Thank you to our sponsors, contributors, supporters and all who participated in our
"Walk for Awareness" on September 16th. We had a beautiful, sunny day with lots of fun and fellowship.
Reflex Sympathetic Dystrophy/Complex Regional Pain Syndrome, RSD/CRPS...
What is it? Our newsletter and webinar this month will be devoted to this subject.
In our Marlton office we take a blended holistic and conventional approach to the treatment of RSD/CRPS.
While Dr. Getson does utilize conventional therapies like physical therapy and medication to try and control the patient's symptoms, we also incorporate holistic health counseling sessions and our infra-red sauna, the "POD", to those suffering with this disorder.
Hippocrates said, "Let food be thy medicine and medicine be thy food."
The ancient Greek physician Hippocrates is known as the Father of Western Medicine and for the saying, "Let food be thy medicine and medicine be thy food." His theory of medicine is also revealed in the Hippocratic Oath..."Do no harm," an oath doctors and nurses take upon graduating medical school. It seems that today's medicine rarely practices the Hippocratic Theory of healing using food, herbs and gentle healing practices. Hippocrates disliked using potent drugs for sickness but would look at a sick person 'holistically' to determine a cure; very much like naturopathic doctors and herbalists do today.
Hippocrates practiced passive gentle medicine. He would approach healing believing with proper nutrition, appropriate herbs and rest the body could heal itself in most cases. This is the basis for 'alternative' or 'natural cures' medicine. Hippocrates and others were masters at using various herbs and foods to target specific ailments
Healing takes time and patience. The body did not get sick overnight but over time. And over that time period the body is also trying to communicate exactly what it needs to get well by cravings and symptoms.
A well balanced nutritional diet is essential for what ails the body. If suffering from a long term chronic condition, chances are the body will require significant time to heal. If suffering an acute situation or sudden illness, the importance of having a healthy body from the start is imperative to assist the healing process.
Natural News Posted Tuesday, January 27, 2015, Laura Halfpenny
A nutritional and lifestyle modification approach as an adjunctive therapy for the treatment of RSD/CRPS....clients report an "overall feeling of well-being."
I am going to paint some broad strokes to provide a brief overview of some of the modalities that I utilize during a holistic health counseling session. The internet has provided us with the means to have information at our fingertips, I provide support and guidance to those trying to find their way through what has become the somewhat murky waters of "what to eat."
An initial session usually lasts about 90 minutes, in which I talk with the client about what is going on in their life, what their life was like before the diagnosis of RSD/CRPS and what is it now. This conversation would fall under the category of "primary food". Primary food is more than what is on your plate. Healthy relationships, regular physical activity, a fulfilling career and a spiritual practice can fill your soul and satisfy your hunger for life. When primary food is balanced and satiating, your life feeds you, making what you eat secondary.
Once primary food is addressed I move on to what clients are actually eating.
For instance, I strongly encourage everyone to move to an organic diet, one rich in nutrient dense foods. It is very difficult
for a person with a healthy immune system to handle the impact of all of the toxins, antibiotics, pesticides and hormones in the conventional diet. A person with RSD/CRPS really cannot handle the toxic load that comes from eating the Standard American Diet or the SAD diet. Most grocery stores, even the big box stores, have an organic section. Or better yet, start your own little organic garden. It doesn't have to be an acre big, it could start out as a box garden or some herbs on the windowsill; keep it simple.
I strongly encourage the elimination of processed food, sugar and gluten. I implement a plan called "crowding out". If you fill your body with healthy, nutrient dense foods, it is only natural that cravings for unhealthy foods will lessen substantially. When you increase your intake of nutritious foods, such as dark leafy greens and healthy fats, your body will have less room for processed, sugary, nutrient-deficient foods. Once you start adding these healthy foods your body will naturally start to crave them. This helps you to avoid feeling deprived and before you know it you are eating a healthy, well balanced diet, almost without effort. It becomes a lifestyle.
Hydration is very important. We should be drinking half our body weight in ounces of water. We are 60 % water. We need it for our bodies and organs to function properly. You might be surprised by the myriad of symptoms caused by dehydration.
