CRPS, ANS dysfunction, and chronic vertigo

The central nervous system is bathed in fluid. This fluid provides a buffer against shock, as well as providing a good medium for the transmission of chemical signals. (Electrical signals are handled by the neurons.) The central nervous system is extremely sensitive to dehydration, which is why headaches are so common: most people are somewhat dehydrated. We consider ourselves too busy to drink water and whizz it out again.

Water is also the main ingredient of blood and lymph. These two essential fluids bring nutrition to the cells, transport chemical signals such as hormones and regulatory signals, and carry away cellular garbage. When there’s not enough of them, that doesn’t happen very well. More garbage piles up in the tissues, aging happens faster, disease trends faster, our muscles get stiffer, it’s harder to recuperate from injuries and illnesses, our sex lives suffer, and we just don’t feel as good.

With that in mind, not having the time to drink in water, process it through, and whizz it out again doesn’t really make sense, but a lot of us are really attached to that idea.

Reality checks

One of the really ducky things about diseases like CRPS, especially when there is strong autonomic involvement, is that normal quantities of fluids (and vitamins, proteins, and other nutrients) are often inadequate to our unusual metabolic needs. It may be possible for a basically healthy person to meet all their needs with three good meals and three or four liters of water per day, but for systems so consistently under siege as those with CRPS, it may be impossible to meet metabolic needs within these (otherwise very reasonable) parameters.

I have several friends with terrible vertigo, due to autonomic dysfunction in CRPS. This isn’t the, “I held my breath too long,” kind of dizziness. This is the kind of dizziness where you can’t keep your feet under you, you feel like you’re going to throw up, and it JUST WON’T QUIT.

The mechanism behind this has only been researched recently. It's not very well understood. I'm hoping for an informative comment from an expert on this...

What’s happening (partly) is that the vessels, which are directed by the autonomic nervous system, are flopping open too much. This means that the normal amount of fluid in the blood, lymph, and cerebrospinal fluid has to fill a space that’s considerably larger than normal. What you get is a type of hypovolemic shock, where the brain and major organs simply can’t get enough nutrition, oxygen, and garbage collection.

This normally happens on a short-term basis, after some assault on the system; normally, it’s either corrected quickly, or the person dies.

There are very few instances where this happens continuously over time, but with CRPS, some people have to live with it. It can make doing anything impossible, and if you try to imagine, just for 5 minutes, what it’s like to be that desperately dizzy and try to do anything -- even get a fork to your mouth without bloodshed -- you’ll see what I mean.

Sometimes, these symptoms can be somewhat reduced. There are pharmaceutical and mechanical approaches, each with its drawbacks and benefits. Since doctors (and many patients) tend to think in terms of pharmaceuticals first, let's start there.

Pharmaceutical management

Whenever you think in terms of disease and pharmaceuticals, it's important to keep in mind that:

• Every system is unique.
• Every system with CRPS is even stranger.
• Unless you're a doctor getting a visit from a pharmaceutical rep, there is no such thing as a free lunch. Everything you take in affects your whole system. With our systems under siege, it behooves us to be mindful of our chemistry.

NB: This is not intended to diagnose, treat, or cure any disease. Consult your physician with any questions, and if your doctor can't give you a credible answer, get a referral to someone who might be able to.

Vasopressors, which can help restrict blood vessel size, have mixed results. They depend on the regulatory system being able to work somewhat, which is problematic in CRPS. Moreover, they have their own side effects, and given what a cocktail of medications most people with CRPS are on anyway, this can be quite noticeable. It has to be handled on a case-by-case basis.

Anti-dizziness pills, such as Atarax, affect the central nervous system and tend to make people sleepy and goofy. They are related to antihistamines and acid-suppressing medications (H2 inhibitors), and for those with hotwired immune systems and the nutrient assimilation problems common in chronic CRPS, they're not without side effects. Moreover, because they address only the generic mechanism for dizziness, but not the particular mechanism for CRPS/ANS vertigo, they don't necessarily help in these cases. Also, case-by-case basis.

