DR. DAN TUTTLE, DC, LCSW

Depression is becoming more and more of an issue. And more and more young people are depressed, according to this article here: 
https://www.webmd.com/depression/news/20180511/depression-striking-more-young-people-than-ever#1

Some depressed people have been in psychotherapy for years or even decades. The absence of a resolution of the depression symptoms suggests that there may be a brain-based reason for the depression. Younger people may not have been depressed as long, but the same analysis can be used to figure out what are the best treatment options. ​

Depression and the brain

More and more studies and research are showing that particular areas of the brain are involved in depression. These include areas like the frontal lobe, which often shows asymmetry in function when viewed on a qEEG brainmap. Another area is the anterior cingulate. 

I have the ability to look at these areas of the brain and determine if they may be contributing to your symptoms of depression. 

When a patient comes and sees me for symptoms of depression, I first take a history of symptoms and what seems to have helped and not helped. If appropriate, we can record the brain to determine if there are dysregulated areas of the brain that can be linked to symptoms of depression. 

What if I told you there were actually 2 parts of the SI joint?  The part I discussed previously IS NOT supposed to move.  The part I am discussing in this blog entry is the part that IS supposed to move.
Part of the sacroiliac joint is a synovial joint. Synovial joints have synovial fluid in them, which allows them to move. Your knee, for example, has synovial fluid in it. So does the SI joint. Curiously, it is shaped like a boot and is sometimes called the "boot" portion. 

Since the 1920's, chiropractors doing what I do, called Sacro-Occipital Technic® have been saying the SI joint moves. Conventional medical wisdom dismissed this, but science has now shown that the joint moves. 1

Why does the joint move?

One of the functions of the movement of the "boot" portion of the sacroiliac joint is to circulate cerebrospinal fluid (CSF) throughout the brain and spinal cord. The brain and spinal cord are surrounded by sheath called the dura mater and inside that is the CSF. Conventional wisdom used to teach that the CSF was simply padding for the brain and spinal cord. But recent science has confirmed what chiropractors and osteopaths have been saying for almost a century - that CSF is vital to the health of the nervous system and the rest of the body. 

​CSF brings nourishment to the brain and spinal cord. It also helps remove toxins from the brain and spinal cord. Picture a your kitchen with no new fresh food in it and nobody taking out the garbage. Eww!

Now it has been shown that it has a relationship with the lymphatic system (which also removes waste from the body).  And CSF has been found to have a relationship with the immune system.  2, 3, 4

​Restriction of this part of the sacroiliac joint interferes with the ability of CSF to move throughout the body, which can interfere with the processes I just mentioned above. 

​Would you like to have a well nourished brain and spinal cord that removes toxins and interacts with the lymphatic and immune system effectively? Heck yes! That is something that I do for every one of my chiropractic patients. 

​The nervous system exerts a tremendous amount of influence on the rest of the body. Therefore, effects of CSF restriction are thought to be related to a variety of symptoms including:

• Insomnia
• Headaches
• ​Low back pain
• Neck pain
• ​Visceral disturbances (organs like stomach, spleen, intestines, liver, male and female sex organs and more)
• Hormonal disturbances
• Emotional problems
• Skin problems
• Abnormal brain function

​The last statement about brain function is interesting because, in my study on the effects of chiropractic and brain function, we showed how altering the synovial portion of the SI joint had profound effects on the brain. 

​A chiropractor fully trained in Sacro-Occipital Technic®, AKA SOT Methods®, looks at both parts of the SI joint to make sure they are working properly. This helps the body have the stability it needs to function properly and the motion necessary for CSF to be moved throughout the body. This works to ensure proper functioning of the nervous system to promote health.

SOT Methods® takes hundreds of hours of additional training beyond that of a basic chiropractic education required in school. This is a specialty I am proud to offer at my practice.

You can schedule an appointment to get your SI joint checked online clicking above or at the Tuttle Health, LLC Facebook page. Or you can call the office at 727-509-3760 or email thedclcsw@gmail.com

1. The Sacroiliac Joint: a Review of Anatomy and Biomechanics with Clinical Implications. Harrison DE, Harrison DH, Troyanovich S.  J Manipulative Physio Ther .1997.
2. Reassessing cerebrospinal fluid (CSF) hydrodynamics: A literature review presenting a novel hypothesis for CSF physiology. Chikly, B and Quaghebeur, J. Journal of Bodywork and Movement Therapies. 2013. 
3. A Paravascular Pathway Facilitates CSF Flow Through the Brain Parenchyma and the Clearance of Interstitial Solutes, Including Amyloid β. Illif et. al. Science Translational Medicine. 2012.
4. Vascular, glial, and lymphatic immune gateways of the central nervous system. Engel B. et al. Acta Neuropatholigica. 2016.

