Traditional Chinese Medicine (TCM) is a comprehensive medical system that has its origins in China. TCM encompasses a variety of complementary modalities including acupuncture, acupressure, Chinese herbology, cupping, Chinese dietary therapy, moxibustion, and Chinese style bodywork. TCM is based on the belief that all things in the universe are connected. In people, the mind, body, and spirit are similarly viewed as an energetic system in which all body systems and organs are connected. TCM can be used to treat and/or prevent disease.

Contrasting East and West
TCM has a deep tap root of a recorded history greater than 2,000 years, a history that is still honored today. TCM addresses the subtle, significant energetic determinants of health that regulate balance. It is symptom-based, individualized, holistic, minimally invasive, strengthening, and respectful of nature.
Though Hippocrates, the Father of Western Medicine, lived nearly 2500 years ago, the roots of modern Western medicine as it is practiced today have their origins in the early to mid 1800s. It was then that Western medicine took a sharp turn toward a diagnosis-based, mechanical, drug-based, technological, anatomical view of the body that divided and reduced the whole person into its parts in an attempt to better understand it. Western medicine often opposes nature (as in anti-inflammatory, antihistamines, antibiotics).

If Western medicine were symbolized by the newest gleaming piece of medical equipment, TCM would be symbolized by a living, flowing stream.

The body energetic
TCM understands that an imbalance, deficiency, or blockage of energy flow results in pain and disease. This natural flow of energy is called Qi (pronounced chee). Qi is referred to as the life force, the vital force that is responsible for nourishing and activating the mind, body, and spirit. More than 365 acupoints on the body that are connected by twenty pathways called meridians.

There are twelve major meridians, each connected to a particular organ, plus eight extra meridians. Qi travels through the meridians, connecting the organs to each other and the interior of the body to the exterior. They form a virtual road map of the entire body.

The art of acupuncture
Acupuncture is the practice of placing very thin needles at special junctures or “points” along these meridians to affect the energy and balance of the body. Needling tonifies what is deficient, reduces what is excessive, heats what is cold, cools what is hot, circulates what is stagnant, stabilizes what is reckless, raises what has fallen, and lowers what has risen. Acupuncture balances Qi, thus allowing normal flow of Qi throughout the body and thereby restoring health. Balancing the body is a delicate art. The acupuncturist must be sensitive and observant in determining which points to use and how to use them. After performing an individual assessment, an acupuncturist attempts to bring the body’s energy into harmony.

The science of acupuncture
In 1993, the U. S. Food and Drug Administration (FDA) estimated that Americans made 12 million visits to acupuncture practitioners. Acupuncture is one of the most thoroughly researched and documented alternative medical therapies, and is recognized by the National Institutes of Health and the World Health Organization as effective in treating a wide variety of medical problems. The existence of acupuncture meridians was documented by Western medicine’s scientific methodology in 1985, when radioactive isotopes injected into acupoints were tracked by gamma imaging and shown to have traveled about 12 inches within four to six minutes along the invisible pathways that acupuncturists had defined centuries prior. In a separate study, NIH researchers found that Single Photon Emission Computed Tomography (SPECT) brain scans of people who had various pain syndromes revealed brain changes consistent with pain. After receiving acupuncture treatment, follow-up SPECT scans showed changes in the brain consistent with baseline scans of the pain-free control subjects.

How does acupuncture work?
Due in part to the anatomical location of many acupuncture points near neural structures) much of the benefit of acupuncture is thought to derive from stimulation of the autonomic nervous system and the hypothalamus, the brain’s hormonal and emotional “control center.” Stimulation of acupuncture points results in the release of biochemicals in the muscles, spinal cord and brain. These chemicals either alter the experience of pain, or trigger the release of other chemicals and hormones that influence the body’s own internal regulating system.

Endorphins, one of the better known brain hormones that are responsible for feelings of pleasure, are produced from various activities, such as a “runner’s high,” eating chocolate, and laughing. Acupuncture treatments result in the release of this natural, morphine-like substance from the brain that reduces pain and increases feelings of well being.

Does acupuncture hurt?
Unlike hollow needles used to give an injection, the pre-sterilized, disposable needles used in acupuncture are solid and extremely thin, and simply part the skin. The needles stimulate sensation rather than cause pain. Acupuncture treatments are not painful. However, if significant pain is experienced when being needled, it could mean that the treatment is being administered improperly.

Other TCM healing modalities

• Moxibustion—the use of heat to stimulate acupuncture points, using a specific herb, Ai Ye (Chinese mugwort) that is burned indirectly over an acupuncture point
• Cupping—the use of glass cups over specific acupuncture points or areas of the body to “pull out” disease by creating a vacuum-like suction
• Chinese dietary therapy—an individualized nutrition program based upon TCM principles of balance
  Chinese style bodywork/Tui Na (pronounced twee nah) – a traditional system of massage that invigorates Qi and promotes circulation.

Your acupuncture appointment
Your first visit to an acupuncturist begins with a detailed health history intake. Since TCM encompasses all aspects of mind, body and spirit, you may be asked questions that initially seem to be unimportant, but they are actually vital in determining the type of care needed. Such questions may include sleep habits, temperature preferences, dietary habits, primary emotions experienced, overall energy, etc.
After attaining your health history, the acupuncturist examines your tongue and pulse, two major diagnostic techniques of TCM. Using all three tools (intake, tongue and pulse examination), the acupuncturist will determine the cause of your symptoms and administer the appropriate treatment.

Your first visit may take between 60-90 minutes. Follow-up treatments are usually 60 minutes. Although a single treatment can improve some acute injuries or problems, most people see and feel significant results in four or five treatments. Of course, the total number of treatments varies according to the severity and duration of the condition. Any response is ultimately tempered by the overall health and vitality of the person being treated.

Indications
TCM has been shown to relieve these common conditions, among many others:
Anxiety
Arthritis
Asthma
Bronchitis
Chronic fatigue
Constipation
Common cold
Depression
Diarrhea
Digestive problems
Emotional problems
Fatigue
Headaches
High Blood Pressure
Incontinence
Infertility
Injuries
Irritable bowel syndrome
Low back pain
Menstrual irregularities
Migraines
Nausea
Pain syndromes
PMS
Sciatica
Shoulder pain
Sinusitis
Sleep problems
Stress
Tennis elbow
Wrist pain

Traditional allergy treatment vs. SRT
Although skin testing and blood testing are effective at identifying a specific type of classic allergy (IgE mediated allergy), they are not effective at identifying other more common mechanisms by which a person can have delayed allergic reactions. The Elimination/Challenge Diagnostic Diet, though effective in revealing food allergies, can require weeks of effort and relies on dietary and lifestyle restrictions that are difficult for many. SRT more quickly identifies and desensitizes allergens and requires fewer lifestyle changes.

What is SRT?
SRT is a non-invasive, drug free, and natural solution to desensitize allergies and sensitivities to a variety of substances. It utilizes computer assisted evaluations, acupressure, and homeopathic principles. SRT was developed by an Ohio physician, Dr. Sherri Tenpenny, who desired to streamline similar methods in which she had trained: Nambudripad Allergy Elimination Technique (NAET), BioSET, and Jaffe-Mallor technique. After her adaptations were perfected over seven years of practice, Dr. Tenpenny trained others in her techniques.

