“Combating Chronic Lyme,” a Presentation by Dr. Gary Kaplan

This is a presentation by Dr. Gary Kaplan that was recorded on Sept. 26, 2019.

To subscribe to the Kaplan Center’s YouTube channel visit http://bit.ly/1N4YqmA.

Dr. Kaplan delves into the very controversial topic of identifying and treating chronic Lyme disease, a tick-borne illness that lingers past standard courses of treatment. Dr. Kaplan discussed the difficulties in correctly diagnosing chronic Lyme as well as new research and treatments that are currently available.

To download the handouts that were provided or a copy of Dr. Kaplan’s powerpoint presentation, we have made them available to download at https://kaplanclinic.com/resources/chronic-lyme-disease-lecture-resources/


Dan Sheehan lectures on EDS and POTS

EDS & POTS: A New Clinical Perspective

This is a presentation by Dr. Dan Sheehan that was recorded on Oct. 17, 2019.

To subscribe to the Kaplan Center’s YouTube channel visit http://bit.ly/1N4YqmA.

Dr. Sheehan discusses the connection between EDS & POTS and how certain regenerative treatments, like Platelet Rich Plasma Therapy, help strengthen and heal areas of the cervical spine improving symptoms and overall quality of life.

Evidence suggests that there is a unique connection between hypermobility disorders such as EDS (Ehlers Danlos Syndrome) and dysautonomia, a disorder of the autonomic nervous system. Patients with EDS often experience symptoms common to a type of dysautonomia called POTS (postural orthostatic tachycardia syndrome), characterized by dizziness and feeling faint, palpations, nausea, digestive problems, blood pressure fluctuations, fatigue, urinary problems, and more, resulting in a less than desirable quality of life.

Say Goodbye to the Daily Grind

Do you grind or clench your teeth at night? Are you currently using a mouth guard, or have you been told that you may eventually need one? Do you experience ringing in the ears, either constant or intermittent?

If you grind or clench your teeth you may also experience pain with chewing or hear a popping noise when your mouth opens or closes. Often, headaches, neck and shoulder pain can occur.

More and more dentists are realizing CranioSacral therapy can be a missing piece to a successful dental procedure.

CranioSacral treatment can be effective for treating hypertonicity (continual increase in the muscle tension) in the soft tissue which directly impacts the position of the temporomandibular joints (TMJ) or malocclusion (misalignment of teeth when jaws are closed).

CranioSacral therapy helps reduce the sympathetic response in the body and helps it return to a place of balance.

CranioSacral therapy follows the osteopathic premise that if structure is normalized, function will follow. The gentle manipulation and adjusting of the cranial bones help balance the body’s system.

Dr. John Upledger DO, O.M.M stated: “The temporomandibular joint (TMJ) syndrome may be primary or it may be just the tip of the iceberg. The syndrome is part of the whole person and it is the whole person that must be evaluated and treated.” Stress factors of TMJ can be physical, physiological, psychoemotional or environmental. Teeth or jaw clenching is a natural response to increased stress, chronically compressing the temporomandibular joints.

CranioSacral therapy is a very effective, light-touch therapy that supports the body’s own healing resources to release physical imbalances and restrictions, as well as residual emotional trauma, that has been stored in the body’s membranes and connective tissue. This frees the central nervous system to perform optimally — allowing patients to experience pain relief, stronger immune function and an enhanced sense of well-being.

Be Well, Do Good Work,
Pat Alomar, M.S., P.T.
Appointments: 703-532-4892, Ext. 2

texting neck syndrome

“Texting Neck Syndrome” Is No Joke

Does your neck hurt from using your phone? That pain-in-the-neck is trying to get your attention.

In addition to neck pain, bending your neck for too long may also cause upper shoulder pain and headaches. A 2016 study published in the Journal of Bodywork and Movement Therapies describes a link between headaches and poor posture from using electronic devices.

“Texting Neck Syndrome,” also called forward head posture, can not only lead to chronic pain but can also be an important clue to the existence of underlying health issues. For example, cervical spine (neck) problems could be an indicator of low thyroid in women and low testosterone in men.

