1. Have an inspirational playlist to listen to every day.  Some of my favorites:
   • “Rise up “by Andra Day.
   • “You Say” by Lauren Daigle.
   • “Break the Shell “and “I am light” by India Arie.
   • “Imagine” by John Lennon. “Let it Be” by the Beatles.

2. Read every day or listen to books on tape. I am currently loving the below books or authors, but if something fictional or a little lighter such as a beach read will help relax your mind and make you feel good, go for it! It’s less about the content and more about taking time for ourselves to learn new things and focus our mind on something besides the current state of the outside world.
   • Eckhart Tolle’s “The Power of Now”
   • Any book by Brene Brown or Rachel Haller
   • “Radical Acceptance” by Tara Brach.
   • “The Uncharted Journey” and “Learning to Love” by Don Rosenthal.

3. Post Inspirational quotes around your house as a reminder of who and what life is all about. Some of my favorites:
   • “Don’t shrink, don’t puff up, stand your sacred ground.” Brene Brown.
   • “Nothing ever goes away until it teaches us what we need to know.”  Pema Chodron.
   • “Acceptance is the answer to all of my problems today” AA
   • “Whenever you go to war with what is, you always lose.” Byron Katie.
   • “The spiritual life is not a theory; we have to live it.” The Big Book.
   • “Yesterday I was clever, so I wanted to change the world. Today, I am wise, so I am changing myself.” Rumi

4. Every day.  Yoga, stretch, dance, walk outside wearing a mask and practicing physical distancing or around the house just to move your body in a way that makes you feel good.  If it does not feel good do not do it, but there may be some inertia one has to overcome to see if it will feel good.  Try an activity for 5 minutes and stop if still not “feeling it.” Do not overdo it either-if you are doing too much and not enjoying it, this is the flip side of not doing a little something.  If you go too far right of the target there is rigidity.  Too far left and there is laxity.  Hitting the target in the middle is probably about right.

5. Eat well. Choose foods you enjoy if they make you feel good!  Chew well, eat slow and savor what you are eating and drinking.  Be mindful of what you are doing.  What and how we eat, tells us how we feel about ourselves, remember the target.  A good question to ask yourself if you think you are hungry is, “Would I eat broccoli? (if you don’t like broccoli substitute something else you like that is a fruit or vegetable).  If the answer is no.  You are not really hungry-you are just mouth hungry.  Distract yourself with something, maybe exercise, crafting or reading or even try drinking a large glass of water. If the answer is yes-I would eat broccoli.  Eat! You are hungry.  Drink at least 6-8 glasses of water per day.

6. Sleep enough but not too much. Try for 8 hours (or more if you need) at night.  Get up at the same time every day and go to bed around the same time.  Keep a routine.  Take a nap if you need between 2-4 pm for 30-90 minutes.  Take melatonin if you have trouble sleeping right now.  Anywhere from 1-20 mg 30 minutes pre bed.  It must be dark for melatonin to work as a sleep aid.  The ER spray works best for some people.  Except for some “weird” dreams there are no real side effects to melatonin.  For those who say they are sedated the next day, try a lower dose and this side effect goes away after a week or so of use.

7. Be creative. Craft (make homemade masks?), do art, make music, color, do magic, learn to juggle,  do card tricks, etc. whatever is of interest to you and you enjoy enough to “lose” yourself in and are not aware of time passing b/c you are so focused on what you are doing.  This creative space is beyond “thought” getting us in touch with who we really are (outside of the public persona we don daily to be in the world).  When we are our authentic selves, we are healing ourselves at a deep level including activating the parasympathetic nervous system which calms flight, fight or freeze.

8. Have the intention to be kinder to yourself. If you are caught up in your mind with worry about the future or lamenting the past, you are not present. In this moment, unless it’ s a life and death situation, everything is OK.  Worrying about the future is not useful, it is an illusion, it has not happened.  Lamenting the past is also not useful- you cannot do anything about it.  We could, however, learn from our past and do things differently going forward.  If you are feeling bad about yourself-imagine a beloved child having the same experience.  Would you be as harsh with them as you are to yourself?  If not?  It doesn’t hold true that you should treat yourself differently.  Doesn’t everyone deserve love?  We may not like certain behaviors, we may have to protect people from them, but deep down, don’t we all deserve some empathy?

