I have extracted this (and other) nerves from cadavers, and this circuitous cranial nerve (XII?) is as beautiful and complex as the multibranch plexus-es (e.g. brachial). So delicate.
Human anatomy, at first glance, often seems wrongly-engineered. After you've worked inside dozens of people, you begin to realize that everybody is unique — and nobody is "textbook" anatomy. Who knows what all this goop even does?!
If you ever get the chance, I highly recommend this humbling human experience. My hope is that my own cadaver is ripped apart by somebody as crazy/appreciative as me =D
I know you’re exaggerating for poetic effect but this might actually be true in some parts of the human anatomy.
For example the description of the anatomy of vessels and anastomoses around the knee…I have had a professor tell me that the standard anatomical descriptions for this might all essentially be fiction. Basically the variation in some of these vessels over there is so high that the standard anatomical textbook description might be wrong.
That being said maybe the professor was wrong. I don’t know. But it was an interesting thing to think about.
Even identical males twins don't have the same penis structure/routing. Thanks for sharing your own personal example (I am the twin, in mine).
Another example is that of sciatia, which is much more prevalent when your sciatic nerve takes one particular path to get through the glutes. Other routed methods and sciatia is much less likely to be debilitating.
>Even identical males twins don't have the same penis structure/routing. Thanks for sharing your own personal example (I am the twin, in mine).
A form of biometric authentication, perhaps? Assume one has a spare CT scanner or some such thing, and doesn't mind discriminating against roughly half of the population.
I know someone where the main artery into one kidney branches in two. Seems like a possible evolutionary step to bifurcation into more smaller kidneys. ;-)
I was being prepped for wrist/arm surgery years back and the anesthesiologist got a bit flummoxed and muttere, “huh, that’s strange… let’s get an ultrasound” while trying to administer a nerve block on my arm. I asked what and they ”oh, it’s nothing to worry about, but your nerve isn’t where it is supposed to be…”, and then knocked me out before I could ask anything else.
For perspective, when I learned to do nerve blocks (UCLA Department of Anesthesiology, 1977-1980 residency), portable ultrasound for guidance was a pipe dream.
For the axillary approach to brachial plexus blocks, we tried to elicit paresthesias from actual needle impaction on nerves and then pulled back a tad and injected a bolus of anesthetic.
We did that repeatedly, aiming to deposit anesthetic near each branch of the plexus.
Failing that, hitting the brachial artery with the needle and then continuing to advance the needle until no blood could be aspirated, injecting half the intended volume of anesthetic (2% lidocaine with epinephrine 1:1000) behind the vessel, then withdrawing the needle until no blood could be aspirated and then depositing the remainder of the anesthetic on the front side of the artery was the technique of choice.
Oh, sure. From U/S experience I would guess that transarterial method was probably the most likely to work. Never did one, but was taught the concept and it looks like it would work.
Did femorals and popliteals by stim, it was quicker than ultrasound. Now that we have ultrasound everywhere, there’s no reason not to use it.
Residency 06-09.
One facility I worked at had a family medicine guy who was in the National Guard who asked me about field treatment. I mentioned Valium rather than Versed for reducing dislocations and fractures, and said that he really should find someone to teach him interscalenes by stim, I would teach him popliteals. Just to get those ankle fractures and dislocated shoulders comfortable until they could be evacuated (this is training, not combat, so plenty of troops don’t get moved until next day at least). Unfortunately this was as U/S was really becoming standard of care so it would be hard to justify teaching stim for a brachial plexus block - but he can’t fit that u/s in a field kit.
Last time I counted there were three or four of us, but bookofjoe is a prolific reader and poster courtesy of being retired.
We have a lot of down time during the day, just in very short increments. Thus the stereotype that we’re all crossword/Sudoku nerds. HN is something you can pick up and put down in a moment.
Also, I have always thought of the job as a sort of human engineering, or a big physiology lab. Programmers have REPL; we have vital sign monitors for instant feedback. Thankfully it is difficult to crash a human accidentally.
People think doctors bought computers early because they were rich. They could, but it’s worth remembering that if you were a science-and-math kid in the post-WW2 era, medicine and engineering would be the fields you would be pushed toward. That is not as prominent now as tech has started paying better and medicine less, but it’s still not terrible reasoning. I would have to screw up a lot to be unemployable, even if it did take me a lot of school to get to that point. Doctors bought computers because they looked fun.
Only one of my partners has an engineering degree (MechE). I majored in chemistry. Two pharmacists, one accountant. Don’t know about the rest.
"I have always thought of the job as a sort of human engineering, or a big physiology lab."
I like this. I used to tell med students doing a month-long rotation that the specialty could be described as a combination of applied physiology/applied chemistry/applied anatomy with the great thing being you get to find out if you were right in the moment/that day, rather than having to wait days/weeks/months/forever to learn if you had done the right things.
P.S. I majored in political science
P.P.S. ChatGPT-4o just told me that "The use of nerve stimulators for brachial plexus blocks became more widespread in the late 1970s and 1980s."
