Audio-Visual Entrainment, History and Physiological Mechanisms

History

Clinical reports of flicker stimulation appear as far back as the dawn of modern medicine. It was at the turn of the 20th century when Pierre Janet, at the Salpêtrière Hospital in France, reported that when he had his patients gaze into the flickering light produced from a spinning spoked wheel in front of a kerosene lantern, it lowered their depression, tension and hysteria (34). Then, in 1934, Adrian and Matthews published their results showing that the alpha rhythm could be "driven" above and below the natural frequency with photic stimulation (1).

This discovery further propagated dozens of small physiological outcome studies on the "flicker following response" by many well respected researchers (4,5,11,20,18,22,43). However no one considered the subjective and behavioral effects of photic stimulation. Finally in 1956, W. Gray Walter published the results on thousands of test subjects comparing flicker stimulation with the subjective emotional feelings it produced (46).

Meanwhile, William Kroger accomplished other important developments in photic stimulation. Kroger was a physician investigating why radar operators were going into trances in front of their radar sets and of course, leaving the ship or plane at great risk to the enemy. He concluded that the rhythmic "blip" of the radar was "pulling" the radar operators into a trance state. These findings compelled Kroger to team up with Sydney Schneider of the Schneider Instrument Company of Ohio to construct and market the first electronic clinical photic stimulator, called the "Brainwave Synchronizer." It comprised of an intense xenon strobe light complete with a rotating dial that could be set to the frequencies of the standard four brain wave rhythms. They found the Brainwave Synchronizer had powerful hypnotic qualities and soon published a study on hypnotic induction (24). They also prompted other studies involving hypnotic induction in surgery and dentistry, and studies of general interest to the hypnosis profession (38, 31, 29).

In 1981, my wife, Nancy, and I incorporated Comptronic Devices Limited, with a focus on designing TENS units and EMG feedback devices for dental (TMJ) applications. In 1984, I designed the "Digital Audio-Visual Integration Device" (DAVID1), used for hypnotic induction and to calm anxiety in performing arts students at the University of Alberta. The "light and sound" (L&S) market at this time was in its infancy and resided primarily within the new age sector. There was little "known" research to support L&S technology, and professionals by and large showed disinterest. Due mainly to poorly designed L&S products and a lack of research, about 40 L&S companies have come and gone, most of them during the 1980s and 1990s. However, since the time of Adrian and Matthews, a considerable number of studies have verified photic and auditory "driving" of the EEG. I have since re-named this phenomenon as "audio-visual entrainment" or AVE, as any given frequency of stimulation that is reflected in brain wave activity and observable on an EEG or QEEG can be entrained. Many more studies on photic or combined audio/photic stimulation exist than pure audio stimulation studies, however audio-only stimulation studies have confirmed audio entrainment (8) and its effect on calming masseter muscle tension (30).

Physiology of Audio-Visual Entrainment

In order for entrainment to occur, a constant, repetitive stimuli of sufficient strength to "excite" the thalamus must be present. The thalamus then passes the stimuli onto the sensory-motor strip, the cortex in general and associated processing areas such as the visual and auditory cortexes. Figure 1 shows the visual pathway with the retina of both eyes becoming excited and sending pulses down the optic nerve, through the optic chiasm, and into the lateral geniculate of both thalami. From here, the visual signals are passed onto the visual and cerebral cortexes for further processing. Notice that there is very little delay from the onset of the flash to the response in the optic nerve, but a delay of approximately 100 msec occurs by the time the visual evoked potential (VEP) is elicited in the visual cortex. This delay may be why entrainment occurs best at the natural alpha frequency -- as 100 msec equates to 10 Hz.

Figure 1. The EEG Photic Stimulation Path

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Photic entrainment begins its process as a series of overlapping evoked potentials (23). Kinney broke down a simple VEP into its various components (Figure 2) representing the passage of time for 4, 8, 12 and 20 Hz. As can be seen, much of the VEP occurs within 250 msec, correlating to four Hz. The various overlapping parts were then vector summed into the mathematical VEP and compared with the actual VEPs observed by EEG at the higher, entrained frequencies, shown in Figure 2.

