Cranial Electrotherapy Stimulation (CES) for Pain Control and Other Issues

Used around the world for over 50 years, Cranial Electrical Stimulation (CES) is used for neurotransmitter balancing, mood control, IQ gains, sleep, exploration of altered states, peak performance, pain, anxiety, stress, depression and much more.

First, lets have some technical information: 

Most CES units (of which there are many) are considered: Class IIa. Type BF medical device generating microcurrent pulses which are thought to reach the brain via the auditory meatus. 

By placing either ‘electrical clip/electrodes’ on the earlobes, or small, sticky electrodes behind each ear, cranial stimulation sends a micro-current which helps to ‘balance’ the chemicals and reestablish optimal neurotransmitter levels in the brain.  CES differs from TENS stimulation; which is low-frequency and tends to just block nerve pain. Also known as ‘The Sleep Machine,’ cranial electrotherapy stimulation has been proven to help reduce stress and anxiety in patients, while allowing them to become drowsy. In addition, it has been proven useful (although, not yet FDA approved) in treating ADD, ADHD, PTSD, stage 1 hypertension, headache, tics from Tourette syndrome, Alzheimer symptoms and dementia, autism, and painful conditions of traumatic brain injury, cancer, dental pain or surgery, Parkinson’s disease and MS. CES is not electro-convulsive therapy, and has few side effects –  such as causing more lucid dreaming. Some contraindications, however, are:

  • Do not use this device if you are pregnant or lactating without first seeking advice from your doctor.
  • Do not use if you have a pacemaker (particularly demand type pacemakers) or other implanted bio-electric equipment without, again, first consulting your doctor.
  • There have been isolated reports of CES treatment lowering blood pressure so care should be taken while using CES in conjunction with high blood pressure medication. The same is true with other medications; who’s effectiveness may be ‘sped up.’ This has the advantage of being able to ‘reduce’ the dosage of some medications.

How often should one use a CES device? That is something that the patient should ask their doctor or neuropathist. If having dental work, we recommend taking the device into the dentist office with you to use during treatment. If treating at home for depression, it depends upon your symptoms; some patients use CES on an ‘as needed’ basis, where others may use it once, twice or three times per day. In our office, we will have patients use it while having other treatments; which can help them to relax or sleep through treatment. Or, for insomnia, most patients use CES an hour before going to bed. While treatment keeps most patients asleep, some people may wake up in the middle of the night and use the device again.

Depending upon the CES device, some MS or Parkinson’s patients may use it on a continuous basis to reduce tremors, drooling or to help bring back the power of speech. With the proper frequency, even facial atrophy and tongue numbness can be helped.

A ‘prescription only,’ device, CES can be purchased through an authorized distributor. Chico Holistic Healthcare can, either, use a device on you during treatment, monitor your use through our office, or help you obtain a prescription to own and use your device at home.

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What is Peripheral Neuropathy?

(Taken from a previous blog on a different site)

 

Peripheral Neuropathy: Simply put… ‘Peripheral:’ meaning the ‘outer most parts of the body; i.e., hands and feet. ‘Neuropathy: meaning, nerve dysfunction.’

Being the only ‘Holistic Neuropathist’ in Northern California (at the time of this writing), I get invited to lecture around our community a lot; as well as, invitations to speak all around the state. I’m James Skaug; not only a neuropathy patient myself, but a practitioner whom treats most forms of neuropathy and other nerve and muscle pain/numbness issues through non-drug, and generally ‘holistic/natural’ means and modalities. In future Posts, I’ll often refer to myself as a patient for example.

What is a neuropathist one might ask? If you look it up in the dictionary, like neuropathy was just a few years ago, it’s not listed. Looking it up on Google, one either finds my name or merely listings for neuropaths, naturalpaths or neurologists. But, unlike a neuropath, naturalpath or neurologist, a holistic neuropathist deals with not only treating the existing pain/nerve/muscle issues, but REBUILDING the nerves and atrophying muscles. We do this by treating with several different modalities; everything from nutrition, to massage, to neuromuscular stimulation, to whole body vibration, to anodyne or far wave infrared therapy, and more!

But, there is more to treating neuropathy than just ‘applying a therapy’ to it or taking a vitamin or pain pill! It is a very difficult process learned by the neuropathist to identify their symptoms; not only as a ‘neuropathy’ but the ‘kind’ of neuropathy in the first place.

