August 16, 2010 at 11:32am
Lots of people have commented on how the stresses of life have caused MS exacerbations and flare ups for them. My husband Jeff has noted this; he'd be in a stressful situation at work, and his left foot would tingle and then go numb. Many of you have written about how stress brought about your MS diagnosis. So, what's up with this? How does it fit in with what we know about CCSVI? I've got a theory I wanted to share it with you, in case it might help someone. It's helped Jeff a lot.
There's new research out about internal jugular vein valve incompetence and people who have transient global amnesia. This is different than CCSVI, but related. These people have been shown to have reflux of blood in their jugular veins, which creates an ischemic (low oxygen) event in the brain.
"A high prevalence of internal jugular vein (IJV) valve insufficiency appears to be present in patients with a clinical diagnosis of transient global amnesia (TGA), suggesting that venous congestion in areas of the brain associated with memory may partially explain episodes of benign TGA. Claudia Cejas, MD, and colleagues at the Institute for Neurological Research, FLENI, in Buenos Aires, Argentina, found that IJV valve insufficiency was present on at least 1 side in almost 80% of patients with TGA, compared with only 25% of control subjects. There was also a trend toward a predominance of right-sided IJV valve insufficiency."
There are many papers about the connection of venous return and TGA.
The researchers tested the reflux in the jugular veins using doppler ultrasound and having the patients do a "valsalva maneuver". A valsalva manuever is when you force air up from your lungs, but keep your mouth and nose closed. Some people do this to relieve pressure in the ears when flying, some people do this when breath holding, or straining with lifting heavy objects, having sex or going to the bathroom. This is not something you want to do with any regularity. Many people do this when they are under stress, and do not even realize it! Valsalva manuevers create reflux of blood.
(It's important to note that Dr. Zamboni found a reflux of blood from blocked jugulars in people with CCSVI---he did NOT use valsalva manuever to see refluxing blood. That means pwMS are at a disadvantage, because your blood could be refluxing without performing these breath holding manuevers.)
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Another link to transient global amnesia is severe emotional stress. Read the next case history.
A healthy 61-year-old man was brought to the emergency department by his wife after she noticed that he was forgetful of the previous evening's activities and was unable to form new memories during the subsequent day. The patient repeated the same questions and could not remember events minutes after their occurrence. There was no history of intoxication, drug use, head trauma, or obvious physical or emotional stress. He had no medical history other than seasonal allergies and took no regular medications. The physical and neurologic examinations were otherwise normal.
On hospital day 2, the patient had a normal mental status and was able to form anterograde memories. He remembered that just before his amnestic episode, he had fallen asleep and dreamed about his son joining the Marines and being killed in combat in Iraq. He vividly saw his son in a casket draped with an American flag. At this point, he screamed and woke up with amnesia. The patient was especially distraught because his son was contemplating joining the military at the time the dream occurred. The episode of transient global amnesia was considered to be due to the stress of the dream, and the patient was discharged."
Stress can create this retrograde blood flow. It can be so severe, it can starve the brain of oxygen.
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So, what can pwMS do to prevent this exacerbation of reflux? How can we avoid this kind of emotional turmoil, and keep blood flowing back to the heart?
I believe the answer begins with our breathing.
When we are stressed, we tend to hold our breath, use valsalva manuever, or breathe too shallowly.
Try this experiment.
Breathe on your fingers like you just burned your hand. Make your breath cool, and do it quickly.
This is called "clavicular breathing", it is from the top of your lungs, and is shallow.
Your throat is tight. This is what I call "stressed out breathing."
Now, breathe on your hands like you are outdoors at winter time and want to warm your fingers.
Make your breath warm, do this slowly.
This is called "diaphragmatic breathing." It comes from deep in your belly, below your lungs. Your throat is open.
This low, warm breath is what we want to find when we start to get stressed. This type of breathing is practiced in yoga and the ancient traditions of meditation and breath counting. It is this low and slow, conscious breath that can slow our heart rate, open our blood vessels, relieve valsalva pressure, calm our spirits.
Take a deep, low breath. Open your mouth, open your throat. Lower your shoulders, fill your lungs. Let your belly release.
Now, let this breath slowly escape thru your nose. Think "warm air" at the back of your throat.
This is conscious breathing.
Feel the sense of calm. Try to do this when the world gets too noisy or insane.
I do this is the car during traffic jams, when LA traffic is driving me crazy.
Jeff does it when work becomes overwhelming, and his feet don't tingle any more.
I hope this connection of jugular vein reflux, valsalva manuever and stress makes some sense to you, and that learning how to counteract life's stresses and strains with your own breath will help you--
don't forget to breathe,
Joan