Some SSRIs, typically used as antidepressants but extremely effective for nerve pain, can also provide support for the ANS. There is additional benefit to the use of SSRIs, because of their assistance with the nerve pain component of CRPS; when they can also improve the autonomic nervous system, it's a big deal. Naturally, SSRIs being the idiosyncratic category that they are, it can take a few tries to find the one that works best in each person's system. As I learned the hard way, getting the dose right can be a long and interesting task, given the idiosyncratic nature of our systems.

Mechanical management

Mechanically, it’s possible to increase blood volume by taking in lots of fluids, even if you already drink “enough.” “Enough” is a relative term, and what’s “enough” for a person with a normal autonomic nervous system may be “completely inadequate” for somebody with vertigo due to CRPS.

Blood pressure is a complex system, involving more than just fluid, vessels and the brain. Maintaining electrolytes helps contribute to a healthier fluid balance, and towards that end, sometimes doctors suggest increasing your salt intake. That only raises your blood pressure when you already have a predisposition to high blood pressure, so it may not be obviously useful; however, adequate sodium is important in maintaining renal function and supporting potassium levels.

Potassium is another key electrolyte, along with magnesium (found in Epsom salt), calcium, and bicarbonate. It doesn’t take much; four or five of the smallest grains of Epsom salt, stirred into a glass of water, can make a noticeable difference when you are magnesium depleted. Also, it usually makes the water taste better.

It’s easy to tell when you’ve taken too much, partly because it doesn't taste good, but especially when it gives you the runs. Less is generally better than more!

Bicarbonate is better managed by eating plenty of vegetables, rather than trying to supplement and get the dose just right. Having an overly alkaline system doesn’t feel very good, either.

Calcium and magnesium are present in food, especially if you’re eating plenty of nuts and leafy greens. If you have CRPS, you really want to eat plenty of nuts and leafy greens! They provide so much in the way of A and B vitamins, antioxidants, minerals (which support cellular processes and regulation), healthy fats (which help your body absorb your nutrients and protect your nerves), fiber, digestible protein (which helps your body absorb the calcium), and so much else of what your body really needs.

Activity, even horizontal activity, even just stretching out gently in bed, provides the body with much needed prompting about how to keep things moving. It keeps your muscles loose, so that your body is more comfortable to live in; it also activates sensors in your joints which communicate with your body’s regulatory mechanisms, and this helps with maintaining blood pressure (one can only hope it helps enough.)

Any movement is better than no movement.

Changes in position should happen slowly, which is terribly frustrating, but it’s going to take as long as it takes. If your body doesn’t get to move, it forgets how to handle itself in movement. This becomes a negative feedback loop.

So, keep moving, even if you’re not moving in any way that the doctor would recognize. Frankly, most doctors are somewhat limited in their ideas of what constitutes exercise. Most of them have no trouble walking from the car to the office, let alone from the bedroom to the kitchen.

Don’t let perfection assassinate your drive towards improvement. Do what you can, and don't sweat the rest.

• If you can’t run around the park, walk around the block;
• If you can’t walk around the block, practice ballet or t'ai chi with one hand on the back of the sofa;
• If you can’t do that, fire up YouTube and do chair qi gong or chair yoga;
• If you can’t do that, stretch out gently in bed, and do range of motion exercises. (This is a wonderfully pretentious term for moving each limb all the way up, then all the way down; all the way in, then all the way out.)

There is always something you can do to keep your joints active.

Moving your joints sends a message to your regulatory centers that they need to pay a little more attention to your blood pressure. That’s why it’s important to stay active. Our regulatory systems are screwed up enough; we need to keep them gently tuned, and be persistent about it, even when it seems absurd to do so. The habit of activity will serve you well for the rest of your life.

I'm aware that there are some herbs that have tonic effects on blood pressure and possibly the ANS. I would love to learn more about that.

Assume there is a future, and that what you do, even little things, can change how it goes.

That’s a good general policy, anyway. Especially with CRPS.

While I’ve known all this for many years, applying it to CRPS has been an education. When I’m able to focus a little longer, I’ll put together some references. Meanwhile, any of you who have references, either to support or contradict any of this, would be very welcome to post them in the comments.