Figure 2. EEG Wavelet

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When this mathematical model was compared with the actual observed EEG of the entrained stimuli (Figure 3), a high degree of predictability was observed, demonstrating that photic entrainment is indeed a vector summation of VEPs and not a novel neuronal process.

Figure 3. EEG VEPs - Vector Addition (theoretical) Model vs Observed EEG

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By definition, entrainment occurs when an EEG reflects the brain wave frequency duplicating that of the stimuli, be it audio, visual or tactile (41). Entrainment occurs best near one's own natural alpha frequency (43, 23). LEDs and xenon strobe lights contain much harmonic content due to the "squareness" or rapid turn-on and turn-off transitions of the stimuli and these harmonics are reflected within the EEG. Figure 4 shows a strong and pure entrainment at 12 Hz. The harmonics (small wavelets) seen in the EEG are a reflection of the actual harmonics contained within the stimulus. Square wave stimulation is associated with an increased risk of seizure (21, 37). The only way to produce entrainment without harmonics is via sine wave stimulation in which the stimuli turn on and turn off in slow, gentle transitions and do not contain harmonics. (45, 44, 35, 41).

Figure 4. EEG Showing Photic Entrainment

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AVE at 18.5 Hz has also been shown to produce dramatic increases in EEG amplitude at the vertex (14), where it was found that:

a) eyes-closed 18.5 Hz. photic entrainment increased 18.5 Hz EEG activity by 49%.

b) eyes-open auditory entrainment produced increased 18.5 Hz. EEG activity by 27%.

c) eyes-closed auditory entrainment produced increased 18.5 Hz EEG activity by 21%.

d) eyes-closed AVE produced increased 18.5 Hz. EEG activity by 38.3%.

Entrainment primarily shows itself frontally and near the vertex (41). Figure 5 is a QEEG, or "brainmap" from the SKIL (Sterman-Kaiser Imaging Labs) database, in 1Hz bins showing the frequency distribution of AVE at 7.8 Hz. The area within the circle at 8Hz shows maximal effects of AVE in central, frontal and parietal regions (at 10uv in this case) as referenced with the oval area on the legend. It is through these effects that AVE has proven effective in treating depression, anxiety and attentional disorders. A harmonic is also present at 16 Hz. (the circled image), which is typical of semi-sine wave (part sine/part square wave) stimulation.

Figure 5. Brain Map in 1Hz Bins -- During 7.8 Hz AVE (SKIL-Eyes Closed)

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Body/Mind Effects of Audio-Visual Entrainment

We conceptualize AVE as achieving its effects through several mechanisms at once (40). These include:

1) dissociation / hypnotic induction,

2) increased neurotransmitters,

3) possible increased dendritic growth,

4) altered cerebral blood flow, and

5) normalized EEG activity.

Dissociation

Dissociation is described as a process where feelings, memories and physical sensations are kept apart from other information that would normally be logically associated. In pathological terms, dissociation is a maladaptive disruption in integrated functioning typically associated with depersonalization, stress, identity, amnesia and depersonalization disorders (7).

On the other hand, dissociation occurs when we meditate, exercise, read a good book, take in a movie or enjoy a sporting event, because we get drawn into the present moment and dissociate from all of our daily hassles, worries, anxieties and the resulting unhealthy mental chatter. Several techniques such as dot staring and stimulus depression have been shown to induce dissociation (26). Audio dissociation analgesia using white noise has been shown to effectively increase pain threshold and pain tolerance during a dental procedure (33).

Regardless of the activity, this type of dissociation reduces our weekly stress load, whether we are aware of it or not. In essence, when we focus on something, we dissociate from other things. The saying, "a change is as good as a rest," has much more truth to it than initially meets the eye (40).

The first study on dissociation induced via entrainment involved hypnotic induction and found that photic stimulation at alpha frequencies could easily put subjects into hypnotic trances (24, 29). Figure 6 shows the results of Kroger and Schneider's study in which nearly 80% of the participants in the study were in a hypnotic trance within six minutes of photic entrainment.

Figure 6. Photic Stimulation Induction of Hypnotic Trance (24)

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Psychologists have been looking for ways to dissociate their clients as a part of fear and phobia treatment. Inducing dissociation using AVE delivered by the DAVID1 was found to be more effective than dot staring or stimulus deprivation (26) as shown in Figure 7.

