Hyperbaric Medicine, Serotonin, and Its Effects on Neuropsychological ConditionsMegan Hughes
Dr. Hughes discusses hyperbaric oxygen therapy (HBOT) and regulating serotonin for traumatic brain injury (TBI) and and post traumatic stress disorder (PTSD) at the OMED conference in Baltimore.
The Neurobiochemical Cascade in TBI/PTSD & the Beneficial Effects of Oxygen &...Megan Hughes
Dr. John Hughes presents at the JPNI Virtual Conference October 2020 about TBI and PTSD symptomology, the neurobiochemical cascade, serotonin, high-dose oxygen, SSRIs, and hyperbaric oxygen therapy.
A Multimodal Regenerative Approach JPNI November 2019Megan Hughes
Dr. Hughes discusses the TBI Therapy mutlimodal approach to treating traumatic brain injury including hyperbaric oxygen therapy (HBOT), IV nutrition, intransal PRP, insulin, and adult stem cells, cranial osteopathy, and the ketogenic diet at the JPNI conference in Broomfield.
A Multimodal, Regenerative Approach to Traumatic Brain Injury - OMED Oct 2020Megan Hughes
Dr. John Hughes discusses traumatic brain injury, the neurobiochemical cascade, and how to treat a TBI with hyperbaric oxygen, adult stem cells, prp, and IV nutrition.
Dr. Hughes discusses the TBI Therapy protocol used to treat traumatic brain injury. Modalities include hyperbaric oxygen therapy, adult stem cells, PRP, IV nutrition, as well as supplementation and a ketogenic diet.
It remains the responsibility of all clinicians using LA
to understand their potential
for severe systemic toxicity and to be prepared to respond immediately to these events when they occur.
Hyperbaric Medicine, Serotonin, and Its Effects on Neuropsychological ConditionsMegan Hughes
Dr. Hughes discusses hyperbaric oxygen therapy (HBOT) and regulating serotonin for traumatic brain injury (TBI) and and post traumatic stress disorder (PTSD) at the OMED conference in Baltimore.
The Neurobiochemical Cascade in TBI/PTSD & the Beneficial Effects of Oxygen &...Megan Hughes
Dr. John Hughes presents at the JPNI Virtual Conference October 2020 about TBI and PTSD symptomology, the neurobiochemical cascade, serotonin, high-dose oxygen, SSRIs, and hyperbaric oxygen therapy.
A Multimodal Regenerative Approach JPNI November 2019Megan Hughes
Dr. Hughes discusses the TBI Therapy mutlimodal approach to treating traumatic brain injury including hyperbaric oxygen therapy (HBOT), IV nutrition, intransal PRP, insulin, and adult stem cells, cranial osteopathy, and the ketogenic diet at the JPNI conference in Broomfield.
A Multimodal, Regenerative Approach to Traumatic Brain Injury - OMED Oct 2020Megan Hughes
Dr. John Hughes discusses traumatic brain injury, the neurobiochemical cascade, and how to treat a TBI with hyperbaric oxygen, adult stem cells, prp, and IV nutrition.
Dr. Hughes discusses the TBI Therapy protocol used to treat traumatic brain injury. Modalities include hyperbaric oxygen therapy, adult stem cells, PRP, IV nutrition, as well as supplementation and a ketogenic diet.
It remains the responsibility of all clinicians using LA
to understand their potential
for severe systemic toxicity and to be prepared to respond immediately to these events when they occur.
Classification
Mechanism of action
Duration of action
Absorption and distribution
Mode of action
Theories of action of L.A
Pharmacokinetics of local anaesthetics
Routes of administration
Metabolism or biotransformation
Individual agents
Vasoconstrictors
Systemic effects
Toxicity
Advantages
Disadvantages
Maximum allowable dose
Local anaesthetics in community trust services
Endocannabinoid System - Literature ReviewLouis Cady, MD
In this brief review of the literature, Dr. Louis Cady of the Cady Wellness Institute reviews the endocannabinoid system and the role it plays in bridging the connection between mind and body, modulating anxiety, inflammation, memory and other physiological processes. Nothing in this presentation suggests that any of the products mentioned are appropriate for the treatment, remediation, cure, or prevention of any disease or illness. It does appear, however, that this natural, indwelling, genetically passed down endocannabinoid system may have major implications for holistic physicians and health care practitioners, and for the patients that they serve.