Sleep is really important.

During sleep, there is all sorts of repair that goes on in your body. In layman's terms, the body shuts down from it's daytime activities and can focus on internal housekeeping. Waste and toxins are removed from the brain during sleep. Consolidation of memories occur when you sleep. 

But what happens when you don't sleep? All of these health promoting processes are interfered with.  And that's called insomnia. 

Insomnia is subdivided into different types.

• There is the type where you can't get to sleep.
• Then there is the type where you wake up in the night and can't get back to sleep for a while and then fall back asleep.
• Thirdly, there is the type when you wake up early and can't get back to sleep period. 

I have a variety of things I can use to treat people with sleep disorders.

Neurofeedback

Yes, neurofeedback can have great effects on sleep. And it makes sense, because it is your brainwaves that change when you fall asleep. While every individual is different, often stimulation of the sensory-motor rhythm (SMR) can greatly improve people's sleep.

Chiropractic

Many people report improvements in sleep patterns after undergoing chiropractic care.  I myself find that difficulty sleeping can be an indicator that I need a chiropractic adjustment.  Generally speaking, chiropractic increases parasympathetic nervous system activity.  As with so much of chiropractic, more research is needed to validate what people have been saying for decades.

Biofeedback

Not to be confused with neurofeedback, biofeedback measures things that are indicative of a non-relaxed state in the human body.  These are things like temperature, heart rate variability, and galvanic skin response.  You can learn how to relax your body and increased parasympathetic nervous system activity by doing biofeedback.  And that's good for sleeping and health in general.

Nutrition

Valerian root can be very effective for treating sometimes of insomnia.  It is an herb and I used to take it the night before a big test or national boards when I was in school.  There are other supplements like melatonin and 5-hydroxytryptophan that can be used as well.  However, it is important to not ignore addressing the reasons why a person may not be making enough melatonin or why they are not absorbing the nutrients they need to create the proper neurotransmitters.  That is really a topic for another discussion.

Psychotherapy

Intertwined with all of this is stress. There's insomnia for no reason and then there is insomnia related to stress in life. Psychotherapy can help identify the cognitions that may be contributing to the sleepless state. Insomnia doesn't always exist in a bubble. It can relate to lots of other mental health problems including anxiety, depression and trauma. That's an advantage to working with someone who is a licensed psychotherapist - they can help tease out what is what to determine the most appropriate and effective interventions. 

As you can see there really are a lot of treatments for insomnia that I can offer people that do not involve taking medicine.  If you are suffering from insomnia and looking for help, please contact my office so that we can set up an appointment and discuss treatment options tailored to your individual needs.

​Image above Copyright: <a href='https://www.123rf.com/profile_bialasiewicz'>bialasiewicz / 123RF Stock Photo</a>

​There's a first time for everything. And the neuroimaging above was a first!

The question "does chiropractic change the brain" has been the subject of 5 years of my research. Until my work, nobody had looked at live brain function and chiropractic.  This video above shows the FIRST real-time imaging of what a brain looks like before and after a chiropractic adjustment. I had the exciting experiences of presenting this to others at Life University in 2014 and the Association of Chiropractic Collages Research Agenda Conference in 2015 as well as the Sherman college International Research and Phillosophy Symposium in  2015. 

How does this apply to patients? Let's say a person comes to me seeking help for headaches. We can look at the brain and see if there are areas that are abnormal. We can then see if those areas of the brain match the headache symptoms. We can then try interventions, for example chiropractic, and see if the brain is responding. If the brain is, then that's validation that what we are doing is helping (in addition to a person's report of symptoms, of course). If not, we can change what we are doing with a particular treatment or try something else entirely.  Neurofeedback can be used for headaches. Metabolic testing and changes in diet and/or lifestyle may be what is needed to help a person. Or maybe the person is unhappy in their life and needs help in making a change. My job is to help people figure that out so that they can get better. 

I am excited to bring to my patients ground breaking technology and pioneering interventions. This is another part of what allows me to provide care to my patients unlike any other. 

