fight or flight response

The World We Created Causes Us to Over Breathe

What is the Cause of Over Breathing?

I’ve already written about the importance of breathing to our health, the biochemistry and mechanics of breathing, what optimal breathing looks like and what it doesn’t look like, so it is now time to discuss the cause of dysfunctional breathing or over breathing.

In short, STRESS CAUSES OVER-BREATHING. More specifically, we become conditioned to respond to stress by over-breathing or mouth breathing as an emergency response.

Our innate response to stress is the ‘fight or flight’ state which is an evolutionary response to a perceived threat, and served to effect changes in our bodies that prioritise or make us more capable of ‘fighting’ or ‘fleeing’. For example, if a wild animal poses a threat to our safety, we choose to either fight or flee the source of this extreme stress. In this evolutionary example, the stressor either goes away either by us successfully fighting or fleeing the animal. Or we die. There was indeed an “emergency” that asked for a body/mind response that called upon all of our resources. With the removal of the stress, our physiology returns back to a basal level and we return to the tasks of living.

The modern stressors we deal with are, more often than not, far less threatening to our safety. Whilst the the sources of stress are often far less severe, due to the culture we have created being far different to the environment our bodies evolved or adapted to, they are far more chronic or long lasting. Unfortunately we do not often return to this basal low level (or zero level) of stress we predominantly existed in (outside of emergencies) in times past. As a result we reduce our body’s ability to deal with more acute stressors and we often regularly respond in ‘emergency’ fashion to stressors that do not require this response.

Nevertheless, the process of evolution has led to us responding to any stress in a way that has long been our mode of functioning, because that its what we evolved to do. That the severity and types of stress we now deal with are vastly different to those we evolved dealing with is not of consequence to the body. Our safety is far more assured than in previous times, yet our body still responds with this ‘fight or flight’ mechanism.

Our body’s innate stress response is driven by the ‘autonomic nervous system’ (ANS) – a part of our nervous system that controls the functions of our organs and many of our body’s functions (including respiration!!) which functions regardless of whether we are conscious of it or not; i.e. the functions it controls still operate whether we are awake or asleep. It comprises the sympathetic nervous system (SNS), which excites or arouses the body to prepare for the ‘fight or flight’ stress response, and the parasympathetic nervous system (PSNS), which calms the mind and rejuvenates the body. The sympathetic and parasympathetic divisions typically function in complementary opposition to each other.

A common analogy used to compare these two facets of the autonomic nervous system describes the SNS as the ‘accelerator’ and the PSNS as the ‘brake’. The sympathetic division typically functions in actions requiring quick responses. The parasympathetic division functions with actions that do not require immediate reaction.

The ‘fight or flight’ response to stress causes the sympathetic nervous system to dominate. Sympathetic nervous system dominance leads to the following changes characteristic of the ‘fight or flight’ response:

  • Adrenaline levels in the blood rise.
  • Over time, blood levels of cortisol increase.
  • Heart rate increases
  • Blood pressure increases
  • Blood is redirected from the digestive system to skeletal muscles
  • Breathing rate and volume increases
  • Triggers the burning of sugar and storage of fat.
  • Elevation of plasma levels of clotting factors and histamine.

When breathing rate and volume rise we over breathe. When we over breathe we lose too much CO2 and the blood becomes too alkaline. As a result, haemoglobin holds on to inhaled oxygen in the blood stream, cells become deprived of oxygen and we experience different symptoms.

Once this response occurs regularly enough it becomes a conditioned response or a habit. Over time, this adaptive response, originally designed as an emergency response to an acute stress, becomes our normal mode of functioning.

But, as humans we are born ‘obligate nose breathers’ meaning that we do not possess the voluntary ability to breathe through our mouths. Mouth-breathing, the most common example of over-breathing is a learned response triggered by our emergency response to stress.

For example, you will notice that newborn infants breathe quietly through their nose all of the time. However, if their nose becomes blocked they will struggle to get air into their lungs. As they have not learned the response to mouth breathe, they will begin to suffocate. As a response, they begin to cry which allows large volumes of air to enter the lungs rectifying the emergency. The infant then returns to its normal nose breathing.

When subsequent stressors arise they repeat this emergency response, until they become conditioned from a very early age to respond to any sign of stress with this emergency mouth breathing response.

In our modern world of chronic low level stress, mouth-breathing, originally an emergency response, becomes a conditioned response and a habit. And, eventually our normal way of functioning.

The parasympathetic nervous system, on the other hand, promotes a “rest and digest” response, thus a calming of the nerves return to regular function, and enhance digestion. Some of the functions of the PSNS are:

  • Increase in digestive system function.
  • Breathing rate and volume decrease
  • Lowering of the heart rate (or returning it back to normal or resting rates)
  • Lowered blood pressure
  • Reduced blood cortisol
  • Constriction of the pupil and contraction of the ciliary muscle to the lens, allowing for closer vision.
  • Stimulation salivary gland of secretion, and accelerates peristalsis, so, in keeping with the rest and digest functions, appropriate PNS activity mediates digestion of food and indirectly, the absorption of nutrients
  • Increase in blood flow to the brain
  • Increase in ‘happy’ neurotransmitters, serotonin and dopamine – low levels of these are seen in depression
  • Is also involved in erection of genitals
  • Stimulates sexual arousal
  • Increase in night time melatonin – promoting a more restful sleep.

If you observe the cascade of changes that are evident when we over breathe and are in ‘fight or flight’ responsiveness, you will see that this cascade of changes accounts for many of the pathologies that occur in a great number of the chronic ailments we suffer from in the modern world.  Which, in turn, points out that over breathing is not something that we should ignore or take for granted.

The Breathing Dynamics training program will teach you to beak the cycle of over breathing, and help to get out of habitual ‘fight or flight’ responsiveness.

 

Breathing is a function that is vital for life - yet most of us completely take i8t for granted, and don't even though that we breathe way below optimal levels...

BREATHING FOR LIFE – OR DEATH!!

Introduction to Breathing Dynamics – Why is Proper Breathing So Important

Breathing is the most central process of our functioning that we have direct conscious control over and the area where we can have the most influence regarding whole health.

Breathing is central to all life – we cannot live without it for more than a few minutes.

It is the one thing we do more than anything else – the average person breathes up to 30,000 times per day on average.

BUT did you know that:

  • The quality of your breathing affects the quality of your life?
  • And that most of us OVER-BREATHE – both in rate and depth? For example, diagnostic norms suggest that we should breathe 12-14,000 times per day rather than 30,000 times.
  • Do you know what it means to breathe OPTIMALLY?
  • The limiting factor in OPTIMAL RESPIRATION, and therefore OPTIMAL ENERGY FOR OUR CELLS, is not a lack of oxygen that we inhale? It is a lack of oxygen released into cells (due to low levels of carbon dioxide) caused by OVER-BREATHING OR DYSFUNCTIONAL BREATHING!!!!

So why do most of us take our breathing for granted?

Why do we accept less than optimal breathing function?

Perhaps, until now, we have not been aware of the link between dysfunctional breathing and symptoms of ill-health or disease. Some of these symptoms include:

 

Fatigue & Lethargy Digestive upsets – IBS, constipation, diarrhoea. Irritability Waking un-refreshed
Anxiety Allergies Shortness of breath Headaches/migraines
Depression & emotional disturbances Skin irritations – eczema etc. Breathing difficulties – asthma, wheezing. Sinusitis & excessive mucus production
High blood pressure Poor  concentration Night-time toilet trips Frequent colds & flus
Dental problems &/or deformities Memory loss Poor sleep or leep disturbances Muscular or nerve chest & pains

Also, very few of us are aware that we could make significant changes to our health, stability, posture, attention, composure and sleep quality by learning how to breathe functionally. In addition to reversing the symptoms of ill-health or disease mentioned above, some more of these changes include:

 

Enhanced energy levels Greater endurance & stamina Improved focus & concentration
Improved immune system function Improved blood flow to extremities Improved responsiveness to stressors
Better posture & stability Delayed lactic acid onset during exercise Greater access to “Zone” states during exercise/performance
More relaxed muscles/joints Better focus & concentration Enhanced happiness/self image
Improved flexibility Improved mood stability Lower heart rates

 

Breathing Dynamics aims to restore optimal or functional breathing and therefore maximise delivery of oxygen to cells (for energy) by offering a variety of understandings and techniques that encourage:

 

  1. Breathing through the nose at all times.
  2. Using the diaphragm as the principal or primary muscle for breathing.
  3. Regulating breathing rate and volume.

 

We offer breathing retraining courses for individuals and groups, which usually run for 8-10 hours (broken up into a few sessions) plus ongoing evaluation. These courses have a strong practical focus. To facilitate learning, we use CapnoTrainer® biofeedback technology, which gives an individual information on their own functioning from their own body’s perspective rather than just relying on coaching or feedback from a another person. By the end of the course we give clients the knowledge and understanding, both theoretically and practically, for them to be able to breathe functionally or optimally in many of life’s varying circumstances.

We also offer online modules (purchased via the online shop) on breathing retraining to optimize function and facilitate healing for a number of ailments and purposes. These include:

  1. Asthma
  2. High blood pressure/hypertension
  3. Fatigue
  4. Anxiety/depression
  5. Snoring/sleep apnoea
  6. Eczema/skin conditions
  7. Stress management
  8. Allergies
  9. To facilitate dental corrections
  10. Enhanced sporting performance
  11. Enhanced work performance – artistic and business.
  12. Ability to hold the breath underwater (specific to surfers etc)
  13. Breathing for yogis.
Keys to maintaining constant energy levels throughout the day, and preventing illness.

Optimal Performance Nutrition for Feeling Awesome

Blood Sugar Regulation for Optimal Performance

Blood Sugar Regulation is aimed at regulating blood sugar levels to optimise energy production (and remove slumps in energy levels – such as mid afternoon).