Looking down for an extended period of time puts a person at risk of overstretching the supporting muscles, tendons, and ligaments of the cervical spine. These elastic structures should recoil back to normal, but there are many reasons why the connective tissue in the neck doesn’t rebound, including:

  • Disc problems
  • Facet Arthritis
  • Hypermobility Syndromes
  • Hormonal Changes
  • Chronic Infection
  • Altered Metabolism
  • Nutritional Deficiencies
  • Emotional Stress

Many people “carry stress” in their neck which presents as pain and can cause real physiological changes.

A case example is John, a 50-year-old man with neck pain, headaches, upper shoulder pain, and grinding sensations when he turns his head which he calls “snap-crackle-pop” noises. John saw a massage therapist who told him that his neck and shoulder muscles are extremely tight. Despite taking Advil and a prescription muscle relaxant, Flexeril, his symptoms did not improve.

As a supervisor of a multistate technology company, John is texting on his phone all day. An x-ray of his neck was relatively normal with mild arthritic changes of the facet joints. Although he thought it was unrelated, previous lab tests revealed low testosterone levels. Since massage was ineffective and his busy schedule could not accommodate a course of physical therapy, he chose to undergo two sessions of regenerative injections with platelet-rich plasma (PRP) in the tendons and ligaments of the cervical spine. John’s symptoms improved but were likely to come back if he didn’t address his testosterone deficiency. After additional testing, he also chose to treat his low testosterone symptoms with Testosterone Pellets. Testosterone Pellets are small tablets of bioidentical hormone which are placed under the skin (typically in the buttock area) which dissolve over a few months and deliver a steady supply of hormone replacement.

Neck problems are best treated by a multidisciplinary team. At the Kaplan Center, our team of providers includes specialists in acupuncture, osteopathic manipulation, hormone replacement, rehabilitation medicine, physical therapy, immune function, and nutritional support and supplementation. In addition to managing the root causes of postural muscle weakness, regenerative medicine strategies including prolotherapy, platelet-rich plasma, and, in some cases, stem cell injections have been very successful for the treatment of neck pain related to texting and poor posture. In my experience, a combination of treatment strategies works best.

Don’t ignore the message. Comprehensive treatment is key to long-lasting results.

When Lymphedema Occurs After Breast Cancer Treatment

Q: As a breast cancer survivor, I have started to notice swelling in my arm on the same side as my surgery, could that be lymphedema? What would the treatment for that include? Does it hurt?
Answered by Michele McLellan, PT, OCS, CLT
A:You may indeed be starting to develop lymphedema. One sign that you may be developing lymphedema may be if your rings are starting to be tight on that hand.
After life-saving breast cancer treatment the risk for developing lymphedema in the adjacent arm increases. Lymphedema is a type of swelling that occurs when the lymph system is altered and protein rich fluid accumulates in your arm and or chest wall. Factors that alter the lymph system’s proper functioning may include: removing the lymph nodes to stage the cancer, radiation on the remaining lymph nodes, chemotherapy, and a surgical scar as a result of removing the tumor. This excess fluid causes swelling and heaviness, decreases your motion, and puts you at risk for getting an infection such as cellulitis.
Treatment for lymphedema involves very gentle manual lymphatic drainage, compression wrapping, then a sleeve and a glove, meticulous skin care, and exercise. There is no pain involved. In fact women often find the experience to be relaxing and helps them to regain the use of their arm.
How to Find the Right Provider
The Vodder School of North America has a website that lists therapists who are certified to treat lymphedema. Another advocacy group the National Lymphedema Network (NLN) recommends that your therapist has had at least 135 hours of training. The credentials that could be after your therapist’s name are CLT (Certified Lymphedema Therapist) or LANA (Lymphedema Association of North America), which means they passed an extra test to prove they have a comprehensive knowledge base for treating lymphedema, particularly if the person is a cancer survivor.

New study shows that probiotics may improve bone health.