Once we establish some good dietary habits I may introduce some high grade, high quality vitamins, supplements, protein and greens powders.
We also cover stress reduction and body movement. We know that if your stress levels are high then your cortisol level is high which increases pain. There are many modalities for stress reduction, the trick is to find one that works for you and then do it. The same with moving your body. If you have RSD/CRPS you will most likely not be working out at the gym 5 days a week but how about some chair yoga or stretching?
My clients that have been able to slowly implement all the little steps and changes have said they have an "overall feeling of well-being." They still have the RSD/CRPS pain but it is more manageable. Because they are hydrated, getting nutrient dense food into their bodies and cells, sleeping better and doing stress reduction they are better able to handle the curve balls that life inevitably throws at us. Being are more grounded and centered allows them to keep their cortisol levels down which decreases their pain.
Diet and lifestyle may not be the whole answer but it certainly is part of the equation.
Autumn, the year's last and loveliest smile.
William Cullen Bryant
Wishing you a colorful and transformational Autumn
Does CRPS Spread?
To those of us who treat patients with Complex Regional Pain Syndrome on a regular basis, the answer to this question is simple. Absolutely yes! However, many uninformed clinicians and allied healthcare practitioners dispute this fact. They seem to feel that once the disease presents itself in one area of the body,
it is "impossible" to spread to other areas.
Reviews of the literature has shown that the first formal explanation of this comes from an article written by Dr. Schwartzman in 2000 entitled "Patterns of Spread in Complex Regional Pain Syndrome, Type I."
In 2011, an article called "Spreading of Complex Regional Pain Syndrome: Not a Random Process" provided some additional opinions.
Also, in the journal "Pain" in 1996, Veldman and Goras authored an article called "Multiple Reflex Sympathetic Dystrophy. Which patients are at risk for developing a recurrence of reflex sympathetic dystrophy in the same or another limb."
The one common denominator in these articles is that they discuss the spread from one limb to another. It seems to be the consensus that when the disease spreads it does so horizontally or vertically (left arm to left leg, left arm to right arm, etc.) 95 percent of the time with a contralateral spread (left arm to right leg) about five percent of the time.
There does not seem to be a known etiology or "time table" for spread. However, it has been offered as an opinion that most of the spread occurs within the first year of the onset of symptoms but can also take as long as 12 years to spread.
From a clinical perspective, however, what is clear is that the disease most certainly does spread. Almost universally, individuals afflicted with this disorder report that the pain in the second limb is "worse than the first." It is difficult to determine whether the subjective perception of pain is because the condition is more amplified in the second limb or whether individuals have "gotten used to" the pain in the first limb causing the "new" pain to feel more intense. Additionally, spread is not limited to just the other limb. There are also individuals who have three or four limbs affected over a period of time.
A recent article from a Scandinavian journal suggests that patients with CRPS are at risk for spread following a second traumatic event including surgeries or injury to a previously unaffected limb. Although there is some credibility to this report, more often than not, the spread is spontaneous and not secondary to such a traumatic event. Further, the term "traumatic event" needs to be classified downward to include such seemingly innocuous occurrences such as a venipuncture, blood pressure cuff that is too tight, etc.
However, what is not reported is the spread of Complex Regional Pain Syndrome to internal organs. Clinically, there are many manifestations of this disease that often go unnoticed and untreated. Some of these include:
- Cardiac: Sensitization of the intercosticobrachial nerve causes cardiac arrhythmias. These manifest themselves as tachycardia and bradycardia most often with occasional ectopy noted as well. Unfortunately, some patients require the use of pacemakers to deal with the bradycardia as it becomes so pronounced they become markedly symptomatic with rates as low as 40. Hypersensitization of the same nerve causes atypical chest pain which is non-cardiac in nature.
- Visual disturbances can include double-vision, blurred vision, ocular migraines, vision loss with field cuts, photophobia and burning of the eyes. Headaches tend to emanate from sensitization of the greater occipital nerve. Other headaches are migraine type, ocular migraines, and tension headaches.