There are over 100 different kinds of neuropathy identified by doctors and researchers; and new ones being found every day. Even carpal tunnel syndrome is now considered a neuropathy. What are the most common types? Of course, as previously mentioned, peripheral neuropathy – being the most commonly identified forms of dysfunction. But, there is, also, idiopathic neuropathy, focal neuropathy, proximal neuropathy, autonomic neuropathy, sensorimotor neuropathy, age related neuropathies, mononeuropathies, polyneuropathies or even just ‘diabetic’ neuropathy…, which, also, takes in many of the afore mentioned neuropathy types.

Technically speaking, peripheral neuropathy is caused by a lack of oxygen (hypoxia) to the nerves and tissues. But, this lack of oxygen can be caused by many, many things. Many disorders can cause neuropathy, such as drug addiction, alcoholism, chemotherapy related issues, statin drugs and blood pressure meds, physical and emotional traumas, and etc.; even smoking or the onset of age can be responsible for a neuropathy. Fortunately or unfortunately, with so many different neuropathies and causes, most neuropathies are distilled down by the doctor, and even the neurologist, as being just ‘idiopathic’ neuropathy – meaning ‘of unknown origin.’ Unfortunately, most doctors are either unwilling or are too untrained to not only be able to ‘identify’ the neuropathy, as stemming from a disease such as diabetes, but even just to identify the ‘TYPE’ of neuropathy in the first place; i.e., is the neuropathy ‘short/small’ nerve related or is it ‘long’ nerve related? Does it make a difference? Of course it does; just like it makes a difference if one has type 1 or type 2 diabetes! How about hypoglycemia or either type of diabetes? All three disorders deal with the glucose or ‘sugar’ levels of the blood… high and low… again, of course it makes a difference! One would not ‘treat’ one disorder exactly as another; or else, why would we even distinguish between disorders?

Unfortunately, not all neurologists keep up with current innovations regarding the nerves and neuropathy. Like the term ‘neuropathist,’ neuropathy didn’t even appear in common dictionaries just 7 years ago. It’s a ‘keyword’now; and unfortunately, still, has become something of a ‘catch phrase’ for a lot of disorders when one is unsure of the disorder; with countless chiropractors purchasing ‘franchises’ to ‘treat’ peripheral neuropathy.  But, what they don’t realize is, just as type 1 and type 2 diabetes are different, each of the different neuropathy responds differently to treatment as well – not to mention every patient being different or reacting to treatment in different ways.

In the same sense, many doctors don’t properly identify neuropathy because it falls outside their range of training; choosing to blame the disorder on other issues. Sometimes, however, the “other issues” ARE the reason for the neuropathy. This is especially true with trauma issues to the lower back. Stepping back a bit to bring in more information and to use myself as an example, I have had peripheral neuropathy twice in my life. One was cured, one was not! Whereas, I often today tell people that “most likely, you did not develop this disorder overnight”… that is exactly what I did. I had my back broken and neck injured; and developed instant peripheral neuropathy. One year and 10 days later, I had surgery to correct the damage to the back and achieved an ‘INSTANT CURE’ for that neuropathy. Remember, I have said previously, that out of the over 100 different type of neuropathies out there, only a select few are curable. Mine was… trauma to the lower back, instant neuropathy; surgery to the lower back, Instant cure!

Some twenty years later in life, I developed peripheral neuropathy once again… pain, burning, numbness (something doctors said I couldn’t experience at the same time)… I could hardly walk. The ‘expert’ doctors looked at my back surgery history and proclaimed, “Oh, you’re just having more back issues again. What do you expect… you don’t have all the pieces back there anymore?” Being a neuropathist by this time myself, and running my own tests, I felt the answer lay elsewhere… in the form of diabetes. Seven different doctors all told me “nonsense” and wouldn’t even prescribe an HA1C test to look at my blood sugar levels. Instead, I was told I had, allergies, asthma, COPD, pneumonia, bronchitis, sensitivity to smoke (we had forest fires in our area that time), and even sudden aortic death syndrome…, all, before the last doctor I saw for the sudden aortic death syndrome (one smart cardiologist) asked: “Did you ever stop to think you might have diabetes?” “Yes,” I shouted, as I treated diabetics every day in my office and could see my patients’ very same symptoms in myself!

To make a long story short, he prescribed an HA1C test for me and my results came back that I was not only diabetic, I was VERY diabetic. The cardiologist felt that the pain and numbness I had in my feet was probably from the diabetes.  I concurred.  I, myself, had turned out to be just as I have told many of my diabetic patients for years; “most peripheral neuropathies appear 5 years BEFORE a diagnosis for diabetes is achieved.” So, like most of my own patients , I was a very common, ‘textbook’ case.

