Dr. Frisch

Hello and welcome to this issue of Dr. Frisch's ENews.  If this is the first time that you are reading one of my newsletters, I hope that it is informative and a learning experience for you!  For those of you that read my ENews regularly, welcome back!

You may notice from the first article that the topic of this ENewsletter is Fear.  There are many different causes for each of us to be fearful at times in our lives, but often times our fear is unfounded and it results in a negative reaction...inside of us!

Fear is psychological, fear is physical, and yes, fear is even social.  The ability to sustain fear is in each one of us, and as research has shown, many animal (including fish) have higher-order thinking that allows them to experience and suffer reactions because of fear.

If fear is common and not so unique to any of us, why do we find each episode of fear so dramatic.  Shouldn't we know what's happening?  Shouldn't we be able to use our past experience to calm any irrational fears?  Why then don't we???  

Fear can induce learning on a level below conscious thought.  Once this fear response is 'learned' and stored by the brain, it can efficiently use the response for other events and situations.  This means that we learn to have and experience fear on a subthreshold level.  This is one instance when the brain may work a little too well.

Our ability to recognize fear in ourselves and in others is often masked by our busy lives.  We are also too quick to run to the medicine cabinet with each ache, pain or unpleasant experience.  Unless addressed appropriately, fear may permanently alter our mental and physical well-being.

Fear imparts a negative affect on each one of us.  Some reactions are minimal, while some produce dire consequences.  A scary movie can be fun, but a scary stranger in the neighborhood can have long-lasting impact unless the situation is resolved quickly.

I hope that I have brought you some interesting and thought-provoking material this month.  Please contact me with any questions or comments.

Enjoy!

Dr. Frisch

~ FEAR ~

What is fear?  

Do we really know?

Why are we afraid of anything...ever?

First, let's define what fear is and what fear isn't.  Fear is a unique, self-preservation mechanism of our brain and body.  This self-preservation mechanism is partly learned and partly genetically programmed.  Fear is not worrying that fried foods might give you heart burn.  That is apprehension, anxiety, and probably foolishness, but it is not fear because you will probably eat the fried dish anyway!  Worrying about the 'after-affects' of a personal action is not fear because you have a choice, which is likely based on a past experience.  Fear is actually a neurochemical response in your brain that is not under your conscious control.  Some may call this the 'flight, fight or freeze response', but the response is merely secondary to the initial action of fear in the brain.

The fear-generating region in your brain is found within the H-P-A Axis.  The relationship between the Hypothalamus-Pituitary-Amygdala generates the hormonal and neurochemical sequencing that allows the sensation and realization of fear to be generated into a physical action or plan.  This signaling sequence happens in milliseconds.  In close proximity to the H-P-A Axis is the Hippocampus.  This is the region of you brain responsible for short and long-term memory.  After the sequence of fear is stimulated and a physical response is initiated, we will have a short-term memory that is temporarily under 'conscious thought'.  If considered new or novel enough, that short-term memory may be stored in your long-term memory banks.  Once a fear response is generated, sequenced and stored into long-term memory, the process of fear gets slightly more interesting.

Have you ever been sitting with a small group of friends and felt uncomfortable, anxious or fearful, for no good reason?  How about standing up in front of a large group of people, while giving a presentation?  Your 'conscious' realization of a fear response may not seem to make any sense to you.  You may have known these friends for years or been a professional speaker, accustomed to lecturing to large crowds.  Why then the does the fear response 'pop up' at odd or inconvenient times? 

An infant who has real fears of abandonment will cry as a response.  This is a genetically programmed fear sequence that stimulates the mother to return, comfort and protect the infant.  All animals do this, including humans.  The infant soon learns, however, that crying will garner a mothering response and he or she begins to use it at will.  The mother, aware that the infant has 'learned' a new tactic for attention, soon ignores the non-emergency crying.  The infant continues to use this tactic until a different attention-getting tool is found.  The fear response has now changed to an attention-getting activity.  The infant, though, may be unknowingly, developing patterns of emotional/fear response that are being learned by the brain and stored in long-term memory.  As the infant develops into childhood and then adulthood, the recall of specific memories are probably not even needed to begin the neurochemical sequencing to initiate a physical fear response.  

Every new fear is learned, even if consciously forgotten.

For this reason, we are probably each responsible for a considerable portion of what makes us fearful in any one situation of our daily lives.  We may not even know why we are anxious or afraid.  We don't realize that our brain has efficiently taken an emergency response and stored it for long-term learning and use.  After all, why learn the same thing twice?  The brain likes efficiency and it would seem a waste of energy to experience a new and novel fear-response when one is already stored in the archives.  For example:  

• Why wait to experience the humiliation of singing a wrong note during a solo when you can be ready to experience the embarrassment and fear before the concert even begins! 