Most of us over-consume or eat mostly carbohydrate rich foods, which the body converts into high levels of glucose for energy production in the cells. It is estimated that the average Westerner consumes at least 50% more carbohydrates daily than our hunter gatherer ancestors. In response to a higher carbohydrate intake, the pancreas produces high levels of insulin, which is used to transport this glucose to the cells for energy production.

Excessive production of insulin is termed hyperinsulinaemia, and prolonged hyperinsulinaemia can result in the cells becoming insulin resistant. The cells do this to prevent more energy being produced than our body demands at the time. What this means over time however, is that the cells, having become conditioned to being resistant to insulin, can no longer get the glucose they need for energy.
The cells of the body make up all of the systems within the body. If these cells cannot produce enough energy to function properly, then the systems begin to break down leading to the indicators of lack of health mentioned earlier. And, ultimately to more the deep seated, chronic pathological conditions.

In addition, insulin resistance is a process that is inflammatory in nature. It is no surprise also, the the chronic illnesses that we most commonly suffer from, and that account for 90% of deaths in the Western World, are inflammatory conditions.
Unfortunately, as is very often the case, if the input of fuel for energy outweighs the demand for energy, then this glucose floating around in the blood stream must be stored. Apart from the small amounts of glucose that can be stored in the liver and skeletal muscles as glycogen, the main storage mechanism of this fuel involves converting the glucose to fat and storing it wherever this fat may be deposited (and most of us are aware of these areas in our own bodies).

What compounds this even further, is that insulin is a storage hormone, and elevated levels of insulin, or hyperinsulinaemia, prevents the release of this converted glucose from the fat stores when it is required. Fat is the most efficient source of fuel for energy in our bodies (in terms of amount of energy produced per gram), and when the cells can no longer gain access to this extremely efficient fuel source, apart from the circulating glucose in our blood or glycogen stores in the liver and muscles which are very limited, the body must access our protein stores for energy. Our protein stores include our muscles and vital organs. Not ideal.

Extensive scientific research has shown that the number one biological marker in the body of ageing is a reduction in our muscle mass to fat ratio. And this marker adversely affects all other biological markers of ageing; such as basal metabolic rate, heart rate, blood pressure, cholesterol levels, HDL (good fat) to VLDL (bad fat) ratio, bone density, blood sugar tolerance, aerobic capacity etc.
So, in addition to our systems not producing energy efficiently and adequately, and potentially leading us down the path to obesity, we are also accelerating our own ageing process. This all leads to a poor quality of life in comparison to what is available to us all if we are prepared to open up to our genetic potential.

If you are lean it does not mean however, that your cells are not insulin resistant. It just means that you are burning all of your circulating glucose for fuel before it gets deposited in the fat cells. The excessive levels of carbohydrates and resultant insulin resistance will still cause the body to function less efficiently as it will not produce the energy required at the rate that it is demanded, as it can’t get access to the fuel quickly enough. And body will also be inflammatory.

The “Optimal Performance Nutrition” program is based on predominantly eating foods that our hunter gatherer ancestors ate, as, from a genetic perspective, our body still functions as if we were still wandering the bush. These foods are generally low glycaemic load (GL) foods. The GL is the ranking of foods based on their immediate effect on blood glucose (blood sugar) levels and the amount of sugar they contain. The lower the GL, the lower the sugar content, and the better the food is for you.

Some of the benefits of a low GL diet:
• Improved energy levels.
• Maintenance of healthy cardiovascular function.
• Weight/fat loss.
• Low GL foods keep you feeling fuller for longer.

It was once thought that table sugar and particularly sugary foods such as sweets were the only foods that had to be avoided by people trying to control their blood sugar. However, the GL has shown us that complex carbohydrates such as potatoes, and particularly refined grains such as white flour (bread, pasta, cakes, biscuits, many cereals etc. etc.) and white rice can have an effect that is comparable to eating table sugar. And our hunter gatherer ancestors did not have access to these foods either.

One of the reasons for this is that refined grains have the fibrous, outer (often brown) shell removed. This outer shell, or husk, contains a lot of fibre which slows down the entry of the sugar into the blood stream. Fibre is also very important in maintaining the motility of our digestive system, and keeping our bowel movements regular. Given that up to 70% of our immune cells line our digestive tract, it is far more healthy to have an efficient, regularly moving digestive system than one that is blocked, irritated and festering!!!!

In addition, the husk also contains most of the micronutrients (vitamins and minerals) in the grain. These micronutrients are essential in so many of the chemical reactions and processes that occur in the body. If these vitamins and minerals are absent in the food we consume, then the body will take them from its own stores.

An example of this is Calcium. The main stores of calcium in the body are in the bones and muscles. Calcium is essential in firing many of the chemical reactions in the body, including the production of energy in the cells. If Calcium is deficient in the food we eat, then the body will remove it from the bone and muscle stores. Maybe this may go a long way towards explaining why in the Western World, whilst we are the largest consumers of dairy (which are high in Calcium), we also experience the far higher rates of osteoporosis in comparison to countries where the population eat predominantly whole foods, and are far more active. Is it possible that because we eat such extraordinary amounts of refined carbohydrates, that our bodies end up leeching our bones of major minerals such as Calcium or Magnesium to perform their functions?
So, essentially, when consuming refined grains, you are eating nothing more than empty, sugary calories (see Table 2 – Pasta & Sugar Equivalents).

In addition to low GL foods, the Optimal Performance Nutrition program may require you to modify your protein intake. More specifically, to have small amounts of protein regularly. This is because you may not have been eating enough protein at certain times of the day, and too much at other times. A healthy protein intake improves appetite control, increases metabolism and helps maintain lean muscle mass. It is important to note that this does not imply or suggest a high protein diet – just a small to moderate amount regularly.

On the Optimal Performance Nutrition program you will also need to ensure you consume adequate amounts of “good” fats, known as ‘essential fatty acids’. Whilst saturated fats and trans fats (a thickener found in margarine, spreads, biscuits etc.) are very bad for you, certain fats and polyunsaturated fatty acids are very good for us and have important health benefits. Fats from oily fish, nuts, seeds, and healthy oils such as extra virgin olive oil anti-inflammatory and immune stimulating. They improve a wide range of conditions and may even help improve your mood and skin.

To gain optimal performance from your nutritional program, certain basic guidelines need to be observed.

In this program Tim will assess your current daily food intake and offer solutions to optimise your health and energy production by providing a plan which focuses on your body’s needs.

Follow up consultations will continue to assess your performance and energy levels while building a solid foundation for a healthier, happier you.

Mickel Therapy

Mickel Therapy. A potent cure for CFS, Fibromyalgia, IBS & Anxiety. Also fantastic for Performance

Article: Why it’s time to eliminate ‘should’ from your vocabulary.

In Mickel Therapy we show how being guided by our Primary emotions can lead to health & wellbeing. It’s amazing how little words like “should” “must” and “have to” can prevent us from taking the action that feels right in our gut. This is an excellent article that highlights the danger of a little word like “should”.

http://coach.nine.com.au/2016/12/08/13/55/attack-of-the-shoulds

Since I’ve taken on Mickel Therapy as a modality nearly 3 yeas ago, I’ve seen more complete recoveries in clients suffering CFS, fibromyalgia, IBS and anxiety than I’d seen previously in my 16 years of practice specialising in treating these chronic ailments, or that I’d heard from other practitioners, including integrative doctors.  It is also fantastic for performance, relationships, work-life balance etc.

The results have been a wonderful surprise. After investigating it and understanding it properly, I knew it made sense, bu I did not expect it to yield such outstanding results. It shouldn’t be a surprise in theory, given it gets to the root cause by targeting a hypothalamus in overdrive (in perpetual fight or flight) and dealing with how we uniquely process stress as individuals. Stress, especially internalised stress, then adversely affects the performance of all other vital functions that influence our health – nutrition, sleep, how we move and stabilise, breathing, all automatic functions, how we rest and rejuvenate, and how we think and emote.

 For more information on how Mickel Therapy could help you, please contact me. I would be happy to offer a fee 15 minute initial chat to see if it resonates with you and could help you.

‘Self Silencing’ Will Make You Sick – Especially in Women

Article: “When Silence Isn’t Golden”

Linked is a terrific article focusing on how research into a personality trait called ‘self silencing’ adversely affects women’s health.

Self silencing refers not only to not speaking one’s mind or bottling up feelings, it also refers to a chronic mindset which is conditioned in most women, a habit of staying quiet and putting your needs second to those of everyone else.

The article highlights a few research studies which reveal links between self silencing and several common chronic ailments including IBS, depression, eating disorders etc.

http://well.blogs.nytimes.com/2007/10/02/when-silence-isnt-golden/?smid=fb-share

Definitely an interesting article that is worth a read. And something I see regularly in women when working on overcoming chronic illness using Mickel Therapy.

Silence, or suppressing one’s own needs over others, can often lead to suppressed emotions which send the hypothalamus into overdrive. Whilst symptoms are very real, they are often impossible, or extremely difficult to remove unless you get the hypothalamus out of over-drive, by reversing sub-conscious, self limiting patterns, such as not communicating or meeting one’s needs.
The key to Mickel work is an action based technique that addresses these patterns and restores ideal function in the hypothalamus. When the target action is appropriate (and you will know from the body’s reaction), symptoms start to resolve in chunks.
I have seen many cases of complete resolution of previously immovable cases of chronic illnesses, including CFS, fibromyalgia, anxiety, depression, IBS etc. using this wonderful technique.
It’s also fantastic for removing self-limiting patterns that hinder performance, weight loss and general happiness.

Look at the information on this website or contact me if you’d like to discuss Mickel Therapy further. I offer a free 15 minute chat or consultation for those interested.