A new study, published recently in the Journal of Internal Medicine, showed that probiotic supplementation may have a positive affect on bone health in humans. The double‐blind, placebo‐controlled study involved 90 women aged between 75 to 80 years old and had low bone mineral density (BMD). They were randomized to receive daily oral supplementation (1010 colony‐forming units of L. reuteri 6475) or placebo over a 12 month period. The results of the study showed that daily supplementation reduced bone loss in older women with low bone density. While more studies are necessary to back up these results, this study introduces new possibilities for those who are looking for non-pharmacological approaches to treating osteoporosis in the aging population.
Read the abstract, here, or read the study in its entirety below.
For more on how probiotics can improve your health, watch Dr. LeBaron’s lecture: “What’s Your Gut Feeling?
[gview file=”//kaplanclinic.com/pdfs/Nilsson_et_al-2018-Journal_of_Internal_Medicine.pdf”]

Q&A: Do women who have never had children experience incontinence with or after menopause?

Do women who have never had children experience incontinence with or after menopause? There are estrogen receptors on muscles, including the bladder, so if a woman never had a child – and therefore never stretched out her pelvic floor – would she still have incontinence because she has so little estrogen?
Thank you for your great question. Women who never have given birth, can and do experience urinary incontinence peri or post menopause. It is true that over time, our bodies become depleted of estrogen. However, low estrogen is not the only factor contributing to incontinence.
Good hormonal health is a balance of estrogen, progesterone, and testosterone. Onset of urinary incontinence can be attributed to an accumulation of many issues: A history of urinary tract infections, obesity, constipation, hormonal imbalance, high stress lifestyle, over active abdominals, sedentary lifestyle, abdominal, pelvic, low back, hip surgical procedures, certain medications, gradual pelvic floor weakness. This list is not complete, but you get the picture. The reasons for incontinence are multiple; a “stretched out” pelvic floor or not, is only one consideration.
Jeanne Scheele, PT, PRPC



CDC Report: Vector-Borne Disease Cases Rapidly Rising

Vector-borne diseases (diseases transmitted by insects) in the United States are steadily – and in some cases, rapidly – increasing, according to a report released earlier this month by the Centers for Disease Control (CDC).
An analysis of data collected over the span of a decade showed that disease cases from tick, flea, and mosquito bites more than tripled nationwide between 2004 and 2016. While this increase is evidence enough of a serious public health concern, some estimate that the actual number of infections (including unreported or undiagnosed cases) far surpass the reported numbers. The CDC report also confirmed that since 2004, 9 new germs have been discovered or introduced in the United States, including Zika virus and West Nile Virus.
If you have been diagnosed with Lyme disease, you are already well aware of how detrimental its effects can be on the body. Vector-borne diseases can cause serious disability and neurological harm if left undiagnosed and untreated and can have serious effects on the body’s musculoskeletal and nervous systems. Symptoms can linger for months, and sometimes are permanent. In older populations and with young children the risks can be far more serious and can even result in death.
With the risk of infection steadily rising, taking precautions to reduce the number of bites you get is more important than ever before. Along with wearing clothing that covers exposed skin during peak hours, an effective repellent is a must. We recommend that you choose a repellent that contains one of the following: Picaridin (20%), IR3535 (20%), DEET (20-30%) or Oil of Lemon Eucalyptus (30-40%).
But for those who are more inclined to try DIY repellents or natural bug sprays due to concerns over chemical additives, most important is to know that what you’re using actually works. Finding a repellent that is both safe and effective can be difficult, so Dr. Jane Marke has analyzed some homemade remedies and natural bug sprays to see what works best.
For those who are interested in natural solutions to treat lawn and garden, Arbico Organics offers a wide array of pesticide-free products.
After spending time outdoors, always check for ticks! If you find one, use this guide to see how to remove it safely.
Talk to your physician right away if you experience symptoms such as fever, joint aches, headaches or other flu-like symptoms, as these are also common to vector-borne illnesses.
You don’t have to sacrifice enjoying the outdoors, but you do have to be diligent in protecting yourself.



What the New High Blood Pressure Numbers Mean For You

When the American College of Cardiology (ACC) & American Heart Association (AHA) lowered the numbers that define high blood pressure (HBP) this past November, 46% of the adult population in the United States suddenly met the new criteria – that’s nearly half!

What was the motivation for making these changes that placed an unwelcomed label on so many people virtually overnight? It rests in the reality that despite the enormous amount of research, outreach, and medical advances, heart disease and stroke still remain 2 of the leading causes of death in men and women in the United States. Broadening the scope of high blood pressure numbers will generate more conversations between patients and health care providers about the associated risks that go with HBP, namely developing heart disease or having a future cardiac event. More importantly, it gives physicians the opportunity to introduce early non-pharmacological intervention methods to a wider population.