I look forward to better science and better medicine for chronic vertigo in CRPS. It's so thoroughly disabling, yet so thoroughly underrated.

Repeated stress knocks out the prefrontal cortex

... In a number of ways.
This article describes a new finding which relates memory loss and cognitive dysfunction to a loss of glutamate receptors in the prefrontal cortex (PFC):
body=http%3A%2F%2Fwww.sciencedaily.com%2Freleases%2F2012%2F03%2F120307132202.htm&subject=How+repeated+stress+impairs+memory
They state that this is why the PFC tends to falter in the face of repeated stress: the receptors for one of the key neurotransmitters become depopulated, leaving fewer sites to accept the glutamate and allow that part of the brain to do its job.
Cognitive impairment in the face of repeated or chronic stress is not a monolithic problem, though. Memory and decision-making are probably the most complex of brain tasks, and there are plenty of things that go wrong when memory and cognition fail.
Other factors include dopamine depletion, leaving less of that transmitter to carry messages back from the PFC, thereby making executive decisions harder to make and still harder to follow through on. (I wrote a previous post on dopamine and decision making. I'll dig it up and link over.)
And then there's the adrenaline overproduction and overuse that characterizes chronic and repeated stress, leading to disruption of the hypothalamic-pituitary-adrenal axis (the body's entire signaling structure for body processes) which contributes to brain dysfunction in still more ways: by disrupting sleep, which disrupts memory formation and impedes logic; and by contributing to the rise of metabolic syndrome, creating less stable blood sugar -- which, in the brain, adds considerable insult to injury: a hungry brain is a low-functioning brain.
Take your vacations. Simplify your life. Move your body around regularly. Meditate early and often. If you cherish your brain, you might as well let it work -- and that means getting a half-Nelson on stress before it gets one on you.

Links:
The article on overuse of dopamine (on my Living Anyway blog): http://livinganyway.blogspot.com/2011/03/dopamine-poverty-and-pain-lighter-side.html
Another Biowizardry entry on neurotransmitters: http://biowizardry.blogspot.com/2011/08/scared-of-wrong-things-role-of-mao-in.html

Scared of the wrong things: depressive chemistry and danger

Funny how the whole delicate neurological/neurochemical structure is so interwoven:

http://www.sciencedaily.com/releases/2011/08/110810133127.htm?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+sciencedaily%2Fmind_brain+%28ScienceDaily%3A+Mind+%26+Brain+News%29#.TkPZJ2TGXNQ.mailto

"...The researchers suggest that the strange defensive behavior exhibited by the enzyme-deficient mice may actually reflect a limited range of adaptive responses and lack of emotional flexibility -- the mice may only have one gear for fear."

We've all known people who make exaggerated choices around danger that make no sense to ourselves. (Having heard my mother and my sometime partner on the subject of my riding motorcycles, I'm pretty sure of that.) However, only at my most desperately depressed have I engaged in unsafe sex, which is the second stupidest risk I can think of (the first having nothing to do with motorcycles.) 

The role of MAO-A and depressive neurotransmitters, combined with the dopamine-deficient sense of hopelessness and diminished executive function, make that make sense: 

"Monoamine oxidase A is the main enzyme in the brain that breaks down serotonin, norepinephrine and dopamine..."

Which makes me think that it's possible, in humans in vivo, to be deficient in both MAO-A and in dopamine, serotonin, etc. It would explain a lot about certain mental states, even though it seems chemically tautological at first glance to be both Big 3-deficient and MAO-A deficient. As I've learned, though, deficiency and dysregulation do have additive effects, they don't cancel each other out. 

I'd like to see more studies which monitor serum and brain levels of these key chemicals together, preferably in humans. Science tends to take the simplest possible approach, which is rarely the most realistic and not necessarily the most telling. It does get funded and it does make it simpler to design the studies. 

I look forward to having more sophisticated thinkers (and funders) get into this branch of psychoneurology, since all these lively lovely tiny bits of info won't come together in a meaningful way until we can look at them in concert with a higher degree of exactitude and completeness. I suppose I'll have to be patient. And careful. 