Unfortunately, none of the doctors I had seen, had ‘read’ that textbook like myself and the cardiologist had! Just as most doctors have had very little training or ‘book learning’ while in school about issues such as nutrition, most neurologists haven’t had very ‘up to date’ training in school in regard to new research on nerves; and don’t continue their education AFTER graduation to keep up with new procedures or modalities. Because of which, it is my recommendation, when a patient is seeking a neurologist, don’t look for the one who has been around the longest and has the best reputation, necessary; look for the NEW or YOUNG neurologist who has just finished school! Most likely, he/she is much more up to date on current nerve procedures. If nothing else, seek out the biggest and best and most experienced; but go to the new guy for a ‘second opinion!’

But, before ANY surgery is done or anything drastic such as toxic drugs be prescribed and taken, check out a neuropathist to see if the neuropathy can be reversed with something other than radical surgery or toxic drugs. Sometimes, the answer might be as simple as nutrition!

 

Next Blog: The New neuropathy Patient

 

 

Examination and Testing

The first thing I do when I look at most new patients feet is observe the condition of the skin.  Is the skin firm?  Is it filled with fluid (edema), is it discolored, is it covered with fungus… etc., do the toenails have fungus, etc.?

However, if it is a man’s foot and legs which I am looking at, the first thing I might look for is ‘hair;’ hair on the foot, hair on the ankles, hair on the knuckles of the toes and lower legs. As 70% of the people whom enter my office are diabetic, it makes sense right from the beginning to look for signs of type II diabetes.  Of course, their Intake should tell me that; however, often we find that many patients are ‘pre-diabetic.’ Many, including myself, are diagnosed with peripheral neuropathy 5 years BEFORE the diagnosis of diabetes, in fact! Next, we, usually, examine and measure the calf muscles; noting, if they are equal in size. This is compared to other testing factors to tell ‘which’ leg might be more adversely affected. Actually, it IS possible to have a better score on one leg/foot than the other; but, have that ‘better’ leg, be more adversely affected with muscle atrophy or other issues. And, through treatment, or the patients diet, ‘good or bad sides,’ may even switch, from time to time.

Next, observation is made as to if the skin on the legs or feet are cracked and dry or not.  Diabetic ulcers or sores are looked for, measured and recorded/photographed as well; even on those patients who are not diabetic (as, this could be in indication that they are pre-diabetic or fully diabetic and not know it). By photographing the sores, we can accurately gauge how well or fast the sore might be healing.

We can learn a lot just from looking at the feet.  If the tissue is blue or purple, it will lead to the next question: “Do you smoke?”  Or, as stated in previous Blogs, “were you ever a skier or a pilot, etc.”  We need to attempt to find the cause of the lack of circulation to the feet.  If the feet are purple, that is certainly an indication that the blood is just ‘pooling’ down in the feet and there is little circulation.

At this point, we turn to what is known as Toronto Clinical Scoring.  If the patient is diabetic, we use a standard test; however, if the person is not, we use a modified version of it. So, what exactly is a Toronto Clinical Scoring Test; and even more important, what is a MODIFIED Toronto Clinical Scoring Test?

Toronto Clinical Scoring Tests were originally devised to check on the ability to sense ‘sensation’ in the foot or leg; mostly, to determine if someone was suffering from Sensorimotor Neuropathy.  The physician or clinician tests for cold, cool, heat, pin prick and other issues and records their findings.  A totally healthy foot/leg scores 74 points; and points are judged by sensation on a scale of 0 to 10; with minus 5 given for any ‘hyper’ sensitivity.  This test is very effective.  However, during our years of service performing this test, we have found it to be just as accurate and effective for ‘non-diabetics’ as well; we have just ‘modified’ this test to include hands and fingers, arms, toes. Even the face is checked to see if sensitivity is just as keen on one side as the other; as often it has been found that a stroke or small TIA could affect the results of the test. If one has had a stroke or TIA, then sensitivity is going to be lower on the side with the stroke; i.e; testing scores will be lower on the side with the stroke.

Generally speaking, if one scores the same up and down a leg and foot, but still has symptoms of pain or numbness (not to mention burning or tingling) or even restless leg syndrome, the results tend to dictate symptoms of  ‘long nerve’ neuropathy – meaning, the ‘long or longest’ nerve in the body. But, when the nerves test differently from one spot to the other on the leg and/or foot/toes (or with the hands/fingers and arms), one is more likely to have short nerve neuropathy. Some of the same symptoms, such as hypersensitivity may be present in either form; as can a few other symptoms.