 

 

 

 

Article: Asthma. “The End of the Beginning”

Asthma. “The End of the Beginning”. How to prevent the onset of an attack rather that treating it after the event?

Below is a fantastic article by respiratory physiologist, Roger Price, who taught and inspired me to be a respiratory therapist, on the natural, drug free prevention and treatment of asthma that gets to the ‘root cause’ of the condition rather than the medical approach of putting out fires. The breathing based solution is easy to learn and implement and does not take long to see results. The long term results, most of the time, see clients free of reliance on pharmaceutical medications to manage their asthma, and free of symptoms.

If it sounds too good to be true then read the article and read further on respiratory therapy on this website and you’ll see it’s the simplest and most logical solution to the prevention and treatment of asthma. And that’s exactly why it woks so well.

Roger is now based in the USA kicking goals as a health educator spreading the incredible value of respiratory therapy and breathing retraining as a fantastic solution (or co-solution) to many ailments, chronic health conditions and as a potent performance enhancement tool.

The article is published in the Journal of Lung, Pulmonary & Respiratory Research – Volume 3 Issue 2 2016.

Instead of linking it, I’ve copied the whole journal here – including references. It’s definitely worth a read for anyone interested in furthering their understanding of asthma and/or breathing retraining. I think it sums up the whole situation or mess associated with asthma, and outlines the solution beautifully.

I also included Roger’s Facebook summary at the beginning.

 

“For over 50 years I have been involved with people who have been diagnosed with “asthma” and have seen the industry grow from one or two simple ephedrine and theophylline based medications to a multi-billion dollar enterprise where Asthma – COPD medications now occupy 40% of the top 10 selling drugs on the market – creating an annual wholesale revenue of around $12 billion.  The reality is that nobody ever gets better – they just have their symptoms chemically controlled.  Attached is an article just published June 2016, in the Journal of Lung, Pulmonary and Respiratory Research JLPRR.  

 

Journal of ISSN: 2376-0060JLPRR 

Lung, Pulmonary & Respiratory Research

Review Article

Volume 3 Issue 2 – 2016

Asthma. “The End of the Beginning”. How to prevent the onset of an attack rather than treating it after the event?

Roger L Price*

Respiratory Physiologist and Integrative Health Educator, USA

Received: May 15, 2016 | Published: May 19, 2016

*Corresponding author: Roger L Price, Respiratory Physiologist and Integrative Health Educator, Breathing Well LLC, 1425 Broad St Suite B, Clifton NJ 07013, USA, Tel: (973) 778-9225; (505)331-1051; Email: 

Citation: Price RL (2016) Asthma.“The End of the Beginning”. How to Prevent the Onset of an Attack Rather than Treating it After the Event?. J Lung Pulm Respir Res 3(2): 00080. DOI:10.15406/jlprr.2015.03.00080

  Download PDF

Go to…

NOTE: The complex physiological and biochemical processes have been deliberately simplified in order to allow lay people to grasp the concepts without being confused by the pure science. What is essential is for people to understand ‘why’ and not necessarily to have to know ‘how’.

Author’s Note:

I fully accept that asthma is a potentially life threatening condition and strongly support the use of appropriate medication when required. What I do not support however, is the reckless abandon with which ‘puffers’ are prescribed and used, for everything from a niggling cough to fundamentally dysfunctional breathing – which has nothing to do with asthma.

How does an ‘asthma attack’ begin?

The first signs are usually tightness in the chest and difficulty in breathing.

WHY does this happen?

No matter which definition you use, nor which set of data are used as a reference, the message is always the same.

“Asthma is a chronic inflammatory disease of the airway causing the breathing tubes to narrow”

Again – one must ask the question WHY? What is the cause of the inflammation, how does it happen, and what can be done to prevent this?

But firstly, let’s look at some facts about ‘asthma’.

The following statement has been taken directly from the Website of the American Asthma and Allergy Foundation.

Go to…

 

WHAT CAUSES ASTHMA

“Since asthma has a genetic origin and is a disease you are born with, passed down from generation to generation, the question isn’t really “what causes asthma,” but rather “what causes asthma symptoms to appear?” People with asthma have inflamed airways which are super-sensitive to things which do not bother other people. These things are called “triggers.”

If this is true – where does the notion of “late onset asthma”, “hidden asthma” and “exercise induced asthma” come from?

And furthermore, why is it that in the vast majority of cases that I have come across in the 50 years plus, that I have been working in this field, very little – if any – family history is taken, relative to the incidence of asthma in parents, grandparents, siblings and children? The diagnosis usually relies on either spirometry, peak flow or provocation tests – and the outcome is predictable.

My understanding of the nature of heredity in asthma is confined to three specific areas:

  1. The bands of smooth muscle surrounding the bronchioles, are thicker, stronger and tighter than in people with no genetic tendency – and when these bands tighten – it is very difficult to get them to relax.
  2. The mucus producing cells in those with genetic asthma are larger and more productive, so on stimulation, will produce copious amounts of mucus – causing the wheezing.
  3. People with ‘heredity asthma’ usually have a far wider range of allergic triggers, creating an enhanced environment for problems to occur.

BUT this does not adequately answer the question as to what causes the onset of an attack.

If one looks at the structure of a bronchiole it is easy to see what happens when the smooth muscle bands go into spasm.

The airway narrows and makes breathing difficult.

What is it that triggers the spasm in the smooth muscle bands?

Surprisingly enough the main trigger is the sudden drop in Alveolar or End Tidal CO2. The moment the brain detects that the PaCO2 pressure is dropping and the pH of the respiratory system is heading towards alkalosis, it immediately acts to restrict further loss, by narrowing the bronchioles.

If the person persists in gasping, overbreathing and any other activity which continues to drop the ETCO2, then the mucus cells respond by producing copious amounts of mucus minimizing loss by further occluding the airway.

This is NOT a disease. It is a protective mechanism initiated by the body to prevent cell death from respiratory alkalosis brought about through hyperventilation/overbreathing.

The simple answer to a complex question is that it is primarily mouth breathing, or overbreathing/hyperventilation, that causes low CO2 levels, or hypocapnia.

Could you imagine a person sitting quietly in a chair, breathing gently through their nose, suddenly having an ‘asthma attack’? Unlikely. Most ‘attacks’ come through a sudden change in breathing patterns – usually accompanied by a rapid drop in ETCO2. Exercising with open mouth, crying, laughing, coughing – all lower ETCO2 – provoking bronchospasm – ultimately leading to a full blown attack.

According to a study in the UK published in January 2015, more than one million people in the UK have been misdiagnosed as having asthma. 1

In my own practice, in which I have certainly handled more than 10,000 ‘asthmatics’ over the years, less than 10% have required ongoing management with bronchodilators and corticosteroids. The vast majority have been able to lead perfectly normal lives just by learning how to breathe functionally.

This has been borne out in numerous trials, papers and reports – published in the cream of respiratory journals such as Thorax, Chest, and the main medical journals such as the BMJ, AMJ, MJA and others. See the list of published articles and trials at the end of this article.

So this calls into question the accuracy and validity of the current method of diagnosing asthma

The first fundamental law of scientific measurement states that the measuring methodology should not alter the parameters of the function being measured.

Considering the rapid effect that a sudden drop in ETCO2 has on bronchioles, causing almost an instant response, does spirometry and peak flow not provoke bronchospasm?

If that bronchospasm is provoked, and the patient is then nebulized in order to break the spasm, and the next reading taken when the airway is artificially ‘propped open’, where is the validity in the ‘diagnosis’ that the person has ‘asthma’?

The Gold Standard for Asthma Management

I remember only too well the sacrosanct command that if a reliever was used more than 4 times a week, asthma was out of control, there was a danger of heart problems developing from the over-stimulation brought about by the adrenalin-type action of the salbutamol, and that it was then ‘mandatory’ to use a steroid preventer to reduce the amount of reliever.

The main purpose of the inhaled steroid – and of course the systemic prednisone, was to suppress the immune response and reduce the inflammation to such a degree that it was no longer necessary for the regular use of bronchodilators, avoiding the associated side effects.

Contradiction One

If the use of a short-acting bronchodilator more than 4 times a week is deemed dangerous,where is the justification in giving someone 24 hour long-acting bronchodilator, which is the equivalent of 6-8 puffs of short acting beta 2 agonist, every day of their lives?

What has been suggested is that by altering the chain length of the beta-2 agonists, there is less of a “jolt stimulation” to the heart and a lower risk of an adverse effect. This is borne out by the warning that the long-acting beta-agonist (LABA) should not be used as a ‘rescue’ to address an immediate attack, as it can take up to 40 minutes before the effect is felt. The reasoning further goes on to explain that by using the long-chain drug there is a smoother and more sustained bronchodilating effect which has a lower risk.

But what about the effect of a 24 hour bronchodilator? There are numerous papers and articles written about the remodeling of the airway as a result of long-term (lifetime) asthma medication – and it is no secret that in many segments of modern medicine ‘iatrogenesis’ or as it is more subtly put, ‘unintended consequences’, have the potential to cause additional comorbid diseases.

Propping the airway open, in direct conflict with nature’s response to shut it down, has the potential to cause inflammation of the mucous lining. Is this perhaps the reasoning behind adding the inhaled steroid to the combination drug, to address the inflammation that was caused by propping it open in the first place? A little like the boy who shot both parents and then asked the judge for clemency on the grounds that he was an orphan.

Contradiction Two

Everyone knows that cortisone is given to suppress the immune system so that it will not react to, or reject foreign objects. This has been the standby of the organ transplantation industry for decades. Remember however, that in the case of cortisone saturation to prevent rejection, the patient was so at risk of bacterial or viral infection, that people had to be ‘hazmat suited’ before being allowed to visit.