2015 keynote presentation at the Oregon Counseling Association Conference by Darryl Inaba, PharmD, CATC-V, CADC-III, author of Uppers, Downers, All-Arounders.
cholingeric and Anticholinesterase drug in detail .this ppt contains introduction ,mechanism of action ,pharmacological action ,uses and adverse effect of the drug
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
This lecture was delivered to 2nd year pharmacy students enrolled in a pharmacology & toxicology course. This presentation was designed to accompany Goodman & Gilman's (12e) chapter 12.
The Presentation depicts basic pharmacodynamic aspects of Nicotine. It also includes pharmacokinetic and pharmacodynamic drug interactions of nicotine. This ppt is one in the series of basic neuroscience presentations in addiction psychiatry.
This Presentation for all medicos and Basic science students --
Introduction
Forms of chemical signaling
Posterior pituitary gland
Antidiuretic hormone
Action of ADH
Regulation of ADH
Actions of oxytocin
Control of oxytocin secretion
Factors affecting secretion oxytocin
Classification
Mechanism of action
Duration of action
Absorption and distribution
Mode of action
Theories of action of L.A
Pharmacokinetics of local anaesthetics
Routes of administration
Metabolism or biotransformation
Individual agents
Vasoconstrictors
Systemic effects
Toxicity
Advantages
Disadvantages
Maximum allowable dose
Local anaesthetics in community trust services
Endocannabinoid System - Literature ReviewLouis Cady, MD
In this brief review of the literature, Dr. Louis Cady of the Cady Wellness Institute reviews the endocannabinoid system and the role it plays in bridging the connection between mind and body, modulating anxiety, inflammation, memory and other physiological processes. Nothing in this presentation suggests that any of the products mentioned are appropriate for the treatment, remediation, cure, or prevention of any disease or illness. It does appear, however, that this natural, indwelling, genetically passed down endocannabinoid system may have major implications for holistic physicians and health care practitioners, and for the patients that they serve.
2015 keynote presentation at the Oregon Counseling Association Conference by Darryl Inaba, PharmD, CATC-V, CADC-III, author of Uppers, Downers, All-Arounders.
cholingeric and Anticholinesterase drug in detail .this ppt contains introduction ,mechanism of action ,pharmacological action ,uses and adverse effect of the drug
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
This lecture was delivered to 2nd year pharmacy students enrolled in a pharmacology & toxicology course. This presentation was designed to accompany Goodman & Gilman's (12e) chapter 12.
The Presentation depicts basic pharmacodynamic aspects of Nicotine. It also includes pharmacokinetic and pharmacodynamic drug interactions of nicotine. This ppt is one in the series of basic neuroscience presentations in addiction psychiatry.
This Presentation for all medicos and Basic science students --
Introduction
Forms of chemical signaling
Posterior pituitary gland
Antidiuretic hormone
Action of ADH
Regulation of ADH
Actions of oxytocin
Control of oxytocin secretion
Factors affecting secretion oxytocin
Individualized Webcam facilitated and e-Classroom USMLE Step 1 Tutorials with Dr. Cray. For questions or more information.. drcray@imhotepvirtualmedsch.com
THE ENDOCANNABINOID SYSTEM - Cady Wellness InstituteLouis Cady, MD
This lecture, presented on February 2, 2018 at the Cady Wellness Institute in Newburgh, IN, represented Dr. Cady's review of the current peer-reviewed medical literature current as of that morning. The concepts of "endocannabinoids" vs. "phytocannabinoids" were reviewed. Themes in the medical literature were explored, including the relationship of the endocannabinoid system and CB! and CB2 receptors to modulate hippocampal neurogenesis, cause apoptosis in breast cancer cells, and many other interesting correlations. A careful review of legal vs illegal options for obtaining plant phytocannabinoids in the state of Indiana was emphasized.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
1. Provider Wellness:
Simple Tools to Enhance Your
Health and Improve Patient
Outcomes
Dustin Sulak, D.O.
Maine Osteopathic Association
Annual Oceanside Convention 2014
2. Introduction
I have no relevant financial relationships with commercial interests.
Founder and Medical Director
Maine Integrative Healthcare in Manchester, Maine
Integr8 Health, LLC in Falmouth Maine
Director of Education
Integr8 Massachusetts, Burlington, Mass
6 DOs, 4 MDs, 6 NPs, 1 LCPC, 1 LMT, 1 DN
Integrative Medicine and Medical Cannabis Consultations,
Family Medicine, OMT, laser therapy, hypnotherapy, and more.