- Otorhinolaryngologic symptoms occur. These include otophobia, intermittent and transient hoarseness which comes from the effect of CRPS on the branchial plexus and an increase of hypersensitivity to sound, especially bass. I have seen on patient who began to stutter uncontrollably as a consequence of his Complex Regional Pain Syndrome.
- Dental issues are rampant. Part of this stems from dietary indiscretion, part from immune system compromise, and part from disruption of the dental nerve roots. However, poor oral hygiene, poor nutrition, and a loss of saliva due to dry mouth results in decay, periodontal disease, and ultimately tooth loss.
- Dermatologic issues can occur in the form of neurodermatitis, excessively dry skin or hyperhidrosis. A dermatologic condition that is little understood and rare in its presentation is Dercum's disease. This is manifested by multiple painful lipomas occurring mostly on the trunk, upper arms, and upper legs. The etiology is unclear. Yet another dermatologic manifestation is that of livedo reticularis.
- Gastroenterologic manifestations occur in better than half of the patients. Most commonly this takes the form of gastroparesis with its associated side effects of nausea and vomiting. Acid peptic disease and irritable bowel syndrome are common as well. Dysphagia, indigestion, biliary dyskinesia, and diarrhea and constipation (the latter exacerbated by the use of opioids for control of pain) have also been seen.
- Urinary spread of Complex Regional Pain Syndrome takes the form of symptoms that mimic interstitial cystitis. These include urinary incontinence, dysuria, or the inability/difficulty to void. Bladder pacemakers have been used for this purpose. Botox injections into the pelvic floor have helped. This misdiagnosis of interstitial cystitis can be complicating and prolong the treatment. If the patient does not respond to common modalities of treatment to I.C., a spread of Complex Regional Pain Syndrome to the urinary bladder should be considered.
- Gynecologic manifestations include polymenorrhea, dysmenorrhea, secondary amenorrhea, and menometrorrhagia.
- Neurologic symptomatology such as vertigo, syncope, seizures, and pseudo-seizures can be seen as well. Other neurologic manifestations include cognitive issues, most often short-term memory loss, word retrieval, and difficulty with expression. Some believe that this is due to medication while others believe it is due to the diminished use of brain function caused by the isolation that is sometimes experienced by patients who are no longer a part of the workforce and have a reduced role in society because of the Complex Regional Pain Syndrome.
- Other generalized symptoms include lethargy, fatigue, weakness, sleep disturbance, shortness of breath, neurogenic edema, muscle weakness and atrophy, adrenal, thyroid, and hormonal imbalance, and of course, to varying degrees, anxiety and depression.
There is an article that elaborates further on the internal organ involvement of Complex Regional Pain Syndrome titled "Systemic Complications of Complex Regional Pain Syndrome" by Dr. Schwartzman in 2012.
There is great concern as to what can be done to minimize the likelihood of spread. A concurrent article discusses the issue of spread from a patient perspective. It is important to understand that in elective surgical procedures there is something that can and should be done! In 2012, an article titled "Ketamine as Adjunctive Anesthesia and Refractory Complex Regional Pain Syndrome Patients: A Case Series," authored by Dr. Schwartzman and myself, provided details with regard to a study of a limited number of patients who had undergone various surgical procedures using adjunctive Ketamine
intraoperatively. In my portion of that study, as well as in patients treated in a similar fashion subsequent to the publication of that paper,
no episodes of spread of CRPS following elective procedures, ranging from dental extractions to podiatric procedures, have been reported. The use of Ketamine intraoperatively (with any adjunctive agent that the anesthesiologist chooses) seems to have the effect of blocking the spread, or at least up to and inclusive of this point in time, has worked in that fashion. It is therefore recommended that in cases of surgery, regardless of how innocuous that procedure may be, Ketamine be used during the course of the procedure in a dosage ranging from 80-150 mg of the drug. The dosage depends upon body weight, length of procedure, and involvement of the nervous system in the proposed surgery.