News flash: the gut and brain are connected!

The obvious scatological humor will be left alone. Guys, you know what I mean. (Girls who were outnumbered by your brothers, you too.)

I started to blog this article because the forehead-smacking tone of the revelation that the gut might relate to the brain was a bit too much for me. On closer examination, it looks like the misplaced drama is the writer's, not the scientists'.

One of the places where serotonin is released is in the gut, where it helps digest proteins. That's the most obvious "duh" moment here. Moreover, as those of us who remember our embryology know, the inter-relationships and constant correspondence between neurology and gut, gut and immunity, immunity and endocrine system, endocrine and neurological system are all too intense and interlocked for words.

Most studies make brutally clear that these so-called systems are medically treated as separate and distinct, but our bodies never got that memo. It's all the same system, as far as the body is concerned.

Much of this researcher's recent work focuses on neurology of the gut -- enteric neurology. It's a real thing now. His prior work focused on the biological environment in the gut, or the intestinal microbiota.

// START Word geek goes wild:
Sometimes, I just love medical terminology for the way it rolls, hops, and bounces off the tongue. Enteric neurology. Intestinal microbiota. Hypothalamic-pituitary-adrenal axis.

Maybe that last one doesn't work so well.
// END Word geeking.

If you can stand the medical and chemical jargon, it's worth looking into some of his work. It's probably not a stretch to call it prescient, in that it is likely to lay the foundations for our emerging understanding of the gut as a more complex and self-managing, yet interlocked, set of systems than we've ever imagined before.

I can't find the original science article, just this unsatisfactory and superficial overview. It says that intestinal microbiota affect the person's mood and feelings, and that it's possible to deliver specific probiotics (like yogurt species, naturally-fermented cole slaw, certain cheeses and the like) in order to have a specific benefit to the neurological system.

If you were an empiricist, like me, it would sound like "eating good, living food leads to better mental health," which healers have been saying for millenia. But far be it from me to steal such well-researched thunder.


Link list:

Science Daily article:
A Gut-Full of Probiotics for Your Neurological Well-Being

Credentials of lead researcher, Prof. Lyte:
Mark Lyte, Ph.D., M.S., MT (ASCP)

Wikipedia's digest (sic) of the enteric nervous system (this seems basically congruent with the uber-geeky medical studies I looked at on the subject, so I accept it as a decent primer):
Enteric Nervous System

Couldn't find a good overview that didn't involve more dead rodents than I could, er, stomach.

Hemingway: How courage and depression go together

This article is well-intended, but egregiously judgmental and woefully ignorant:

http://www.npr.org/2011/07/02/137540700/after-50-years-remembering-hemingways-farewell

If it weren't for the inane babble puzzling over why Hemingway lived so intensely, this line would be the Winner of The Most Fatuous Statement award: 

"...in January 1961 he told his wife, Mary, that he could no longer write a single good sentence. And Hemingway would only settle for great ones."

It wasn't a question of settling for less than great, it was a question of how important it is to fulfill your purpose and dig some meaning out of life, even amid the unbearable. That purpose and meaning was taken from him, under the mistaken guise of treatment. 

Hemingway got electroshock therapy for his depression; a common side effect is to knock out your language abilities and cognition, sometimes for months and sometimes forever. The one thing that made his life endurable -- writing like himself -- was taken from him. 

Depressed people have more courage and determination than their non-depressed cohorts. Studies are finally being funded that verify this (which I'll dig up later. Feel free to nudge me with a comment.) 

Think about that next time you curl your lip over suicide. It's not about courage. It's about unbearable pain and a degree of mental crippling that puts a valid life out of reach. 

Waiting and working at it until things improve is a reasonable thing to do: Hemingway waited and worked at it for  40 years, though with so little real hope for treatment. Talk about courage! It's unthinkable how much courage he brought to bear on his life. His intensity and wild behavior were directly related to making his life bearable -- and his work more compelling. Check his quoted remarks on that subject. What's between the lines is breathtaking. 

