...a shoulder dislocation is when the humerus separates from the shoulder joint and is the most common of the large joint dislocation normally the shoulder joint is made up of the head of the humerus articulated with the glenoid fossa of the scapula which is why it is known as the glenohumeral or joint it is a synovial ball and socket joint with a large range of motion but at the cost of being more unstable the head of the humerus is around four times larger in the shallow surface area of the glenoid fossa which contributes to the large range of motion but also to the instability the joint is stabilized by surrounding the glenoid labrum is a bring of fibrocartilage around the glenoid fossa that better anchors the humerus and glenoid and there are also a number

ankle fractures a common injuries involving a break in one or more of the bones that make up the ankle joint there are three bones that make up the ankle the tibia fibula and tailless specifically the medial and posterior malleolus by of the and the lateral malleolus of the fibula there is an additional joint between the tibia and fibula called the tibiofibular syndesmosis this is a fibrous structure made up of the anterior and posterior inferior tibiofibular ligament and the interosseous membrane the ankle is a hinge primarily allowing supplanter and dorsiflexion and is at its least stable in plantarflexion it is described as a mortise and Tenon joint which are essentially a hole and the

for those of you who have not tuned in to us we run essentially a chronic pain practice board Gates is board certified functional neurologist I'm a board-certified functional medicine practitioner we melded those two disciplines into a model of care to address a substantial portion of chronic conditions chronic Jesus and and although we cure few we're able to help most get under some some control quite considerable control and be able to manage their case and the properly selected and the properly cite the patient the reason we cure for you is because pretty much everybody walks in here ends up having an autoimmune problem and they also usually walk in here under a chronic stress with a chronic stress response usually we caught a sympathetic dominance or fight flight system is engaged and it doesn't tend to let go these things can lead to anxiety

.so we're going to talk about Hashimoto and Plastics today Hashimoto's is a subject that we've been long associated with frankly probably for most people are associated with and we're taking quite a bit of use for even diagnosing people at and so and getting heat on it and the point from that is that Hashimoto is the understanding of what's going on with Hashimoto's is the number of things it's related to the things that can create a Hashimoto's isn't it is an immune attack on your thyroid primarily and so you're always looking for the things that are creating the immune attack and and and it can be a multitude of things and I was just mentioning to dr. Gates we're talking about Plastics that I remember reading about that at like 10 years ago but wondering is actually something that has something to do with it because back then it was I was everything was Metals was right it was it was is there anything you could think of the alternative groups were putting out as yet avoid all of this which is basically everything in life it seemed like but it turns out that Plastics do create a negative effect on the condition of Hashimoto's and so we're going to discuss that this probably fairly briefly it's not a long topic I would assume and so and if it's not brief then that's fine too so so Plastics as the famous gentleman in the Dustin Hoffman movie from many years ago The Graduate said to Dustin Hoffman when he had him in his graduate courses okay so I'm 65 days going to be people more my age The Graduate it was the famous line for the decade

"...and today we're going to talk about a concept that has time so I think been controversial I think at times been considered theoretical when I first got into functional medicine years ago is actually a prominent Conrad of the immune system and because what we started to realize was in chronic pain we have a chronic pain practice for those of you who haven't watched us before and we treat just about anything that won't go away and we've combined two disciplines functional neurology and functional medicine to address fibromyalgia and periphery often chronic fatigue and chronic got problems chronic thyroid problems and dizziness vertigo balance things that won't go away people get things they go away B they don't go away you need to know why and the immune system was an obvious first place to start I think for those in the field at that time that there must be something with the immune that's causing the problem there's a concept called th1 th2 shifts th1 th2 balance I've drawn the little seesaw picture of it and I think a thousand times and try and explain to people and and and I think it's I don't I think dr. Gates is going to explain to me today whether it's getting more credibility or just something that you're using more because you see it's a valuable tool because it is affecting people frequently will talk about that Gates does all the treatment now and he's always researching and frequently will tell talk to me about how this was a th this was a shift during pregnancy this is the mystical why do I get pregnant and then I feel good and then all sudden I don't after I deliver the child it's this is the if you have allergies you have a shift more towards one side than the other so and certain autoimmune problems have a certain quality..."