I never used a nerve stimulator — or US — for brachial plexus blocks during my career (I retired in 2015). I guess I was just so used to doing it the way I learned back in the Dark Ages that as long as I got good results, I kept on keeping on.
Also, if you're doing a locum in some backwoods hospital in a small town in Virginia, you're unlikely to find a working nerve stimulator, much less a portable ultrasound.
I suppose this is why they have a mandatory retirement age for airline pilots.
Cool! Thanks for the perspective. They found a Vernitrol (basically copper kettle) at an older hospital I do a side gig at that was set up for cyclopropane and some other agent a few years ago; I pointed out that you could still do anesthesia with it today if you fixed a couple of broken pieces. Neat to look at even if it didn’t have the circular slide rule to determine through-kettle and bypass flows at each temperature.
Is ultra sound that little monitor they/you look at while the needle thing is in your arm to apply the nerve block? That process a bit unnerving no pun intended. I thought maybe since my arm had been tweaked by being in a full arm cast for a month even with the screen they weren’t going to find it.
Yes. You can see the needle, see the tissues. Nerves sometimes aren’t visible right where you want to block them, but if you can see them headed in the right direction and then see the structures they are supposed to be (and usually, though not always, are) near, you can make good guesses and get results.
I honestly don’t know anything about that market. We don’t use sonographers because it’s interventional; I need to be able to control my own view very tightly.
Hmm that is the opposite what I would have expected. Because there is so much variation an AI that has trained on an insane breadth of data should easily be able to outcompete a human on specialized tasks.
My thought is the exact opposite. AI can handle predictable situations fine, but the 20% of situations which are unpredictable require a general intelligence that can understand context that current AI technology (or possibly any AI technology) just doesn’t possess. There will always be situations that training doesn’t cover.
The other side is that AI can learn every last bit of information from all CT scans, operating room video recordings (and more) in the world with no rest or sleep, and with 100% diligence
Gradients, spectrums and distributions describe the quantifiable diversity in humans. People have different heights, weights, eye colors, and other numerically measurable qualities. We’re exposed to this and it’s not surprising.
What this thread is talking about is things like extra fingers, missing or extra nerves and muscles, and varying structural differences.
I recently started learning a lot about the muscular and nervous system in the hip area. Even on Wikipedia you routinely read things like „this muscles is missing in x% of population”. It blew my mind that there is so much difference to our internal structure.
The genetic code is basically configuring a generic vertebrate body; the same sort of variation we see between vertebrate species we can also see as developmental variation in a species.
there are many interesting anatomic variants
one interesting thing is the muscles that move our "grasp" - to cause our fingers to close or open. One muscle, with a "lead" per each finger.
anatomic variant is sometimes these include the pinky, sometimes they dont. The pinky has its own set of muscles in either case. If you try moving your fingers you can see there's a bit more traction with the pinky isolation versus other fingers and thats why
This reminds me of a conversation I was having recently about genetically engineering humans. I think people are greatly underestimating the complexity of the human body and it’s nature mechanisms of adaptation. Everyone is a little different - but that’s okay because all the little feedback loops and receptor sites account for changes. Like a drug addict needing more and more to get their fix. There isn’t just one variable we can adjust to really solve most problems. You have to look at the entire web of interconnected systems and modulate how each of them work together. We sort of take it all for granted since life is so abundant, but it’s truly nothing short of miraculous.
> I have extracted this (and other) nerves from cadavers
One of the most incredible exhibits I've seen are the anatomical tables on display in the Royal College of Physicians museum in London. When I walked into the room there were these 3-4 "doors" with what looked like shadows of people on them. The more I looked, and the more I understood what I was looking at, the more amazed I became.
The museum, and building I think, was closed for a few years but understand it's back open again.
The tables are visually spectacular. They show the recognisable form of the human body laid out flat, as if illustrating a book. The nerves, veins and arteries on display were dissected at the University of Padua’s famous anatomy theatre in the 17th century, and skilfully arranged on varnished wooden panels.
Yes, a bit uncomfortable to consider the ones they have plasticized into sexual acts
into eternity and the pregnant woman and fetus (and there’s a lot of intrigue into that poor lady and baby). But ultimately, the non-consensual advancement of understanding of our bodies is a deep, dark, tragic rabbit hole that goes from antiquity up to… this very moment.
Don’t know what to do with the information I have discovered in the end but a good reminder to pause and reflect occasionally with the hope that we may not enable whatever the next “great idea, damn the costs” is.
I watched a fullautopsy in a theater high school at the Walter Reed National Military, followed by an open heart surgery. I'm sure there are videos of this. Beware it's a lot they pick apart the human body.
Multiple options, including: attend medical school; become employed by an anatomy farm.
As for "chance of being hacked apart," anybody can donate their cadaver to science — most facilities require prior enrollment and will recover the corpse, nationwide.
You might end up sold into scientific experimentation... if you're morbidly obese (e.g.) you won't be used for student anatomy (if you care).
And one example of scientific experiment is being left out on an open field to study how cadavers decompose when exposed to “the elements” wind/rain/sun/bugs/birds/wolves etc to help solve crime scenes. You can look up forensic anthropologists and body farms for more info.