This imaging was part of the firs three-armed randomized control study of chiropractic and brain function, which is coming soon to a major peer-reviewed journal near you. 

Attention-Deficit Hyperactivity Disorder (ADHD) is a condition that occurs in both children and adults. The Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-V) defines ADHD by a collection of a certain number of symptoms. There are the inattentive symptoms (the attention deficit) and the hyperactivity/impulsivity symptoms (hyperactivity). Some of the more common complaints I hear from parents are that their child does not pay attention, does not seem to listen, is fidgety or is not performing well academically. ​

But it is the consensus of the scientific community that true ADHD is a brain-based disorder. The vast majority of medical doctors, including psychiatrists, do not look at the underlying brain physiology when diagnosing ADHD and then prescribing medicine. To put that in perspective, imagine you had chest pain. Causes of chest pain are numerous. A short list includes myocardial infarction, coronary artery disease, myocarditis, pericarditis, pulmonary embolism, pneumothorax (collapsed lung), pleurisy, pneumonia, lung abscess, pulmonary hypertension, GERD (acid reflux), peptic ulcers, gallbladder problems, rib subluxation, shingles...and the list goes on.  Imagine going to the medical doctor and having them tell you that they were not going to run any tests to figure out what was causing your chest pain. Instead, they were going to prescribe some medicine and see what happens. It seems ridiculous to even make up such a scenario, yet it is the standard of care with ADHD.

Using quantitative electroencephalography (qEEG) I can "look under the hood" with my patients and see what their brain is doing. The fascinating thing is that when that is done there is not one type of brain people with ADHD have. There are actually at least 6 different variants of brain activity that can result in the same symptom! And each variant responds differently to both Neurofeedback interventions and medications. Thus, ADHD is actually not one disorder. It is at least 6 different brain disorders presenting with the same symptom. Remember the chest pain example above? 

It is not just me saying this. Published studies have been done on these different sub-types of ADHD and how they respond differently to medications, such as atomoxetine.  Daniel Amen, a psychiatrist who is known for doing SPECT scans of people's brains, concurs that there are different types of ADHD brains that present with the same symptoms. He is now recommending Neurofeedback as a treatment for ADHD and other disorders.  

Patients who come to see me for ADHD will get a qEEG evaluation done to assess brain function. They will also get computerized testing done to confirm that they actually have ADHD and help determine that they do not, in fact, have another disorder that has some of the same symptoms as ADHD. Sometimes, when I run the tests for ADHD, I discover that the person who was being prescribed medication for ADHD does not even have this disorder. People can have other problems that mimic ADHD including Autism Spectrum Disorders, sensory integration problems (often but not always related to autism), auditory and/or visual processing disorders, developmental trauma or Oppositional Defiant Disorder.   

I also utilize a program called Brain Dx which is a qEEG normative database developed over decades of peer-reviewed, published research at New York University. Brain Dx has a discriminant function that tells the doctor the likelihood that a brain is one of a person having ADHD. Discriminant functions in neuroimaging are not stand alone instruments for diagnosis. However, in conjunction with other testing and assessment measures, they can offer valuable insight into the organic basis of psychological problems. There are also discriminants for things like major depression, bipolar disorder, schizophrenia, dementia, autism and traumatic brain injury. I use whichever ones are appropriate when working with patients. 

I have had excellent success treating ADHD. While working at the Psychological Sciences Institute, I worked with a neuropsychologist and we presented our research on ADHD at the International Pharmaco-EEG conference in New York City. In our sample of 41 people, 100% of subjects had improvement in their attention and impulsivity scores using the IVA+ continuous performance test (objective computerized test) after Neurofeedback treatment. YES, 100%. Here is a link to the poster we presented. ipeg_poster_2012_final-1.pdf. Publication of this material is in development. At the end of this blog is a list of over 100 more studies on Neurofeedback and ADHD. 

There are a handful of studies on chiropractic and ADHD. Most are case studies and present very limited objective evidence. However, in certain cases I have seen chiropractic be an effective intervention. I am able to provide chiropractic as a stand-alone trial intervention or in conjunction with other therapies should a patient request such. My goal is to help people get better as soon as they can. 

Another co-factor of ADHD can be metabolic dysfunction. This can often relate to things like gut dysbiosis with associated food sensitivities. Poor diet will facilitate such a condition and perpetuate it. Other more complex metabolic processes and neuro-inflammation can be at play and I can test for these at my office.