Figure 7. AVE Induced Dissociation (26)

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Furthermore, Leonard completed a second study with people who experience dissociative anxiety (27). People with dissociative anxiety feel a need to have a sense of control in their lives and become anxious or panicky when they dissociate, be it driving home, at the office, or in a clinical setting. The Acute Dissociation Inventory (ADI) is a 35-item self-report scale (26). It assesses dissociative sensations (ADI-Dissoc) and subjective anxiety, or dissociative anxiety in response to dissociative provocation (ADI-Anx). Leonard and her colleagues clinically dissociated people who become anxious when dissociating, by using a DAVID Paradise HemistepTM alpha session. As expected, the participants' anxiety (ADI-Anx) had almost doubled by the end of the AVE session. The surprise, however, was that their heart rate actually decreased, contrary to normal anxiety reactions (Figure 8). With the ability to clinically dissociate these people, yet simultaneously calm them down somatically, AVE can be used as a desensitization tool for reducing dissociative anxiety.

Figure 8. Dissociative Anxiety and Somatic Arousal (27)

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A dissociative mindstate or hypnotic trance may be described in terms of an altered state of consciousness (ASC) in which the subject (or an independent observer of the subject) observes a qualitative shift in the normal pattern of mental functioning (16). ASCs produced via overstimulation also occur when a person is bombarded with higher than normal levels of sensory input, usually in more than one sensory modality (19, 28, 17). Glicksohn studied photic entrainment and the ASCs produced. He monitored the EEGs of subjects during photic entrainment. They all described a wide variety of reactions to the stimulation with some reporting incredible imagery consisting of items they had seen before in their lives, intertwined with geometrical patterns while others reported no visual changes at all. At the end of the study, Glicksohn concluded that:

1) It is the increase in alpha activity created by photic driving, and not the natural alpha activity itself, that is conducive to an ASC.

2) The appearance of visual imagery is neither necessary nor all that is involved to indicate the experience of an ASC.

3) If a photic driving response is not elicited, the subject will not experience an ASC.

Glicksohn's observations support the concept that in order for AVE to occur, the stimulating frequency must have a direct impact on brain wave frequency and be observable on an EEG.
Dissociation and Restabilization

Dissociating clients with trauma histories, during the course of treatment is important. The state of mind that a person has at any given moment is made up of the brainwave activity associated with apprehension, anxiety, physical tension (proprioceptive/afferent associations), destructive thoughts, and conditioned responses relating to the colors, smells, sounds, etc. Once the mind is clear, all of these tensions, conditioned responses (bracing habits), fearful thoughts and the effects of afferance (sensory information) subside, allowing the mind and brain to relax, become more malleable and open to new healthy thoughts, post-hypnotic suggestions, brainwave activity and so on. During AVE, the EMG and electro-dermal responses fall, finger temperature increases and breathing becomes smooth and diaphragmatic. These changes reflect a return to homeostasis or restabilization, hence the term dissociation and restabilization (DAR) (40).

Figure 9 shows a typical reduction in forearm EMG and Figure 10 shows a typical increase in finger temperature. Notice that restabilization begins after about six minutes of AVE, when the user begins dissociating. Figure 11 shows normalization of breathing and heart rate variability following exposure to AVE at 7.8 Hz.

Figure 9. Forearm EMG Levels During AVE (Hawes, 2000)

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Figure 10. Peripheral Temperature Levels During AVE (Hawes, 2000)

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Neurotransmitters

There is evidence that blood serum levels of serotonin, endorphine, and melatonin rise considerably following 10 Hz., white-light AVE (42). Increases in endorphines reflect increased relaxation while increased norepinephrine along with a reduction in daytime levels of melatonin, indicate increased alertness (Figure 11).

Figure 11. Neurotransmitter Levels Following AVE (42)

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Dendritic Growth

There is evidence that stimulating neurons with mild electrical stimulation promotes growth of dendrites and dendritic shaft synapses in the cells being stimulated (6, 25). However, studies do not yet exist on the influence of AVE on dendritic growth, although it is suspected because many people with autism, palsy, stroke and aneurysm (36) have gained significant motor and cognitive function following a treatment program of AVE.