What if we found some good in this experience to make it more positive?  What if we got in better shape? Changed our eating habits? Developed reading lists and playlists that inspired us and made us feel better? What if by feeling better we could give back to the world more?  This could be on a physical level of service or if human beings really are (as quantum physics says) just subatomic particles that vibrate, what if we vibrated at a higher level?  Could that alone help ourselves and the planet?  Leading scientists and spiritual leaders believe so.  I know when I am around someone or something inspirational, I feel better.  What if we deliberately choose to feel better?  What is possible?

P.S. Playing monopoly in my house does not lead to feeling better!

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What you need to know about Coronavirus (COVID-19)

Please see our new web page dedicated to COVID-19

https://evergreencenter.net/covid/

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The word Inflammation is derived from Latin; inflammare (to set on fire), and Inflammation is a major contributor, if not the primary cause of all disease. Inflammation is the immune systems response to protect itself against harmful stimuli-like damaged cells, irritants or pathogens, and can be acute and short lived, chronic, low grade or systemic. Inflammation is also the way the body begins the healing response, and can have both harmful and beneficial effects.

The Good (Acute Phase Inflammation)

Inflammation can be beneficial in the acute phase. Acute inflammation prevents the spread of infection and damage to nearby tissues, helps to remove damaged tissue and pathogens and assists the body’s repair responses. For example, you sprain your ankle. The ankle becomes warm, red and swellon and there is pain causing you too want to immobilize it. These symptoms usually don’t last too long and the body, with its infinite wisdom, has known what to do since the beginning of time to heal itself. It has 50 billion cells that work together in a beautiful symphony to engulf damaged cells and increase blood flow and oxygen to the injured area.
The Bad (Chronic Inflammation)

Unfortunately, sometimes the system goes awry, and the result is chronic inflammation. Chronic inflammation is detrimental. It can lasts months to years and cause pain, stiffness, fatigue, increased blood sugar, increased blood pressure, ulcers, “brain fog”, Irritable Bowel Syndrome, skin issues (e.g. eczema) to name a few possible symptoms. Chronic inflammation is insidious. It can cause destruction of tissue, scarring (fibrosis), and death of cells (necrosis).

What Causes Chronic Inflammation?

Genetics play a small part, as well as lifestyle choices, but the bulk of inflammatory causes is thought to be due to infectious (bacterial, viral, fungal, parasitic) and environmental toxin exposure.
The idea that infection can cause chronic disease is not new and gained popularity in 1981 when an Australian physician, Dr. Barry Marshall, discovered that h. pylori bacteria could cause peptic ulcer disease as well as stomach cancer. It took 10 years for antibiotics to become the standard of care to treat h. pylori and 25 years for Dr. Marshall to win the Nobel prize in medicine for his groundbreaking work. We now know that HPV (virus) causes cervical cancer, HIV can cause Kaposi’s Sarcoma (cancer), researchers at Yale have linked chronic Lyme disease to Alzheimer’, MS (Multiple Sclerosis) has been linked to a bacteria called c. pneumonaie by researchers at Vanderbilt University (Charles Stratton, Ph.D) and c.pneumonaie has been linked as well to asthma.

So, it leads one to wonder what diseases are affected by inflammation? The short answer is ALL of them. Whether it’s MS, Lyme, Parkinson’s, Stroke, ALS, Autism, Alzheimer’s, or other neurological diseases-the common denominator is brain and spinal cord inflammation. If it’s Rheumatoid arthritis, Lupus, Fibromyalgia, Sjogren’s, Chronic Fatigue Syndrome, Diabetes, etc. The joints, muscles and tissues or organs are inflamed. If it’s IBS, Crohn’s Disease, Ulcerative Colitis, GERD, SIBO, diverticulitis, or Hepatitis it’s the GI system that is inflamed, asthma and allergies it’s the pulmonary system. If it’s hypertension or myocardial infarction or ischemia (high blood pressure, heart attack, angina) it’s the cardiovascular system, and so it goes for the laundry list of other chronic medical conditions.