Not my cup of tea, personally, but my ultimate point is you might get used in something you disagree with. Look into the history of cell lines used in medicine for some of the controversy and perpetual pain for surviving family members, as an example.
And it was originally the last cranial nerve in vertebrates, before the first spinal nerves have been incorporated in the cranium as the nerves XI and XII.
It and several of the nerves preceding it, which originally innervated the branchial arches, remain different in nature from the following nerves (spinal nerves + cranial nerves XI and XII), whose original main purpose was to innervate the somatic muscles. This difference is more important than whether the nerves happen to exit the central nervous systems between adjacent vertebrae or by holes through the cranium (which are the result of the first vertebrae becoming fused to the occipital bone).
The nervus vagus and its associated ganglia of the vertebrates has a correspondent in the nervous system of most animals, including the arthropods, as a vegetative nervous system of the gastro-intestinal tract, which is connected to the central nervous system from the head, e.g. with the tritocerebrum of the arthropods.
I know med students get to attend cadaver vivisections, is this accessible to others as well? (of course this may depend on jurisdiction and university practice, just asking in general in case anyone has experience).
So, textbook anatomical pictures are ideal just as ideal gases and point masses are. In the real world, concrete anatomy, concrete gases are different.
Physiological responses, the kind relayed from major body organs to the brain via the vagus nerve, are not necessarily your “mind” in the sense that they contribute towards your conscious actions or self-directed goals. But yeah, they send signals which can be interpreted one way vs. another depending on if you’re being mindful.
Arousal is especially interesting because you can compress a nerve in the right way and experience something you don’t actually feel or want to feel. Feelings, however, are not the “mind”, i.e. the self-directed, persistent and conscious entity.
I think it’s important to say this because people often fall into the trap of thinking physiological responses are indicative of consciousness.
Another cool thing about the vagus nerve is what happens when people get vagotomy (from Wikipedia)
> Researchers from Aarhus University and Aarhus University Hospital have demonstrated that vagotomy prevents (halves the risk of) the development of Parkinson's disease, suggesting that Parkinson's disease begins in the gastrointestinal tract and spreads via the vagus nerve to the brain.[24] Or giving further evidence to the theory that dysregulated environmental stimuli, such as that received by the vagus nerve from the gut, may have a negative effect on the dopamine reward system of the substantia nigra, thereby causing Parkinson's disease
Unfortunately, that link between vagotomy and reduced risk of PD hasn't been supported by subsequent studies. In fact, it wasn't really even supported by the initial study[1]: although the point estimates of the hazard ratios were below 1.0, the confidence intervals did not exclude 1.0 -- or stated differently, at p<0.05, the null hypothesis cannot be rejected.
Cool, interesting! Though I wouldn’t be surprised if there are such links, even if this one is not supported by further research. We know that gingivitis can lead to heart disease, so I wouldn’t be surprised to find that gut microbial imbalance could have other implications.
its even more complicated than that...
-Parkinson's has lower amount of GI lining
-Parkinson's is a severe lowering of dopamine...how severe...patients take 1800mg dopamine daily....
Just a random "vagus nerve story". A while back, I started having weird heart flutters that turned out to be extra heartbeats (doctors call them PVCs and PACs). Sometimes I'd be fine for days or even weeks, but then they'd come back pretty bad. After a bit, I noticed these flutters were linked to what I ate, which seemed really strange. I couldn't figure out how my food could make my heart skip beats.
I saw a bunch of heart doctors for almost a year before I found one who knew what was up. He told me I had something called "gastrocardiac syndrome." Apparently, not many heart doctors know about it. It's basically when acid reflux in your stomach messes with the vagus nerve. The doctor gave me some medicine to stop the acid (PPIs), and just like that, my weird heartbeats went away completely.
This has to be super common. My wife and I both are acutely aware of acid reflux causing flutters and other weirdness. During her pregnancy it got worse, and after a full cardiac workup her doctor's best guess was interaction w/ the vagus nerve.
I've also had a couple brushes with vagus nerve stimulation. While in a specialized chiropractor's office undergoing traction to correct an old neck injury, I passed out. Apparently this is quite common, especially when blood sugar is low. The vagus nerve does all sorts of weird stuff, including acting like an off switch.
I had the exact same reaction: "mind" as in "mind-body" for me refers to things such as reasoning, qualia, intentionality, the fact that neural patterns somehow receive "real meaning".
The mind may or may not be immaterial. This age-old question has not been resolved in any way, not even close.
Part of the problem is the idea of mind-body duality. Your body is your mind, but a physiological reaction relayed from a nerve is only part of the equation that’s you.
>Your body is your mind, but a physiological reaction relayed from a nerve is only part of the equation that’s you.
you are presenting an untestable-and-only-descriptive-hypothesis as a theory.
if we assume that what we know about it today is all there is, then yes, it must be your way. But why assume that what we know is all there is, that assumption has always turned out wrong for thousands of years? Better to say "we don't know what the nature of the mind is or where it comes from beyond the clear evidence that it's tied to the brain."