serotonin syndrome also known as serotonin toxicity is a potentially life-threatening condition due to excessive serotonin levels in the body this can come from using medication as a therapy due to drug interactions recreational drug use or even intentional overdoses the end result is an increase in the amount of serotonin in the synaptic cleft able to bind serotonin receptors for example selective serotonin reuptake Inhibitors like Citalopram inhibit the reuptake of Serotonin into the presynaptic neuron meaning more is available to bind the post synaptic receptors monoamine oxidase Inhibitors likes alleged lean prevent the breakdown of Serotonin so more is available ssris tend to be the most common cause

schizophrenia is a mental disorder characterized by impairments in the way reality is perceived with Associated changes in schizo means split and free Nia means mind in Greek but it's important to remember it is not meant to mean split personality which is a condition schizophrenia affect how people think feel and behave and the symptoms are divided into three main types Karthik or positive symptoms negative symptoms and cognitive symptoms psychotic symptoms include hallucinations meaning sensing something that there and auditory hallucinations are particularly common thought to occur in 80% of patients at some point delusions are

"...today we're going to talk about pots and why it is becoming more common prevalent rights becoming more prevalent so we are seeing more pots aren't we're seeing more pots and I had noticed that we were seeing more pots we were giving more pots diagnosis pots postural orthostatic tachycardia syndrome we get a zillion people okay exaggeration we so many people that come in here with heart palpitations and I bend over and I get lightheaded and by the time people most people get here with those symptoms they've usually been evaluated for like trans ischemic attacks and and and pretty much give it a clean bill ..."

"...today we're going to talk about pots and why it is becoming more common prevalent rights becoming more prevalent so we are seeing more pots aren't we're seeing more pots and I had noticed that we were seeing more pots we were giving more pots diagnosis pots postural orthostatic tachycardia syndrome we get a zillion people okay exaggeration we so many people that come in here with heart palpitations and I bend over and I get lightheaded and by the time people most people get here with those symptoms they've usually been evaluated for like trans ischemic attacks and and and pretty much give it a clean bill of and we see it a lot

all right so say keycaps is a mnemonic to remember the DSM-5 criteria for depression or depressive disorder remember the patient needs to have five of the following symptoms within the same two-week period and these must include either a depressed mood or a loss of Interest or pleasure is anhedonia the possible features RS4 sleep disturbances I for interest diminished also known as anhedonia G4 guilt and or for energy decreased so fatigue C stands for concentration problems and a stands for appetite or weight changes which includes significant weight loss without dieting or weight gain P is for psychomotor agitation or retardation

Bulls could be often overlooking details or making careless mistakes difficulty maintaining focus on tasks or during conversation even when there's no obvious others are failing to follow instructions complete tasks organize tasks losing items and forgetfulness females tend to display more symptoms of inattention and distractibility then hyperactivity and impulsivity the hyperactive-impulsive features include trouble sitting still fidgeting talking constantly including others or even being unable to wait turns such as Inner Line as patients get older the symptoms become less evident poor handwriting and dyslexia have also been found to be more prevalent in patients with ADHD additionally emotional dysregulation

obstructive sleep apnea is a breathing disorder characterized by recurrent episodes of Airway obstruction during sleep leading to periods with breathing stops known as apnea moving from wakefulness to sleep causes relaxation of muscle tone including the muscles of the upper Airway this allows the soft palate and the tongue to relax and to create an obstruction that reduces the patency of the respiratory tract rapid eye movement or REM sleep in particular is known to feature this reduction in muscle tone but it can happen throughout the Sleep Cycle there is snoring when some are still enters but as the obstruction progresses the airflow can be severely reduced causing apnea the reduction in the ventilation

we spent a long time looking at these at these varying aspects that you've all probably been exposed to at this point in time and managed to get a what we feel is a pretty good understanding of how to go about these autoimmune problems because it turns out to pretty much every walks in here with just about anything they walk in with Aniston autoimmune problem and and if you have something that comes and won't go away and it came out of nowhere and won't go away for example people get migraines and then they go away and they never get them again okay the people walk in here the people get migraines they come in here you never go away and it's the same way with certain pains and it's the same way with certain gut problem and it's the same way with many of the conditions dizziness vertigo Bells fibromyalgia chronic fatigue those types of things so whatever reasons they don't go away maybe the maybe the biggest reason we last week we argued for the chronic stress response may be the biggest reason is autoimmunity and