If cortisone suppresses the immune system how in the name of any sensibility can it ‘protect the lungs’ during the cough and cold virus winter season, and even more bizarre, at a higher dosage?

Cortisone certainly helps to reduce the inflammation – but renders the user more susceptible to catching common infections – especially in the winter months.

Using the same general principle, in the same way that the ‘orthodontist’ accepts that the teeth are crooked and have to be straightened, that the ENT accepts that the tonsils are infected and have to be removed, the pulmonologist just accepts the fact that the airway becomes inflamed and has to be treated with steroids.

Just look at the definition of ‘asthma’ and it would appear that the inflammation is of an unknown etiology – usually an immune response to allergic triggers. That is VERY vague – just like saying that the ‘teeth are crooked’ or ‘the tonsils are enlarged’.

Go to…

 

What Is Asthma?

“Asthma (AZ-ma) is a chronic (long-term) lung disease that inflames and narrows the airways. Asthma causes recurring periods of wheezing (a whistling sound when you breathe), chest tightness, shortness of breath, and coughing. The coughing often occurs at night or early in the morning.

Asthma affects people of all ages, but it most often starts during childhood. In the United States, more than 25 million people are known to have asthma. About 7 million of these people are children.”

AND – how does this definition then correlate with that of the Asthma and Allergy Foundation of America statement that “Asthma is a disease you are born with?” The contradictions are bizarre and, quite frankly, embarrassing to say the least. What we have here is a concept that appears to be fundamentally flawed. Well… If the concept is fundamentally flawed, and you specialize in it, all you become is a specialist in a flawed concept. It does not make that concept any more valid.

Nowhere does it explain HOW and WHY the inflammation occurs – it just accepts that it is there and medicates it.

Why does the airway become inflamed?

The answer is so simple it is embarrassing. The airway becomes inflamed largely because it is subjected to a large volume flow of inhospitable air, and is simply not designed to be able to cope with this onslaught.

The air entering the lungs needs to be:

  • The correct volume
  • Filtered
  • Sterilized
  • Warmed/cooled to body temperature
  • Humidified so that the lungs are able to allow the gases to permeate (Henry’s and Fick’s Laws)

The NOSE is the perfect 4 stage filtration system, and in addition to the filtering process, nasal breathing stimulates the paranasal sinuses to produce and release Nitric Oxide, which is a potent antimicrobial as well as a vasodilator.

The adenoids and tonsils are the final stage of micro-filtration to ensure the quality of the air entering the lungs.

Surely it does not take a great leap of imagination to see that bypassing this sophisticated system, and breathing large volumes of untreated outside air, straight into the delicate lung tissue, could be the major cause of inflammation and infection?

The bypassing of the Nitric Oxide production/release removes a very powerful vaso/bronchodilator from the system, and the rapid loss of CO2 from the large volume of mouth breathing, is the main trigger for the protection provided by bronchospasm.

Does it make sense?

That if the bronchioles are shutting down in self defense, in order to protect the body, that propping them open twenty-four hours a day is self-defeating, and can only aggravate the condition further?

It is not possible that it is this very action that perpetuates the inflammation, and that is why ICS is added to the LABA to counteract the inflammation caused?

If the Gold Standard calls for the use of steroids to offset the overuse of bronchodilators, does it not make sense that reducing the need for bronchodilators will reduce the need for steroids?

In the face of all this ‘sense’ how can it be justified to increase bronchodilator use and thereby consign the patient to a lifetime of steroid medication – with zero chance of the ‘disease’ being ‘cured’?

Go to…

 

REWRITING THE RULES

It is no secret that ‘standards’ change under the observation and reporting of data which is collected on a routine basis. The SRG is a group of clinical pathologists who constantly review collected data and adjust the “norms” to reflect what is being noticed in pathology reports coming in from participating countries. 
(http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1769782/)

These corrected “norms” then become accepted as fact – and using the orthodontic profession as a prime example – end up drawing the conclusion that 3rd molars are no longer necessary in modern day life – and 28 teeth are now the “norm”. The fact that 3rd molars simply cannot erupt because the Western diet has largely removed the requirement of ‘chewing’ and resulted in under-developed jaws – is conveniently ignored, and wisdom teeth are ‘expected’ to be impacted and therefore require surgical removal.

COMMONPLACE BUT NOT NATURAL/NORMAL

Under the deluge of propaganda, advertising, TV promotion and pressure from representatives of drug and medical equipment companies, society has accepted that commonplace equals normal, and is unavoidable. In other words, crooked teeth are commonplace and have to be straightened. Inflamed tonsils are commonplace and have to be removed. High blood pressure is commonplace and has to be medicated.

The reality is that these things are commonplace, but are NOT normal or natural, and CAN largely be avoided by early detection and remediation.

As will be seen from the accompanying chart – Minute Volume – the amount of air inhaled and exhaled per minute – has always been accepted as approximately 6 liters per minute. Simple mathematical calculation, based on lung volume and respiratory rate, then shows that functional breathing at rest should be approximately 8-10 breaths per minute – breathing between 4-6 liters of air per minute.

Just remember, in 1930, before the start of WW2, the average minute volume was 4.5 liters/minute and at an average breath rate of 6-8 per minute.

With the advent of fast foods in the 1950s and onwards, minute volume and breathing rate steadily escalated to the present ‘accepted norm’ of 12 liters/minute and 18 – 20 breaths per minute.

That is Hyperventilation, and is not normal. Just because it is commonplace it means nothing other than there are a lot of dysfunctionally breathing people out there – contributing in no small measure to the epidemic of the awful Western disease called Average Health.

The physical structure of the nose, the airway and the lungs can happily accommodate this rate and volume, and functional breathing is silent – with no irritation to, or vibration of the tissues of the nose, mouth and airway.

This can ONLY be achieved through nasal breathing, driven by the diaphragm, and this is the way the body was designed to function.

Mouth breathing, with its accompanying hyperventilation, drags more than double the volume of air, unfiltered and non-sterilized, at more than twice the rate that the airway structure is designed to handle – causing localized and systemic inflammation – as well as severely disrupted biochemistry. This in turn leads to compromised and compensatory physical and postural behavior which in turn aggravates other functions of the body.

Go to…

 

WHY NOT PREVENT THE ATTACK FROM HAPPENING?

Why not teach people how to avoid an attack by not creating the conditions that cause one?

Numerous double-blinded, randomized, placebo controlled trials have proved – conclusively – that by changing breathing from high-volume, chest/mouth, to low volume nose/diaphragm, bronchodilator usage can be reduced by 86% and ICS usage by 50% – with absolutely zero side effects.

These trials have always been criticized on the grounds that they have not shown any improvement in FEV1. That is a total red herring and maintains the resistance to clinically trialed and proven facts.

The Tiffeneau-Pinelli Index – better known as the FEV1/FVC index was designed for restrictive and obstructive lung disease – where there is a degradation in lung tissue – such as related to pathological and degenerative diseases.

This is yet another example where a metric – designed to be used as a comparator, or indication of progress or regression, has become perverted and is used as an empirical diagnostic tool in a totally different environment. The FEV1 has no correlation with the triggers that cause overbreathing. All it attempts to do is measure the consequences of congestion/dysfunction brought about by provocation – and is therefore of dubious value in the context in which it is used, namely to discredit the numerous trials. I become very frustrated when I hear ‘holier-than-thou’ specialists dismiss these valid, clinically based, published and peer reviewed trials on the grounds that “it did not improve FEV1 – therefore it is of no value.”

ASTHMA IS NOT A DISEASE. It is a condition which only manifests itself when provoked. Remove the provocation and the condition is controlled.

THERE IS NO DOUBT THAT ASTHMA CAN BE LIFE THREATENING – but this is in a very small number of cases across the spectrum. Brittle Asthma is a reality – and people need hospitalization and extreme care when this happens.

What I am talking about is the extremely high percentage of misdiagnosed cases – due to a flawed diagnostic process – where the diagnostics provoke the condition. It is this very significant percentage – estimated at approaching 90% of those diagnosed, who are being over medicated, spending billions of unnecessary dollars on medication which they do not need, and potentially causing iatrogenic issues later on in life.

Go to…

 

THE SOLUTION

In the same way that a person can be coached in a sport so that they do not hurt or harm themselves, it is possible to coach people in how to breathe functionally.

Our diet and lifestyle are working against us – and the vast majority of people are in a state of constant stress.

This sympathetic dominance has them in a state of alertness all the time, and as a result of this Fight/Flight response, they are hyperventilating or overbreathing.

There are simple and effective ways of addressing this situation and teaching people how to return to normal breathing.

Massive Costs In Terms of Medication

Given that the diagnosis of asthma is so often incorrect, but the patients are still placed on ‘puffer therapy’, it is no wonder that the costs to individuals, as well as the system, are as high as they are.

In a recently published survey, by IMS Health: FDA, the top 10 most frequently prescribed drugs were listed by wholesale prices.  This means what was earned by the manufacturers, not what the consumer pays, which could be between 50% and 100% more.

Of the $38.2 billion dollars generated by these drugs, just on 40% – $11.7 billion – were for asthma and COPD drugs.

How much of this could be saved by reducing, or even eliminating the unnecessary usage – due to misdiagnosis?

There is no shortage of people available to teach, train and guide ‘asthmatics’ in how to prevent the onset of an ‘attack’. The ideal people are Occupational and Physical Therapists, and other trained, licensed and registered Respiratory and Manual therapists, as they have the correct training, understand the human body as a whole, and will readily learn the specialized skills required to teach people how to normalize their breathing.

‘Idiopathic-Iatrogenic’ – The final indignity.

There is no doubt that stress is one of the major drivers of breathing disorders. The Fight/Flight response instantly changes breathing rate, depth, dynamics and mechanics, as well as major physiological and biochemical responses, resulting in a multitude of changes throughout the body. Being in a state of constant stress, as a large percentage of “asthmatics” are, maintains a level of sympathetic, or cortisol dominance, and a reduction in the time spent in parasympathetic recovery.