The problem is 400 years ago people would have said exactly this about the soul.
It seems very possible the mind is just a superstitious artifact but this idea persist in various forms because to let go of it truly means the lights go out at death. We seem incredibly good at telling ourselves stories to deny that reality.
There's no 'I think therefore I am' equivalent for the notion of a soul as there is for the notion of a mind though, it's easy to say there's no such thing as a soul for lack of evidence but I don't think you can relegate the mind to same category as trivially. If the mind is a mere illusion then what is the nature of the thing being deceived by that illusion for example?
I don't think it's necessary a fear of death which makes theories that eliminate the mind unappealing to many either, personally I find the idea of oblivion a lot less unsettling than many of the proposed afterlifes!
>The problem is 400 years ago people would have said exactly this about the soul.
that's not a problem. you have proof there is no soul? if there is another "physics-cal" ingredient for the mind that we don't know about, and it is discovered in a particle accelerator, "it" could even be the soul.
I was an atheist from my earliest beginnings (when my 5 years older sister tried to teach little-me what she learned in Sunday school, I did not believe it, at all), and I have never believed, and still don't. HOWEVER, intellectually it freed my mind to figure out/learn/realize that "scientific materialism" is based on just as much pure FAITH as religion; only it's generally accompanied by less doubt so it comes off as, forget about arrogant, blind. I try now to no longer to say things that are based on assumption.
Correlation is not causation, right? you know what the implications of that is? We have no evidence of causation of anything anywhere in the universe, all we have is very good correlation, even through our popperian refutable hypotheses, "well, it's worked every time we've made a prediction and tried it" is not causation any more than just correlation.
so what people said 400 years ago about souls, and what they say today about minds, you still should not claim to know the answer to, simply because you don't. And I know this from the perspective of holding the same BELIEFS as you.
and before anybody writes to tell me I'm wrong, be prepared to answer these questions: what is the mechanism for gravity? what is the mechanism for momentum? what is the mechanism for electric charge? you won't be able to say anything except "it's a property we observe"
But it’s not untestable at all, scientists have a reasonable understanding of what properties are inherent to consciousness. But if we frame experiments or hypotheses in a Neo-Kantian framework, that will always distort or bias the accuracy of estimations.
Though we have an understanding of what the Vagus nerve does, and I think this article misses that it is involved in both calming and stimulating the para-sympathic nervous system (someone correct me if I'm wrong), but the challenge with any of the "therapies" that apparently stimulate the vagus never is that we can't measure the vagus never directly, and are therefore making assumptions that this is the pathway these therapies are taking.
I had built a "vagus nerve stimulation app" a while back which used vibration to enhance calm. I did some measurements comparing this vibrating stimulation to neurofeedback with a Muse device, and the results seemed positive, but because we couldn't say specifically which mechanism was being triggered, and that it wasn't more than just "listening to calm music", we didn't pursue it.
I really wish these articles cited more primary sources. I would love (and prefer) to review the empirical work that led to the communicated understanding of these systems.
> However, some people have taken the vagus nerve’s expansive bodily influence as an invitation to engage in pseudoscience. In some corners of the internet, so-called polyvagal therapy — physical or breathing exercises that some claim reset the vagus nerve — is proposed to address(opens a new tab) just about any disorder of the mind or body. There’s little to no evidence that these popular remedies are anything but placebos.
but is the polyvagal theory backed up by concrete scientific evidence? i’ve heard tons about it but practitioners never seem to have real statistics about it all. i thought that the polyvagal theory has never been actually proven?
Porges started with studying the difference in the length of successive heartbeats, and the nerve systems that control this variability. He accumulated lots of data, and published his findings. He looks at the function of the different branches of the vagus nerve before he eventually connects the state of the vagus nerve with the functioning of the social engagement mechanism--the system that enables us to recognize faces and read their emotional signals. He also connects the vagus nerve with fight-or-flight survival mode of the organism, vs. the rest-and-recuperate mode where resources are made available for healing. It is well-founded, plausible, has good explanatory power for how (to give one example) family visits to a hospitalized family member contribute so greatly to their recovery.
For anecdotal data, I'm a big fan of Apollo Neuro. It's a small band worn on the wrist or ankle and vibrates to stimulate the vagus nerve. Similar effect to tapping on your wrist. The sleep mode seems to improve my deep sleep scores on my Oura ring. I haven't done any proper data analysis to confirm.
Correct, the vagus nerve itself doesn't extend into wrists and legs AFAIK, but other nerves connect to it. Wrist tapping and acupuncture stimulation of points on the wrists are quite common. I'm assuming devices like Apollo Neuro target a similar effect on those pressure points on wrist and ankles.
Here's a random article about vagus nerve and acupuncture [1]. I'm not sure about actual pubmed type studies. On a personal level, I think these devices are well worth giving a try. Just pick one with a good return policy if it doesn't work for you.
I disagree with the title. The vagus nerve is just the telephone line of the mind-body connection. The release of Catecholamines[1] and Purines[2] orchestrates the mind-body connection connection, like people talking on opposite ends of the telephone.
