Chronic Inflammatory Demyelinating Polyneuropathy CIPD More Than Meets The Eye

Today's post from hillandponton.com (see link below) has a long title, describing a severe form of neuropathy called chronic inflammatory demyelinating polyneuropathy but in fact, the content applies to practically everyone who suffers from neuropathy and in that respect, is a useful description of what neuropathy entails. The title is also a long-winded description of the form of nerve damage that many people suffer from but is more often called peripheral neuropathy, or just neuropathy. CIPD involves damage to the myelin sheath insulating the nerves but this also applies to most cases of peripheral neuropathy. However, it also suggests that the standard protocol for CIPD neuropathy treatment involves just three components: IVIG (intravenous immunoglobulin); Corticosteroids and plasma exchange. That this is misleading is an understatement. Treatment for CIDP is much wider than that and is certainly not limited to those three options as most patients will know. It's difficult to see where the author has got her information from and from what angle she's approaching the subject but this article is an example of how you need to be careful not to jump to conclusions from just reading one source of information.

What is Chronic Inflammatory Demyelinating Polyneuropathy (CIDP)?
 March 6, 2017/in Veterans /by Brenda Duplantis, Accredited Claims Agent

Chronic inflammatory demyelinating polyneuropathy (CIDP) is a neurological disorder characterized by gradually increasing sensory loss and weakness associated with the loss of deep tendon reflex in the legs and arms. The hallmark of a peripheral nerve disease is loss of ankle reflex. This is when your doctor hits your Achilles tendon and there is no reflex.

CIDP is a progressive motor and sensory neuropathy that is very painful and debilitating. CIDP is caused by damage to the covering of the nerves, called myelin.



The axon (nerve fiber) works like an electric wire. The myelin sheath around the axon is the insulation necessary for the nerve to conduct electrical impulses properly. In CIDP, myelin is attacked through very complex mechanisms. In such cases, the body sees the peripheral nerve as foreign and antibodies bind to the myelin and begin to break it down. In people with CIDP, this translates into symptoms. For example, if you want to move your finger, messages tell your brain to move the finger. Then electrical communication within your body tells your nerves and muscles to move the finger. When there is disruption in the myelin sheath, those messages are weakened. Your brain is telling your finger to move but the nerves are damaged and the movement is weakened, delayed, or absent. When the myelin sheath is completely damaged, the message is blocked and this is called paralysis.

The disease can be present in a person for years prior to diagnosis. Because it is a gradually progressing disorder and its symptoms may, at early stages, wax and wane, a definitive diagnosis may require invasive tests. However, a neurologist that has experience in this type of disease should be able to identify the gradual symptoms and rule out any other cause. Typically, a diagnosis of CIDP is based on the person’s symptoms. Common symptoms in CIDP patients include:

In extremities:
 
Pain
Tingling
Numbness
Weakness
Loss of deep tendon reflex
Foot drop
Difficulty walking (altered gait, stumbling)
Fatigue

In addition to the aforementioned symptoms, tests such as a nerve conduction study (NCS) and electromyography (EMG) – a diagnostic procedure to assess the health of muscles and the nerve cells that control them – may be administered to determine the extent of demyelinating disease. In demyelinating disease, there is damage to the lining of the nerves that are critical for electrical nerve conduction. This can be confirmed by EMG studies or nerve biopsy. A nerve biopsy is used to confirm inflammatory process in the patient’s nerve.

A spinal fluid analysis is another diagnostic test that helps determine if a patient has elevated protein with normal cell count, an abnormality found in CIDP patients. Finally, your doctor may order blood and urine tests to rule out other disorders that may cause neuropathy, such as diabetes, which is the number cause of peripheral neuropathy.

The therapy for CIDP includes these three primary protocols:
 
IVIG (intravenous immunoglobulin used to treat various autoimmune, infectious, and idiopathic diseases) – can aggravate kidney dysfunction, cardiovascular disease, cerebrovascular disease, and other.
Corticosteroids (oral prednisone, pulse oral dexamethasone, IV methylprednisolone) – often improve strength, are conveniently taken by mouth, and are inexpensive. Side effects, however, can limit long-term use.
Plasma exchange – a process by which some of the patient’s blood is removed and the blood cells returned without the liquid plasma portion of the patient’s blood. It may work by removing harmful antibodies contained in the plasma. Short-term relief.