How do we know if we are inflamed?

In 2004, Time Magazine called inflammation “The Secret Killer.” Every day we all make choices that are either pro-inflammation (smoking, poor diet-too much sugar, alcohol, processed food), not enough or poor quality sleep, overweight, sedentary lifestyle, under too much stress, have increased toxin exposure (noise, pollution, mold, etc.) On the flip side, we make anti-inflammatory choices: take fish or plant oils, exercise, have good sleep hygiene, practice weight control, eat a healthy diet, manage stress in healthy ways, avoid toxins as much as possible.
Someone may wonder, how do we know if we have inflammation? The answer is; If you have a chronic disease or chronic symptoms you are inflamed. Going one step further, there are blood tests you can do to check for inflammation. They include: sed rate, C-reactive protein, homocysteine, RA factor, ANA, anti CCP, increased levels of insulin and blood sugar, and c4a. It is important to note, the tests can be negative, and you can still have inflammation. Symptoms are always the “tell.” If quality of life is being affected by your chronic symptoms more investigation is warranted.

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Is there such a thing as Chronic Lyme Disease?

Is Lyme Dsease, as some critics say a bogus diagnosis?  Why is there such controversy surrounding the issue?  Why can’t physicians agree?  Are the physicians who treat Chronic Lyme “fleecing” unsuspecting patients, or are they courageous mavericks “thinking outside the box”, willing to question the status quo for patients who are desperately ill and in need of answers?

Let’s begin with some clarification, Chronic Lyme Disease is now known as Persistent Lyme Disease as opposed to Post-Lyme Syndrome.  Post-Lyme Syndrome is the presence of continuing symptoms after a patient recovers from acute Lyme disease.  It affects up to 10% of acute Lyme patients.  For those physicians who do not believe in Persistent Lyme Disease, it is not considered a chronic infection but the residual damage from the acute disease.  It behaves more like an autoimmune disease than an infectious one.  Persistent Lyme Disease is seen as an ongoing infection and thus amenable to antibacterial treatments by those who believe in its existence.

The Two Conflicting Schools of Thought

In the conventional medical world there are two schools of thought. One is IDSA (Infectious Diseases Society of America) who does not believe in Chronic Lyme as a diagnosis.  The other is ILADS (International Lyme and Associated Diseases Society) which does.  IDSA is made up of Infectious disease doctors and ILADS consists of MDs, NDs, ARNPs, nurses, etc.

IDSA is 10,000 members strong, ILADS is much smaller but growing.  Interestingly, both quote the same studies in defense of their positions.  The data is just interpreted differently.  IDSA believes a 1-time dose of antibiotics is appropriate for a high-risk tick bite.  ILADS believes it might be more appropriate to treat for up to 20 days with an antibiotic for an acute tick bite.  If there is an erythema migraines rash (bulls-eye rash), IDSA recommends treating with antibiotics for 2 weeks and ILADS recommends treating for up to 4-6 weeks. ILADS also believes you need to treat for possible co-infections of Lyme at the same time.

IDSA recommends clinicians be aware of possible co-infections. Ticks can transmit other bacterial infections at the time of a bite in addition to Lyme. To date, the known co-infections include:  Bartonella, Babesia, Anaplasma and Ehrlichia.  In the case of Persistent Lyme ILADS recommends treatment with antibiotics and IDSA doesn’t recognize Persistent Lyme Disease.

The controversy between IDSA and ILADS includes IDSA’s argument that using continuous, open ended antibiotics can cause antibiotic resistance, hurt the gut microbiota and isn’t necessary, as any symptoms post-acute Lyme disease is Post-Lyme Syndrome, and should be treated like an autoimmune illness. ILADS counters that treating a chronic bacterial disease like an autoimmune illness will suppress the immune system and cause the bacteria to proliferate.  ILADS believes in treating Persistent Lyme with open ended antibiotics until the bacteria is eradicated enough, and until the patient is well, while also addressing issues that may occur because of using antibiotics (e.g. C. diff. infections and probiotics as a prevention). ILADS points to other bacterial diseases that are treated with long term antibiotics as the standard of care like resistant tuberculosis for example.