"It is possible to stimulate the nerve fibers with a mild electrical pulse by surgically inserting electrodes into the chest or, more simply, clipping them to an earlobe."
The electric pulse stimulates the release of catecholamines and purines which initiate and heighten nerve signals along the pathway,
The "simple" way they describe the vagus nerve leads to an inhibition of creative thinking in the field of psychiatry and health.
My vagus nerves were constantly being compressed until roughly 4 months ago, when I had bilateral Eagle's syndrome surgeries - Eagle's syndrome a hardening, calcification-ossification of ligaments that connect from the styloid process and wrap around the neck connecting to front of throat; I had played American football for all of high school and most likely the cause from reptitive injuries/trauma to the tissues.
Well, this understanding, if true, could help explain why the severe-debilitating pain level I've had would very easily cause me to get completely lost in the pain - where I couldn't get my mind going, couldn't focus past the pain, would be lost and fully distracted by the pain if I didn't 1) keep my activity level as low as possible (even slight movement of my neck would strongly worsen the symptoms of Eagle's syndrome, particular to the right - a commonly described symptom that one side is much worse), and 2) if I had had any inflammatory foods during the prior 2-3 days or 5 days if dairy.
Now my struggle is, now that my nervous system isn't so interfered with with my vagus nerves' signaling no longer being interfered with - my nervous system is working far stronger now, so I feel the remaining few areas of pain far more strongly - and along with that emotionally the experience is far harder as well, far more aggravating; and I arguably no longer get as easily lost in the pain anymore, but now that I am more often connected to my mind, the remaining more strongly experienced pain is more constantly disruptive - whereby the disconnect otherwise was arguably a sort of coping mechanism; being lost in pain is not fun, but at least then routine could act as a functonal crutch.
The biggest problem now though is it is even more difficult to get my mind focused on a specific task that I need to get done, having had severe executive dysfunction that had slowly been improving over the years as I played whack-a-mole to knock out the next strongest sources of pain - but now trying to organize and get together what's needed to book next diagnostics for next likely needed treatments to get last 2-3 major-excruciating remaining pain sources has been so difficult now, the uphill battle has turned into a steep cliff; the biggest problem is I am in Canada, Ontario specifically, and the knowledge and competency-critical thinking here is absolutely abysmal - where I've had to spend likely now over $800,000 for medical treatments in the US over the last ~8 years, and now struggling to find competent dentists - made worse by a dentist 1+ year ago - lastly being bounced around I think to 5 different dentists now the past 3 months.
My story is more complex than this however. My issues with pain only started after "successful" LASIK eye surgery ~12 years ago caused my nervous system to get overwhelmed - causing central sensitization - was the tipping point or the "final straw that broke the camel's back." Prior to LASIK my mind could handle suppressing whatever underlying pain the injuries and nerve compressions I had; so there is definitely a factor of compounding and arguably amplification (along with hyperalgesia, a hyperesensitivity to pain) between different the eyes and the rest of the body-brain.
I'm at my wit's end, and as pain has localized, unmasking the remaining pain sources more strongly, it appears there's a possibility while LASIK may have been the impetus - it may have been the teeth damage-specific teeth pain but overall bite occlusion causing severe sensitization via disruption of my reflexes-autonomous nervous system, essentially TMJ-TMD but only problems runaway guarding-muscle spasming that's compressing nerves - and then perhaps TMJ-TMD guarding compounding with the Eagle's syndromes; and then perhaps also with the corneal damage that happens in 100% of LASIK surgeries, of which there is nothing more I can try to reduce that as a source of pain.
I have a story about as long in text but not in duration. Nonetheless, I was unaware of a neck injury for about four years, then I got an MRI. Orthopedist suggested seeing a brain surgeon as soon as possible, and luckily the one I found suggested immediately that surgery for my young age was no option.
I ended up getting corrective soles and a mouth guard, and with the mouth guard specifically, I immediately went from 100% to 30% pain, and still recovering.
The nervous system and the interconnectedness of our bodies is impeccable. Throughout my recovery I learned so much about my own bodily systems. I recommend everybody, especially desk-jobbers, to see a qualified orthodontist for their chronic neck/shoulder/back pains. You will be surprised what you find out about the damage, and how fast recovery might come.
I had two herniated disks (T2/4) and one with a small fracture (T3). Clenching my jaw at night was leading to my SCM being tightened and applying pressure to the herniations, which was then causing imbalances in my upper back (which lead to the body correcting posture all the way down to your feet in a zig-zag manner) and also from my shoulder down to the wrist.
Mouth guard helps prevent too much pressure being applied to the neck, which gives pain relief all over.
As for soles, I had one foot that was facing outward while walking, which was identified by a physio to be due to hamstring tightness. But why is the hamstring tight? Automatic posture correction by my body! Since getting mouth guards, I've also been enjoying shoes with wide toeboxes and no rise too, which helped me correct my gait and reduce the impact on my hip.
That is incredibly interesting. I have a combination of flat feet and clenching my jaw, with a few posture issues and back/neck pain. So this gives me some insights to talk to my physio about - thanks for sharing!