If treated early, most CIDP people respond well to therapy that can reduce the damage to peripheral nerves and contribute to improved function and quality of life. If left untreated, 30% of CIDP patients will progress to wheelchair dependence.

https://www.hillandponton.com/cidp/

How To Make Your Daily Nerve Pain More Bearable

Today's post from mnn.com (see link below) is another 'self-help' post designed to reduce the impact of your symptoms on your daily life and you may find it interesting, depending on the level of cynicism you're feeling today. At least it doesn't resort to clichés based on mindfulness, or yoga, or meditation (all of which may be useful for many people) and any list of self-improvement tasks that includes, swearing and sex, gets my vote. Give some a try - you never know and it may reduce your dependence on chemical pill treatments.

10 everyday activities that can reduce pain, according to science
Starre Vartan December 2, 2015,

Most of us have pain some of the time; some of us have pain most of the time. Whether your pain is temporary or chronic, it doesn't matter: Pain is the worst. Not only is it physically uncomfortable, it's overwhelming, taking over other feelings, interests or desires. Strong pain is debilitating, and for some of us, it prevents basic activities either directly or secondarily. For example, nausea frequently accompanies pain, making meals impossible. (I know when I have a bad headache or aching ankle, I can't eat).

Of course, there are a raft of pharmaceutical options for temporary pain and medical procedures for chronic pain, but some are safer than others and some of us like to avoid taking pills as much as possible. Wherever you are on the pain spectrum, doing any of the things below definitely can't hurt and may very well get you some relief — and we have the science to back up that claim.

Swear: Letting a few choice words fly can reduce feelings of pain in most people, according to a 2009 study. Researchers from Keele University in the U.K. found: "Swearing increased pain tolerance, increased heart rate and decreased perceived pain compared with not swearing. However, swearing did not increase pain tolerance in males with a tendency to catastrophise. The observed pain-lessening (hypoalgesic) effect may occur because swearing inducesa fight-or-flight response and nullifies the link between fear of pain and pain perception."

Hug yourself: An interesting 2011 study in the journal Pain found that in 20 subjects who were given painful electric shocks, pain was reduced when arms were crossed in front of the body. Like studies that have helped patients with phantom limb pain who use mirrors to confuse or reorient the brain's understanding of the body in space, arm crossing "...impairs this ability to localize tactile stimuli," according to the study, meaning that pain is lessened due to the brain's becoming confused about its origins.

Listen to music: A number of studies have shown that music reduces pain after surgery of various kinds, from gynecologic to major abdominal. And it's even been found to be effective for terminally ill patients with pain.

Sing: Feel free to sing along if you are already listening to music. In a study that compared those who sang versus those who just listened to music and relaxed, those who belted out a few reported better moods and less pain.

Get a hug: Since hugging has been proven to lower cortisol (the stress hormone) and relax the body, it can have some temporary mitigation for pain — as can gentle stroking or other affectionate touch between two people who are both comfortable with the action. A good hug should last 20 seconds for best effect (again, as long as both parties are comfortable with that).

Rub the area around the injury: This floods the brain with stimuli from the area that has been hurt, reducing the brain's ability to focus on the pain's origin area. (This works particularly well for bumped shins and is my go-to move!)

Dance: Dancing in time with others releases endorphins, which can up one's pain tolerance, as found by testing Brazilian dancers who engaged in synchronized and non-synchronized dancing. Those who danced with others released more endorphins, probably due to the social bonding aspect of dancing with others — though you get some positive effect from moving to music too. "Both synchronisation and exertion had independent effects on these measures, so moving energetically or moving in synchrony can both make you feel closer to others when you are dancing," Bronwyn Tarr told Phys.org. "But combining high energy and synchrony had the greatest effects – which might explain why people love to Flashmob!"

Sex: Sex can be mighty distracting, which can help with pain, but it also gets endorphins flowing around the body, making it better for reducing some aches (like migraines) than painkillers. According to researchers: "Sex can abort migraine and cluster headache attacks, and sexual activity is used by some patients as acute headache treatment." Don't have a partner? No worries; the same effects in pain relief can be achieved by reaching climax solo.

Laugh at a comedy show: Watching silly movies and laughing can genuinely make you feel better if you are experiencing pain. According to one study from the 1980s: "Movies were viewed by two groups (humor and non-humor) and differences between groups were noted on measures of perceived pain and affect. Humor is shown to provide significant benefits." And more recent studies back up those older findings.