• The actor who forgets the same lines nearly each and every time he or she recites them.

• The 'bad test taker' who really knows the material, but does poorly on stressed, testing recall.

• The man or woman who truly wants a committed relationship, but for whatever reason, just can't commit.

• The individual trying to complete college or finish writing a novel , but just can't quite seem to complete the task, in spite of his or her greatest attempts.

Each of the situations that I have just listed, and the thousands that I didn't, have something in common.  Each stressful and fear situation has an activation of the H-P-A Axis and the Hippocampus!  

Each fear is experienced and consciously forgotten or experienced and consciously remembered.  Each fear experience, however, is always neurochemically remembered in the brain and it can be experientially recalled without conscious memory!  This will result in a fear response for seemingly, 'no good reason' .

In the articles that follow, I have tried to relate to you how fear impacts our daily lives, both consciously and unconsciously.  Fear is not imaginative.  It is a real entity that must be addressed before it visits us again...and again...and again...and again...

The Face of Fear

Most of us would like to think that we are observant of what goes on around us in the environment. We pay attention to our dress, what we drive, where we live and what friends and family members are up to.  But, do we really pay attention to what is happening in our small world?  I think that we are all probably a bit too self-absorbed and busy to answer that question with a resounding YES!

I would like to show you an example of what I mean.  I want you to look at the picture above for 4 seconds and then look away.  While looking away, I want you to pay attention to one thing around you.  It could be the printer next to your computer, a picture on the wall, or anything else that has detail.  I want you to focus on that object and really study it for 30 seconds.  After that I want you to return to the picture of the girl above and focus on the details that she is revealing.

DO IT NOW!

For those of you who are keenly astute, you will have noticed some descriptive things about this young woman.

1. Her forehead is not wrinkled, as one would see in a 'questioning or agreeing pose'.  This woman is alert and concerned!

2. Her eyes are wide and reactive.  This is common with a guarded or fearful posture.

3. Her mouth is non-descript.  She is not smiling, frowning or grimacing.  She is genuinely concerned and likely fearful of a situation.

4. The hands were unnecessary in this picture to relate an emotion and likely took away from the impact the photographer wanted to make.  The hands give the picture a 'staged' look.  People with real fear and concern do not appear staged.

Conveyed emotions are subtle and often missed by those not paying attention to the people with whom we interact. Two of the most consistently detected expressions are that of fear and pain, but in our fast paced society, even these are often missed or ignored.  Considerable research has been performed on the topic of expression and emotion, with the most recent study being published on May 22, 2007 in the Journal of Neuroimaging. ¹  

In this study, scientists attempted to determine if there was a consistency of brain patterns detected when fearful stimuli were induced.  Sixty six participants (32 women) were administered 'functional' MRI's of the brain to determine reaction to event-related stimuli.  Fifty (50) different pictures were shown to the subjects, with 20 of those pictures designed to induce fear.

The results of the study were positive for consistent brain response with fear-inducing and disgusting pictures.  The occipital (visual), prefrontal cortex (higher order thinking), and the amygdala (emotional) regions of the brain were consistently active and processing, while observing each picture for only 4 seconds.  This means that fear does impact a specific region of the brain and a specific action or plan of response will follow, even if that response is programming for the future.

An equally interesting study was published in the May 10, 2007 issue of Neuroimaging,²  in which fear-inducing odors were used to determine brain response.  The individuals were prevented from thinking about smells  to determine an emotion (pretty cool).  The brain would react anyway.  The Amygdala and Hypothalamus, again were fired for response and action.  This means emotion doesn't necessarily have to have direct, conscious thought to have physical impact on the body!

I have consistently said that 'words are everything' when it comes to interaction with others, expressing feelings, emotions, desires and goals, but I think its important to also stress that emotions direct and drive words and actions, both physical and emotional.  For this reason, some (or many) of the physical maladies that we suffer with may result from a direct brain stimulation of which we weren't even aware was present.

READ ON!!!!

1. Stark, R., Zimmermann, M., Kagerer, S., Schienle, A., Walter, B., Weygandt, M., Vaitl, D. (2007) Hemodynamic brain correlates of disgust and fear ratings. Neuroimage. May 22. (Epub ahead of print).

2. Chen, W., Tenney, J., Kulkarni, P., King, JA. (2007) Imaging unconditioned fear response with manganese-enhanced MRI (MEMRI). Neuroimage. May 10. (Epub ahead of print).