SRT can reduce or eliminate adverse reactions to foods, food additives, spices, drugs, nutrients, pollens, flowers, molds, perfume, animals, cosmetics, chemicals, tobacco, pathogens, and other environmental triggers including heat and cold. SRT will not treat symptoms from toxic effects of chemicals. Avoidance or reduction of chemical toxins and known carcinogens is recommended even after tolerance is gained.

East meets West
From a Western medicine perspective, allergy is an overreaction of the immune system to a substance that is harmless to most individuals. Chinese Medicine principles see allergies and sensitivities as resulting from disrupted energy flow in the meridians (energy pathways). Blocked flow of energy causes imbalances in yin and yang, or opposite states (moist and dry, hot and cold, male and female, etc.) that combine to form chi (vital energy). Chi is balanced in health and imbalanced in disease.

According to Oriental medical principles, when the body is in perfect balance (homeostasis), disease is not possible. According to acupuncture theory, stimulating specific acupuncture points is capable of bringing the body to a state of homeostasis and restoring the flow of energy.

The immune system has a memory, a fact that helps assure survival by providing lifelong immunity to infections. That memory is also responsible for developing chronic symptoms from repeated exposure to offending substances (allergens) including foods and toxins. SRT can be thought of as pressing the autonomic nervous system’s virtual “reset button,” thereby reprogramming the autonomic nervous system to develop a new cellular memory so tolerance can replace the former allergic response.

SRT treatment described . . .
The patient initially receives a computer-assisted evaluation to determine which substances need to be desensitized and the priority in which they need to be treated. This evaluation takes about five minutes.

Then, while the patient holds vials that contain homeopathic representation of the substances that have been identified as allergenic, acupressure is applied to specific acupuncture points along the spine to open up energy flow to the autonomic nervous system. Acupressure is used once again to activate specific acupuncture points on the arms and legs to open energy flow throughout the body.

The patient then lies quietly for 15 minutes. Experiencing tiredness, fatigue or hunger during the 24 hours following a treatment is common. Symptoms including headaches, chilliness, perspiration, nausea, and emotional releases may occur in more sensitive people. Though successful treatment can occur without any symptoms, if symptoms do occur, they are seen as evidence that the patient’s physiology is responding as desired. The patient is required to avoid eating or drinking anything for two hours after an SRT treatment, in addition to avoiding other substances to which he is being desensitized. Resting is recommended if symptoms occur following a session.

How many treatments will I need?
All patients receive two basic treatments that enhance digestion, build the immune system, and desensitize basic essential bio-chemicals and nutrients, preparing the body for further desensitization. After the initial two treatments are completed, an average of four to seven more treatments may typically be needed, depending on the extent of allergic illness.

Customize your treatments
The first two basic treatments pave the way for subsequent customized treatments during which the patient can be tested and desensitized to virtually any item to which he suspects he reacts. Discuss any specific allergens needing desensitization with the SRT staff to enhance your treatment.

Prepare for your treatments
Wear comfortable lightweight clothing. Eat and drink shortly before your appointment, as you will be asked to avoid eating and drinking for two hours immediately following your treatment. You will be given detailed written instructions for future appointments at your first appointment. Plan on one 90-minute initial treatment and two to six 30-minute follow-up appointments.

A word about food and nutrients
Considering the fact that most people eat three or more times a day, there are many opportunities for an allergy-prone person to develop allergies or sensitivities to foods. Not only can symptoms of food allergy be uncomfortable, the resulting changes in the digestive and immune systems can cause interference with the absorption and utilization of nutrients, contribute to autoimmune diseases, and result in allergies and sensitivities to vitamins and minerals.

In an effort to feel better, persons suffering from allergic illnesses often take vitamin and mineral supplementation and may unknowingly take the very nutrients to which they are allergic, perpetuating allergies and sensitivities. After problematic nutrients are addressed by SRT, patients may experience improved tolerance to and effectiveness of a program of nutritional supplementation needed for optimal health.

Osteopathy is a holistic medical treatment modality developed by Andrew Taylor Still, M.D. in the Midwestern United States at the end of the 19th Century. Osteopathy emphasizes the role of the framework of the musculoskeletal system in health and disease, including the connective tissue that supports all organs and tissues.

Dr. Still promoted the concepts that body structure and body function are intimately related and that the body is an integrated unit of mind, body, and spirit.

Balanced alignment of the body assists the inherent self-regulatory and self-healing mechanisms of the body by allowing the blood to nourish the tissues and waste products to be removed, in addition to promoting optimal nervous system function and assisting free and efficient movement.

Structural imbalances are too often undiagnosed even though they are common causes of pain, restricted movement, feeling unwell, and eventually even disease. Physicians familiar with the relationship between body structure and function are often able to go beyond treating symptoms and managing disease by treating the root causes of health problems.

Osteopathic Manual Therapy

By using treatments that focus on the inherent health and self-correcting mechanisms to guide treatment, Dr. Hoch finds his patients are often able to obtain lasting results without ongoing visits. Dr. Hoch uses a variety of gentle techniques to help the body align itself, including:

• Myofascial release to correct tension, laxity, or displacement of fascia, the web of connective tissue surrounding and connecting organs and the musculoskeletal system 
• Cranial osteopathy to support normal cerebrospinal fluid flow and nervous system health and optimal functioning of the head and neck
• Visceral osteopathy to assist health and function of the internal organs

Dr. Hoch counsels patients re: posture, diet, exercise, etc., to help them maximize their health and treatment benefits. His goal in using osteopathic treatment is simple: to help patients be able to do activities comfortably.

Cranial Osteopathy

Cranial Osteopathy is based on perceiving and working with the inherent mobility in the brain, spinal cord, skull, and surrounding tissues, all of which are subjected to subtle cranial pulsations or rhythms.
Imbalances in cerebrospinal fluid flow, tension in the nervous system, and misalignments in the skull, face, and spine can be relieved and balance restored through gentle manipulation of the skull.

The subtle cranial rhythms in cranial osteopathy were discovered by Dr. Still’s student William Garner Sutherland, D.O. more than 100 years ago. The presence of these rhythms has since been validated by several scientific methodologies. The cranial osteopathic method is now used around the world. 

Conditions Treated

Back pain
Injuries
   ~ motor vehicle, falls, sports injuries,  sprains, healing after fractures
Neck pain
Pain syndromes
Plantar fasciitis/Heel spurs
Rib pain 
Sciatica
Scoliosis
Temperomandibular joint (TMJ) syndrome
Tension headaches
Tendonitis

The following conditions are treated when a structural component is found on exam:

Asthma/Breathing problems
Constipation
Facial pain
Gallbladder problems
Heartburn/reflux
Menstrual cramps
Migraine headaches 
Recurrent ear infections in children

Healthy digestion breaks down food into its smallest components (glucose, amino acids, fatty acids, vitamins, minerals, etc.) that are necessary for the body to perform all of its vital functions. 