My story is very similar. Have had tons of pain and muscle related problems for decades - played a ton of sports like you when i was a kid, and did a lot of physical risk-taking too (skateboarding, bmx-style biking taking them off jump-ramps...) and also had lots of injuries.
On top of chronic pain, I had (and still have but is greatly reduced) muscle clenching on the left side of my body - for some reason my body on the left side is clenching up, with this constant pulling on my head, pulling down and to the left. I also have severe TMJ, again on the left, and constant headache, light sensitivity, difficulty focusing and fatigue. It was truly horrible - imagine going through life with an extremely strong pull on your head and body. Your posture is messed up so physically, you look like a wreck, and sitting is painful as is standing. Also, you are just fighting this pull every second of the day. It never ends and you constantly have to think about it and ways to reduce the pull and the pain.
I worked with physical therapists and orthopedists for decades to try to figure out what was going on, but nothing worked. So about 8 years ago (I'm 50 now, so it was around my 42 birthday), I finally realized that I needed to look beyond the obvious causes of these types of problems, and explore almost everything, really ramping up the number and types of doctors I was seeing. Saw many types of docs: pain specialists, TMJ docs, gastroenterologists, ENT's (I have throat tightening and stomach issues too), neurologists...
Eventually, like you, found that many of my issues were from compressed nerves. And yeah, it's a struggle for you and the docs to find the right ones, but once you do, it makes a big difference. I'm not 100%, but I'd say I'm 60% there, and it's definitely changed my life, and is visible both physically and socially.
Of course, every person's body and causes of health-problems is different, so what helped for me may not help for you, but seems like you're on the right path. Keep searching, and would suggest being scientific about the process (this really helped me). I may write about my experience one day, so if you have any questions, let me know. And best of luck
How did you go about finding problematic nerves? I have had issues with nerve pain in my left leg for about 7 years now, did the full gamut of MRI s, bone scans, CT scans, ultrasound and saw about 5 different specialists including a neurologist and nobody has been able to help me.
Exercise definitely helps but it doesn’t actually seem to turn the nerves off, just desensitize them.
Sitting is very painful as I get pain in my sit bone and shooting numbness down my leg and all the way into my foot.
I have almost given up and accepted that I will be a cripple for the rest of my life. I live in British Columbia where the medical system is OK, but not near world class and all of the ambitious doctors have went to the USA.
I have a very bad bite which makes me suspect that my whole posture is messed up from the top down.
A good peripheral nerve specialist will direct the diagnostic nerve blocks, and he prefers you use his pain management guy who he trusts is doing the nerve blocks properly - so you're getting an actual proper diagnostic response from patient.
Dr. Tollestrup in Las Vegas would be my recommendation - I've done 7 surgeries with him so far. To note, every doctor I've encountered isn't perfect - in this case with Tollestrup, he himself hadn't heard of Eagle's syndrome before, arguably because he's a peripheral nerve expert - and the vagus nerves aren't considered peripheral afaik.
An "LVI Global" trained dentist may be able to help you find a proper bite, to create an orthotic that will allow your low jaw to relax/stop guarding. They try to upsell you to full mouth reconstruction, where they actually make money, although the daytime+nighttime orthotics they make for you aren't cheap either. Part of their protocol is also doing a head/neck CBCT scan - which is what incidentally found the Eagle's syndrome for me.
There are many things that I and the doctors did to figure these spots out (and we're still in the process of locating a few last key spots). Oh, one thing though, I have a hard time giving this info out nowadays, as people often just take the info and run - And am not sure of your gender, but honestly, it's guys especially. Think it's an independence thing, need to feel like they did it all on their own, which I get actually. Yeah, I'm a guy and have this instinct too, but still doesn't change the fact that they take this info and then act like it didn't help at all...
... although, just read loceng's comment. He definitely has part of the path I found too, so this could be enough (diagnostic nerve blocks is a key). But if you're really serious about getting more info, than feel free to provide with a way to contact you. Thanks.
You describe exactly what I experience. I can't afford to see specialists so in the past 15 years, I have taken time to listen to my body in an attempt to figure it out. It's been a long journey of self-discovery and healing but the progress I have made have been worth it. I recently discovered that I had bruxism as a child and wonder if that caused the TMJ. I also started eating dates and that helps alleviate some of the tightness I feel on the left side of my body.
Sorry for the late response, your message was pushed fairly low in my HN threads.
Agreed, listening to your body is really important. And, as you may already know, a key it to ask: Is this problem a secondary symptom or the source? You're always trying to find the root cause of the problem.
For instance, (am not saying this is it), but often, TMJ is caused by problems lower down, as the head/jaw naturally move in association with the pelvis (just do a google search online). May want to try doing accupressure on the pelvic floor, hips, and hamstrings to see if this helps
Please don't take this the wrong way but I'm very curious if either of you have heavily modified your diet in an effort to remove part of the pain cycle? A low inflammatory diet might help from my own personal experience with diabolical pain.
No problem at all, great question because, as you know with your own pain, complex health problems are difficult to solve.