Inhalation drives the sympathetic and exhalation drives parasympathetic responses, and the ratio should be roughly 40% to 60%, thereby allowing the person more time in recovery mode than in excitation mode.

Most people’s breathing patterns are reversed – with longer inhalations and shorter exhalations – due to the brainstem response initiating the next inhalation before the full exhalation has been completed. This is as a result of many years of dysfunctional breathing causing the medullary trigger to ‘kick in’ earlier than it should.

To take someone who is in a constant state of adrenalin/cortisol dominance, and place them on permanent long-term, 24 hour medication, with a combination drug whose components are long-term beta-2 agonists and inhaled corticosteroids, can only aggravate this condition and consign the sufferer to a lifetime of the iatrogenic ‘stress-symptom-stress-symptom’ cycle. This then completes the idiopathic-iatrogenic loop of “I don’t know what is causing it”, and, “what I am doing is actually making it worse”

There is a better way to manage this ‘pandemic’.

Go to…

 

REFERENCES

  1. http://www.dailymail.co.uk/health/article-2929353/1m-asthma-cases-misdiagnosed-fear.html
  2. Controlling Asthma by Training of Capnometry-Assisted Hypoventilation (CATCH)
  3. Versus Slow Breathing: A Randomized Controlled Trial.  CHEST 11/22/14
    Thomas Ritz, PhD1*, David Rosenfield, PhD1, Ashton M. Steele, MA1, Mark. M. Millard, MD2,
    and Alicia E. Meuret, PhD1* 
    1Southern Methodist University, Dallas, Texas, USA
    2Baylor University Medical Center, Dallas, Texas, USA
  4. American Thoracic Society Committee on Diagnostic Standards. Definitions and classification of chronic bronchitis, asthma, and pulmonary emphysema. (1962) Am Rev Respir Dis 85: 762.
  5. Slader HK, Reddel LM, Spencer EG, Belousova CL, Armour SZ, et al. (2006) ASTHMA Double blind randomised controlled trial of two different breathing techniques in the management of asthma CA. Thorax.
  6. Sandberg S, Järvenpää S, Penttinen A, Paton JY, McCann DC (2004) Asthma exacerbations in children immediately following stressful life events: a Cox’s hierarchical regression. Thorax 59(12): 1046-1051.
  7. Atherton M (2000) Outcome measures of efficacy associated with a web-enabled self management programme: findings from a quasi-experiment. Disease Management and Health Outcomes 8(4): 233-242. 
  8. Barnes G, Partridge MR (1994) Community asthma clinics: 1993 survey of primary care by the national Asthma Task Force. Qual Health Care 3(3): 133-136.
  9. Barraclough R, Devereux G, Hendrick DJ, Stenton SC (2002) Apparent but not real increase in asthma prevalence during the 1990s. Eur Respir J 20(4): 826-833.
  10. Beasley R, Cushley M, Holgate ST (1989) A self help management plan in the treatment of adult asthma. Thorax 44: 200-204.
  11. Beilby JJ, Wakefield MA, Ruffin RE (1997) Reported use of asthma management plans South Australia. Med J Aust 166(6): 298-301.
  12. Villiger PM, Hess CW, Reinhart WH (1993) Beneficial effect of inhaled CO2 in a patient with non-obstructive sleep apnoea.
    J Neurol 241(1): 45-48.
  13. Hancox RJ, Subbarao P, Kamada D, Watson RM, Hargreave FE, et al. (2002) Beta2-Agonist Tolerance and Exercise-induced Bronchospasm. Am J Respir Crit Care Med 165(8): 1068-1070.
  14. http://www.nhibi.nih.gov.
  15. International consensus report on the diagnosis and treatment  of asthma .National  Heart, Lung and Blood Institute, National Institute of Health. Bethseda, Maryland 20892 publication  no.92- 3091, March 1992. EUR Resp Journal 5(5): 601-641.
  16. Bousquet J, Jeffery PK, Busse WW, Johnson M, Vignola AM (2000) Asthma. From bronchoconstriction to airways inflammation and remodeling. Am J Respir Crit Care Med 161(5): 1720-1745.
  17. Bowler S, Green A, Mitchell C (1998) Buteyko Breathing Techniques in Asthma: A Blinded Randomised Controlled Trial. Med J Aust 169(11-12): 575-578.  
  18. Tobin MJ, Chadha TS, Jenouri G, Birch SJ, Gazeroglu HB, et al. (1983) Breathing patterns. 1. Normal subjects. 84(2): 202-205.
  19. Brewster CE, Howarth PH, Djukanovic R, Wilson J, Holgate ST, et al. (1990) Myofibroblasts and subepithelial fibrosis in bronchial asthma. Am J Respir Cell Mol Biol 3(5): 507-511.
  20. Bryce FP, Neville RG, Crombie IK, Clark RA, McKenzie P (1995) Controlled trial of an audit facilitator in diagnosis and treatment of childhood asthma in general practice. BMJ 310(6983): 838-842.
  21. Bucknall CE, Robertson C, Moran F, Stevenson RD (1988) Management of asthma in hospital: a prospective audit. Br Med J (Clin Res Ed) 296(6637): 1637-1639.
  22. Bucknall CE, Slack R, Goddley CC, Mackay TW, Wright SC on behalf of SCIAD collaborators (1999) Scottish Confidential Inquiry into Asthma Deaths (SCIAD), 1994-6. Thorax 54: 978-984.
  23. Burney P (2002) The changing prevalence of asthma? Thorax 57(Suppl II): ii36-ii39.
  24. Burr ML, VerrallC, Kaur B (1997) Social deprivation and asthma. Respir Med 91(10): 603-608.
  25. McHugh P, Aitcheson F, Duncan B, Houghton F (2003) Buteyko Breathing Technique for asthma: an effective intervention.
    N Z Med 116(1187): U710.
  26. Simon D Bowler, Amanda Green, Charles A Mitchell (1998) Buteyko breathing techniques in asthma: a blinded randomised trial. Medical Journal of Australia  169: 575-578.
  27. Buteyko K, Odintsora M, Nasonkina N (1968) [The Ventilation Test in Patients with Bronchial Asthma]. Vrach Delo 4: 33-36.
  28. Cambach W, Wagenaar RC, Koelman TW, van Keimpema AR, Kemper HC (1999) The long term effects of pulmonary rehabilitation in patients with asthma and chronic obstructive pulmonary disease: a research synthesis. Arch Phys Med Rehabil 80(1): 103-111.
  29. Burggraaf J, Westendorp RG, in’t Veen JC, Schoemaker RC, Sterk PJ, et al. (2001) Cardiovascular side effects of inhaled salbutamol in hypoxic asthmatic patients. Thorax 56(7): 567-569.
  30. Carey OJ, Cookson JB, Britton J, Tattersfield AE (1996) The effect of a lifestyle on wheeze, atopy and bronchial hyperreactivity in Asian and white children. Am J Respir Crit Care Med 154(2 Pt 1): 537-540.
  31. Carswell F, Robinson EJ, Hek G, Shenton T (1989) Bristol Experience: Benefits and cost of an ‘asthma  nurse’ visiting the home of asthmatic children. Bristol Med Chir J 104(1): 11-12.
  32. Sears MR (1995) Changing patterns in asthma morbidity and mortality. J Investig Allergol Clin Immunol 5(2): 66-72.
  33. Charlton I, Charlton G, Broomfield J, Mullee MA (1991) Audit of the effect of a nurse run asthma clinic on workload and patient morbidity in a general practice. Br J Gen Pract 41(347): 227-231.
  34. Charlton I, Charlton G, Broomfield J, Mullee MA (1990) Evaluation of peak flow and symptoms only self management plans for control of asthma in general practice. BMJ 301(6765): 1355-1359.
  35. Clark NM, Nothtwehr F (1997) Self-management of asthma by adult patients. Patient Educ Couns 32(1 suppl): S5-20.
  36. D’Souza W, Burgess C, Ayson M, Crane J, Pearce N, et al. (1996) Trial of ‘credit card’ asthma self management plan in a high risk group of patients with asthma. J Allergy Clin Immunal 97(5): 1085-1092.
  37. Demeter S, Cordasco EM (1986) Hyperventilation Syndrome & Asthma. The American Journal of Medicine 81: 989-994.
  38. Donnelly PM (1991) Exercise Induced Asthma: The Protective Role of CO2 during Swimming. Lancet 337(8734): 179-180.
  39. Robert Cowie (2005) Resident Respirologist of Foothills Hospital in Calgary and head researcher on the Buteyko Breathing Technique Medical Trial.
  40. Droogan J, Brannigan K (1997) Organisation of asthma care: what difference does it make? Nurs Times 93(34): 45-46.
  41. Xie A, Rankin F, Rutherford R, Bradley TD (1985) Effects of inhaled CO2 and added dead space on idiopathic central sleep apnea. J Appl Physiol 82(3): 918-926.
  42. Egbagbe E, Pavord ID, Wilding P, Thompson-Coon J, Tattersfield AE (1997) Adenosine monophosphate and histamine induced bronchoconstriction: repeatability and protection by terbutaline. Thorax  52(3): 239-243.
  43. Ahrens T, Schallom L, Bettorf K, Ellner S, Hurt G, et al. (2001) End-tidal carbon dioxide measurements as a prognostic indicator of outcome in cardiac arrest. Am J Crit Care 10(6): 391-398. 
  44. Ernst E (1998) Complimentary therapies for asthma: what patients use. J Asthma 35(8): 667-671.
  45. Feder G, Griffiths C, Highton C, Eldridge S, Spence M, et al. Do clinical guidelines introduced with practice based education improve care of asthmatic and diabetic patients? A randomised controlled trial in general practitioners in east London. BMJ 311(7018): 1473-1478.
  46. Gallefoss F, Bakke PS (2000) Impact of patient education and self management on morbidity in asthmatics and patients with chronic obstructive pulmonary disease affect. Respir Med 94(3): 279-287.
  47. Gern JE, Lemanske RF Jr, Busse WW (1999) Early life origins of asthma. J Clin Invest 104(7): 837-843.
  48. sru@soc.surrey. ac.uk
  49. Gibson PG, Wilson AJ (1996) The use of continuous quality improvement methods to implement practice guidelines in asthma. J Qual Clin Pract 16(2): 87-102.
  50. Goss JD, Leinbach TR (1996) Focus groups as alternative research practice. Area 28(2): 115-123.
  51. Griffiths C, Naish J, Sturrdy P, F Pereira (1996) Prescribing and hospital admission for asthma in east London. BMJ 312(7029): 481-482.
  52. Guba EG, Lincoln YS (1994) Competing paradigms in qualitative research. 105-117.
  53. Hansler DF, Cooper C (1986) Focus groups n: New dimensions in feasibility study. Fund Raising Manage 17(5): 78-82.
  54. Harrison TW, Oborne GB, Wilding PJ (1999) Sahaja yoga in the management of beta-agonist reduction in asthma. Thorax 54: 98.
  55. Jill McGowan (2003) Health Education: Does the Buteyko Institute Method make a difference?, Education and training consultant in Asthma Management. Thorax 58(suppl III): 28.
  56. Heard AR, Richards IJ, Alpers JH, Pilotto LS, Smith BJ, et al. (1999) Randomised controlled trial of general practice based asthma clinics. Med J Aust 171(2): 68-71.
  57. Hensley, MJ, Gibson PG (1998) Promoting evidence-based alternative medicine. Med J Aust 169: 573-574.
  58. Higgins BG, Britton JR (1995) Geographical and social class effects on asthma mortality in England and Wales. Respir Med 89(5): 341-346.
  59. Holgate S (1993) Mediator and cytokine mechanisms in asthma. Thorax 48(2): 103-109.
  60. Holgate ST, Davies DE, Lackie PM, Wilson SJ, Puddicombe SM, et al. (2000) Epithelial-mesenchymal interactions in the pathogenesis of asthma. J Allergy Clin Immunol 105(2 pt 1):193-204.