Digestion starts with chewing (mastication) as salivary enzymes begin breaking down food into its smallest basic units. After swallowing and passage through the esophagus, digestion continues in the stomach where hydrochloric acid and pepsin continue to break down food. Next, on to the small intestine where bile, bile salts, and enzymes from the pancreas and small intestine continue digestion and nutrients are absorbed. Lastly, to the large intestine (colon) for further absorption of water and nutrients and elimination from the body about 24 hours after food is eaten. A biomass of an estimated 8 pounds of healthy bacteria present in the colon also contributes to digestive and immune health.

Malnutrition

Though we often think of malnutrition as resulting from limited access to food, malnutrition can exist even when adequate food is available if either nutrient-sparse junk foods are over-consumed or if digestion is impaired and vital nutrients cannot be properly broken down, absorbed, and delivered to the cells. Selecting, preparing, and eating all the right foods is of little use if the body cannot digest and absorb them. We are what we assimilate.

Digestion in the Stomach

Hydrochloric acid (HCl) is necessary to break down protein into amino acids and to extract minerals from food. HCl is made by specialized cells in the stomach lining called parietal cells. Upon merely seeing, tasting, or smelling food, the neurotransmitter acetylcholine stimulates parietal cells to make hydrochloric acid. Once food is in the stomach, histamine and gastrin also trigger HCl production.

A healthy stomach lining is designed to tolerate levels of hydrochloric acid that are one million times higher than surrounding tissues. Normal stomach pH is very acidic at 1.5 on a scale of 1 to 14, with 1 being the most acidic.

Parietal cells also produce “intrinsic factor,” a protein that binds to Vitamin B12, enabling its absorption.

Pepsin, an enzyme that breaks down protein into peptides, is also produced in the stomach by “chief” cells and is an important part of healthy digestion.

Hypochlorhydria

Though disturbances in digestion can occur at each of its many stages from chewing to elimination, the most common digestive disturbance occurs in the stomach and is called hypochlorhydria: the deficient production of HCl. The deficiency of HCl production occurs early in the process of digestion, a fact that impacts the effectiveness of all subsequent digestion in the intestines.

Causes of hypochlorhydria include aging, psycho-emotional stress, physical trauma, gastrointestinal viral infections, gastritis, chronic Helicobacter pylori infections, pernicious anemia, and chronic use of drugs including stomach acid blockers (proton pump inhibitors and H2 agonists) and steroids. Since HCl has a sterilizing effect in the stomach, the deficiency or lack of HCl can lead to bacterial overgrowth in the intestines. An estimated 50 percent of people over the age of 60 have low HCl levels, as do 50 percent of people who seek medical care for chronic health problems.

Effects of Hypochlorhydria

Signs and symptoms of hypochlorhydria include uncomfortable fullness after meals, numbness, tingling, undigested food in stools, thinning hair, Candida (yeast) overgrowth, rectal itching, and thin or peeling nails. The long term effects of deficient HCl are related to impairment of body functions that result from chronic nutrient deficiencies, specifically amino acids and minerals. As such, hypochlorhydria contributes to osteoporosis, allergies (including food allergy), cardiac arrhythmias, asthma, acne, ulcerative colitis, auto-immune illnesses (myasthenia gravis, Crohn’s disease, rheumatoid arthritis, pernicious anemia), psoriasis, depression, immune dysfunction, diabetes, celiac disease, vitiligo, hives, eczema, rosacea, and virtually all degenerative diseases. The likelihood of the true cause of hypochlorhydria being addressed is low because of the fact that the onset of these diseases occur years or decades after HCL declines.

Mainstream Medical Treatment

In 2003 alone, over 60 million Americans who experience esophageal or stomach pain, gas, belching, and bloating spent over $4 billion just for the acid-blocking prescription drug Prevacid, not to mention the money spent on its pharmaceutical cousins—Propulsid, Nexium, Pepcid, Prilosec, Protonix, Tagamet, Axid, and Zantac. Over-the-counter antacids such as Maalox, Tums, Rolaids, Alka Seltzer, and Mylanta are also commonly used to neutralize HCl.

Both patients and doctors are quick to assume that heartburn, indigestion, and gastro-esophageal reflux disease (GERD) are caused by excess stomach acid. This is likely resulting from their mutual desire for a quick fix, the widespread availability of drugs that block HCl production, and a lack of knowledge and appreciation by the medical community and the public alike for the health-promoting benefits of HCl in digestion and general health.

Because heartburn or burning stomach pain can be caused by either HCl deficiency or excess, many people being presumptively treated for excess HCl actually have a deficiency of HCl causing their symptoms. Treatment based on a presumption of excessive HCl can compromise long-term health as acid-blocking drugs do in fact decrease acid production, but in doing so also impair normal digestion. Do not stop taking acid-blocking drugs without physician supervision.

Heidelberg Gastric Analysis

Heidelberg Gastric Analysis is a non-invasive test that was developed at the University of Heidelberg in Germany in the late 1960s to measure stomach acidity. The test requires that a patient swallow a small capsule that contains a tiny transmitter which measures the acidity (pH) of the stomach and transmits its data to a radio telemetry receiver that hangs from a neck strap and rests on the patient’s upper abdominal area. The signal is transmitted to a computer for processing. After getting a baseline pH reading, the patient swallows a small amount of an alkaline solution of bicarbonate that challenges the stomach’s ability to properly re-acidify. Testing is well-tolerated and takes between 45 to 90 minutes. 

A Holistic Medical Approach

In addition to Heidelberg Gastric Analysis, other testing that may suggest hypochlorhydria include a comprehensive digestive stool analysis to establish the presence of undigested food, Candida organisms, and imbalances in the normal gut bacteria; and laboratory testing for  vitamin and mineral deficiencies and anemia.

Preservation or restoration of normal digestive function is the goal of an integrative medicine approach to hypochlorhydria. This includes avoiding the use of acid-blocking drugs without first establishing the presence of excess acid production. Medically supervised supplementation of HCl by capsule with meals may be     recommended to replace missing or deficient HCl. Similarly, deficient minerals, vitamins (notably injectible vitamin B12), digestive enzymes, and “friendly” bacteria (probiotics) may be supplemented, in addition to dietary recommendations. Avoidance of drinking water or other liquids with meals is recommended to avoid diluting HCl.

Once properly diagnosed, hypochlorhydria can be successfully treated with approaches that restore optimal digestion and help protect an individual’s future health.

Introducing Mark Hoch, M.D.

We are pleased to announce that Dr. Mark Hoch will join GSMC as a staff physician and will accept new patients starting December 1, 2010.

Three Cases of Applied Mindbody Medicine

Learn how mindbody therapies can be used to improve clinical outcomes of common ailments.