Actually yeah, have been basically eat a low-ish inflammatory diet for ~25 years. Ever since in my twenties, realized that I had some major health problem, took my general health very seriously, and have been eating healthy since then (eating a lot of fruits and vegetables, whole grains, and only eating meat/fish once per day). In addition, have been exercising regularly too. This definitely all helps, because I would have felt completely miserable if my general health was also bad.
But seems like when it's a damaged nerve, then diet, exercise, and massage/accupressure can only do so much. The nerve is always firing and basically an electric circuit that is always on. The method that was worked in my case is to find a way to shut off that circuit.
And glad you found a low inflammatory diet helped you:)
I have had a couple of bouts of very painful trigeminal neuralgia, which was successfully treated with carbamazepine (an anti-convulsant). The latest bout was most likely caused by Covid.
I just wonder if there is a drug which can reduce nerve sensitivity, although I guess this is a well explored topic for you.
I have not continued the carbamazepine. In both cases, I used it for about a couple of weeks, and then stopped using to test if there would be a flare-up (and there was none).
Nerve receptor sensitivity is controlled in a large part by the amount of Guanine Triphosphate (GTP) in the cell by sensitizing the G Coupled Protein Receptors (GCPRs). Guanosine[1] and Inosine (Purines) are added to foods as flavor enhancers, along with glutamate because they are excitatory.
I have an enzyme deficiency called Partial PNP Deficiency which slows the speed I can metabolized these low level purines. When I eat these food I have full body pain as well as mood issues.
They add these to nearly every processed food in forms as innocuously sounding as "malted barely extract".
I used to need drugs, now I just need to watch what I eat (and watch other things in my environment like stress).
Good to hear the pain medication worked for you! Have tried a few myself. They work okay, but not well enough that I'd like to take them for the rest of my life - yeah, unlike your temporary pain, my unfortunately came back after stopping the drugs.
>> for some reason my body on the left side is clenching up, with this constant pulling on my head, pulling down and to the left. I also have severe TMJ, again on the left, and constant headache
@computerdork do you have a tongue tie/lingual frenulum or narrow airways/diaphragmatic dysfunction? These things can cause extreme issues with the fascia that lead to things presenting in such a manner.
If you’ve made it to teens/adulthood, it’s typically missed by fucking everybody in the medical profession.
I had some issues from turning my neck to look at at a side monitor for extended periods. You're supposed to turn your whole body to avoid strain, but it's easy to forget.
Neck strain and tmj can be related as well from the overuse of muscles.
hmm, I've always had issues with my tongue, it does not extend very far out of my mouth and my tongue is always clenched and pulling down and left as well. But it's hard to tell if this is because of tongue-tie or because if my throat muscles are tight.
Low dose Xanax (alparazolam) and meditation helped me through a flare up of tinnitus. I’m not sure to what extent amplified sound and amplified pain are similar though. I found that I could eventually calm down and ignore the tinnitus sound, but I’m not sure I’ve ever felt that way about pain. Maybe something to think about.
But, this is how tinnitus is handled. You have to relax and not be hypersensitive to it, because there is a feedback loop, and you don’t want to contribute to it.
Best wishes. Pain is a difficult thing to have to deal with.
Just look at how xanax works for a clue. Xanax increases the function of the GABA receptor. So you either have low GABA (inhibitory) or high glutamate (excitatory).Or have high levels of GTP which are making your auditory nerves more sensitive.
"Relaxing" will either slow glutamate release or increase GABA release. Processed foods often contain glutamate as a flavor enhancer.
What's considered a low dose for Xanax? Never taken it before.
Re: Tinnitus -
Interesting thought to put forward, thanks.
If you still have issues with tinnitus or hypersensitive hearing, look into Berard AIT (Auditory Integration Train) - and where there's a book called "Hearing Equals Behavior: Updated and expanded" that details it, and a sound treatment that can help with all that you said.
Oh boy, so familiar. I have Complex Regional Pain Syndrome, which is another CNS sensitised pain syndrome. "localised" for CRPS is usually a whole limb though. It's hard to explain how fully mind-consuming neuropathy is, as most people don't get much more than a toothache or a sciatica flare (which are bad enough, but usually "short" lived).
I've had an aweful lot of procedures and meds over 30 years, over 200, including 12 spinal procedures in 12 weeks when an attempt to deliver steroids to the C7 dorsal horn tore my dura mater. Very unpleasant.
It's really hard, as you say, to find good medical practitioners when you've got chronic nerve pain. They have to understand the relationship between hyperalgesia, allodynia (things that should not hurt hurting like crazy), movement (and lack of same) and meds, physio and psychs. Other injuries get involved once your brain is programmed to hurt you, and post surgical care involves more hard drugs to avoid sensitisation, leading to more complex drug tapering to get off the damn opioids (which only make chronic nerve pain worse paradoxically).
You say "I'm at my wit's end", and I've been there, past it and back again. You need to see a pain psychologist, a specialist psych. They can teach you "Jedi mind tricks" that may work for you. Things like how to focus your conciousnes into a bit that's NOT hurting. How to use disassociation to help getting day-to-day tasks done when you just want to curl up in a ball and cry.