What is High Blood Pressure (HBP)?

When the blood pressure sleeve tightens around a patient’s arm it is taking two important measurements: the force of blood being pushed against artery walls when the heart pumps (systolic, or top number) and when the heart is at rest between beats (diastolic, or bottom number). These numbers are of particular interest to doctors as they can be an early warning sign of the patient’s risk for a future cardiac event or stroke; the higher the numbers, the higher the risk.

There are many factors that can elevate blood pressure, age being the most common, but lifestyle (think stress, activity levels, diet, etc…), weight, gender, race, medications, and certain medical conditions can also contribute. When a person is diagnosed as having high blood pressure (also called hypertension) it means very simply that there is too much force on a regular basis putting stress on the heart and blood vessels. Over time this constant, excessive pressure can cause damage to the walls of the arteries and blood vessels, causing them to narrow or leak, creating areas where plaque deposits can accumulate causing hardening and narrowing of the arteries, reducing elasticity, and all the while producing no obvious symptoms.

According to the American Heart Association, nearly half the population of patients with high blood pressure do not have it under control. This is an alarming statistic as so much is known about the correlation between high blood pressure and cardiovascular disease. But the good news is that high blood pressure is something that can be controlled with lifestyle modifications and, when necessary, medications.

Know Your Numbers!

The new guidelines stress the importance of proper blood pressure readings by both health care providers and patients. Blood pressure can be easily taken at home with the right device, and knowing your numbers is the first line in prevention!
High Blood Pressure Guidelines
Previously, blood pressure measured between 120 – 139 mm Hg was defined as pre-hypertensive, however, this terminology no longer exists. Now, patients diagnosed with having Elevated Blood Pressure are encouraged to look at a number of non-drug interventions as a first approach. These are lifestyle modifications that will not only help lower blood pressure but are positive changes for all aspects of health.

Non-pharmacological interventions recommended in the new guidelines include:

  • Weight loss
  • Eating a heart-healthy diet
  • Regular exercise
  • Reducing sodium intake
  • Potassium supplementation
  • Stopping or reducing alcohol consumption

In addition to the recommendations above, there are several mind-body therapies that have also proven effective in lowering blood pressure.

Patients now diagnosed with Stage 1 or Stage 2 Hypertension (HTN) would likely be prescribed anti-hypertensive medication in addition to the lifestyle recommendations above, with dosages and medications varying depending on each patient’s risk assessment and medical history.

The startling reality is that heart disease is responsible for 1 out of 4 deaths in the U.S. each year. The new guidelines introduce a number of wonderful non-drug therapies that can have an immediate effect on overall health and well-being. By knowing your numbers and taking proactive measures to get heart-healthy today, you can make a significant impact on your health in the future.

Mycotoxin Illness: Could the air you breathe be making you sick?

Years ago I had a teen patient who presented with nausea, fatigue, weight loss, and cognitive decline. He was so sick, he was missing weeks of school at a time and could not keep up. After a thorough workup, I tested him for mycotoxins, naturally occurring, poisonous substances that are released by certain types of fungi (aka mold), through a urine test. He had 3 different types of mycotoxins, but the level of one certain type of black mold toxin, called trichothecene, was through the roof. He had been living in the basement of his family home. The home was tested and mold was found and remediated. Fortunately, I tested several other family members who were all negative.

However, finding and ridding the environment of the mold was not enough to heal my patient. The toxins had settled into his tissues and because his liver genetically was not clearing them; help was needed. First, he moved out of the house, left high school temporarily, and moved in with another family member in order to remove himself from the toxic environment completely. I then put him on supplements to support the liver detox process, and binding agents to reduce the toxic load through the gut. I also gave him supplements aimed at lowering inflammation in the brain and nervous system. It took several months, but over time he felt better and was able to move back home to finish school. He is now a healthy, happy young man who just left home for college.

I’m happy to report things ended well for my patient. Unfortunately, this type of case is becoming more common, but why?