3. Introduction
Learning Objectives:
1. Define Health and Healing.
2. Describe mechanisms by which the health of the
practitioner impacts the health of the patient.
3. Become competent in simple self-governance tools
that can modulate biological oscillations, relieve
stress, and improve health.
4. Outline
• What is Health? What is Healing?
• The Importance of Provider Wellness
• Caring for your Endocannabinoid System
• Physiologic Coherence, Heart Rate Variability
• Emotions, Optimism
• Practice
6. “To find health
should be the object
of the doctor.
Anyone can find
disease.”
Andrew Taylor Still
Founder of Osteopathy
7. • Health is a natural phenomenon like gravity, the tendency for
two bodies to attract, or entropy, the tendency towards
randomness.
• Health is the tendency for living beings to grow and adapt.
• Health is the force or presence that sustains life.
• Health is both entropic and negentropic.
• Health is a biological oscillation with the period of a lifetime.
9. What is Healing?
• Homeostasis
– The tendency of a biological system to regulate
its internal conditions to maintain function in
response to fluctuations in the external
environment
• Tissue remodeling
• The emergence of new patterns that allow
freedom in function and fitness in one’s
environment
10. Emergence of New Patterns
• Systems Theory
– As system in perfect equilibrium does not have
the internal dynamics to enable it to respond to
its environment, and it dies.
– A system in chaos ceases to function as a
system.
– The reciprocal relationship between equilibrium
and disequilibrium promotes the emergence of
new patterns
12. Physicians
• Smoke less, exercise more, and eat healthier
than our patients
• Yet our per-capita rates of heart disease,
depression, and stroke are higher than any
other working group.
Why?
Arnetz BB: White collar stress: What studies of physicians can teach us. Psychother Psychosom
55:197-200, 1991
Heim E: Job stressors and coping in health professions. Psychother Psychosom 55:90-99, 1991
15. Medical Training
• Fear of Failure
• Perfectionism Obsession
• Social isolation (long hours)
• Exhaustion, disrupted biological rhythms
• Emotional and Physical Dissociation
• Compassion Fatigue Syndrome, Burnout
16. Suicidal Ideation Among American Surgeons
• 1/16 of surgeons reported suicidal ideation within
the last year.
• Only 26% of these surgeons sought mental health
services.
• There are many factors which conspire to isolate
physicians
– 60% of these surgeons were unwilling to seek help
because of the potential that doing so would adversely
affect their licensure.
» Shanafelt, Tait D., et al. "Special report: suicidal ideation among
American surgeons." Archives of surgery 146.1 (2011): 54-62.
18. The Physiology of Health
The Endocannabinoid System
Physiologic Coherence
19. The Endocannabinoid System
Endocannabinoid synthesis is an adaptive
response to cellular stress, aimed at re-
establishing cell homeostasis.
Pubmed search results for “endocannabinoid”
1993: 10 citations
2014: 6,141 citations
22. CB Receptors Evolved 600 Million Years Ago
human
monkey
rat
mouse
finch
newt
Fugu fish
sea squirt
Caenorhabditis
Drosophila, Apis
McPartland et al., 2005
23. CB1 Receptor Distribution
• Most common G protein coupled
receptor in the brain
• Highest densities:
– hippocampus
– cerebral cortex
– cerebellum,
– amygdaloid nucleus
– basal ganglia
• Accounts for effects:
– short-term memory
– cognition
– mood and emotion
– motor function
– nociception.
• Virtually absent in brainstem
cardiorespiratory centers – no
lethal overdose
Glass M et al. Cannabinoid
receptors in the human brain.
Neuroscience 1997;77:299-
318
25. anandamide (AEA)
Devane, Mechoulam et al., Science (1992) 258:1946-1949
Endogenous Cannabinoid Ligands:
The Endocannabinoids
2-arachidonoylglycerol (2-AG)
Mechoulam et al., 1995
Sugiura et al., 1995
26. AEA and 2-AG:
• Retrograde messengers in nervous system.
• Autocrine or paracrine mediators
elsewhere.
• Synthesized “on demand” from cell
membrane precursors and immediately
released.
• Degraded by enzymatic hydrolysis
(FAAH).