Increasing Life Expectancy
Deficient testosterone levels weren?t a health issue when men didn’t live long enough to experience many years without this life-enhancing hormone. The life expectancy of American men is currently 74.5 years, which means they can outlive their ability to produce adequate amounts of testosterone by 20 years.
Taking Pause
Women can usually find trained physicians to treat their age-related hormonal decline, menopause. However, men facing their age-related hormonal decline, andropause, often have difficulty finding a doctor to treat their dwindling vitality and health. Currently, there is about a 20-year gap in clinical experience between treating menopause and treating andropause.
Aim for the Right Target
Because testosterone production naturally declines with age, older men are often told by their doctors that their testosterone levels are “normal.” Having an age-adjusted ?normal? testosterone level at age 75 could, in fact, be the cause of seriously declining health, mood, and vigor. An appropriate and safe target when replacing testosterone for an aging man is the mid to upper limits of the normal range for a 40-year-old man.
Not Guilty by Association
Testosterone is classified as a steroid, along with other health-promoting substances, including cholesterol, cortisol, and Vitamin D. The misuse of synthetic anabolic steroids by athletes (and wanna-be athletes) in doses far higher than the body could possibly produce, have rightfully given synthetic steroids a bad name. Even though testosterone can be responsibly and safely prescribed, it has not escaped a “guilty by association” verdict by the public and even some medical professionals. Young athletes and body builders who take steroids to enhance performance far exceed steroid levels that the body is capable of producing are at high risk for developing serious, even fatal, side effects. In comparison, men whose deficient testosterone levels are restored to physiologically normal levels have far fewer risks.
Paths Often Traveled
Testosterone rapidly converts in the body by one of two major pathways. First, it can be converted to estrogen through the aromatization pathway. The enzyme aromatase, which is required for this conversion, is especially abundant in fat cells, a fact that puts obese men at higher risk for developing signs of feminization from excess estrogen. These signs include testicular atrophy, breast enlargement, loss of body hair, and loss of lean body mass. Monitoring estrogen levels of men taking testosterone replacement therapy (TRT) is thus recommended.
This spiraling loss of masculinity can be offset by weight loss, exercise, consumption of organic, non-genetically-modified soy powder, and avoidance of sugar and other refined carbohydrates. Fish oil, chrysin, and Diindolmethyl (DIM) can also decrease aromatization. DIM occurs naturally in cruciferous vegetables: broccoli, cauliflower, brussel sprouts, collards, kale, and cabbage.
The second pathway that testosterone can take in the body is its conversion to dihydrotestosterone (DHT), the most significant biologically active form of testosterone. This conversion requires the enzyme 5-alpha-reductase, which is especially abundant in the prostate gland. Nearly all testosterone that enters the prostate gland is converted to DHT, which, in turn, stimulates the growth of normal prostate cells. Some scientists and clinicians theorize that DHT can also stimulate the growth of abnormal or cancerous prostate cells.
If developing prostate cancer was simply a result of high levels of testosterone or DHT, a lot of 20-year-old men would be diagnosed with it, because the production of testosterone and DHT is at its highest in young men. The incidence of prostate cancer actually is highest at ages that are associated with the lowest levels of testosterone and DHT in older men. Obviously, other factors contribute to the development of prostate cancer. Because the incidence of prostate cancer is highest at the time of life when men’s estrogen levels are highest, imbalances or excess of estrogen are thought to contribute to the risk of developing prostate cancer.
An Evolving Understanding
Several studies have found a lack of causative relationship between androgen levels and prostate cancer. In a Finnish study involving 16,481 men aged 18 to 78 years, blood samples were drawn between 1966 and 1972. Twenty-five years later, 166 of the men had developed prostate cancer. When levels of testosterone, DHT, and SHBG in men who developed prostate cancer were compared with those in 300 men who did not, no association was found between high androgen levels and prostate cancer.
Every man needs a digital rectal exam of his prostate and a prostate-specific antigen (PSA) blood test prior to starting TRT and at regular intervals during treatment. Men should report any change in their breasts to their doctor.
The presence of male breast cancer, prostate cancer, an elevated prostate-specific antigen (PSA), or a suspicious digital rectal exam is a contraindication for TRT in the United States at this time.
Testosterone’s Benefits
The heart is a muscle, and like any other muscle, it improves in strength and efficiency (a particular benefit in congestive heart failure) when there are adequate levels of testosterone. Whether it is “homemade” or “store-bought,” testosterone has been shown to lower levels of total cholesterol and Lp(a), a fat linked to heart disease risk.
The benefits of TRT in treating impotence can be especially rewarding for a man who has previously been told by his doctor that his “low normal” levels of testosterone are unrelated to his inability to get or maintain an erection. In fact, the boost given to age-related, diminishing sexual performance is one of testosterone?s starring roles.
TRT can enhance vitality, confidence, and cognitive functioning, in addition to decreasing anxiety. Improved muscle strength and visual-spatial performance (necessary for balance that plays an important role in preventing falls) that are associated with adequate testosterone levels help maintain mobility and, therefore, functional independence.
In short, utilizing TRT in older men who have a proven deficiency in testosterone, can help add quality to their years both physically and psychologically.
Safe Prescribing of TRT
Prescribing some hormones (e.g., thyroid hormone or insulin) is a routine, accepted standard of care in medical practice. However, replacement of the hormone testosterone is (most unfortunately for men who suffer from its deficiency) often overlooked.
Considering a patient’s lifestyle, personal preferences, and compliance with therapy regimens, a single injection of long-acting, slow-release testosterone every two to three weeks may be the best option to boost lagging testosterone levels for some men. Others may be prescribed bio-identical testosterone drops, topical gels, or patches applied daily.
Replacing only what the body would normally make (physiological, not pharmaceutical dosing), monitoring TRT with laboratory tests, and tweaking other hormones (thyroid, adrenal, etc.) at the same time that testosterone is taken all contribute to TRT’s effectiveness.
Testosterone Poisoning
Excess testosterone has several known adverse effects. These include acne and fluid retention; increased production of red blood cells (which creates a greater likelihood of clot formation); aggression, infertility, and worsened sleep apnea.
Because a healthy liver breaks down testosterone and estrogen every day for eventual excretion from the body via the kidneys, abnormal liver function can contribute to excessive hormone levels.
In Summary
Because an excess and a deficiency of testosterone both have serious health risks, moderation and balance are the guiding principles for safe, effective TRT.
For several decades, alternative doctors have safely and responsibly prescribed TRT for men who have dwindling health associated with age-related testosterone deficiency.
TRT is best accomplished in a holistic context that includes a thorough medical history and physical exam, a healthy diet, nutritional supplementation, and exercise, in addition to regular laboratory monitoring and clinical follow-up.

Symptoms of Menopause
The symptoms of menopause can be mild to severe and include hot flashes, vaginal dryness, dry eyes, dry skin, loss of skin elasticity (wrinkles), poor bladder control, difficulty thinking and sleeping, frequent urinary tract infections, decreased libido, and mood disturbances. These symptoms can significantly impact relationships, health, and quality of life.

