that fits that hole in this case the space formed by the tibia and fibula and the projection which is the Dome of the talus bone ligaments helped provide more stabilization there is the medial or deltoid ligament coming from the medial malleolus which branches into four ligaments and is mostly involved in preventing / e-version while the lateral ligament comes from the lateral malleolus and is made up of three ligaments with the main function of preventing over inversion of the foot in 70% of cases there is an isolated fracture of either the medial or lateral malleolus if both the fractured this is termed a bye the fracture seen in twenty percent of cases and if the posterior malleolus is also fractured this is called a try malleolus fracture but this is only the case in fewer than

...arm in an anterior dislocation due to the posterolateral portion of the humeral head being compressed against the anterior part of the glenoid labrum they can be compression fractures on the humerus known as Hill Sachs lesions they are closely linked with bankart lesions which is a rupture in the glenoid labrum these can also be accompanied by avulsion fractures which are then termed bony bankart lesions the arm is typically held in external rotation with some abduction and all movements are painful there is a loss of the normal Contour of the deltoid and the acromion can be particularly prominent posterior dislocation 's make up only two to four percent of all shoulder dislocations and occur due to the head of the humerus being forced posteriorly while...

"...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 Sia T panic attacks depression things of that nature and I lead off with that to say one of my one of my one of my points with people when they come in and I address this with them is my observation based on watching what happens with the brain rehab exercises that we do in certain other types of supplementation is that these are not necessarily personality disorders their poor frontal lobe this sort of and there's a lot of things that add to causing your frontal lobe to not work properly poor poor lack of blood supply to your Bruno lobe from anemias be your frontal lobe needs oxygen inflammation which are probably going to talk about a little bit blood sugar stress hormones and and so but lately we've been seeing last couple of years maybe we've been even seeing little kids come in we're stressed out of their minds and like two or three years old and say what's going on with that and then other people who've had just this kind of stress responses that seemed to be like even a little bit over a top for what we see and and dr. Gates is going to share with you some of the things that he's come across in that in the literature that we've been implementing and what are our Protocols are and kind of giving you the understanding that I know stress hormones now can cross the placenta from the stressed mother into the young person but there's even more to it than that our genetic components that need to be considered if they're there and that oftentimes respond well to the types of things that can be done wow without drugs frankly so yeah we treat a lot of patients with fibromyalgia in our clinic at least we have and that's actually started off with yeah that's kind of how we got into depression because a lot of patients were coming in with their fibromyalgia and they didn't want to take medications for the depression so they said well can you handle what could you do so that started us on this quest in this journey of..."

.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

"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"

"...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 to 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 fixed belief that something is true despite having evidence that it is not in schizophrenia paranoid delusion is a common for believing the FBI is following them or that they're being poisoned delusions of reference are also common in schizophrenia where a person believes messages and meant for them for example believing a newsreader on TV is talking directly to them they can be delusions of control where a person believes that someone else is controlling their thoughts such as the FBI placing thoughts in their minds they can be delusions of grandeur meaning being a figure of great importance and delusions of erotomania meaning believing a person typically of higher status is in love with them another positive symptom is disorganized..."

"...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 the medication as a therapy due to drug interactions recreational drug use or even intentional overdoses the end result is an increased 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 postsynaptic receptors monoamine oxidase Inhibitors likes alleged lean prevent the breakdown of Serotonin so more is available SSRIs tend to be the most common cause was because of their widespread use while monoamine oxidase Inhibitors tend to produce the more severe cases other medications include serotonin noradrenaline reuptake it is tricyclic antidepressants serotonin modulators and tryptophan supplementation as it is converted and leads to serotonin formation opioids amphetamines and cocaine also increase serotonin release serotonin is found mostly in the gastrointestinal system it is carried by platelets and also exerts a acts on the central nervous system within the CNS it has rules in attention mood sleep cognition and thermoregulation in the other systems it is involved in vasoconstriction gastrointestinal motility uterine contraction and..."

"...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 because we see we see a lot of thyroid problems that can heart palpitations we see a lot of stress responses that can cause tachycardia like issues like like more than that walks in the door but pots rear its ugly head in here every now and then and it's got a lot more unique to get some more unique features to it that it's diagnosis and dr. Gates is going to talk with you about that because spoiler alert the reason they were seeing it in a number of patients is that it's getting diagnosed more Amy's reason you're seeing it be diagnosed now you're seeing people will have it and so on and so forth it's being diagnosed more and I can totally understand that from the from what's actually causing pots and and and the fact that even though people have been..."

"...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 that 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..."