Is it possible to have BOTH long and short nerve issues?  Most certainly.  In testing, we start looking for issues like hypersensitivity.  In a regular diabetic test, we might take off 5 points if the foot is a bit ‘overly sensitive’ to cold or merely running the tip of a pen or Wartenberg Wheel up the bottom of the foot.  However, we might take of an additional 5 points, for a total of 10, if the foot is also unusually sensitive to cold or other touch. Pain can come from both issues as well; this is one reason, we tend to ‘double check’ ourselves and treat at least once for each short and long nerves. Whichever treatment seems to work better, tends to indicate which neuropathy tends to be the most prominent.

Through the use of this test, we can generally determine what course of action is required for treatment; to RESTORE, MANAGE and MAINTAIN ones reduced symptoms.

Of course, there is much more to determining what is needed besides just a single test; balance issues and testing may be required as well… such as Berg Balance Testing or even examination of the back. We might even check sensitivity to pressure and trigger points; or muscles which have not only ‘shortened’ and are pulling on the spine, but are adding ‘unnoticed edema’ to the back as well. 

But, the ‘Modified Toronto Clinical Scoring Test’ is instrumental in determining the ‘type’ of nerve neuropathy.  The ’cause’ of the neuropathy is quite a different matter; and, depending upon our findings, ‘assorted modalities’ might be in order in addition to a change of diet or lifestyle.

 

Next Blog: Berg Balance Testing.

Ask the Neuropathist!

Welcome to Ask the Neuropathist.

Neuropathists treat pain, burning, numbness, tingling and other issues; generally, associated with Peripheral, Autonomic, Proximal, Focal or Sensorimotor neuropathy; however, there are many more forms of neuropathy with other symptoms as well.

This page offers two ways to ask questions: either, questions in general for us to put into our Blog, or “Quick/Short Questions;” for “Ask the Grumpy Neuropathist!”

This site is not intended to diagnose or give medical advice in any way, shape or form. It is strictly to be used as an informative site to help explain some of the ‘myths’ regarding neuropathy, and actual treatments/modalities which are available through some doctors, neuropathists or physical therapists.

 

The New Neuropathy Patient

OK, you have seen your doctor or neurologist and he/she says “you have peripheral neuropathy!” Most likely, he has prescribed some sort of medication such as Gabapentin (Neurontin), Cymbalta (Duloxetine) or Lyrica. There are other drugs, but these are the primary ones to treat peripheral neuropathy – or ‘nerve pain,’ that is. Gabapentin, or its generic equivalent, Neurontin are anti-convulsive agents, and Lyrica, and Cymbalta are anti-depressants. Like other common neuropathy drugs, like Topamax, they can be used for many other issues besides what they were designed for. Unfortunately, these agents, like most drugs, have certain negative side effects; the thing neuropathists are concerned with is the fact that they ALL can cause neuropathy symptoms.

What was that? Was that a misprint? Neuropathy meds can CAUSE neuropathy? Absolutely! It doesn’t seem logical that one takes an agent which causes neuropathy to treat ones neuropathy, does it? Let’s step back and look at the big picture again; are these agents useful for neuropathy pain? Absolutely! I have taken them myself before I was diagnosed as having neuropathy – my doctor thought my issue was my former back injury. (In my case, however, I gave up the Gabapentin after only three days as I was unable to drive, work was difficult, as was my ability to even think while taking it. And, the Lyrica CAUSED depression in me.) But, even though I was a working neuropathist, I thought I should at least try what my competition was offering for neuropathy. (Frankly, my nerve pain in my feet was so severe that if someone had suggested “shoving beans up my nose” would have helped… I would have found myself with a nose full of beans!) It wasn’t until I had a visit from a patient in my office, that I made the decision to stop my meds – which, I’ll talk about in a moment.

I found that whereas my own treatments helped, the meds simply did not; at least, not the way I wanted them to. They caused many side effects with me that I didn’t like. Weight gain, depression, sleep issues, anxiety and stress to say the least. Did they help with the pain in my feet? They certainly did – but, I found there was nothing in the drugs which directed them to ONLY go to my feet. They went all through my body; aiding with pain in my back and elbow, but NUMBING my brain where I couldn’t think or work well. I had trouble making decisions or holding conversations, and certainly, my reflexes were adversely effected. When I drove, I was all over the road! In addition, my feet went from hurting, to having major burning and numbness. Before the meds, I had only a little numbness in my toes, but now my feet were totally numb.