HT Research
In 2002, the Women’s Health Initiative (WHI) study once again raised concerns about the long-term safety of post-menopausal synthetic hormone therapy (HT). The WHI studied more than 161,000 women between the ages of 50 and 79. Women were placed in one of three groups: Premarin-treated, Prempro-treated, or a control group with no treatment. The Prempro group showed increased risks of pulmonary embolism (113%), strokes (41%), heart disease (29%), breast cancer (26%), and deep venous blood clots (11%). Researchers felt that Prempro’s and Premarin’s risks outweighed their benefits and the trial was stopped early.

A Closer Look
Premarin is a combination of estrogenic hormones called Conjugated Equine Estrogens (CEE), which are derived from pregnant mares’ urine (PMU). Of the many estrogens found in Premarin, only two (estrone and estradiol) are bio-identical to human estrogens. The remaining estrogens are many times stronger and longer-acting than human estrogens and are thus thought to have more potential for side effects in humans. Premarin’s label warns that taking it for a year without also taking progesterone raises uterine cancer risk by 14 percent.
Prempro consists of Provera and Premarin. Provera, medroxyprogesterone acetate (MPA), is synthetic progesterone or progestin. Though “progestin” sounds similar to natural “progesterone,” progestins are riddled with serious side effects; natural progesterone has few, minimal side effects. Progesterone levels are naturally high during pregnancy, while progestin in “morning after” pills terminates pregnancy.

Wyeth Has a Hot Flash
When WHI trial results were released, 66 percent of women who’d been prescribed Premarin stopped taking it. Warnings quickly appeared on Premarin’s labels; sales fell and (Premarin manufacturer) Wyeth’s stock plummeted.

Man’s Laws/Nature’s Laws
Natural substances can’t be patented. To ensure profits, manufacturers must alter those substances before they can be patented. Even tiny changes to the structure of a natural substance can result in serious, unforeseen side effects.
Prescribing hormones derived from PMU has been likened to putting Ford parts in a Volvo: they don’t fit, they don?t work as intended, and their use could result in both known and unknown consequences.

A Risky Proposition
Estrogen’s health risks have been known as early as the 1930s. Months after the WHI trial was stopped prematurely in mid-2002 because of serious risks of synthetic hormone use, the National Institute of Environmental Health Sciences’ Toxicology Program added estrogens used in HT and birth control pills to its official list of cancer-causing substances.

Enter Bio-Identical Estrogens
Three natural estrogens occur in balance in healthy women. They are: estrone (E1), estradiol (E2), and estriol (E3). Each can be manufactured to be bio-identical.
Estrone is the dominant estrogen in Premarin and is the main storage form of estrogen in the body. During the reproductive years, estrone is derived from estradiol. Around the time of menopause, estrone is increasingly made from testosterone in fat cells (even more so in women who are overweight or drink alcohol). High levels of estrone have been linked to uterine and breast cancers.
Estradiol, a potent estrogen also linked to cancer, is the active ingredient in nearly all transdermal estrogen patches used to treat menopausal symptoms. Estradiol converts to estrone in the body.
Estriol, a weaker estrogen, comprises about 85 percent of circulating human estrogens. Estriol is theorized to occupy estrogen receptor sites, thereby blocking stronger estrogens from occupying them in uterine and breast tissue, lowering cancer risk. However, estrone levels can increase in some women who take estriol. European studies have shown estriol to be effective in treating vaginal dryness and stress incontinence in postmenopausal women.

Good Estrogen/Bad Estrogen
Pharmaceutical estrogens (when taken orally) and “homemade” estrogens are detoxified by the liver to estrogen metabolites for excretion from the body.
Estrogen metabolites include 2-hydroxyestrone, a “good” metabolite that opposes cancer, and 16-alpha hydroxyestrone, a “bad” metabolite that has been shown to be elevated in women who have breast cancer or who have a family history of breast cancer.
A more potent “bad” estrogen metabolite, 4-hydroxyestrone, is formed when estrone is oxidized and “burns” a hole in DNA, an event that can initiate cancer.
Bad estrogen metabolites promote inflammation and clotting and increase the risk of heart disease and cancer. Cancer risk from estrogen metabolites can be measured by laboratory testing of urine, the preferred method, or serum.
The cancer risk posed by estrogen’s “bad” metabolites may be decreased with a program designed by an alternative practitioner trained in management of women?s HT. This program may include taking ground flax seeds, resveratrol, fish oil, di-indole methane (DIM), calcium d-glucarate, and iodine, and eating cruciferous vegetables (kale, broccoli, cabbage, collards, brussel sprouts, etc.).
Estrogens used transdermally (patch, gel, or cream) bypass the liver and do not break down into risky estrogen metabolites. Also, applying estrogen transdermally results in more stable hormone blood levels than taking estrogen by mouth.

Enter Menopause
Women who have a sudden entry into menopause (usually from surgical removal of their ovaries with a total hysterectomy) may develop symptoms of estrogen deficiency. Suddenly stopping estrogen prescriptions can also cause the same symptoms.
However, in women who have a natural, more gradual entry into menopause, the adrenal glands increase their production of pregnenolone and DHEA, which support the production of estrogens, progesterone, and testosterone that, in effect, can help moderate the symptoms of estrogen deficiency.
Because fat cells produce estrogen, overweight women may have fewer symptoms of estrogen decline.

Vital Woman
Testosterone may be used in small doses in a comprehensive HT program to strengthen women’s overall vitality and, when applied transmucosally, to enhance sexual response.

Estrogen Dominance
The modern environment is increasingly estrogen-laden. Health experts are concerned about estrogen-mimicking substances that include pesticides, plasticizers (phthalates and bisphenol A), synthetic estrogens both in meat and those that are excreted into the water supply by people who take HT. Excess estrogen contributes to early puberty, blood clots, diabetes, endometriosis, cancer, obesity, liver stress, and fibroids.
Natural micronized progesterone can help offset estrogen?s cancer, vascular, and clotting risks and also has beneficial effects on cholesterol levels. Most over-the-counter plant- or yam-based creams do not have this benefit, while synthetic progestin increases these risks.

Menopause Treatment Options
Non-hormonal treatment of menopausal symptoms includes balancing neurotransmitters and making lifestyle changes, e.g., reducing intake of harmful dietary fat and alcohol, eating more cruciferous vegetables, eating fermented soy (miso and tempeh) and ground flax seeds, addressing thyroid and adrenal imbalances, getting regular exercise, and reducing stress. Because the liver detoxifies and excretes excess estrogens from the body, supporting liver health can help lower estrogen toxicity. Dietary fiber can assist in removing toxic estrogen stores from the body. Maintaining normal body weight can help lower risks of estrogen toxicity.
Helpful herbs include soy isoflavones, chasteberry, dong quai, black cohosh, red clover, and Siberian ginseng.

Hot Flashes/Cold Turkey
When family or personal risk for heart disease, clot formation, or cancer makes it advisable for a woman to stop HT, or if stopping prescribed HT “cold turkey” results in symptoms, tapering hormone doses slowly over a period of months mimics the healthy, gradual decline of hormones during menopause. An herbalist can often help ease withdrawal from estrogen therapy (ET). Medical monitoring is advised during this process.