"Help, I've Fallen and I Can't Get Up"!

I think that most of us have seen the commercial from which that line originates.  The salesmanship of that medical alert device was tops.  I wonder, though, how many sales were generated by a real fear of falling and being unable to recover or if the sales were made as a security blanket for when they (expect to) fall? 

I have discussed fear extensively to this point, but now I am going to add another dimension to the topic of fear.....pain!  Many studies over the years have shown that pain can be used as a stimulus for response and that an individual can be trained to ignore pain or become apathetic to a conditioned pain. There is currently new research being performed to evaluate the influence that conditioned fear has on human pain thresholds.¹

University of Tulsa researchers found that when they used expressions of happiness and that of fear for test participates, they were able to alter pain thresholds.  They did this by inducing an electrical stimulation to the participant each time a picture associate with fear arose on a computer monitor.  This conditioning was also done with the happy pictures.  The results were quite interesting.

This study revealed that when people were conditioned to experience pain, even once the electrical shock was removed, they still experienced higher and measurable pain on a radiant heat device than did other test groups.  The group that had been trained to get a shock when viewing happy pictures DID NOT experience altered pain thresholds once the stimulus was removed!  

"Fear can cause physical pain"

Once an older person becomes fearful of things like falling, the pain of arthritic conditions and trauma often increase in response.  Their self-generated fear actually increases pain levels that they already experience.  How unfortunate!

For the elderly who have fear of falling issues, their fear may be unfounded and actually related to a true physical malady.  The Department of Neurology at Tel Aviv Sourasky Medical Center² recently completed a study of gait patterns in the elderly with some interesting findings.   

Fear of falling (FOF) was tested in 21 seniors under these four conditions:

1. Usual walking

2. Holding a Therapists hand while walking

3. Using a walker

4. Being guarded

While the testing conditions did appear to provide a mild amount of benefit with a fear of falling issues, gait problems were not alleviated, which means that they have a physical problem that needs to be addressed.  Their altered gait wasn't present because of trying to be careful not to fall, but rather a disorder in the brain itself!

Another study performed at the same Medical Center³ evaluated the 'freezing of gait' in the elderly.  Freezing of gait is when someone does not seem to be able to 'take off walking' at will or if they stop walking, when they should continue to move.  The senior will often blame it on being afraid of falling, but that is not quite accurate.  In cases of freezing gait, they weren't actually afraid of falling, but rather, the frontal region of their brain was not working right.  People with freezing gait need to have a medical evaluation as soon as possible.  

Evaluating these studies does raise some interesting thoughts when evaluating fear and pain:  

1. Pain can be create apprehension and result in fear.

2. Fear can create and enhance pain

3. Both pain-created fear and fear-created pain result in long-lasting, physical impairment!

as well as fear and falling:

1. Fear of falling can impair physical mobility and force the senior to walk in a 'guarded' manner.

2. Gait problems may not be related to a fear of falling, but may be an indicator of brain dysfunction, requiring a medical evaluation.

1. Williams, A., Rhudy, J., (2007) The influence of conditioned fear on human pain thresholds: does preparedness play a role? Pain Jul;8 (7): 598-606.

2. Balash, Y., Hadar-Frumer, M., Herman, T., Peretz, C., Giladi, N., Hausdorff, J. (2007) The effects of reducing fear of falling on locomotion in older adults with a higher level gait disorder. Journal of Neural Transmission. Jun 18. (Epub ahead of Print)

3. Giladi, N., Huber-Mahlin, V., Herman, T., Hausdorff, J. (2007) Freezing of gait in older adults with high level gait disorders: association with impaired executive function. Journal of Neural Transmission. Jun 18. (Epub ahead of print)

Eileen's Corner

"This is a 'blast from the past' recipe that I made back in my 4-H days.  I have served it a couple of times this Summer.  Each time, it's like revisiting an 'old friend'........Enjoy this one!"

Shoestring Salad

 
1/2 cups grated raw carrots
1 cup diced celery
1/2 teaspoon grated onion (Add more depending on your taste.)
2 cans of tuna
1 cup salad dressing (Miracle Whip)
1 to 2 cups shoestring potatoes (Add more or less, depending on your taste.)

 
Mix all of the ingredients together, except for the shoestring potatoes. 

Chill for one hour. 

Just before serving, add the shoestring potatoes.  You may also add other seasonings, depending on available herbs or spices.  This is a dish to have fun with!
 
Serving idea:  Serve on a lettuce leaf with a garnish of hard cook eggs and tomato wedges.

Have a Great Month!