"depression is a mental state of low mood there are several subtypes of depression but the major depressive disorder is the one that is usually intended it is expected to be the number one cause of disease burden worldwide by 2030 the term major depressive disorder was first used in the 1970s and the disorder was added to the diagnostic and statistical Manual of mental disorders known as the DSM in the in 80s today we have the DSM-5 which lays out nine criteria on which the diagnosis is based they include a low mood most of the day on most days and anhedonia which means a loss of pleasure or interest in previously enjoyable activities these two are considered core symptoms and one of them must be present for a diagnosis of major depressive disorder the other criteria include significant weight loss or weight gain insomnia or hypersomnia meaning not sleeping enough or sleeping too much fatigue or a loss of energy nearly every day psychomotor retardation which means ass going down of thoughts and physical movements that is noticed by others then there is inappropriate guilt or feeling worthless a reduction in the ability tea to concentrate and it recurrent thoughts of death a total of five or more over a period of at least two weeks leading to significant clinical distress or impaired functioning need to be present for the diagnosis and the symptoms cannot be the result of substance abuse or another condition major depressive disorder is thought..."

welcome back to me chiropractor and functional medicine practitioner primarily is dr. Gates I am a board-certified chiropractic neurologist and and so we have practice in which we have morphed into a practice of chronic pain and chronic conditions in the title of today's topic is hot flash going Beyond hormone replacement therapy and little did I know when I started getting into treating fibromyalgia many years ago and that it would morph into the practice that we have and even less that I know that it would more into me having to understand something about hot flashes and or hormone therapy and hormone replacement therapy seems to be pretty popular in this country I know those of you who may be watching in Southern California there seems to be

"I never heard a group okay and so the bottom line is that he was talking about that a long time ago it's been around a while when I started to see the Improvement in my page consistently I thought wow this is what I want to do for a living and I had no clue 0 no clue at all that I was going to become conversant in gut problems I did that was going to become in thyroid problems there's going to have to become conversant and hormonal issues but the biggest thing is I had no clue art practice with developed into a man it's almost virtually 100% so this immune issue the autoimmune issue and the Celiac and the non-celiac gluten sensitivity all really go together I know mites I hope we haven't thrown out too much I hope we have a like confused you on this matter if we have confused on this matter because it's a complex matter and if just get that to you then relative to these chronic problems than that's good but we go back to the beginning of this and the bottom line is is there is such a thing as non-celiac gluten sensitivity we see it everyday it is hugely important for you to understand that if you are eating eating glue is creating incentives and you amount of what the tests say you get off of it and you need to stay off of it the tests are convoluted I am certain that what we are telling you is going to be proven not only is it's been proven in the but in future testing the testing I think is in evolution I think they will be better like the test that you just got talking about the dma believe Mom feels that is a better test is pretty cost-effective it's not real expensive so I think we're going to see this thing calm down as time goes on I don't think the gluten free market is going to go away that'll that'll sink"

e the autoimmune issue and the Celiac and the non-celiac gluten sensitivity all really go together I know mites I hope we haven't thrown out too much I hope we have a like confused you on this matter if we have confused on this matter because it's a complex matter and if just get that to you then relative to these chronic problems than that's good but we go back to the beginning of this and the bottom line is is there is such a thing as non-celiac gluten sensitivity we see it everyday it is hugely important for you to understand that if you are eating eating glue is creating incentives and you amount of what the tests say you get off of it and you need to stay off of it

they also looked at patients who had PTSD suicidal ideation so those are your severe depression patients and bipolar disorder and they looked at all of their stress hormones they looked at cortisol they looked at aldosterone aldosterone is a hormone that goes up when you're trying to save sodium into your circulation like if you cut off an arm and you're bleeding out that's why we have aldosterone but it is a stress hormone look to DHEA DHS a sex hormone that comes from your adrenal glands they also looked at estrogen and testosterone levels and what they found is that in the marathon runners their cortisol levels and they're all dosterone just went up a little bit but it was only temporary whereas they saw in these soldiers who are out there for two weeks and you know bad conditions their aldosterone went up three times normal what it should be