Endogenous Cannabinoid Ligands:
The Endocannabinoids
27. Depolarization-Induced Suppression of Excitation
Ca2+
channel
Na+, K+
channels
glutamate
presynaptic cell
action potential
NMDA
postsynaptic cell
AMPA
• Action potential from
depolarized neuron
arrives at axon
terminal and opens
voltage-gated calcium
channels.
• Ca2+ influx releases
glutamate vesicles,
glutamate diffuses
across synaptic cleft
to activate receptors
in postsynaptic cell.
Wilson & Nicholl, 2002
28. AMPA
Ca2+
channel
Na+, K+
channels
glutamate
presynaptic cell
action potential
NMDA mGLU NMDA
postsynaptic cell
• Strong stimulus of
presynaptic cell
increases glutamate
release, which
upregulates other
glutamate receptors in
the post-synaptic cell.
• Upregulated
glutamate receptors
open Ca2+ channels in
the post-synaptic cell.
Ca2+
channel
Wilson & Nicholl, 2002
Depolarization-Induced Suppression of Excitation
29. Ca2+
channel
Na+, K+
channels
glutamate
presynaptic cell
action potential
postsynaptic cell
NMDA mGLU NMDA
• Ca2+ influx into
post-synaptic cell
stimulates the
synthesis and
release of 2-AG.
• 2-AG diffuses
retrograde to
presynaptic CB1,
which closes pre-
synaptic Ca2+
channels and stops
vesicle release.
Ca2+
channel AMPA
Wilson & Nicholl, 2002
Depolarization-Induced Suppression of Excitation
30. Ca2+
channel
Na+, K+
channels
GABA
presynaptic cell
action potential
postsynaptic cell
GABAA
• Ca2+ influx into
post-synaptic cell
stimulates the
synthesis and
release of 2-AG.
• 2-AG diffuses
retrograde to
presynaptic CB1,
which closes pre-
synaptic Ca2+
channels and stops
vesicle release
Ca2+
channel
Depolarization-Induced Suppression of Inhibition
GABAB
Wilson & Nicholl, 2002
31. • Sprouting and pruning of synapses, changes in
dendritic spine density, and changes in
neurotransmitter pathways.
• Gives rise to all types of adaptive learning, including:
• Conscious act of gaining a new skill.
• Unconscious acquisition of a new emotional
response.
• Subcortical events leading to a facilitated spinal
segment.
Neural Plasticity
32. Mechanisms:
• Neurogenesis
• Depolarization-induced suppression of excitation
• Depolarization-induced suppression of inhibition
• Long-term potentiation
• Long-term depression
Cannabinoids Modulate Neural
Plasticity
Fishbein, Miriam, et al. "Long-term behavioral and biochemical effects of an ultra-low dose of Δ9-
tetrahydrocannabinol (THC): neuroprotection and ERK signaling." Experimental brain research 221.4
(2012): 437-448.
Lovinger DM. Presynaptic modulation by endocannabinoids. Handb Exp Pharmacol 2008;184:435–77.
33. Cannabinoids Modulate Neural
Plasticity
• Cannabinoids modulate
– HPA axis reactions to mood and stress
– Fear conditioning
– Habituation
– Fear extinction (Passie, 2012)
• Phyto-cannabinoids enhance fear extinction
in humans
• THC (Rabinak, 2012)
• CBD (Das, 2013)
34. Osteopathy and
the Endocannabinoid System
“Suppose again the nerves of
nutrition should fail to apply the
nourishing showers, we would
surely die in sight of food”
–Philosophy of Osteopathy, 1899
35. Osteopathy and
the Endocannabinoid System
• Endocannabinoid system requires the presence of
CB1 in the peripheral terminal of the nociceptor.
• CB1 receptors are synthesized in the dorsal root
ganglion of nociceptors and are carried by
axoplasmic flow to peripheral sites.
• By obstructing axoplasmic flow and cellular
trafficking of CB1, the pathophysiology of
somatic dysfunction perpetuates itself.
Hohmann AG, Herkenham M. Cannabinoid
receptors undergo axonal flow in sensory nerves.
Neuroscience.1999; 92:1171 -1175
36. Osteopathy and
the Endocannabinoid System
• A blinded, randomized controlled trial of 31 healthy
subjects measured AEA levels pre- and post-OMT.
• The OMT intervention consisted of myofascial release,
muscle energy and thrust techniques. The control
intervention consisted of a sham cranial method.