Overview
Health risks from estrogen stem from a woman’s cumulative estrogen exposure during her lifetime – early onset of menstrual periods, late onset of menopause, use of birth control pills and other hormone therapies, and exposure to chemicals that mimic estrogen.
The lowest effective dose of ET should be used for the shortest amount of time possible. Herbs, diet, environmental controls, nutritional support, and exercise can be used to support healthy estrogen metabolism.
HT is not one-size-fits-all, a fact making individualized medical management of women’s HT essential. Each woman with peri-menopausal health concerns should be individually assessed for vascular disease, clot, and cancer risks prior to receiving HT. Women taking HT should inform their doctors if they develop breast swelling, pain, or discharge, uterine bleeding or pain, or nausea. Women taking HT need annual pap smears and breast cancer screening, in addition to ongoing lab testing of hormone levels to guide the practitioner’s dosing to optimize HT’s safety.

List of Bio-Identical Hormones
Estrone, estradiol, estriol, testosterone, micronized progesterone, Alora, Biest, Climera, Estrace, Estraderm, EstroGel, FemPatch, Menostar, Prometrium, Estring, Triest, Vivelle, and Vivelle Dot.

Relief in Sight
Estrogen deficiency and imbalances that occur at menopause can seriously undermine women’s health and quality of life and should not be left untreated. Many women with moderate to severe peri-menopausal symptoms can be assured that options to synthetic HT exist. Properly prescribed, monitored bio-identical HT offers safe and effective relief for the symptoms of menopause, and at the same time, enhances bone, heart, and cognitive health, and helps lessen hormone-related aging symptoms.
Balancing the need for relief from the symptoms of estrogen deficiency against the risks and side effects of synthetic HT can be accomplished by consulting an alternative practitioner trained in the use bio-identical HT

Uses of Fluoride
Fluoride is used in glass etching, in the manufacture of synthetic fabrics (including Gore-Tex?), in the smelting of all metals (e.g., steel, aluminum, gold), and in the plastic and phosphate (fertilizer) industries. Some prescription drugs are fluoride based, including Prozac, Cipro, Prevacid, Paxil, Crestor, Lipitor, Celexa, Celebrex, Diflucan and several general anesthetics. Fluoride is essential for the enrichment of uranium needed for nuclear power reactors. It is in rat poison, pesticides (Cryolite?, 82 percent of which is used on grape crops, and sulfuryl fluoride), Teflon?, military nerve gas, and is added to municipal water, toothpaste, and mouthwash.

A Concerned Physician
Armed with passion for the well-being of people and the truth, Danish physician Kaj Roholm documented numerous toxic effects of industrial fluoride pollution in Europe in a 364-page paper published in 1937. He recommended that industry leaders protect people from fluoride?s devastatingly toxic effects on the brain, skin, lungs, bone, teeth, glandular, and digestive systems. Roholm said, ? The once general assumption that fluorine is necessary to the quality of enamel rests on insufficient foundation . . . the enamel organ is electively sensitive to the deleterious effects of fluorine.?

Concerned Industrialists
After the turn of the century in the United States, workers in aluminum and phosphate industries and animals grazing on land downwind from industries? fluoride-rich stack emissions got sick. Industrialists were naturally concerned. In an effort to offset paying settlements from an onslaught of lawsuits by injured workers, industrial leaders needed to convince the public that fluoride exposure was not only harmless but beneficial.
In 1945, a ten-year long study began when fluoride was artificially added to the municipal water supply of Newburgh, NY. Children aged seven to 14 who drank the treated water were monitored for dental effects, growth, hemoglobin levels, and joint health. There is now evidence that several concerning effects of fluoride never made it into the whitewashed final public report. Ongoing evaluation of the original data and also of additional data collected during the ensuing years reveals no significant general or dental health benefits of fluoridation, but documents health concerns from fluoridated water.

Government Experts
Industrialists and their attorneys strategized correctly that the general public would likely rely on doctors? authority to help them form opinions on fluoridation. By creating a media campaign that touted fluoride?s safety, industrialists were also tipping the odds that jury members in a trial of fluoride litigation would uphold fluoride?s reported safety in a courtroom. After all, didn?t the government add it to drinking water? The orchestrated campaign that resulted in fluoride being dispensed to the public was very effective.
Unquestioning endorsement of fluoridation became the norm, despite criticisms from leading scientists who pointed out that fluoride is extremely toxic and that its therapeutic benefits had never been established. While 98 percent of western European cities have banned fluoridation of water, currently more than 66 percent of municipal water supplies in the United States are now fluoridated.

Toxic Sludge Is Good For You
The Environmental Protection Agency (EPA) found fluoride to be toxic to farmlands and crippling to animals, and mandated stack scrubbers to decrease the amount of fluoride spewing into the environment. Compliance cost industries millions of dollars. Fluoride-rich stack sludge was bound to silica and thus had little value in the marketplace. However, the red ink on the books suddenly turned black when toxic fluoride was collected, concentrated in ponds, pumped into tanker trucks and sold to cities following government sanctioned fluoridation of water following the Newburgh study.

Testing to determine the safety of fluoride was performed on sodium fluoride (NaF). However, more than 90 percent of the fluoride added to public water supplies today is unrefined hydrofluorosilic acid (H2SiF6), toxic sludge, largely from Florida?s phosphate industry. This sludge contains not only fluoride but arsenic, beryllium, lead, cadmium, and other toxins.

Concerned Courts
In the 1970s, three legal cases were heard about the dangers of one part per million (ppm) fluoride in drinking water. All three trials concluded that water fluoridation increased cancer death rates and found no convincing evidence of benefit. At each trial the defense?s fluoridation expert was asked to name a single valid broad-based, double-blinded scientific study with results suggesting a significant reduction in permanent tooth decay from the addition of fluoride at one ppm to public drinking water. Each time the expert was unaware of any such study. All three courts determined that fluoridation was not beneficial and actually harmful. Each decision was eventually overturned by the Supreme Court.

Sources of Fluoride Exposure
Sources of fluoride include toothpaste (half a tube can be fatal to a small child), mouthwash, topical dental solutions, Teflon-coated pans, black and green teas (decaffeinated and instant being the worst offenders?up to 7.7 ppm), wine (from Cryolite??sodium aluminum fluoride? a pesticide used by grape growers), chewing tobacco, infant formulas reconstituted with fluoridated water, reconstituted foods including juices (42 percent of juices tested exceeded EPA limits, white grape juice being the most toxic), sodas (varying in fluoride content according to regional bottling water sources), industrial exposure during arc welding, fumes from coal burning, and manufacture of aluminum, steel, phosphorus, freon and glass. Airborne industrial fluoride emissions contaminate downwind food crops and pasturelands.

Health Concerns
Fluoride is absorbed through contact, inhalation, and ingestion. Infants, children, the elderly, and people with impaired kidney function and nutrient deficiencies (especially calcium and Vitamin D) are more vulnerable to the poisonous effects of fluoride. Fluoride?s chronic health effects are cumulative. Scientists worry that the increasing exposures to fluoride have already surpassed the EPA recommended maximum exposure limits.
Acute fluoride toxicity can cause nausea and vomiting. Fatal cardiac arrhythmias from severely lowered serum calcium levels can occur.