Such procedures as dental cleaning, endoscopies, etc. do not appear to require the buffering.
Once the spread of CRPS has been identified, it is strongly suggested that treatment be initiated to the secondary limb or internal organ as soon as possible. Once symptoms begin to manifest themselves, immediate intervention seems to minimize and in some cases, cause a recession of those symptoms. For example, a patient whose disease spread from the leg to the arm and has received a series of three sympathetic nerve blocks into the stellate ganglia at weekly intervals has a much better chance of minimizing the effects of that spread than someone who waits until the symptomatology becomes more amplified.
Finally, in an interesting observation, I have noted patients who have presented for a full body thermography due to the presence of Complex Regional Pain Syndrome in a single limb. Thermographic images clearly portray sympathetic dysfunction in a second limb while the patient manifests no clinical symptomatology. It would be ideal if interventional blockade could be given
before symptoms presented themselves in the second limb. This, of course, is precluded by insurance denial of treatment in an asymptomatic body part.
In conclusion, the spread of Complex Regional Pain Syndrome is common and multifaceted. It is clearly important for afflicted individuals to be cognizant of the potential sites of spread in order to report symptomatology to their treating clinician. It is similarly essential that physicians make themselves aware of the fact that the disease does in fact spread and can have constitutional manifestations, not simply those that occur in one or more limbs. It is
not necessary for there to be an inciting traumatic event for this spread to occur.
As always, the earliest possible intervention leads to the best possible outcomes.
- "Patterns of Spread in Complex Regional Pain Syndrome, Type I," Schwartzman et al, Pain 88 (2000 - 259-266).
- "Spreading of Complex Regional Pain Syndrome: Not a Random Process," Journal of Neural Transmission, Monique A. van Rign, et al, 2011 September: 118(9): 1301-1309.
- "Multiple Reflex Sympathetic Dystrophy. Which patients are at risk for developing a recurrence of reflex sympathetic dystrophy in the same or another limb," Pain, 1996 March: 64(3):463-6.
- "Atypical Chest Pain: Evidence of Intercostobrachial Nerve Sensitization in Complex Regional Pain Syndrome," Rasmussen, et al, Pain Physician 2009; 12:E329-334.
- "Systemic Complications of Complex Regional Pain Syndrome," Robert J. Schwartzman, Neuroscience & Medicine, 2012, 3, 225-242.
- "Ketamine as Adjunctive Anesthesia and Refractory Complex Regional Pain Syndrome Patients: A Case Series," Robert J. Schwartzman and Philip Getson, Journal of Clinical Case Reports; 2:186 (August 2012).
- Philip Getson, D.O.
Thermographic Diagnostic Imaging/Health through Awareness
is proud to announce
a free holistic health webinar presented by Dr. Philip Getson:
"Light Bulb Moments and the Art of Deductive Medical Reasoning"
When self-proclaimed mystery buff and "Sherlockian", Philip Getson, DO, was stumped by a medical case in the mid 1980's, he began a journey to seek answers that would eventually lead him to becoming an expert on Reflex Sympathetic Dystrophy/Complex Regional Pain Syndrome. In this webinar Dr.Getson will be discussing the diagnosis and treatment of this debilitating and often misdiagnosed disorder.
Reflex Sympathetic Dystrophy or as it is now known, Complex Regional Pain Syndrome is an insidious disease of unknown etiology. Primarily it is a neurological disorder and as such affects not only the nerve endings as we know them but also internal organs and the musculoskeletal system and its ramifications are far reaching.
The primary hallmark of this disorder is pain and in instances where this follows a traumatic event, the pain is out of proportion to said event. There are many other symptoms such as but not limited to swelling, color change, temperature change, hair growth and nail growth changes, and motor movement dysfunction. The pain is more often than not described as burning but frequently can be described as deep bone pain, sharp pain, dull pain, and many other adjectives have been used to describe this primary symptom.
Dr. Getson's medical philosophy is derived from this simple premise. It is far easier to come to a diagnosis in most cases by taking a comprehensive history and in cases of injury by reenacting the traumatic event. "It never ceases to amaze me what people will remember if you take them step by step through the circumstances that led them to present in your office."
