss of control
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Absolute Stress
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Relative Stress
Interpretation of the world
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stress4 parts
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Stress Stimuli
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Experience the stimuli
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Physiological Response(Body Chemistry Response)
• Hormones
• Neurochemistry
• Immunochemistry
• Energy Metabolism
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Experience of thePhysiological Response
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Stress Hormones
• Corticosteroids– Cortisol
• Catecholamines– Adrenaline (Epinephrine)– Nor-adrenaline (Nor-epinephrine)
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Cortisol
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Cortisol Regulation
• Brain– emotion, pain,
memory
• Hypothalamus– autonomic function
• Pituitary– stimulating hormone
• Adrenal Gland– cortex
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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
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Immediate Effects of Cortisol
• Response to Absolute Stress– increase vigilance– respond to emotion don’t think– raise blood sugar– increase psychomotor activity– obtain food
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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
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Pituitary Tumor & Cushing’s Disease
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Disease States
• Moon facies
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Catecholamines• Adrenaline (Epinephrine)
• Nor-adrenaline (Nor-epinephrine)
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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
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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
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Self-report AMI Trigger412 reports from 849 AMI
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Chronic Stress & Immune Dysfunction
• Influenza Vaccination
• Difference between stressed and non-stressed group.
– Lancet 1999
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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
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So now what?
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www.calgaryhealthregion.ca/cmbm/
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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
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Self-regulation• Somatic Awareness
– experiential– link emotional state with body symptoms– effortless breathing
• Medication Reduction / Elimination
– group therapy– education– heartmath– guided imagery
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Don’t forget to breathe…
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Breathing... by any other name...
• ‘naked’ woman
• Living with COPD – diaphragmatic breathing
• Living with COPD – relaxing w diaphrag btng
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Humor....
• Laughter Therapy
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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
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Goodwill
• Mother Theresa Effect
– improved self-esteem
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• 290 patients 2004 - 2009
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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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