Cerebral Blood Flow

Cerebral blood flow (CBF) is essential for good mental health and function. SPECT and FMRI imaging of CBF show that hypoperfusion of CBF is associated with many forms of mental disorders. CBF increases dramatically during AVE (12, 39). Figure 18 shows an increase of 28% in cerebral blood flow within the striate cortex, a primary visual processing area within the occiput. As an interesting note, maximal CBF occurs at 7.8 Hz, the Schumann Resonance of the earth.

Figure 12. Cerebral Blood Flow at Various AVE Repetition Rates (12)

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Following Fox and Raichle's study was a whole head PET analysis of visual entrainment at 0, 1, 2, 4, 7, and14 Hz (32). This study on 19 healthy, elderly (mean age=64 years) subjects found that regional cerebral blood flow (rCBF) was activated differentially with the:

1) left anterior cingulate showing maximal increases in rCBF at 4 Hz.

2) right anterior cingulate showing decreases in rCBF with frequency.

3) left middle temporal gyrus showing increases in rCFB at 1 Hz.

4) striate cortex showing maximal rCBF at 7 Hz.

5) lateral and inferior visual association areas showing increases in rCBF with frequency.

While there may be benefits to increasing occipital CBF, there is even greater concern regarding conditions involving hypoperfuson of CBF in frontal regions. Frontal disorders include: anxiety, depression, attentional and behavior disorders, and impaired cognitive function (2). Figure 13 shows an increase in frontal CBF recorded on Hershel Toomin's "Thinking Cap" (or "Hemoencephalogram") using infra-red light to measure perfusion of CBF. Notice that CBF at FPZ increases by 15% in 10 minutes (Toomin, personal communication).

Figure 13 Hemoencephalographic Measure of Cerebral Blood Flow During 10 Hz AVE

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Normalized EEG Activity

Figure 14 shows a fairly typical brain map in 1 Hz bins of a person with mild depression and anxiety as shown on the Skil database. Notice that alpha is slowed and approaching +2SD from the norm and that some beta frequencies (16-18 Hz) are high (>1SD) in central frontal areas.

Figure 14. Brain Map in 1 Hz Bins of Individual with Depression and Anxiety (SKIL-Eyes Open)

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Following an AVE session of 7.8 Hz., both alpha and beta activity are normalized as shown below in Figure 15.

Figure 15. Brain Map Following 7.8 Hz AVE (SKIL-EO)

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Conclusion

In closing, AVE has the ability to quickly and effectively relax people out of high sympathetic activation and traumatic states of mind, bringing a return to homeostasis. AVE may be used alongside hypnotic suggestions on tape/CD or live via a microphone. At the same time however, AVE exerts a powerful influence on brain/mind stabilization and normalization. At the end of an AVE session, the user may realize that he/she has not felt so relaxed for years -- perhaps not since childhood.

Footnote:

1. For more information, address all correspondence to:

David Siever, c/o Mind Alive Inc., 9008 - 51 Avenue, Edmonton, Alberta, Canada, T6E 5X4
Toll Free: (800) 661-6463 Fax: (780) 461-9551 Web: http://www.mindalive.com
Email: info@mindalive.com

Mind Alive Inc., 9008 - 51 Avenue, Edmonton, Alberta, Canada T6E 5X4 http://www.mindalive.com

Copyright 2006. Reproduction of this material is allowed as long as it is unaltered and complete with Mind Alive contact information. Reproduction for marketing purposes is prohibited without permission from Mind Alive Inc.

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Can a Chiropractor Fix a TMJ Disorder?

Yes, a chiropractor can fix TMJ, according to many studies and reports that confirm this to be true. In fact, a chropractor will often provide significant relief and even a cure for TMJ symptoms.

A chiropractor will not only be better able to diagnose the problem that is causing TMJ pain, but he will also be able to give more direct relief and provide non-invasive and all natural treatments as well that have little or no side effects.