"...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 still enter but as the obstruction progresses the airflow can be severely reduced causing apnea the reduction in the ventilation of the lungs causes a reduction in blood oxygen levels and as a result there is an interruption in sleep known as neurological arousal with a partially awakens in order to restore muscle tone and therefore oxygenation but this isn't necessarily perceived by the person partial collapses with reduced oxygen or arousals a termed hypo apneas while apnea is defined as over a 90% airflow obstruction lasting 10 longer a cycle is there for generated alternating between periods of deeper sleep and higher wakefulness with a typical sleep cycle is which ultimately disrupts the quality of sleep and can cause sleep deprivation risk factors are thought to be obesity as it increases the amount of soft tissue around the airway..."

"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..."

"...I am a certified functional medicine practitioner dr. Gates, I am a board-certified chiropractic neurologist and say that from now on because I always mess it up and together we have chronic pain I say it every week kind of just evolve kind of developed on its own frankly in the efforts are actually in the efforts of me to get better from my issues but ultimately with the help of some very very talented people and we've been doing it for a while and we it's pretty much all we do now so we share we're sharing with you what we know because a lot of most people everybody comes in here with these ideas from the Internet or from their research no offense to those of you who do your research but research on the Internet is fraught with landmines I would put I think that would be an understatement but because doctors would agree with that almost got it was in today's day and age going with that yeah so so so anyway so we're going to talk about "berberine" what we want to do is put it in a context because it can be a pretty amazing adjunct to what we do some really good success with them but lately I have been seeing pamphlets going out to the nation on various things one of them was on gluten one was a for those of you have Celiac for those of you who are Gluten Sensitive it was a pamphlet to said take this supplement you can eat pizza for the rest of your life I'm trying to assimilate my disastrous that must have been for a lot of people but they probably sold a lot of their product but one right now I'm seeing a lot of is burglary products that have significant success in clinical populations are frequently taken to Market by some unfortunately some..."

"...I am a certified functional medicine practitioner dr. Gates, I am a board-certified chiropractic neurologist and say that from now on because I always mess it up and together we have chronic pain I say it every week kind of just evolve kind of developed on its own frankly in the efforts are actually in the efforts of me to get better from my issues but ultimately with the help of some very very talented people and we've been doing it for a while and we it's pretty much all we do now so we share we're sharing with you what we know because a lot of most people everybody comes in here with these ideas from the Internet or from their research no offense to those of you who do your research but research on the Internet is fraught with landmines I would put I think that would be an understatement but because doctors would agree with that almost got it was in today's day and age going with that yeah so so so anyway so we're going to talk about "berberine" what we want to do is put it in a context because it can be a pretty amazing adjunct to what we do some really good success with them but lately I have been seeing pamphlets going out to the nation on various things one of them was on gluten one was a for those of you have Celiac for those of you who are Gluten Sensitive it was a pamphlet to said take this supplement you can eat pizza for the rest of your life I'm trying to assimilate my disastrous that must have been for a lot of people but they probably sold a lot of their product but one right now I'm seeing a lot of is burglary products that have significant success in clinical populations are frequently taken to Market by some unfortunately some..."

"...on polycystic ovarian syndrome PCOS and depression today much to my surprise doctor uh Justin for me we've never done one which is because we've done a lot of talk on PCOS and we see it a lot pretty common clinical picture that comes in here we see a lot of thyroid to correlate coordinate with a lot of Hashimoto's types problems so I'm not exactly sure where dr. Gates is going with this because we just talked about it but this is a subject that I happen to know that we're extremely conversant with and so I'll be anxious to hear if he comes up with anything new today it's good I'm not aware of and if not I may or may not chime in what's that so PCOS and depression well what's menopause but that's what people come in...of times guys am I going into menopause yeah yeah and actually some of the lead Endocrinology researchers will say that most women and menopause are actually kind of in a state of PCOS because at that point chemically yeah chemically so for those of you have PCOS you know how what a burden this condition really can be especially emotionally and not only affects you know your menstrual cycles and whether they're happening every month or every six months but also hair growth can be a big big factor for PCOS patients unwanted hair growth as well as those cysts on your ovaries for all intensive purposes explode at times and that can be exquisitely painful as well but PCOS is incredibly common it's one out of five females and Essence when diagnosed via the Rotterdam criteria the Rotterdam criteria was established to say that if you have two out of the three that I just mentioned if you have..."

hormone replacement therapy doctor on every other corner and and it's it seems to be like so many of the other treatments that have evolved current medical model or this current Healthcare model even relative to we have a symptom we try to alleviate the symptoms we find we don't have enough f let's take more estrogen that's we'll talk about a few minutes that is rarely a good long-term response and that's not even a saying that that's like the endocrine Society I agree with that so harm or replacement therapy has become really popular for a lot of different things but three things can happen when you use hormone replacement therapy for and and hot flashes are certainly one of the most common options that doctors will use hormone replacement therapy for

hormone replacement therapy doctor on every other corner and and it's it seems to be like so many of the other treatments that have evolved current medical model or this current Healthcare model even relative to we have a symptom we try to alleviate the symptoms we find we don't have enough f let's take more estrogen that's we'll talk about a few minutes that is rarely a good long-term response and that's not even a saying that that's like the endocrine Society I agree with that so harm or replacement therapy has become really popular for a lot of different things but three things can happen when you use hormone replacement therapy for and and hot flashes are certainly one of the most common options that doctors will use hormone replacement therapy for