The Issues At Hand

The biggest issues for the controversy are:  1. The lack of awareness of Lyme disease and its presentation.  Most people (including physicians) are aware that ticks can give you Lyme disease from a bite.  However, most people (including physicians) think only a certain geographic area in the U.S. have Lyme, specifically the Northeast.  These same people might also believe the tick needs to be attached for at least 24 hours and that you must have an erythema migraines rash (bulls-eye rash) plus be acutely ill to have Lyme disease. The truth, is you don’t.

Lyme disease has been documented in every state, the tick can be attached for less than 6 hours to transmit Lyme, and a bulls-eye rash only shows up in about 30% of those bitten by a tick with Lyme.  In addition, the bulls-eye rash may be mistaken for other benign rashes such as tinea corporis (ring worm).

2. Conventional, sensitive diagnostic testing to detect Lyme is sadly lacking.  The 2-tiered Lyme antibody test with western blot (the test used by physicians not as familiar with Lyme) is only 48% sensitive.  Its specificity is at least 90%, so there are much less false positives than false negatives.

3. The 2- tiered testing is not for diagnostic purposes but for surveillance purposes only, so very strict criteria must be met to record a CDC positive Lyme result.  If the physician doing the testing sees the result as negative they may believe they did due diligence and ruled out Lyme as the diagnosis.  Lyme disease is, and always has been, a diagnosis that is made based on clinical judgement not testing. If you are not aware of this, you may make decisions based on faulty or incomplete information.

CDC Reported Cases Grow Each Year

While the controversy continues, the CDC reports increases in the number of Lyme cases in the U.S.  Over 300,000 new cases are identiefied and reported yearly.  This number is for surveillance only, and likely severely underestimated.  Since Lyme was first discovered in 1981, at least 15 new tickborne pathogens have been identified.

The evidence base for treating Lyme disease is best described as sparse, conflicting and emerging.  In fact, most recommendations in Infectious Disease medicine are generally based on low-quality evidence probably accounting for why there are at least 25 diseases including Lyme that have conflicting guidelines.  Using the GRADE system (Cameron, et al), recommendations for treatment should consider not only the quality of the evidence but also the balance between benefits and harms and patient values and preferences.  When quality of evidence is low as in Persistent Lyme Disease, recommendations should identify a range of therapeutic options and acknowledge that different choices may be appropriate for different patients.

The goal of medicine is and should be disease prevention, treatment to cure when possible, improving quality of life and preventing disease progression.  When the evidence isn’t clear, there is no established standard of care because of conflicting guidelines and patients are suffering with an illness that is not diagnosed properly or not responding to conventional treatments, physicians need to make a cost-benefit analysis with patient input and use their best clinical judgement to treat.

Evidence assessments and guideline recommendations in Lyme disease:  the clinical management of known tick bites, erythema migraines and persistent disease.  Expert review of Anti-Infective therapy.

Cameron DJ, Johnson LB, Mahoney EL.

2014 Sep;12(9): 1103-35

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An estimated 1.7 million Americans suffer a traumatic brain kinjury (TBI) annually. Roughly 80% of these patients are diagnosed as mild TBI, or having a head injury that did not result in a coma.   250,000 of these brain injuries are in children from sports and recreational activities. These mild TBI or concussion sufferers are treated and released from the emergency room and typically get better in a few weeks, but up to 20% continue to have persistent symptoms for months or even years.  These symptoms can include: headaches, dizziness, cognitive issues (poor focus, retention of information, inability to multitask, decreased memory, etc.), anxiety, depression, fatigue, light and noise sensitivity, irritability and so on.  Persistent symptoms after a mild TBI is known as post- concussion syndrome or PCS.   Having just 1 concussion increases the risk for further brain injury if another concussion is experienced.  The risk further increases for each sequential concussion.

Despite the epidemic of TBI’s, research to date has few treatment options available.  Currently, at Jupiter Medical Center in Florida (Joe Namath Neurological Research Center) a TBI clinical trial is underway with the goal to determine if Hyperbaric Oxygen Treatment (HBOT) can have a significant  impact on reversing damage from head trauma so the treatment can become standard practice for patients suffering from TBI.