If you or a loved one struggles with ADHD, or you think they might have ADHD, please contact me to set up a consult and evaluation. It would be an honor to help you. 

Here is a list of over 100 studies on Neurofeedback and ADHD, cognition and learning disorders:

Click here: ​Over 100 ADHD studies

Low back pain? Leg pain? Sciatica? Often we have come to think of that as a disc problem.

Your spine is made of vertebrae stacked on top of each other. Sandwiched in between the vertebra is the intervertebral disc. Discs are like padding between the vertebra. When a disc ruptures, its jelly-like contents can spill, irritating nerve roots and causing pain.

Discs became popular as the culprits of low back pain when MRI's came out and you could really see the discs. But here's the catch: there are a lot of abnormal MRI's with unhappy looking discs and the people have no low back pain at all! .

Turns out that discs aren't the cause of a majority of low back pain cases. What has been overlooked for a long time by the medical field is the sacroiliac joint. Chiropractors have been talking about it since the 1920's. And medicine is now catching on. 

Sacro-who? The sacrum is the bone at the base of the spine. It's the one people call their tailbone, although technically the tailbone is the coccyx which is one segment lower. The sacrum attaches to your hip bone to form the sacroiliac joint and your pelvis. ​

Here's some random trivia: The word sacrum derived from the Latin word Sacer meaning sacred. The sacrum in Latin was os sacrum meaning "holy bone." The holiness of the bone is up for debate, but its importance is not - it's really important!

The sacroiliac joint has had some controversy. Chiropractors said it moved. Medical doctors said it was immobile. And everyone argued over it. It's accepted now that portions of it do move. 

The sacroiliac joint forms the foundation of the spine. Think of the foundation of your house. A house with a solid foundation will be solid. A house on a cliff with a bad foundation will be in all sorts of trouble. And so will your spine if if it doesn't have a properly functioning sacroiliac joint. 

The sacroiliac joint has multiple functions. In part 1 of the sacroiliac joint blog, I'm going to talk about the weight bearing part. 

Weight bearing means joints and those that respond to things like standing. The sacroiliac joint has a weight bearing part. Other weight bearing joints include your hips, knees, your ankles. The weight bearing part of the sacroiliac joint should not move (another part should move - see part 2 of this series). The weight bearing portion of the sacroiliac joint held together by strong ligaments. 

Problem is, these ligaments can become stretched and the part of the sacroiliac joint that shouldn't be moving starts moving. This creates instability in the pelvis --- and everything resting on top of that pelvis gets disrupted too (remember the house with the bad foundation?). The muscles of the low back and pelvis respond, tightening in an attempt to stabilize things. And there is your low back pain. It's really quite simple in these instances --- if you stabilize the sacroiliac joint, the muscles will quiet down and suddenly there isn't pain anymore. Although if the problem has been there for 10 or 20 years, the muscles will need some work too. 

But what else is above the pelvis? How about the shoulder. Many shoulder problems are actually reactions to pelvis problems. I had a patient in my office the other day  complaining of not being able to raise their arm (frozen shoulder). I corrected the sacroiliac joint and the person was suddenly able to lift their arm. I never even touched their shoulder! What connects to the shoulder? How about the elbows and wrists. And you guessed it, elbow and wrist problems can be the result of a sacroiliac joint problem. Wild, isn't it?

It gets even more crazy though. The neck sits on top of the shoulders. Yep, neck pain can be the result of a sacroiliac joint problem. What's on top of the neck? The head, of course. Tempromandibular joint (TMJ) problems or jaw problems can be (and always are related to) sacroiliac joint problems. 

By now I should have rocked your world. Let me rock it a little more.

What about the other weight-bearing structures: remember, the hips, knees and ankles. Well they are also affected by the sacroiliac joint. Knee pain, ankle pain, foot pain, hip pain - they all can be caused by an unstable sacroiliac joint. Similarly, problems in the knees, ankles, hips, and feet can cause sacroiliac problems, but that's for another blog entry.

I specialize in sacroiliac joints and love to fix them. And I mean that, I really am passionate about it.  I had a patient who had been to 4 other chiropractors, a physical therapist and a pain management clinic for low back pain with minimal results. The problem was they were treating her disc and the problem was, you guessed it, her sacroiliac joint. One adjustment and she was feeling much better. 

Watch out for part 2 of the series on the sacroiliac joint - the part that is supposed to move. ​