He believes the mystery genre and Holmes in particular has made him a better diagnostician. Today with computers and the internet, students seem to rely less and less on intuitive thinking and more on electronic information access.
For Dr. Getson there is no greater sense of accomplishment than to see the look on a patient's face when you can provide an answer to their medical problems. "Whatever the diagnosis may be it still affords for the opportunity to intervene which, I have found, is far better than "not knowing."
He has always practiced using a combination of logic, deductive reasoning and intuition and will continue to do so.
Philip Getson, D.O. is a family physician in practice since 1976 in New Jersey. He is a locally, nationally and internationally recognized expert in the diagnosis and treatment of Reflex Sympathetic Dystrophy/Complex Regional Pain Syndrome and has lectured extensively on the subject. He is an Assistant Professor of Medicine in Neurology at Drexel University Hospital in Philadelphia. He is a Board Certified Thermologist and has reviewed more than 25,000 Thermographic Studies of the breast, thyroid and neuromuscular system.
For more information or to register 856-596-5834 or www.tdinj.com
"Webinars & Events"
TDI/Health through Awareness is proud to sponsor the following class facilitated by Elizabeth Kochanik:
The core and foundation of
What if a gentle touch could change everything?
Imagine if someone could press a button and mute that voice in your head that tells you that you're not good enough or that you can't accomplish
what you dream about.
There is a set of tools from Access Consciousness called "The Bars."
Running The BARS is similar to defragging your computer, but instead of your computer you are deleting all the files that you have stored in your mind's database that keep you locked in limitation and looping back to the same thing over and over again without being able to free yourself fully.
During a Bars session, a trained practitioner lightly touches 32 points on your head which dissipates the electromagnetic charge that gets locked in our brains by the thoughts, feelings and emotions that we have stored over lifetimes. When we gently press on these points we "Run the Bars." Running your Bars can open new possibilities in many areas such as money, communication, healing, relationships and much more. It can open new possibilities that you never even knew existed.
Learn how to run "The BARS" on
Saturday, October 21st from 9:30-5 at
Virtua Hospital Voorhees
100 Bowman Dr.
Holman Conference Center, Room D
Voorhees Township, NJ 08043
$300 First Class -$150 Repeat Class
(payment in the form of cash or check)
Please arrive by 9:15 to give you time to settle in.
There will be two 15 minute breaks and an hour break for lunch.
A very warm thank you to Elsie Kerns,
Elsie gave us some simple yet very effective tips to
handle stress. I encourage everyone to take at look at her presentation.
Click here to watch the webinar!
Is joint pain hampering your life? Have you been told your pain is permanent? Fortunately, we've now discovered many of the reasons why people get inflammation and arthritis. In addition, there are new treatment approaches to help you heal. Whether you've recently been diagnosed or have been living with joint pain for decades--especially those with rheumatoid or osteoarthritis--join us to regain hope that pain is not your destiny! Don't miss The Arthritis Summit from October 9-16, 2017, free and online!
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These statements have not been evaluated by the Food and Drug Administration. The information in this newsletter is not intended to diagnose, treat, cure or prevent any disease. The contents of this newsletter are based upon the opinions and research of Liesha Getson and Health Through Awareness, unless otherwise noted. Individual articles are based upon the opinions of the respective author, who retains copyright as marked. The information in this newsletter is not intended to replace a one-on-one relationship with a qualified health care professional and is not intended as medical advice. It is intended as a sharing of knowledge and information from the research and experience of Liesha Getson and Health Through Awareness. You are encouraged to make your own health care decisions based upon your research and in partnership with a qualified health care professional.
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If you are interested in a Thermogram, individual holistic health coaching session utilizing the First Line Therapy program, Reiki, or an infra-red sauna session in the "POD," please contact TDI to schedule an appointment.
Wishing you abundant health.
Liesha Getson, BCTT, HHC
TDI/Health Through Awareness
100 Brick Road, Suite 206
Marlton, NJ 08053