• In subjects receiving OMT, serum levels of AEA
obtained after OMT more than doubled the pre-OMT
levels. No change was seen in control subjects.
• However, the doubling of AEA was not statistically
significant (P=.139) because of a large degree of response
variability.
McPartland JM, Giuffrida A, King J, Skinner E,
Scotter J, Musty RE. Cannabimimetic effects of
osteopathic manipulative treatment. J Am Osteopath
Assoc. 2005;105:283-291.
37. Endocannabinoids affect every biological
oscillator or pacemaker cell investigated to date,
including:
• Circadian rhythms
• Traube-hering waves
• Peristalsis slow wave
• EKG rhythms
• EEG rhythms.
Biological Oscillators
Pacher P, Bátkai S, Kunos G. The endocannabinoid system as an emerging target of
pharmacotherapy [review]. Pharmacol Rev. 2006;58:389-462.
38. Caring For Your ECS
• The Endocannabinoid System (ECS)
plays a key role in 3 types of healing:
– Homeostasis
– Tissue Remodeling
– Emergence of New Patterns
• How can you support your ECS?
39. How To Enhance the
Endocannabinoid System?
Pre-Clinical and Clinical Review:
40. Caring for your ECS
• Probiotics
– Upregulate CB2 in colonic epithelial cells in mice.
– Decrease pain behavior following colonic distension with
butyrate, reversed by the CB2 antagonist
• Ethanol dampens the effects of the ECS.
– Chronic consumption and binge drinking likely
desensitize or downregulate CB1 and impair eCB
signaling, except perhaps in areas involved in reward and
motivation to self-administer this substance of abuse
41. Caring for your ECS
• Exercise
– Medium to high-intensity voluntary exercise increases
ECS signaling, via increased serum AEA levels, and
possibly increased CB1 expression.
– Forced exercise does not increase AEA and can
decrease CB1
• Stress and Social Play
– Chronic stress impairs the eCB system, via decreased
levels of AEA and 2-AG.
– Social play in rats increased CB1 phosphorylation (a
marker of CB1 activation) in the amygdala and enhanced
AEA levels in the amygdala and nucleus accumbens.
42. High and repeated doses: CB receptor desensitization
Phyto-Cannabinoid Effects
• Persistent agonism
• Phosphorylation
by GRK or PKC
• Binding by -
arrestin
• Receptor pulled
into a clathrin-
coated pit
• Endosome
internalization
43. Phyto-Cannabinoid Effects
Low and acute doses: ECS Upregulation
• THC increases the production of endocannabinoids in
brain cells. (Burstein, 1995)
• THC upregulated CB1 receptors in mouse spinal cords.
(Cichewicz, 2001)
• Acute dose of THC increased cannabinoid receptor
affinity in rats. (Oviedo, 1993)
• Sub-therapeutic does of THC enhance the pain relief
imparted by endocannabinoids in rats. (Suplita 2008)
44. Coherence
• Ordered patterning within one system
• Synchronization between multiple systems
• Physiologic coherence describes a number of
related physiological phenomena frequently
associated with more ordered and
harmonious interactions among the body’s
systems.
45. “When all of the
fulcrums are
synchronized there
will be peace and
harmony.”
-W.G. Sutherland
DO
46. Reduced blood pressure in hypertension (McCraty,
2001)
Increased functional capacity in CHF patients
(Luskin, 2002)
Improvements in asthma (Lehrer, 2000)
Increased calmness and well-being (Friedman, 2000)
Increased emotional stability (McCraty, 2001)
Improved cognitive performance (McCraty, 2001)
Benefits of Physiological Coherence
47. Heart Rate Variability (HRV)
0 1 2
-0.5
0
0.5
1
1.5
2
mVolts
2.5 seconds of heart beat data
.859 sec. .793 sec. .726 sec.
70 BPM 76 BPM 83 BPM
48. Heart Rate Variability
• Key indicator of autonomic function
• Low HRV indicates high sympathetic and
parasympathetic tone = high cardiac risk
• High HRV indicates low sympathetic and
parasympathetic tone = low cardiac risk
• Decreases with age
• Low HRV is predictive of MI and sudden death
Circulation, 1996;93: 1043-1065
49. Low HRV Predicts CHD & All
Cause Mortality
• 14,672 men and women
• HRV measured between 1987 and 1989
• Low HRV increased risk of CHD
formation and death by 40%
• Dekker et al, Circulation 2000:102:1239
50. Low HRV is an Independent Predictor:
• Sudden death from MI
• Fatal arrhythmias
• All cause mortality
• In many demographic populations:
– ICU
– Hemodialysis
– Middle-aged and older men
– Women post-MI and post-cardiac
revascularization
51. References
• Camm AJ, Pratt CM, Schwartz PJ, et al: Mortality in patients after a recent myocardial infarction: A
randomized, placebo-controlled trial of azimilide using heart rate variability for risk stratification. Circulation
2004; 109:990-996.