Joe Namath aka Broadway Joe, the charismatic quarterback for the New York Jets suffered brain trauma due to his years of playing football and underwent HBOT treatment with very positive results.  Joe had heard too many stories of CTE (chronic traumatic encephalopathy) in his peers and was concerned he too, suffered from chronic brain injury.  Unfortunately, CTE cannot be diagnosed except in an autopsy so Joe decided to be proactive and underwent HBOT sessions regularly while having SPECT scans (single positron emission CT scan) performed to evaluate his progress.  The SPECT scans, which are more functional than a regular CT scan, showed improved blood flow to Joe’s brain as well as improved function in areas that were previously under functioning.  Joe reported a better memory, improved energy and performed better on cognitive evaluations.

HBOT treatment is performed in either a mono chamber or a multi person chamber.  It can be done in a soft chamber or a hard chamber.  Hard chambers have the capacity to use higher pressures than soft chambers and would be more appropriate with diving injuries aka “the bends.”  For most other diagnoses including TBI soft chambers are effective.  The treatment consists of about an hour lying in a large tube that pressurizes the chamber to the equivalent of 1.3 ATA or the feeling of being about 10-12 feet underwater.  It is perfectly comfortable except for a little ear popping like on an airplane, when the chamber is pressurized and then depressurized.  The cost is anywhere from $50.00 to 200.00 per session.  It is not covered by insurance for TBI yet.  HBOT treats the underlying pathophysiology of TBI and concussion.

Paul Harch, MD in New Orleans, a leading researcher has used HBOT for 30 years to treat hundreds of people with chronic brain injury, stroke, drowning, Alzheimer’s, etc.  Dr. Harch says HBOT works through several biological pathways.  The increased oxygen appears to trigger healing of brain cells and switches on genes specifically related to brain repair.  It also increases the number of stem cells that migrate to sites of brain injury, promotes the growth of new blood vessels in the brain and boosts mitochondrial activity.  In addition, HBOT decreases inflammation and can stimulate neuroplasticity (the brain’s ability to change, adapt and grow).

Shai Efrati, MD a physician and researcher in Israel is a leading hyperbaric scientist.  Dr. Efrati says the brain is no different from any other part of the body.  Pressurized oxygen has the power to repair many kinds of tissue damage.  HBOT is currently FDA approved to treat diabetic wounds that won’t heal and bacterial infections like necrotizing fasciitis (aka flesh eating disease) so treating the brain is a logical segue.  Efrati and colleagues in Oct. 2017 treated 15 post-concussion syndrome patients with HBOT and results showed increased brain blood flow and more activity in brain areas that were previously dormant as well as improved memory and processing speed.  In a 2015 study by Dr. Efrati, 56 patients with PCS had improved cognitive function and improved overall quality of life.

Dr.’s  Efrati, Harch and others say injured brain cells don’t die but may “idle” (lie dormant, alive but hobbled) and persist for years or even decades which is why they see positive results with HBOT even many years post initial brain injury.

Critics argue HBOT remains unproven for use in brain injury like concussion (although approved for use in multiple other diagnoses) and patients are wasting their money.  A review of the literature using HBOT for TBI shows mixed results.  In the studies stating placebo was as good as treatment doses of HBOT, placebo was considered 1.3 ATA which has been shown in other studies to be a therapeutic dose!  Perhaps it wasn’t a placebo after all.  In other studies not showing a positive response, perhaps the therapeutic dose was too high (2.0 ATA) for the condition?  Overall little, research on HBOT for brain injury is occurring because pressurized oxygen can’t be patented which limits potential profitability.  (The Joe Namath study is relying on donations).

HBOT has been approved by the FDA for 50 years for multiple diagnoses.  When soft chambers are used, it is safe, theoretically sound, cost effective and in my opinion the best available treatment for TBI and concussion.  I would hands down recommend it to anyone who has suffered a concussion until their symptoms cleared (as well as a dose of the homeopathic remedy arnica montana).

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