The article's remark about suicidal lineage is true, but poorly understood. A suicide in the family has the powerful effect of making suicide less unthinkable. There is often a genetic tweak associated with it, but that's not all there is. The thing to know now is, we are not our predecessors; we can do more. Far more. 

Hemingway died before we developed SSRIs, SNRIs, and a tremendously improved understanding of neurochemistry, behavior, nutrition and psychodynamics. We have more options now. Lots more. Waiting and working at it is a real success path now. 

Be good to your depressed friends. You probably have no idea what they're capable of, when they can be well again. Help them persist. 

It's the most important thing to do: persist. A valid and bearable life is a reasonable thing to hold out for. Only death bars the door to healing. Things will change. 

Digestive problems early in life may increase risk for depression, study suggests

http://www.sciencedaily.com/releases/2011/05/110512171517.htm?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+sciencedaily%2Fmind_brain+%28ScienceDaily%3A+Mind+%26+Brain+News%29

This article states that gut disturbance in early infancy/lifelong gut disturbance (the language is kinda sloppy) can trigger lifelong depression and anxiety.

This doesn't surprise me, but most of the rest of the article does.

The rat-botherers who did the study presume it's all about the vagus nerve. Recently, a deliciously expensive procedure which stimulates the vagus has been found to alleviate some depression. It's good to know that.

It's good to keep a couple other things firmly in mind first, though:

- Serotonin is produced in the small intestine, as well as the brain. It helps to digest protein. It also plays a role in immune signaling. Think that could possibly be related, either to depression or to inflamed gut syndromes? H'mmm...

- My first thought: get right on top of infant digestive problems. That means getting serious about both prevention and cure.

Oddly, that idea wasn't even mentioned, even though prevention is infinitely better than trying to manage a lifelong downer like IBS or depression -- let alone both!

Prevention is simple in concept, but inexcusably difficult in our current system. With babies, it's easy: get dead-serious about breastfeeding. Where that's not possible, put aside formulas at the first sign of allergy. Don't switch between cow and soy milk, two of the most allergenic infant proteins on the planet; milk more goats and camels. Go to a breastmilk-bank. Find your local midwives because they are much better with the idea that birth is only the beginning of a much longer life, and they should know how to figure this out. If they don't, they can tell you who else to call.

And punctual treatment for troublesome insides -- with the least invasive meds. Interfere with their little regulatory systems as little as possible, but take care of the problem. For indigestion, chamomile and calcium carbonate are much better than h2-inhibitors (Zantac, Prilosec and the like.) Chamomile also soothes the mind and settles the emotions, so the kid can relax.

Try elimination diets to screen for allergies. Sadly, wheat, eggs, cow dairy, soy, and corn are common allergens which affect the developing gut -- and the developing skin and brain, because their little bodies never got the memo that all of these systems are supposed to be separate from each other.

Google those terms, discuss them with your midwife/pediatrician/nurse practitioner, and take care of the problem at its source.

You don't want more depressed people in the world. There are better things to do with infants than let their guts screw up a good life, handing them into the craps-shooting care of multiple pharmaceuticals and invasive procedures.

When I get on the CPU, I'll set up more links for my factual statements. This is it from the iPhone.

Bon appetit!

Picking a target (volunteers welcome)

I have several topics competing for attention:

- The lowdown on neurotransmitters: what they are, what they do, where and how they're made.
I can't find my old version, but I'd rather rewrite it anyway and lard it heavily with current references and links.

- After that, there's more to say about how neurotransmitters can be affected -- for better or worse -- by what you do, what you eat, and how you use your noggin.
This is aimed at that helpless feeling we tend to get when our minds go awry. There's a lot you can do to mend your mind from the inside out, either with med help or without. I'd like to put the main strategies together here, because so much advice seems conflicting. Mostly, it isn't, but it would be good to see why.

- Putting the "might" back in mitochondria: how to support your mitochondria in sickness and protect them in health.
This goes into the mechanics and physiology of the reparative stuff I mentioned in the prior article on mitochondria.

These are the big 3. Any preferences?