  61. G Hoskins, C McCowan, R G Neville, G E Thomas, B Smith, et al. (2000) Risk factors and costs associated with an asthma attack. Thorax 55: 19-24.
  62. Hoskins G, Neville RG, Smith B (1999) The link between nurse training and asthma outcomes. Br J Comm Nursing 4: 222-228.
  63. House of Lords Select Committee on Science and Technology. Complementary and alternative medicine. 6th report 1999-2000 [HL123]. London.
  64. Osborne CA, O’Connor BJ, Lewis A, Kanabar V, Gardner WN (2000) Hyperventilation and asymptomatic chronic asthma. Thorax 55(12): 1016-1022.
  65. Integrated care for asthma: a clinical, social, and economic evaluation. Grampian asthma Study of Integrated Care (GRASSIC) BMJ (1994) 308: 559-564.
  66. Israel E, Fischer AR, Rosenberg MA, Lilly CM, Callery JC, et al. (1993) The pivotal role of 5lipoxygenase products in the reaction of aspirin-sensitive asthmatics to aspirin. Am Rev Respir Dis 148(6 pt 1): 1447-1451.
  67. Jadad AR, Moher M, Browman GP, Booker L, Sigouis C, et al. (2000) Systematic reviews and meta-analyses on treatment of asthma: critical evaluation. BMJ 320: 537-540.
  68. Jones A, Pill R, Adams S (2000) Qualitative study of views of health professionals and patients on guided self management plans for asthma. BMJ  321: 1507-1510.
  69. Jones K, Cleary R, Hyland M (1999) Predictive value of a simple asthma morbidity index in a general practice population. Br J Gen Pract  49(438): 23-26.
  70. Juniper EF, Guyatt GH, Ferrie PJ, Griffith LE (1993) Measuring quality of life in asthma. Am Rev Respir Dis 147(4): 832-838.
  71. Keeley D, Osman L (2001) Dysfunctional breathing and asthma. BMJ 322: 1075-1076.
  72. Kemmis S, Grundy S (1981) Educational action research in Australia: The state of the art. Australian Educational Researcher.
  73. Kitzinger J (1994, 1995) Introducing Focus groups.
  74. Knafl K, Howard M (1984) Interpreting and reporting qualitative research. Res Nurs Health 7(1): 17-24.
  75. Kumar P, Clark M (1996) Clinical Medicine, Fourth Edition. Saunders.
  76. Laffey J, Kavanagh B.  New England Journal of Medicine 4 July 2004.
  77. Levy ML, Robb M, Allen J, Doherty C, Bland JM, et al. (2000) A randomized controlled evaluation of specialist nurse education following accident and emergency department attendance for acute asthma. Respir Med 94(9): 900-908.
  78. Lieu TA, Capra AM, Quesenberry CP, Mendoza GR, Mazar M (1999) Computer-based models to identify high-risk adults with asthma: is the glass half empty of half full? J Asthma 36(4): 359-370.
  79. Littlejohns P, Ebrahim S, Anderson R (1989) Prevalence and Diagnosis of Chronic Respiratory System in Adults. British Medical Journal 298: 1560.
  80. Lozano P, Finkelstein JA, Carey VJ, Wagner EH, Inui TS, et al. (2004) A multisite randomized trial of the effects of physician education and organizational change in chronic-asthma care: health outcomes of the Paediatric Asthma Care Patient Outcomes Research Team II Study. Arch Pediatr Adolesc Med 158(9): 875-883.
  81. Manoccha R, Marks GB, Kenchington P, D Peters, CM Salome (2002) Sahaj yoga in the management of moderate to severe asthma : a randomised controlled trial. Thorax 57: 110-115.
  82. Martinez FD, Wright AL, Taussig LM, Holberg CJ, Halonen M, et al. (1995) Asthma and wheezing in the first six years of life. The Group Health Medical Associates. N Engl J Med 332(3): 133-138.
  83. McCarney RW, Lasserson TJ, Linde K, Brinkhaus B (1998) An overview of two Cochrane systematic reviews of complementary treatments for chronic asthma: acupuncture and homeopathy. Respir Med 98(8): 687-696.
  84. McCarthy M (2002) US panel calls for more support of alternative medicine. Lancet 359(9313): 1213.
  85. McDermott MF, Murphy DG, Zalenski RJ, Rydman RJ, McCarren M, et al. (1997) A comparison between emergency diagnostic and treatment unit and inpatient care in the management of acute asthma. Arch Intern Med 157(18): 2055-2062.
  86. Mielck A, Reitmeir P, Wjst M (1996) Severity of childhood asthma by socioeconomic status. Int J Epidemiol 25(2): 388-393.
  87. Millar B, Maggs C, Warner V,  Whale Z (1996) Creating consensus about nursing outcomes 1. An exploration of focus group methodology. J Clin Nurs 5(3): 193-197.
  88. Montefort S, Roberts JA, Beasley R, Holgate ST, Roche WR (1992) The site of disruption of the bronchial epithelium in asthmatic and non-asthmatic subjects. Thorax 47(7): 499-503.
  89. Mowat DHR, McCowan C, Neville RG (1998) Socio-economic status and childhood asthma. Asthma Gen Pract 6: 9-11.
  90. Mundinger MO, Kane RL, Lenz ER, Totten AM, Tsai WY,  et al. (2000) Primary care outcomes in patients treated by nurse practitioners or physicians: a randomized trial. JAMA 283(1): 59-68.
  91. Neville R (1995) Two approaches to effective asthma audit. Practitioner 239(1548): 203-205.
  92. Neville RG, Hoskins G, Smith B, Clark RA (1996) Observations on the structure, process and clinical outcomes of asthma care in general practice. Br J Gen Pract 46(411): 583-587.
  93. Ng TP (2000) Validity of symptom and clinical measures of asthma severity for primary outpatient assessment of adult asthma. Br J Gen Pract 50(450): 7-12.
  94. Nyamathi A, Shuler P (1990) Focus group interview: a research technique for informed nursing practice. J Adv Nurs 15(11): 1281-1288.
  95. Birch M (2004) Obstructive Sleep Apnoea and breathing retraining. Aust Nurs J 12(2): 27-29.
  96. Opat AJ, Cohen MM, Bailey MJ, Abramson MJ (2000) A clinical trial of the Buteyko breathing technique in asthma as taught by video. J Asthma 37(7): 557-564.
  97. Patterson C, Britten N (2000) Organising primary health care for people with asthma: the patient’s perspective. Br J Gen Pract 50(453): 299-303.
  98. Pauwels R, Joos G, Van der Straeten M (1988) Bronchial hyper-responsiveness is not bronchial hyper-responsiveness is not bronchial asthma. Clin Allergy 18(4): 317-321.
  99. Pearson MG, Bucknall CE (1999) Measuring clinical outcome in asthma: a patient- focused approach. London: Royal College of Physicians.
  100. Powell RA, Single HM (1996) Focus Groups.  International Journal of Quality in Health Care 8: (5).
  101. Premaratne UN, Sterne JA, Marks GB, JR Webb, H Azima, et al. (1999) Clustered randomised trial of an intervention to improve the management of asthma: Greenwich asthma study. BMJ 318: 1251-1255.
  102. Thomas M, McKinley RK, Freeman E, Foy C (2001) Prevalence of dysfunctional breathing in patients treated for asthma in primary care: a cross sectional survey. BMJ 322: 1098-1100.
  103. Roger L (2006) Proceedings of the American Thoracic Society. 3: A530.
  104. Race KEH, DF Parker T (1994) Rehabilitation program evaluation: use of focus groups to empower clients. ERIC 18(6): 730-740.
  105. Lavie P (1987) Rediscovering the importance of nasal breathing in sleep or, shut your mouth and save your sleep.
    J Layngol Otol 101(6): 558-563.
  106. Davis MS, Freed AN (2001) Repeated Hyperventilation Causes Peripheral Airways Inflammation, Hyperreactivity, and Impaired Bronchodilation in Dogs. Am J Respir Crit Care Med 164(5): 785-789.
  107. Robinson N (1999) Journal of Advanced Nursing 29(41): 905-913.
  108. Rona RJ (2000) Asthma and poverty. Thorax 55: 239-244.
  109. Ross, Wilson (1982) Anatomy and Physiology for Nurses Lippincot publishers 1982.
  110. Scott D, Usher R (2000) Researching Education Data Methods and Theory in Scottish Intercollegiat Guidelines Network  (1998).  Guidelines for Asthma Management.  HMSO.
  111. Sicker J, Wimbush E, Watson J, Milburn K ( 1995) Qualitative methods in health promotion research :some criteria for quality. Health Education Journal 54: 74-78.
  112. Singh V, Wisniewski A, Britton J, Tattersfield A (1990) Effect of Yoga breathing exercise (prayanama) on airway activity in  subjects with asthma. Lancet 335(8702): 1381-1383.
  113. Smith E, Alexander V, Booker C, McCowan C, Ogston S, et al. (2000) Effect of hospital asthma nurse appointment on inpatient asthma care. Respir Med 94(1): 82-86.
  114. Sommaruga M, Spanevello A, Migliori GB, Neri M, Callegari S, et al. (1995) The effects of a cognitive behavioural intervention in asthmatic patients. Monaldi Arch Chest Dis  50(5): 398-340.
  115. Szczeklik A, Nizankowska E, Sanak M, Swierczynska M (2001) Aspirin-induced rhinitis and asthma. Curr Opin Allergy Clin Immunol 1(1): 27-33.
  116. Szczeklik A (1990) The cyclooxygenase theory of aspirin- induced asthma. Eur Respir J 3(5): 588-593.
  117. The British Thoracic Society, the British Guidelines on Asthma Management, (1997) Thorax, the Journal of the British Thoracic Society, 52.  
  118. astthmaabd.org/guideline/section1/definition.hhtm
  119. The Role of Breathing Theory. National Asthma Campaign/Australian Association of Asthma Foundation, Annual Conference.
  120. Thomas M, McKinley, RK, Freeman E, Foy C (2001) Prevalence of dysfunctional breathing in patients treated for asthma in primary care; cross sectional survey. BMJ 322(7294): 1098-1100.
  121. Buteiko KP, Odintsova MP, Nasonkina NS, Vrach Delo (1968) Ventilation Test In Patients With Bronchial Asthma. 4: 33-36.
  122. William MV, Mark O’Hollaren, Kenneth ME, Thomas S, John W, et al. (1997) Speciality differences in the management of asthma. A cross-sectional assessment of allergists’ patients and generalists’ patients in a large cross section HMO. Archives of Internal Medicine 157(11): 1201-1208.
  123. Ware JE, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36).I. Conceptual framework and item selection. Med Care 30: 473-483.
  124. Watanabe T, Oothta M, Murata M, Yamamoto T (1998) Decrease in emergency room or urgent care visits due to management of bronchial asthma inpatients and outpatients with pharmaceutical services. J Clin Pharm Ther 23(4): 303-309.
  125. Wesseldine LJ, McCarthy P, Silverman M (1999) Structured discharge procedure for children admitted to hospital with acute asthma: a randomized controlled trial of nursing practice. Arch Dis Child 80(2): 110-114.
  126. White PT, Pharoah CA, Anderson HR, Freeling P (1989) Randomized controlled trial of small group education on the outcome of chronic asthma in general practice. J R Coll Gen Pract 39(322): 182-186.
  127. Woolcock AJ, Salome CM, Yan K (1984) The shape of the dose-response curve to histamine in asthmatic and normal subjects. Am Rev Respir Dis 130: 71-75.
  128. Worral G, Chaulk P, Freake D (1997) The effects of clinical practice guidelines on patient outcomes in primary care: a systematic review. Can Med Assoc J 156(12): 1705-1712.”