The adverse health effects of chronic fluoride toxicity include dental fluorosis, skeletal fluorosis, and immune dysfunction from inhibition of white blood cell activity, in addition to neurological, pulmonary, dermatological, endocrine, renal, and gastrointestinal symptoms.

Dental fluorosis first appears as opaque white flecks in dental enamel. As the toxicity becomes more severe, the staining becomes yellow, and eventually brown. Dental fluorosis affects nearly one-fourth of American children.
Approximately 80 percent of ingested fluoride is absorbed from the digestive tract. About half of that enters the skeleton, and the other half is excreted in the urine. Skeletal fluorosis from excess fluoride exposure results in dense, brittle bones, skeletal pain, crippling deformity, and rigidity. Calcification of spinal ligaments may compress the spinal cord. Micro-fractures of the brittle leg bones can result in lower limb pain.

A study published in 1990 by the National Toxicology Program determined that rodents which were fed water containing one ppm concentration of fluoride (the amount approved to be added to municipal water) had a higher incidence of osteosarcoma, a type of bone cancer. A subsequent study by Harvard?s Elise Bassin, Ph.D., confirmed that the incidence of osteosarcoma in children was five times higher than that in non-fluoride-exposed children, a conclusion supported by numerous other studies during the past 30 years.
Roger Masters, Ph.D., from Dartmouth University, did a study of over 400,000 children and found that ingestion of one ppm of fluoride decreased IQ test scores and magnified lead?s toxicity ten fold.

In 1958, the medical use of fluorine in treating hyperthyroidism was discussed in the Journal of Clinical Endocrinology. Today, fluoride?s effect of inhibiting thyroid function is known to occur because of fluorine?s ability to out-compete its halogen cousin, iodine, and interfere with the pituitary?s production of thyroid stimulating hormone (TSH).

In 1995, Harvard neurotoxicologist Phyllis Mullenix, Ph.D., showed that rats treated prenatally with fluoride showed behavior patterns associated with hyperactivity, and rats dosed after birth showed hypoactivity. Shortly after, Mullenix was dismissed from her job.

Innocent Victims
In a heart-wrenching saga, champion quarter horse breeder Cathy Justus of Pagosa Springs, CO, lost five prized horses to a variety of mysterious crippling maladies including Equine Metabolic Syndrome, deformity, coughs, infertility, lameness, wasting, and neurological disorders. Justus consulted Lennart Krook, D.V.M., Ph.D., Professor of Pathology at Cornell University, to determine the cause of the animals? deaths. Post mortem analysis of one horse?s exhumed leg bone confirmed fluoride toxicity. The surviving horses were also diagnosed with fluorosis and each improved when their drinking water was changed. Ultimately, Pagosa Springs chose to stop fluoridating its water.

7,000 Concerned EPA Scientists
Following revelations of an alleged cover-up of data from Harvard School of Dental Medicine that linked fluoridation with an elevated risk of osteosarcoma, more than 7,000 environmental and public health professionals called for a moratorium on municipal water fluoridation in 2005. They asked the EPA to recognize that fluoride poses a serious cancer risk.

Scientists in the prestigious National Academy of Sciences (NAS) concluded that the current allowable level of fluoride in tap water conflicted with public health and should be lowered.

Reducing Fluoride Exposure
In summary, the benefits of fluoride are overstated while the risks are understated. Avoiding excessive fluoride exposure is prudent. Familiarize yourself with known sources of fluoride and limit your exposure. Stopping the intake of fluoride can reverse some of the its toxic effects. Use non-fluoridated toothpaste. Deionization and distillation of water are the most effective methods of removing fluoride from drinking water. While deionization is more costly, distillation removes both toxic and essential minerals. Reverse osmosis is partially effective at removing fluoride. All filtration systems need maintenance to perform optimally.

Sources of More Information
The Fluoride Deception by investigative reporter Christopher Bryson is a tell-all expose of the history of fluoridation. More information can be found at: www.fluoridealert.org, www.ewg.org (enter search word ?fluoride?), and www.fluoridation.com.

If the posture or body alignment of a child or teenager is periodically examined and corrected throughout the growing years, that child will be far less likely to experience what we have come to think of as the customary aches and pains of middle and old age. The short-term benefits include the child looking better, feeling better, and being less likely to suffer muscle injuries.

Balance
Structural balancing seeks to free the soft tissues so that the body can align itself comfortably and efficiently with gravity, to help one both feel and look better in the present, and to prevent the aches and pains that typically present problems as one grows older. Although structural balancing would ideally begin in childhood or adolescence, it can be effective later in adulthood as well.

Observation
The client’s biomechanical function is observed from front, back, and sides, taking note of irregularities in the movements of the legs, feet, arches, knees, hips, shoulders, and arms. The client is studied sitting and standing with arms held straight in front, straight up, and out to the sides to see how the body structure compensates for each of these shifts in balance. Balance is observed with the client standing on each foot with eyes open and closed, as is the positioning of the feet and knees in standing. The client is observed while sitting, with special attention to the positioning of the pelvis, sacrum, shoulders, cervical spine and head. A plumb line is used to help define structural imbalances.

Consultation
Structural balancing is focused on the whole body, and the responses of the whole body to the work must be observed. The client will be draped with sheets and positioned with pillows to facilitate therapy. Patients may wear under garments during examination and treatment. The one-hour sessions are usually not more frequent than twice a week (to give the tissues time to respond to the work), and not less frequent than once every 10 to 14 days (to keep from reestablishing old patterns). Generally six to eight sessions will be required for children and eight to twelve sessions for an adult, although this may vary with the types of problems encountered. Treatment may include localized pressure to interrupt neuromuscular bad habits, stretching, and homework assignments. Referrals for chiropractic, radiology, and dental assessments may be made.

Commitment
Before committing to structural balancing therapy, the evaluation findings and the reasons for treatment are discussed, in addition to answering any questions or concerns the client may have. Commitment of the therapist and client to the treatment plan is essential. Biomechanical structural balancing and bodywork is not simply done to the client, but is an ongoing process in which the client actively participates.

Lazlo’s Rules of Good Posture:

• Everything is connected.
• Anything can cause anything.
• Bones go where muscles put them. Bones stay where muscles keep them.
• When you sit: put your tail behind you and sit on your sit bones.
• When you stand: let your head pull and hold your body up.
• Listen to your body when it tells you something is wrong.
• Posture yourself in life by being as kind to yourself as you are to others.