"...training Expedition where they're basically deprived of food and deprived of sleep and then 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 but otherwise their sex hormones their testosterone their estrogen levels were not significantly affect it was just mainly their quarters all in there they're all documents the stress hormones went up but their sex hormones were not sacrificed however in the patients who had PTSD severe depression bipolar disorder they had a significant compromise of their testosterone and their estrogen levels also their stress hormones were much elevated and this has been seen throughout the literature but it's a nice expose relative to a lot of people in their concept of stress..."

"...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

...So today we're going to talk about an unavoidably controversial subject and that is does heavy metals cause autoimmune disease and it's it's and the reason I say that is I do all the intakes here and so I hear the patient's histories and hear what they've been through and Europe told we had a lot of patients that come in here who've been through a ton of heavy metal stuff I had time to get here and nothing happened I have heard the stories of the person's got Mercury out of their mouth and they got better and I've also seen it way more people coming in here with your logical reactions from heavy metals and and and everything in between

"...do you want me to just go down let's go down the so we haven't we have a long list we're not going to get through all of them we're going to spend about 15 or 20 minutes going over over these questions and we'll see how far along we get so the first one and these are quotes right off of the right off of the websites and from you 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 the literature on Ms is robust on the gastrointestinal related to the illness meaning it has been shown that the gastrointestinal tract breaks down and patients who have MS and that leads to immune activation which is also seemingly associated with the immune activation in the brain so we would say stress can be a major component of Ms we've seen viral infections cause patients to go from you know basically secondary Progressive to primary Progressive we've seen the same thing with stress responses so stress is a major factor and if it is present not only in Ms or any other autoimmune illness it's one of the main factors that we have to address some yeah more in general if you're any type of a chronic pain patient the cliff notes on stresses when your chronic stress it can affect your brain it can cause short-term memory loss..."

"...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 can you have fibromyalgia not have irritable bowel syndrome and not hurt when someone hugs you or touches you great question the understanding of what it fibromyalgia is evolve and and we've stayed on top of that Gates has done continued to stay on top of the research so I think this is an interesting question to answer for people who are confused..."

"...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

"...So today we're going to talk about Alzheimer's and sleep and more or less the basic concept of what we're going to talk about is Alzheimer's cause sleep problems or do sleep problems cause Alzheimer's kind of we're going to have kind of a chicken or the egg type of a discussion here today and we just saying that dr. Gates depending on someone asked this yesterday and asked me to retrieve a lot of Alzheimer's and according to that one classification system that has like seven stages so probably 90% of our patients be classified as having some stage of Alzheimer's we treat a lot of stress and stress hormones tend to hit something called your hippocampus and you're going to find out a little bit about the hippocampus that I and stress hits that hippocampus and the hippocampus...cause of sleep problems and so there are so there are the cycles that hit the hippocampus of different things and the hippocampus is where your short-term memory is...

...so Alzheimer's is kind of an interesting topic I still keep hearing nobody's found the cause of it yet I'm not sure there is a the cause relative to that and and and then our observation we do a lot of chronic pain that's what we do for those of you haven't seen us we combine functional medicine and functional neurology to create a paradigm to address kind of the cornerstones of physiology that seemed to be the core of what causes chronic conditions chronic pain in general and so if a person comes in here let's say with fibromyalgia it's pretty common that they're going to have brain fog and short term memory loss and and people come in here and there in PTSD there they're going to have short-term memory loss they're going to have they're going to have difficulty sleeping and things of that natur...going to bed but a substantial portion of our patients come in here with short-term memory loss and brain fog and and other things that you know have that Nuance of is this house hi so the Alzheimer's type of thing we have seen Alzheimer's patients but more often we see people who would seem to me to be in the process of going in that direction so it's of Interest to us to know what's going on and and so this is something that isn't that is it's enveloped in that core of conditions and and of problems chemical problems chemical Pathways neuronal pathways systemic problems that cause chronic problems chronic pain fibromyalgia preferably chronic fatigue dizziness vertigo balance a lot of these things it's interesting how they kind of overlap...

"...you start out with the largest has a lot of people don't realize that the dysbiosis all these things that they're hearing about are a lot of them are are in the and I made a mistake when I said microbiome that's more your that's more to the small intestines but but large intestines the symptoms would be feeling that balance do not empty completely so and within the framework of this entire category there are specifics a lower abdominal pain relief by gas passing store gas means we have a bacterial problem