Pain can ruin your day. But the alternative is a feeling-free life (some people are born without pain receptors) — which is a dangerous, life-threatening condition. So it's worth keeping in mind that pain is part of being human.

http://www.mnn.com/health/fitness-well-being/blogs/everyday-activities-can-reduce-pain-according-science

Core More then Abs and Glutes

As athletes, we spend a lot of time working on our core. We plank. We do sit-ups. We twist. However, there is one muscle which is ignored by most athletes that is use in every stride.  In order to run, swim, bike, you need to breathe. The muscle responsible for breathing is the diaphragm. As you pick up the pace, your breathing increases. Your diaphragm is working hard!

What is the Diaphragm?

The diaphragm is a thin muscle that separates the abdominal cavity from the chest cavity. When it is relaxed it rest up against the chest cavity. When we breath the diaphragm contracts and pulls the chest cavity down. This provides negative pressure in the chest cavity allowing air into the lungs. Typically, the core is just seen as the abdominals and back. The core as a box. The pelvic floor muscles on the bottom, abs and back form the side and the diaphragm is the top.

Photo credit - http://deansomerset.com/core-training-
made-incredibly-complex/

How Does It Affect my Running?

One of the biggest difficulties I see in the clinic is the inability to separate the diaphragm from the core while breathing. When most of us tighten our core, we stop breathing. OR we continue to breath without tightening our core. We have to learn how to disassociate our diaphragm from our core similar to not using your hamstring when firing your glutes. When we are not able to keep our core tight while we running we lose core stability. This will set off a whole cascade of events which can impact the mechanics of our arms and legs.

The diaphragm has multiple attachments including the hip flexors. This is important because most of us have tightness in our hip flexors. Tightness of hip flexors will not allow the diaphragm relax in  resting state. This tightness will limit our ability to take advantage of a full breath. This forces us to take shallow breaths. This can also contribute to the inability to take a full stride. When the leg is trailing behind, the hip flexor is on maximal stretch. A tight hip flexor will pull on the diaphragm limiting full exhalation.

Lastly, and most important, the diaphragm controls our breathing!

Inability to contract our abdominal muscles separate from the diaphragm and tight hips limit our ability to take full breath. Like any muscle the diaphragm can be stretched and strengthened. On top of stretching the hip flexors and strengthening our core we should also work on improving the use of our diaphragm.

Bonus Info

Side Cramps

A side cramp is when the diaphragm spasms. If you have a cramp on the right, exhale when when your left foot hits the ground. This provides a quick stretch to the diaphragm which helps alleviate symptoms. If your cramp is on your left, exhale as your right foot hits the ground

Finding balance

The diaphragm is also connected to the parasympathetic nervous symptom. This is the "rest and digest" system which allows you to relax. Everyone is busy and on the go which stimulates the sympathetic nervous symptom which is your "fight or fight" symptom. Certain chemicals are released when the sympathetic nervous symptom is activated which, over time, can be detrimental. By diaphragmatic breathing, the parasympathetic nervous system is activated balancing the sympathetic response. If I can't sleep, I focus diaphragmatic breathing and I usually fall asleep within minutes!

Exercises

Diaphragmatic Breathing

On your back with knees bent, inhale allowing the abdominal cavity to rise then the chest follows. A sign the diaphragm is under-utilized is when the chest and shoulders rise first. To make this more difficult stack a couple of books on your abdominals. Do this for 10 breaths.


This can also be performed in various positions such as sitting, standing or laying down. Eventually diaphragmatic breathing should be natural.

Diaphragmatic Breathing in 3 D

We will work the diaphragm using the lunge matrix.

Stand tall and inhale, as you lunge forward exhale as you bring both arms up. Return to standing and repeat. In the frontal plane, inhale in standing then exhale as you bringing both arms up and to the side. Lastly in the transverse plane, inhale then exhale as you pivot lunge bringing both arms toward the knee.
This exercise provides an additional cue when performing lunges. If you're already doing lunges add the breathing to your routine. You don't have to perform more diaphragmatic lunges.
Perform about 5 repetitions to each side.

*** Side note I have difficulty performing frontal plane breathing exercises. Those who know me know that I had an injury to that side. This is an exercise I will be re-evaluating in a month!