Advanced Clinical Massage Therapy has benefited the following:

• ADD/ADHD
• Autism
• Bulging Discs
• Carpal Tunnel Syndrome
• Chronic Low Back Pain
• Cystocele
• Effects of Trauma, Including Birth Trauma
• Endometriosis
• Fibromyalgia
• Frozen Shoulder
• Hammertoe
• Headaches
• Overall Health
• Incontinence
• Infertility
• Knee Pain
• Lazy Eye
• Leg Pain, Athletic Performance
• Nerve Impingement
• Muscle Spasms
• Pain Syndromes
• Adjustment of Post-Surgical Joint Prosthesis
• Pregnancy
• Prolapsed Uterus
• Neck Pain
• Limitations from Scars
• Sciatica
• Scoliosis
• Sports Injuries
• Tendonitis
• Tennis Elbow
• Tinnitus
• Symptoms Caused by Structural Misalignment

Lazlo Paule, L.M.B.T., has trained extensively in:

• Therapeutic Touch (Hanna Kroger and Jenice Blitzer)
• Quantum Touch (John Kennedy)
• Cranio-Sacral Therapy (Upledger Institute)
• Neuromuscular Therapy (Paul St. John)
• Myoskeletal Alignment Techniques (Erik Dalton, Ph.D.)
• Active Isolated Stretching (Aaron Mattes)
• Manual and Assisted Lymphatic Massage
• Frequency Specific Microcurrent (Carolyn McMakin)
• Thai Massage (Margie Meshew, C.T.M.T.)
• Applied Kinesiology (Arleen Green, B.S., L.M.T. )
• Visceral Manipulation (Upledger Institute—Jean Pierre Barrall, D.O.)

Sleep Apnea/Hypopnea
The Greek word “apnea” translates to “without breath,” and is defined as a reduction of air flow greater than 80 percent of baseline. Hypopnea is shallow breathing that reduces air flow to 50– 80 percent of baseline.

The two major types of sleep apnea/hypopnea are central (due to lack of effort to breathe, often from a stroke or brain trauma) and obstructive (due to collapse of the throat tissues into the airway). Of the two types, obstructive Sleep Apnea (OSA) is far more common.

Clinically significant OSA is defined as five or more events/hour of 10-seconds or longer cessation of breathing during sleep that is accompanied by a greater than three percent decrease in oxygen saturation or a neurological arousal (when high carbon dioxide or low oxygen levels alert the brain to briefly awaken a person to restore breathing). Five to 15 apnea/hypopnea events/hour is rated as mild, 15 to 30 events/hour is moderate, and more than 30 events/hour is severe.

People afflicted with OSA often have no memory of their frequent, momentary awakenings during sleep and may also be genuinely unaware of the severity of their breathing difficulties for years or even decades, and may think they “just snore.”

Who’s at Risk
An estimated 12 million Americans suffer from OSA, and many of them are untreated. Risk factors for developing OSA include being male and older than 40, smoking cigarettes, and having a short, thick neck, large tongue, receding jaw, and obesity. Additionally, the use of alcohol and drugs that contribute to muscle relaxation contribute to OSA. The incidence of OSA in post-menopausal women approaches that of men in the same age group.

Health Problems Associated with OSA
Health problems/symptoms associated with chronic suboptimal tissue levels of oxygen from OSA include feeling on waking as if one hasn’t slept, high blood pressure, memory problems, heart disease, stroke, esophageal reflux, difficulty concentrating, irritability, decreased libido, impotence, heavy sweating at night, self-reporting a poor quality of life, weight gain, severe daytime fatigue and sleepiness, morning headaches, seizures, heart arrhythmias, adrenal stress (from prolonged physiological stress of struggling to breathe), and death.

Sleep deprivation (which is largely due to the interruptions of deep, restorative REM sleep that is an absolute requirement for normal daytime functioning) can result in difficulty with both relationships and job performance.

Driving Drowsy vs. Driving Drunk
Accurate statistics on the impact of driving while drowsy are difficult to obtain in part because there is no roadside reliable test for fatigue as there is for alcohol intoxication and because people in motor vehicle accidents may not be forthcoming about their level of fatigue. A conservatively estimated 100,000 accidents dur to driving while drowsy result in 71,000 injuries and 1,500 deaths annually in the United States.

A Stanford University study of 113 people with sleep apnea and 80 volunteer control subjects examined the dangers of driving while drowsy.

Following baseline testing of reaction time for both groups, the 80 volunteers were tested three more times while drinking 80-proof alcohol and again afterwards.

On the first follow-up testing, the sleep apnea subjects scored worse on all seven measurements of reaction time than the 80 volunteer drinkers. The sleep apnea patients performed worse on three out of seven tests when compared to those volunteers who tested legally drunk.

Most people overestimate their ability to override their need for sleep by using sheer willpower when they are behind the wheel. Falling asleep at the wheel for even a split second, particularly at higher speeds, can result in tragedy.

Two Cases of Airway Obstruction
Case # 1 A man whose airway is obstructed from choking on food in public is likely to be the recipient of a Heimlich maneuver by a trained good Samaritan coming to his aid to help expel the food obstructing his airway.

Case # 2 A man whose airway is obstructed from his own tissues collapsing into his airway while sleeping at home in his own bedroom is not likely to have his airway obstruction relieved by a well-intended bystander. He is left struggling to breathe and often remains oblivious to the serious nature of his malady.

No Laughing Matter
The use of sleep deprivation as a tactic to coerce prisoners of war to reveal information is considered cruel and is banned internationally. Sleep deprivation that results from airway obstruction during sleep, however, is often mentioned only in humor or for the fact that it’s disruptive to people in the same household. Sleep deprivation can affect the health of an entire family and is no laughing matter.

In-Home Testing for OSA
Watch-PAT100 provides screening, diagnosis and assessment of sleep-related breathing disorders.

Watch-PAT (Peripheral Arterial Tone) provides an in-home, reliable, unattended, affordable, user-friendly, evaluation that is accessible to OSA sufferers. It offers a single button operation and allows patients to sleep in their own beds at home during testing, without the stress of being observed by a stranger in the unfamiliar environment of a clinical sleep lab. Watch-PAT100 also provides a cost-effective ongoing monitoring of the effectiveness of OSA therapies.

The Watch-PAT unit weighs in at a mere 3 ounces, and it is velcroed to a comfortable glove/sleeve worn on the wrist and forearm of the non-dominant hand just before the person being studied goes to bed. Two non-invasive probes are attached to the fingertips to measure the PAT signal, pulse rate, sleep/wake cycles, body movements, and oxygen saturation.

The recorded signals are stored in a removable memory card in the device and are downloaded for computerized analysis of the data after the testing is completed.

Comparative studies have revealed a 90 percent correlation between Watch-PAT results and those of sleep lab testing (polysomnology).

Treatment
Treatment for OSA varies based on an individual’s medical history, the severity of OSA, and the cause of airway obstruction.

Treatments include lifestyle changes such as losing weight, stopping smoking, avoiding sleeping on one’s back, and evaluating the use of drugs which contribute to airway obstruction.

A variety of surgical procedures are used to reduce the volume of the tissue that is obstructing the airway or to support the obstructive tissues to prevent them from collapsing into the throat.

The most common physical intervention is Continuous Positive Airway Pressure (CPAP) in which room air under pressure is delivered to the patient via a mask to lessen airway obstruction.

Other interventions include oral splints, acupuncture, and allergy desensitization.