 

Diagnostic Criteria for CFS/ME – All Explained by the Hypothalamus in Overdrive

Diagnostic Criteria for CFS/ME

Looking at the medical diagnostic criteria below (in italics) for Chronic Fatigue Syndrome (CFS) or ME, every single symptom or criteria can be attributed to the hypothalamus gland in the brain stem being in overdrive.

The hypothalamus is a gland that acts as a link between the body and the brain and it’s job is homeostasis. That is, it regulates the functions of many systems and areas of the body, including all automatic functions (controlled by the autonomic nervous system – digestion, metabolism, breathing, circulation, urinary, lymphatic etc.), the stress response, the immune system, sleep cycles,  endocrine glands, cognitive function and neurotransmitters. It could be described as the general of bodily function.

Unless the hypothalamus in overdrive is reversed or corrected, then treating at the level of bodily symptoms will always struggle to yield significant or complete recovery from CFS and ME. This is why so many sufferers struggle for years or decades, and go though multiple practitioners of various modalities to get a resolution, yet often end up frustrated and in despair due to the lack of the result.

Taking the hypothalamus out of overdrive is the primary objective of Mickel Therapy and explains why the successes using this technique are so frequent and complete.

It does so by addressing the mismatch between the body we have inherited and the world we have created for ourselves.  It targets how we process stress, and how our brain integrates messages that come from our primal, instinctive emotional brain with the rational, thinking brain (or the data control system). It is a bit of a paradigm shift for many clients initially, and very often feels quite foreign, but, with persistence the techniques are easy to implement, and yield extra-ordinary results. Not only for resolving illness; also for performance of all kinds and the feeling of happiness and freedom internally.

It is worth a try.

  1. The individual has severe chronic fatigue for 6 or more consecutive months that is not due to ongoing exertion or other medical conditions associated with fatigue (these other conditions need to be ruled out by a doctor after diagnostic tests have been conducted)
  2. The fatigue significantly interferes with daily activities and work
  3. The individual concurrently has 4 or more of the following 8 symptoms:
  • post-exertion malaise lasting more than 24 hours
  • un-refreshing sleep
  • significant impairment of short-term memory or concentration
  • muscle pain
  • multi-joint pain without swelling or redness
  • headaches of a new type, pattern, or severity
  • tender cervical or axillary lymph nodes
  • a sore throat that is frequent or recurring

Article: “It’s Time Doctors Apologise to Their ME (CFS) Patients”.

Doctors Finally Beginning to Acknowledge that CFS or ME is not a Psychological Condition.

Linked below is a great article on CFS or ME.

Having suffered from CFS and having been told that I was making it up, or it is all in my head, I definitely feel the frustration that many or most of the clients I treat with CFS, Fibromyalgia, Adrenal Fatigue experience when they are told similarly by their doctors or apparent ‘learned’ friends or family.

And like me,  most of the clients that I encounter or speak to experience a low mood, depression or serious and chronic frustration as a result of no-one being able to acknowledge or relate to what they re going through and the inability of the medical fraternity and many natural health practitioners to provide a solution to their ailment.

A quote from the article highlights this: ‘And a major report from the prestigious US Institute of Medicine has recently concluded that ME is a “serious, chronic, complex, systemic disease that can profoundly affect the lives of patients”. ME is not a psychological problem’.

This is at least an acknowledgement from the medical field that ME or CFS is a real, physical ailment.

As to the solution, this comes from understanding cause, and there has been much speculation about the cause – mental illness, post infection (virus, gut bacteria), chronic stress, adrenal exhaustion, dysfunctional mitochondrial energy production. Most treatments focus on one or more of these suggested causes.

The article suggests; “the time has come for doctors and scientists to apologise for the very neglectful way in which ME has been researched and treated over the past 60 years. Doctors need to start listening to their patients and there must now be increased investment in biomedical research to gain a better understanding of the disease process and to develop treatments that these patients desperately need.”

It is great that more doctors and recognising the need for biomedical research tying to identify physical cause rather that writing CFS off as a psychological condition, however it has been my experience and that of many colleagues and experts worldwide that this approach is also near sighted, or is missing the actual cause at a higher level.

In my clinical practice, the more I investigated more effective solutions to CFS, ME, fibromyalgia etc, whilst I saw some great results by focusing physical interventions via nutrition and fasting, herbal medicines, sauna therapy, graded exercise and more, they were rarely complete or 100% resolutions. And the more I began to feel that the cause and solution to these ailments lies at a higher level in the body (or brain).

I was fortunate to discover the wok of Scottish GP and psychiatrist, Dr David Mickel who suggests that the actual ‘root’ cause of CFS, ME and fibomyalgia lies at the level of how we process primary (pre-thought) emotional communication, or stress, from our body at higher levels, and the impact of this on our hypothalamus – a gland in our brainstem that regulates many (or most) body functions; including sleep cycles, many cognitive functions, neurotransmitter function, how we process stress, our immune system and digestive systems, all automatic functions, our endocrine system amongst other things.

The role of the hypothalamus is to keep us regulated or alive via homeostasis and could be described as ‘the general’ of the body. In a way, it is the link between our brain and our physical bodies.

D Mickel found that there was increased blood flow in the hypothalamus of chronically ill patients, and speculated that this indicates that it is in overdrive.

And a hypothalamus in overdrive, as is the case with those suffering from CFS, ME, Fibromyalgia and many other chronic ailments, will cause multiple areas of the body to be poorly regulated and lead to a vast array of varying symptoms, depending on the genetic make up and circumstances of each individual client.