Eileen
 

"I Hate Doctors"

I am somewhat biased when I hear people make statements like this, but I also understand what they are really trying to say.  Most people really don't hate Doctors, but instead, they are afraid of what the Doctor may tell them is wrong with them!

Sometimes the news is bad, but more often than not, the news is encouraging and there is usually a solution to the problem.  I do, however, hear of the horror stories that arise from within my profession and that of our brothers and sisters in Medicine, but thankfully, they are few and far between.  The vast majority of all doctors care greatly that their patients get better with care.  Sometimes, that hardest thing is to get the patient to accept care recommendations and stay around long enough to resolve his or her problem.  We live in a 'quick fix' society and that often gets in the way of reality when it comes to treating trauma.

A recent British Study¹ investigated  the outcomes of care based on early treatment.  One hundred thirty (130) patients were evaluated at a private UK chiropractic clinic (Note: There are more Chiropractic Colleges outside of the U.S. than in the U.S.!).  Most patients presented for care within 4 weeks of the trauma.  Even though many of the patients experienced fear and apprehension when seeking care, it did not restrict or lower successful treatment outcomes.  This was significantly different than earlier studies with patient populations.

What the study found was that the duration of the pain/problem was more important in the overall outcome, than was the issue of fear and apprehension with seeking care.  The greatest benefit of care was notice at about the 6-week period during follow-up interviews.  This study found that the sooner the chiropractor is able to treat the trauma, the better the overall response to care will be.  The longer an individual has trauma in their body, the harder it is to treat and the outcomes may not be a 'cure'. 

This study is supported by a recent paper published in the Journal of Medical Hypotheses (2007)².  Researchers in the Department of Neurology at the University of Vermont proposed that the fear associated with injury and/or trauma may lead to improper healing of the connective tissue in the region of trauma. the body.  When an injury exists and is not treated with therapies like 'Chiropractic manipulation'... "The healing that occurs may result in decreased movement, connective tissue remodeling, inflammation, nervous system sensitization, and further decreased mobility". 

These research papers not only state that fear may stop someone from going to the doctor in the first place, but also that fear of seeking care may induce further physical trauma in the body with improper healing of tissue.

If you have suffered trauma, don't wait! Fear and apprehension can make a simple problem much more difficult to treat!

1. Langworthy, J.M., Breen, A.C. (2007) Psychosocial factors and their predictive value in chiropractic patients with low back pain: a prospective inception cohort study. Chiropractic Osteopathy. Mar 29; 15:5

2. Langevin, H.M., Sherman, K.J., (2007) Pathophysiological model for chronic low back pain integrating connective tissue and nervous system mechanisms. Med Hypotheses. 68(1): 74-80.

Stress + Perception = Pain

There is more to pain than just an event of trauma. So far, I have tried to relate different aspects of fear as it impacts our physical well-being or illness-state. Fear does stop us from seeking needed care and fear also alters how we physically heal after trauma. This type of fear can be considered ‘apprehension-type’ fear, but it is not the single, generating reason for a fear response in the body. Another reason for fear-related actions by the body is stress and pain perception^{1, 2}.

Even though stress is considered an important aspect of the pain response by both patients and doctors, there is more to it than just having musculoskeletal pain. Stress and the interpretation of that stress alter activity within the hypothalamic-pituitary-amygdala-adrenal connection. This means that our brain associates events, pain and perception and fear is generated as a result. Fear-avoidance is actually a key, stress-related, characteristic of perception.

This concept of fear and physical distress is not exclusive to humans. Most vertebrate animals that have higher-order, cognitive thought (frontal lobe), like dogs, cats, deer, and even birds can induce pain and physical maladies by combining stress and what the perception of that stress means to that species. It was recently found, however, that even fish have pain-interpreting neurons that can be measured. This means, that at least one fish on this planet, uses higher-order thought! This surprised even me, but hey, why not. Just because we don’t talk walleye, doesn’t mean that a fish is incapable of thought and perception! Interesting research!

"In closing this issue of ENews, I would like to thank each of you who read, learn and pass on the information that I share with you each month. It is too easy to coast through life without a care in the world about how our bodies work and why we, sometimes, break down. When we are well-informed about topics of health we can carry on an intelligent dialogue with those people who are helping us when we are sick and injured. Intelligent information is not gained from a T.V. sitcom, tabloid magazines or infomercials. That is why I cite studies at the bottom of many of the articles that I write. This is for your benefit. When you are talking to someone about a problem, you can share what you know and be confident that you are sharing more than just an opinion. I hope that I help empower you to do so!"

Take care and be well,

Dr. Frisch