About a half-century or so ago we lived and worked in homes and buildings that were more open to outdoor air. Over the years our homes and buildings have become more airtight and climate-controlled so that we are now breathing recirculated indoor air as opposed to outdoor air. In addition, instead of being built with plaster our homes and buildings are constructed with porous drywall which when combined with moisture creates a feeding frenzy for mold.

What are molds?

Molds are a group of fungi that produce airborne spores. In nature, molds are decomposers that recycle nature’s organic wastes. In medicine, they are the producers of antibiotics such as Penicillin or drugs, like ergotamines used for migraines. Some molds and fungi, like cheese and mushrooms, are delicacies. However, when certain molds infiltrate our environment, they can wreak havoc on our health.

black mold When there is water intrusion in your home or work environment, such as occurs in a flood or even with a minor water leak, within two days mold spores that either have lain dormant or have come from the outside start to feed off the drywall that is now wet. The mold spores produce mold toxins called mycotoxins. Mycotoxins can thrive under the right conditions (high temperatures and moisture are the major determining factors). These wet areas also become breeding grounds for bacteria that produce toxins called endotoxins. The mold and bacteria infiltrate wall coverings, such as wallpaper and paint, and begin to release volatile organic compounds (VOCs), and this contaminated air circulates through the home or building.

Exposure to high concentrations of mold spores (such as black mold toxin or aspergillosis) over an extended period of time which results in the accumulation of these toxins in the body, is known as “biotoxicity” or “neurotoxicity.”

Symptoms of toxicity

The symptoms of toxic inhalation are many. The most common symptoms are respiratory in nature, i.e. sinus congestion, sore throat, cough, wheezing and shortness of breath. This can lead to an autoimmune condition called hypersensitivity pneumonitis.1 However, with continued exposure dysregulation of the immune system and inflammation of the nervous system occurs2,3,4 leading to symptoms such as headaches, fatigue, generalized pain, depression, cognitive issues, rashes, weight gain and digestive inflammation from ingestion of spores.5

We now understand that there is genetic variability among those who have been exposed to mycotoxins. Some people are genetically capable of clearing low levels of these toxins through the liver detox process and never suffer consequences. Others do not have the ability to clear them and get severely ill, which was the case for my teen patient. This is why the “sick building syndrome” is so controversial – not everyone has the same reaction depending on the degree of exposure. However, given a high enough dose, it can be devastating. In fact, mycotoxins, like trichothecenes from black mold, have been used in biological warfare.6,7

Mycotoxins in food

Mycotoxins can also be found in food as well as airborne. There are over 300 identified types of mycotoxins, but only a small number of these are responsible for contaminating the foods we eat. Contamination can occur at any number of points in the production process – from harvesting and storage to packaging and transportation. Staple crops like wheat, corn, barley, nuts, even coffee beans, are highly susceptible to contamination. The toxin itself cannot be seen by the naked eye so once the toxin is established in a food item it is virtually impossible to eliminate. Aside from being invisible, they are also heat resistant, so they are not affected when food is cooked.

Ochratoxin and aflatoxin, two common types of mycotoxins found in contaminated food, have been shown to cause kidney damage, cancer, and liver failure. 8,9

What you can do:

Determining whether you have been exposed to mold toxins is not an easy task. If you suspect mycotoxin illness, let us help you do the appropriate testing and help restore you to good health. The treatment process may include one or more of the options below.

  1. Get tested: Specialized labs that test for both airborne mold toxins and toxins found in food may be ordered.
  2. Talk to an air quality specialist: An indoor air quality specialist can come to your home to determine whether mold is present and what steps are necessary to remediate.
  3. Examine your diet: If exposure appears to be rooted in a food source, such as aflatoxin or ochratoxin, an amylose-free diet (a diet low in sugar, grains, and tubers) may be helpful. Certain nutritional supplements, including Glutathione, N-acetyl Cysteine, Chlorella, Omega-3 Fatty Acids,  Vitamin D, Magnesium and D-Ribose, and binding agents like charcoal, clay or bile acid sequestrants like cholestyramine, may be recommended by your physician to help remove toxins from the body.
  4. Try a complementary therapy: Acupuncture, osteopathic manipulation, and Chinese and American herbal remedies may be helpful in providing relief from symptoms and from any side effects of the detoxification process.

-Lisa Lilienfield, MD