With Mickel Therapy we target the hypothalamus and aim to take it out of overdrive by focusing on how we process stress (or primary emotions) internally using a methodical, talking based approach that does not require any or excessive amounts of drugs or supplements to implement change. This is a radical shift in thinking and practice. But the results are surprisingly potent.

The results of Mickel Therapy really need to be seen to be believed.

My experience since taking on board Mickel Therapy has been that this is the most potent or successful treatment for chronic illness that I have witnessed or heard of. The results I have witnessed have echoed those experienced by Dr Mickel and many colleagues, have led to many, many complete resolutions in clients who have suffered from CFS, ME and fibromyalgia (as well as anxiety, depression and IBS) for many years (in some cases several decades) and had previously tried many, many treatment solutions, all focusing either a mental or purely physical cause, without success.

A quote from a fellow colleague of mine and senior Mickel Therapy trainer, Kim Knight of NZ, pretty much sums up my feelings on this article and the general medical approach to CFS:

“It still STAGGERS me that despite the fact that the real cause of ME, CFS and other related chronic illnesses are now well evident and understood by therapists such as myself, the medical community is STILL looking for a physical solution to a non-physical cause. Staggering. But at least we are making some progress.”

I am available for Mickel Therapy with clients in person in Torquay, Geelong and Melbourne (by appointment) and via phone or Skype for anyone around Australia or overseas.

Contact me via tim@timaltman.com.au or 0425 739 918.

 

 

 

 

http://www.telegraph.co.uk/news/health/12033810/Its-time-for-doctors-to-apologise-to-their-ME-patients.html

Article: The Real Cause of Depression and Anxiety May Have Nothing To Do With Your Mind

The Role of the Hypothalamus in Overdrive in Depression and Anxiety

A good article on depression and it’s causes – linked below.
Having worked with depression using systemic approaches for a number of years, a couple of observations from scientists and doctors mentioned in the article seem a little obvious to me, and raised the ire in me.

But at least they are starting to investigate chronic illnesses from a systemic or whole body approach now. Hallelujah!!

These observations include:
1. “Depression is not a condition that is isolated in the mind, and that the body may play a primary role in causing or preventing depression.”
2. Doctors and scientists are “starting to question whether the pharmaceutical solutions even works” – well how about that!!                                                                                                                                                                                          3. “I don’t even talk about it as a psychiatric condition any more. It does involve psychology, but it also involves equal parts of biology and physical health.”

The article talks a lot about the role of inflammation in depression and the effectiveness of good nutrition and certain nutrients to combat inflammation.
Terrific. We’ve also seen plenty of research come out on the influence of gut health on the immune system and on neurotransmitters that influence mood, sleep etc.

However, these approaches, whilst effective rarely yield complete results (in my observation and experience).

In looking for the ultimate or root cause of depression and anxiety, my belief is that scientists would also benefit in directing their attention higher (in the body or brain-stem) to the hypothalamus for it’s role in influencing inflammation, neurotransmitter levels, gut function and the immune system.

The hypothalamus is a gland that regulates all automatic functions of the body (including the gut and immune system), endocrine function, many higher brain functions including sleep cycles, cognitive function memory and neurotransmitter function.
In fact, you could say the hypothalamus is the general. It’s job is maintaining homeostasis (or balance/health in the body). In other words, it there to keep our bodies and us alive and functioning efficiently.

Effectively the hypothalamus is the link between our mind and our body.

And a hypothalamus that no longer woks harmoniously can significantly alter homeostasis in the body – depression and anxiety being one of the many resultant symptoms of a hypothalamus in overdrive.                         Many doctors and scientists (including Dr David Mickel – founder of Mickel Therapy) are starting to discover that in most people in the modern world, the hypothalamus does not wort optimally – it is very often in overdrive, especially in chronic illnesses such as depression, anxiety, IBS, chronic fatigue syndrome, fibromyalgia and many auto-immune conditions.

A hypothalamus in overdrive sends out regulatory signals to the body at a pathologically accelerated rate that can severely disrupt homeostasis in the body and results in a vast array of symptoms, including anxiety and depression. And it can severely disrupt gut function and exacerbate inflammation, further increasing these symptoms.

It has been suggested that a hypothalamus in overdrive may well be the ultimate or root cause of depression and anxiety.

To rectify this we must start at the level of the hypothalamus or the general and create harmony in the function of this link between body and mind.

Mickel Therapy addresses this by starting with correcting the communication between our primal emotional brain centres (or body-mind which serves to keep us happy, safe and comfortable with relationship to our environment by sending us primal or ‘pre-thought’ emotional signals), and the thinking or rational brain (or the mind which is the data control system for our body and serves to interpret and create action based on these emotional signals sent by the body-mind).

A healthy neural pathway or relationship between these two intelligence centres keeps us happy, safe and comfortable and we maintain homeostasis.

When this relationship breaks down, as it so often does in the modern world due to the mismatch between the world we have created and the bodies we have inherited, we internalise these emotional messages, and therefore stress, and the hypothalamus goes into overdrive; eventually producing symptoms. Effectively, we end up permanently in ‘fight or flight’ arousal.

With Mickel Therapy, we use a set of tools that targets the reason for the breakdown in communication between these two intelligence centres that is specific to each individual, then start taking action to reverse this breakdown, or create a healthy neural pathway. The result being that the hypothalamus is taken out of overdrive and symptoms start to disappear and the hypothalamus can harmoniously regulate bodily function (including gut, immune, inflammation and neurotransmitter function) and create homeostasis or optimal health.

http://www.wakingtimes.com/2015/11/23/the-real-causewith-your-mind/?utm_source=Facebook&utm_medium=PostShare&utm_campaign=TMU

Joel Spry

Chronic Fatigue and Anxiety Success Using Mickel Therapy

Another Resolution of Chronic Fatigue (CFS) and Anxiety via Mickel Therapy

I am very pleased that another client has experienced a complete recovery from chronic fatigue syndrome (CFS), anxiety and panic attacks.

And, this was another client who I worked remotely with – entirely over the phone as Skype was not accessible for him. So, I have never met, nor seen him. Thus providing further Mickel Therapy works extremely effectively via this method as well as in person.

I will let his testimonial (below – which is a hybrid of two emails Joel sent me) do the talking. I’ve also included a photo he sent me and was accompanied with this text; “Check this out mate…..never would’ve done this without you and Mickel”.

Joel did all of the work. It is a privilege to guide any client through such a process. And very humbling to witness their recovery.

It constantly reminds me of the incredible power of the human body to heal itself when provided with the right environment or circumstances that allow it to function harmoniously in the way it is built to. When we understand this incredible healing capacity of our bodies, it becomes clear that the narrow focused and short sighted pill popping approach of the pharmaceutical industry and much of the natural medicine industry is very often fruitless and frequently more damaging to long term health.

Time for me to get off my soap box. This is about Joel’s success story. Below are his words:

“Hi Tim.  I am so bloody happy……as I’ve had a fantastic 3 weeks since we last spoke.

There’s been so much happen but overall, with the exception of one day, the 3 weeks have been amazing. I’ve been tested in a lot of ways and in ways that I haven’t ever been tested before. I’m still full of energy, motivated and have a desire for life again. More importantly to do things rather than think about them. I’m confident that I now have the tools to deal with situations that arise thanks to you and Mickel. Self fulfillment, balancing my days every day and communicating my needs in a way that isn’t confronting for the other person are my keys to energy.

The one day was when I talked to xxx in depth. I should never have picked up the phone. She was reaching out again and it really hit me hard. I was as flat and tired as I’d been in a while. Apart from this day, and maybe leading up to the skydive where I had some nervous feeling in my feet, I haven’t had any symptoms.

I’m also confident that knowing that long term comfort requires regular short term discomfort will help me going forward. I see this as a real winner for me and the next step towards being able to make relationships on all levels really work for me.

I’ve changed the way that I write my notes. I do them in the morning now. As soon as I can really. I do this because I find that it helps me address anything that is happening in my head and to make plans to deal with it. Often just writing about what’s going on in my head is enough. A little pep talk reminding me of what I need to DO during the day really helps me get the day off and running. I also make my bed to accomplish a task first thing as well as meditate when I can and drink my favourite Yerba Mate tea. Generally I’m bouncing into work and remain that way all day. I have flat spots that’s for sure but they are overcome pretty well by actually doing something on my list.

Work has been really tough for others the last 3 weeks since we’ve had our new program manager start. A couple of people have commented that I’m the only one keeping my shit together and therefore the team. Thanks to Mickel that is!

The skydiving was such an amazing experience…… Find the scariest thing you could possibly imagine and do it. It really is life changing. So much so that I’m going to do it again. If you ever need another Mickel therapist I’m prepared to do the training. What I’d really love to add in to the program is a skydive towards the end of the process. If I enjoy the next jump I’m seriously considering looking into what training I can do. To be able to help people overcome their fears in such a way would be a brilliant way to be in business!

Nicole has been a test for me that’s for sure. My notes will reveal that. She’s massivley into vulnerability as well as strength and confidence. Something that I’ve been looking into a lot lately. Whilst I’m confident that I have the tools to communicate effectively as well as deal with any emotional situations that arise there’s this thing around vulnerability and the actual depth of relationships with people that I know I struggle with. I know now anyway. Choosing courage over comfort and protecting yourself from shame and ridicule etc is really hiding who you are, are two things that have really resonated with me recently.

None of this would’ve been possible without you. There was definitely a reason for me sending you the original email as well as detailing some of the things I had endured previously.

I now have the responsibility to myself to keep this going and to further improve.

I’m a changed man.

I’ve filled out the form for you in your email to me. That in itself is a powerful exercise. Reflecting back on what was and what is now. I know now that I have a platform to base optimal exploration from. Zero point.

So, from the bottom of my heart, thank you.”