• La Rovere MT, Pinna GD, Hohnloser SH, et al: Baroreflex sensitivity and heart rate variability in the
identification of patients at risk for life-threatening arrhythmias: Implications for clinical trials. Circulation
2001; 103:2072-2077.
• Dekker JM, Crow RS, Folsam AR, et al: Low heart rate variability in a 2-minute rhythm strip predicts risk of
coronary heart disease and mortality from several causes: The ARIC Study: Atherosclerosis Risk In
Communities. Circulation 2000; 102:1239-2344.
• Katz A, Liberty IF, Porath A, et al: A simple bedside test of 1-minute heart rate variability during deep
breathing as a prognostic index after myocardial infarction [see comment]. Am Heart J 1999; 138:32-38.
• Migliaro ER, et al: Relative influence of age, resting heart rate and sedentary life style in short-term analysis
of heart rate variability. Braz J Med Biol Res 2001; 34:493-500.
• Hayano J, et al: Postural response of low-frequency component of heart rate variability is an increased risk for
mortality in patients with coronary artery disease. Chest 2001; 120:1942-1952.
• Lucreziotti S, et al: Five-minute recording of heart rate variability in severe chronic heart failure: Correlates
with right ventricular function and prognostic implications. Am Heart J 2000; 139:1088-1095.
52. Poor HRV helps stratify risk for
• Worsening CHF
• Bonaduce D, et al. Am Heart J 1999; 138:273-284.
• Yoshikawa T, et al. Am Heart J 1999; 137:666-671.
• Nolan J, et al. Circulation 1998; 98:1510-1516.
• Colhoun HM, et al. Diabetes Care 2001; 24:1108-1114.
• Developing CAD in DM-1
• Liao D, Carnethon M, Evans GW, et al. Diabetes 2002; 51:3524-3531.
• Atherosclerotic plaques in otherwise young, asymptomatic adults
• Colhoun HM, et al. Diabetes Care 2001; 24:1108-1114.
• Worsening Atherosclerosis
• Wennerblom B, et al. Heart 2000; 83:290-294.
• Huikuri HV, et al. Arterioscler Thromb Vasc Biol 1999; 19:1979-1985.
• Elevated Triglycerides
• Jensen-Urstad M, et al. J Intern Med 1998; 243:33-40.
53. Poor HRV correlated with
• Early insulin resistance
• Laitinen T, et al. Diabetes 1999; 48:1295-1299.
• Obesity
• Karason K, et al. Am J Cardiol 1999; 83:1242-1247.
• Hypertension
• Schroeder EB, et al. Hypertension 2003; 42:1106-1111.
• Singh JP, et al. Hypertension 1998; 32:293-297.
54. Poor HRV correlated with
• Depression
• Social Isolation
• Suppressed Anger
• Carney RM, et al. Circulation 2001; 104:2024-2028.
• Hughes JW, Stoney CW. Psychosom Med 2000; 62:796-803.
• Horsten M, et al. Psychosom Med 1999; 61:49-57.
• Armour J: Neurocardiology, New York: Oxford University Press;
1994.
56. “Nerves are the children and associates of one
mother – the heart…
She is the mother, nerve, and soul of all nerves
pertaining to this body.”
A.T. Still, The
Philosophy and Mechanical
Principles of
Osteopathy, 1892, p.47
57. The Heart Has a Nervous System
• Afferent and efferent neurons
• Ganglia
• Local Circuit Neurons
Neurocardiology, Armour, JA and J. Ardell Eds. NY,NY, Oxford University Press, 1994
G.P. =
ganglionated
plexi
61. Stress
• Stress is almost always an
emotional reaction to a situation.
• Stress impacts our ability to think
clearly, respond appropriately and
perform at our best.