Of course, my neurologist told me; “Oh, you can’t have pain and numbness at the same time.” But, as many of my own patients had told me, I certainly did have both pain and numbness – not to mention burning and swelling. In addition, I was informed by the neurologist, “You are only going to get worse. You will soon be in a wheelchair.”

As it happened, a long time patient came in to see me about this time, and was surprised to see me walking with a cane. He had just been given a prescription for Gabapentin for his neuropathy. “What do you think of this,” he asked me? “Now Ed,” I responded, “Gabapentin is great for nerve pain, but you’re only symptom is numbness! Why would you want to take something that causes numbness to treat your numbness?” I had to look at myself for a moment. I could ask myself this same question! Taking my own advice as a neuropathist, I discontinued my meds and pursued an upgraded plan for myself. (You see, even we neuropathists want to listen to our doctors – but we have to make an educated judgment as to pursue the recommended treatment or not!)

The first thing I did, was to have someone in my office perform a test on me – what I had only performed on diabetics up until that time. A Toronto Clinical Scoring Test. I knew that a new biopsy, as suggested by my neurologist, would be inconclusive; as we have TRILLIONS of nerves in our feet and legs – and just happening upon ONE nerve which told the whole store would be a trillion times more difficult than just picking an ‘Ace of Spades’ out of a deck of cards. I hadn’t had neuropathy very long, so there wasn’t much damage to my feet and legs. A nerve conduction test was next ordered. Again, how conclusive would this test be, as my feet were still new to the damage? Plus, so many times, I had seen ‘so-called’ dead nerves begin to respond after as little as two minutes of neuromuscular stimulation. Not surprisingly, the test was inconclusive; as was, the nerve biopsy which I was talked into and soon followed. The Toronto Test showed that my nerves were quite good in both legs and feet. I had my technician check my hands. Same thing. No sign of neuropathy in hands or arms. My symptoms appeared to be totally of a ‘long nerve’ issue. So, being a long nerve issue, I knew that this issue had to come about because of hypoxia – in other words, a ‘lack of oxygen’ to the synoptic junctions of the long nerves.

My schooling reminded me, that whereas I was now diabetic, I did have some damage to my lower back; so I couldn’t rule out my back as being at least partly at fault for my neuropathy and lack of oxygen to the synoptic junctions. But, be that as it may, I would proceed as if I was just a diabetic with neuropathy; then, after keeping strict records, analyze and change modalities as necessary.

I stepped up therapy on myself using a neuromuscular device which put out a low amount of Hertz – one, which was approximately the same as the frequency that my own body had… 7.83 Hertz. Along with daily treatments, I started keeping a closer eye on my blood sugar; not only taking my readings on a regular basis, but now supplementing my diet with cinnamon with chromium. Two to three thousand milligrams seemed to be the correct dosage for me (everyone needs to check with their doctor or nutritionist before starting any vitamin or supplement program, which I will go into more detail in later Blogs). After a few weeks, my feet started getting better; and, I was able to go for a longer period of time between treatments. I reached a plateau, however. The same plateau I had reached with several patients. We would reach a point where the feet could ‘hold their own,’ but not continue to get any better. Through additional research and study, I found that if I added a new modality of whole body or localized vibration, my patients and myself could bypass that plateau and proceed to further recovery.

Our office motto has always been to REDUCE, MANAGE and MAINTAIN symptoms, and now we were doing better with more options. I now incorporated another modality which my patients had found so helpful – especially, when it came to ‘burning’ of the feet and toes; vitamins and supplements. I have always known that my diabetic patients were short on vitamin D, but apparently most of my other patients were as well. In addition, we found that most of our patients were deficient in the B vitamins; particularly, B1 and B6. As with my patients, my nerves became more conductive with the addition of a B complex, and symptoms continued to improve – especially, when an omega 3 was added. I then added ALA (alpha lipoic acid, as it is known). When mixed with the vitamin B1, my burning symptoms totally went away.

Cut to several years later, and my feet seldom bother me anymore. YES, I still have neuropathy; and I still, occasionally, give myself a neuromuscular treatment. In addition, I still take daily vitamins and supplements and my daily diabetic medicine to keep my blood sugar as normal as possible. If I could somehow find a cure for my diabetes, I’m sure my neuropathy would clear up as well; but until that time, I have to be willing to accept the ability to REDUCE, MANAGE and MAINTAIN my symptoms. Treatment is generally only once every two or three months.

Next Blog: Intake