"...and depending on how this goes we may end up doing in the first two weeks I don't know but we'll definitely do it today so I'm just going to get cut right to the chase here this seems to be a stress-related group of questions so is there a link between long-term stress of about five years and hyperthyroidism / Graves disease tell you what I'll just read this and and I'll keep my stuff out of this now I think we should turn back and forth but with Graves disease the literature does state that stress can precipitate the condition some people dispute that in the literature but overall it's pretty well accepted this stress does cause Graves disease stress is not as much identified as a trigger for Hashimoto's yet but we're anticipating that that's going to change because we hear it all the time or person goes through major stressor and then they develop Hashimoto's so just realize this is an evolving situation we don't have all the answers even here in...things are changing all the time but I just read an article this morning...and they were talking about stress as it pertains to hyperthyroidism so yes without a doubt without

"...a chiropractic physician and a board-certified functional neurologist this is Dr. Randul okay you know he's the fourth certified functional neurology we're certified Chiropractic neurologist technical way to had I ever immigrants your certified functional medicine practice can you tell I was just talking about 23 different things before we just started I was just told I don't think that disgusting fish oil the truth about fish oil this is dr. Gates this topic today he chose and why are we picking on fish oil because we're kind of sort of going to pick on fish oil not really like badly if you're taking fish oil doesn't mean I've stopped taking it but we spent a lot of time developing protocols to help people within with chronic pain issues chronic syndromes...we're going to be like emptying the oceans for fish oil and we're not going to make the point that it's not because obviously it has been proven to be useful for a variety of functions of the brain function and anti-inflammatory Sarah however in our clinical World we're responsible results and we have to use certain methods to change symptomatology to get conditions to calm down and or disappear and we haven't had maybe the greatest experience with fish oils versus saying even turmeric we've used turmeric which we don't use that often anymore but we've used to work and when we used it in high dose..."

"...a chiropractic physician and a board-certified functional neurologist this is Dr. Randul okay you know he's the fourth certified functional neurology we're certified Chiropractic neurologist technical way to had I ever immigrants your certified functional medicine practice can you tell I was just talking about 23 different things before we just started I was just told I don't think that disgusting fish oil the truth about fish oil this is dr. Gates this topic today he chose and why are we picking on fish oil because we're kind of sort of going to pick on fish oil not really like badly if you're taking fish oil doesn't mean I've stopped taking it but we spent a lot of time developing protocols to help people within with chronic pain issues chronic syndromes..."

"...first question is do you ever see patients who experience inner Tremors can you address what this might be all about and I would say yes we can address what this is all about we see a lot of patients with a variety of some Tremors and inner tremors are something that have a specific medical understanding for us yeah and the internal Tremors can be a number of things you could be anxiety it could be an autoimmune response your thyroid it could be hyperthyroidism it could be something like a pheochromocytoma which is where your adrenal gland has a tumor on it and makes to me adrenal hormones so all of those are possibilities for the internal Tremors we frequently see it with autoimmune thyroid disease but we see a lot of so that so that's kind of our take on anxiety a lot of anxiety those are two things I would go to those two things first I don't know yeah okay but yes can you have fibromyalgia this is a great question because it's kind of fiber understanding of fibromyalgia...

we're going to address today is pernicious anemia autoimmune seem to me that that one could be pretty well easily fact figured out on the internet Canada cause severe pain and tummy issues you described I think pernicious anemia is autoimmune but I think it's a very interesting thing to maybe expand on a little bit I just things that might be connected to and so is it autoimmune and it caused severe pain and tummy issues through describe the tummy guy will answer that now so relative to pernicious anemia

so first one is a question about multiple sclerosis what is your thought on stress and multiple sclerosis so what I would say is that with most odd immune diseases what we find is that stress can be an exacerbating Factor when you look at the literature that holds true for many different conditions when it comes to Ms lots of times you'll read will stress may not be a major factor or Diet isn't a major factor but we would say in our clinical experience we disagree substantially any time an individual is under chronic stress just looking at the basic physiology of it you're going to decrease blood flow to the gas...hustle track is putting your body into a state of fight-or-flight ready to fight the line or run from it so to speak and in doing so we know

...in the end you have indicated through your research and response to care that you've been treating it as an autoimmune problem for quite a while now I've been three or four or five have I for at least four I'm thinking the one specific case back to back then so at least for so so share with us the data the new data on further on the fact that it's probably an autoimmune attack against the with certain aspects of your adrenal gland y