• Our stress level directly impacts
– How we feel at the end of the day
– Our health
– Our relationships
63. Mantras & Rosary Prayer
• Both practices:
– Decreased sympathetic tone
– Synchronized respiratory and cardiovascular
cycles
– Improved HRV
Luciano Bernardi et al BMJ 2001;323:1446-1449 ( 22-29 December )
64. Improving HRV improves
• Immune Function
• McCraty R, Childre D: The Appreciative Heart: The
Psychophysiology of Positive Emotions and Optimal Functioning,
Boulder Creek, Calif: Institute of HeartMath; 2003.
• Hormone Balance
• Bernardi L, et al: Effect of rosary prayer and yoga mantras on
autonomic cardiovascular rhythms: Comparative study. BMJ 2001;
323(7327):1446-1449
• Depression
• McCraty R, et al: The impact of a new emotional self-management
program on stress, emotions, heart rate variability, DHEA and
cortisol. Integr Physiol Behav Sci 1998; 33:151-170
65. Quick Coherence Practice
1. Heart Focus: Focus your attention on the area around your heart, the area in
the center of your chest.
2. Heart Breathing: Breathe deeply, but normally, and imagine that your breath
is coming in and going out through your heart area. Continue breathing with
ease until you find a natural inner rhythm that feels good to you.
3. Heart Feeling: As you maintain your heart focus and heart breathing, activate
a positive feeling. Recall a positive feeling, a time when you felt good inside,
and try to re-experience the feeling. One of the easiest ways to generate a
positive, heart-based feeling is to remember a special place you’ve been to or
the love you feel for a close friend or family member or treasured pet. This is
the most important step.
http://www.heartmath.com/personal-use/quick-coherence-technique.html
66. The Power of Positive Emotions
• Increased longevity (Danner et al., 2001)
• Reduced morbidity (Goldman et al, 1996; Russek & Schwartz, 1997)
• Increased cognitive flexibility (Ashby et al., 1999)
• Improved memory (Isen et al., 1978)
• Improved decision making (Carnevale & Isen, 1986)
• Increased creativity and innovative problem solving (Isen et al.,
1987)
• Improved job performance & achievement (Wright & Staw, 1994; Staw
et al.,1994)
• Improved clinical problem solving (Estrada et al.,1997)
67. Optimists live longer
• 999 men and women over 9 years divided into four
groups based on their level of optimism.
• Compared to pessimists, optimists had:
– 55% lower risk of death from all causes
– 23% lower risk of cardiovascular death
• Optimists lead healthier lifestyle, but when matched
to pessimists with similar lifestyles optimists still do
better
• Giltay, E. Archives of General Psychiatry, November 2004;
vol 61: pp 1126-1135.
68. Physician’s Mood Influences Care
• On days the doctors felt positive moods, they spoke
more to patients, wrote fewer prescriptions, ordered
fewer tests and issued fewer referrals.
• If the physicians’ burnout level was higher, their
moods more strongly impacted their behaviors.
• 188 family physicians, anonymous self-reporting
questionnaire
Kushnir, talma, et al. "Exploring physician perceptions of the impact of emotions on
behaviour during interactions with patients." Family practice 28.1 (2011): 75-81.
69. Health is Contagious
• Bioenergy
– Magnetic fields of the heart (ECG) and brain
(EEG) can be measured several feet away from the
body.
– The transference of these signals between
individuals in physical contact and even several feet
apart has been measured and documented.
Rosch, P, Markov, M. Bioelectromagnetic Medicine. Informa Health Care,
2004:551-560
• Autonomic tone, other aspects of physiology
70.
71. Health is Contagious
• Psychologist Albert Bandura:
Observational Learning
– The most powerful way of learning is watching
others do something.
• Healthy behavior is contagious
– Physical Activity, Healthy Eating
– Ball, Kylie, et al. Int J Behav Nutr Phys Act 7.1 (2010):
86.
72. Make the Shift
• Self-Awareness
• Acceptance (non-judgment)
– It isn’t important for us all to be perfectly fit and
balanced – but it is important that we are taking
that journey.
– Being whole is accepting who you are – you can
do this for yourself and your patients.
• Choice
73. Health is Contagious
So often it is not what we do, but simply
our presence that allows healing.
74. “It is no use walking anywhere to
preach unless our walking is
preaching.”
St. Francis of Assisi
75. Chung Breath Practice
1. Forcefully and completely exhale through
pursed lips.
2. Close your mouth, relax, allow inhalation to
occur passively without any influence.
3. Pause and repeat.
Yunjo Chung, MD