I also strongly suggest you get in touch with other chronic pain patients. It's incredibly helpful to know you're not a weak freak who is a wimp and a weakling. To hear that other people have the same struggles. And to hear strategies for doing things that don't hurt as much.
Here in Brisbane people used to meet once a year in King George Square, for "Colour the World Orange" day. Three of these people are now friends who know what I mean by "it's not a good day". I found actually meeting other sufferers in the flesh to reinforce knowing that I'm not alone with this curse, other people struggle too.
And one from that group is in remission. We're all living vicariously through her, as this gives hope. Hope is what we all need.
Thank you for sharing your story; I'm sorry you are suffering. I'll lead with this quote and ask that you please feel free to ignore the following links:
> I don't want your advice on how to make the pain go away or to deal with it
--
Over the years on HN there have been discussions mentioning the work of two pain specialists focused on the mind-body connection: John Sarno's "Healing Back Pain: The Mind-Body Connection" (1991) or "The Mindbody Prescription" (1999) and more recently Bessel van der Kolk's "The Body Keeps the Score" (2015). I don't have enough personal experience to contribute any opinions on these resources, but I wanted to make sure you were able to review the recent discussions at these links, along with more anecdotes of the techniques working for many:
The US NIH is funding to not only map the human vagus nervous system in high resolution but also create treatments via the multi-million NeuroMod Prize
A vasovagal syncope is something. It can happen when pain is too strong and you... Simply pass out.
It happened to me once, ten years ago (probably due to a severe kidney stones incident but we never found out) and I passed out, on the ground, in front of my girlfriend.
My layman understanding is this: pain is too strong, the mind-body decides to simply turn the mind off.
Weirdly enough about one minute late I began to "think" again: laying on the floor and... Pain was gone.
I'm using a Dolphin Neurostim VNS to recover from COVID-induced anxiety. I'm getting better over time, especially my sleep, so maybe it's working? I had really bad depression for a while too, and that's mostly cleared up. It's not cheap but it's an FDA approved therapy for a number of conditions.
It sends microcurrent (literally - millionths of an amp) through the two halves of the vagus nerve via the left tragus to the left wrist, and from the right concha to the belly. Each half takes about fifteen minutes.
When I started using it I had some weird moments where my heart would skip a beat, but I ramped up the treatment durations over a couple weeks and now the treatments are uneventful.
Supposedly it's much safer than TENS units which deal with currents that can overload your nervous system.
BTW, look into Silexan lavender oil too ("Calm Aid"). Supposedly better therapeutic outcomes than prescription antidepressants and anxiolytics, especially at 160mg doses.
Art Of Living’s course 1 Sudarshan Kriya offers breathing course which activates the vagus nerve. I have attended this course. It claims to reduce anxiety, depression and addiction. I have not practiced it regularly. Sorry to say that.
Just caution, don’t turn it up to much and don’t overdo it. More is not better. A style of it can be had cheaply with a TENS 7000 and ear clip set off of Amazon. You will find research and anecdotes to support your decision either way. That’s a truism that’s always been true but perhaps especially in this day and age of overstimulated people and an endless amount of content generators.
Ultimately if you think it’s working then it’s working.
A lower risk way is probably breathing techniques and meditation apps.
Polyvagal Theory is a huge part of how I teach yoga to veterans. There’s a great book by Dr Arielle Schwartz - Applied Polyvagal Theory in Yoga. It does work, it can’t cure PTS(D) but it does provide relief if only for an hours r of class.
> However, some people have taken the vagus nerve’s expansive bodily influence as an invitation to engage in pseudoscience. In some corners of the internet, so-called polyvagal therapy — physical or breathing exercises that some claim reset the vagus nerve — is proposed to address(opens a new tab) just about any disorder of the mind or body. There’s little to no evidence that these popular remedies are anything but placebos.
The joy of explaining your sneezes every time you see a bright light during cold/flu/pandemic season.
I'm surprised to see it affects 20+% of the population because I've never met anyone who knew what I was talking about when I said "sorry, light makes me sneeze"
For me, since childhood, it was a common fact that if one were almost going to sneeze but couldn't, they should quickly look at a bright source of light to succeed.
Lights don't trigger a full sneeze if I don't need to but it always helped.
Also motion sickness. Food poisoning makes your brain experience phantom movements, hence its a trigger to purge the stomach. When your car/boat causes unexplained movement, ie your limbs didnt do and your eyes cannot track, time to soil your lap.
In a past professional career, I hacked open a few dozen deceased people. Literally every body has unique configurations within — i.e. constantly evolving different genomic expressions to see what does and doesn't work.
My personal feeling on over-medication of our society is that it encourages more offspring from less-successful brains. (however one might determine that).
Human anatomy, at first glance, often seems wrongly-engineered. After you've worked inside dozens of people, you begin to realize that everybody is unique — and nobody is "textbook" anatomy. Who knows what all this goop even does?!
If you ever get the chance, I highly recommend this humbling human experience. My hope is that my own cadaver is ripped apart by somebody as crazy/appreciative as me =D