TMJ treatments that involve chiropractic treatment usually work by correcting any misalignments which may exist in the jaw, face, head, or neck bones. These misalignments may be contributing to the TMJ disorder, so a series of adjustments or manipulations that realign the bones. If done correctly, the procedure will be painless, quick, and should provide relief almost immediately.

In some cases, this treatment may be necessary to treat TMJ, as the only way re-correct the bones is through a series of adjustments and manipulations; massage and exercise do not necessarily realign the bones on their own.

The chiropractor may be best suited to fix TMJ cases that are caused by accidents to the jaw, face, and neck area that have pushed any of these bones out of place and subsequently caused the tmj, chronic spinal and neck problems (including bad posture and poor sleeping positions) that have contributed to the jaw bones becoming misaligned, or overall blunt trauma to the head, face, or neck region that have created misalignments. The chiropractor as a whole will not focus specifically on or directly treat any causes of TMJ that are dental in nature (such as a bad bite, teeth grinding, missing teeth, etc.); rather he will focus on the neck, jaw, and cranial bones as well as the spine to treat the TMJ.

Other treatments which may be offered by the chiropractor to fix tmj are massage therapy to treat weak muscles that have been affected by the misalignments, specific exercises to rehabilitate the jaw area that are often more effective, dietary and nutritional advice, and other natural and alternative treatments that are non-invasive and have no side effects.

Overall, a chiropractor is greatly preferred over a surgeon or other specialist to fix TMJ, as the surgeries and other invasive procedures which they will recommend are often very invasive, have a high risk of permanent damage, and are overall unnecessary for this particular disorder. But remember, as with any medical condition, it is always a good idea to consult with your doctor in order to determine the best treatment option for your needs.

Want TMJ Relief? Check the Pros and Cons of Treatments For TMJ

There are many types of treatments for TMJ related pain. Three common treatments offered in an attempt to provide TMJ relief are medications, chiropractic help and dental treatment from someone known as a TMJ dentist. There are advantages and disadvantages with all options.

Treatments for TMJ Relief - Medications

Many people reach for pain relievers at the first sign of pain. While this is often one of the fastest methods to get relief from pain it is not a good idea to rely on pain medications for many cases of long term pain. This would certainly include those who suffer with TMJ pain.

The reason is that many types of pain are due to a structural or physical problem. TMJ related pain is no exception. With a TMJ disorder the jaw or bite of a person is out of alignment. This causes the muscles, ligaments and nerves that are attached to the TMJ (temporomandibular joint) in one way or another to become strained and then inflamed.

Pain is the result of this physical problem. Chemicals such as those included in medications simply can not cure a physical problem though. Medications can mask the pain of a physical problem but they can not fix the root cause of a physical problem.

The other disadvantage with taking pain medications is that they can have many negative side effects. You only need to read the label of pain medications too see the long list of additional complications that may result from using a certain product.

The physical problem causing a TMJ disorder mostly gets worse over time so more medications would often be required when pain relief is not found. This increases the chance of possible complications from the use of medications.

The best solution is to get treatment for the real physical cause of TMJ pain.

Treatments For TMJ Relief - Can Chiropractors, Physical Therapists or Ear, Nose and Throat Specialists Help?

The root cause of TMJ pain is not addressed by physical therapists or ear, nose and throat specialists.

Chiropractors may be able to offer help but this depends on the exact nature of the physical problem causing a patients' TMJ syndrome. If there is a misalignment in the spine then a chiropractic adjustment can be of assistance in properly aligning the spine and therefore providing pain relief.

Fundamentally, TMJ pain is mostly because of a poor bite and misaligned jaw so it is often better to first visit a TMJ dentist and then afterwards to visit a chiropractor if the spine is also involved in addition to the jaw.

Treatments For TMJ Relief - How A TMJ Dentist Treats The Root Cause Of A TMJ Disorder

Visiting a TMJ Dentist is one of the surest ways to correct the root physical problem that causes TMJ pain. This treatment is not as fast as simply popping a pain pill but it is the path to take for those wanting to have the core problem corrected so long term pain relief is possible.

While the treatments a TMJ dentist performs to provide TMJ relief are painless and designed to provide long term results, there are a few disadvantages.

First, a TMJ disorder is very complicated to properly diagnose and then provide treatments for. Because of this, not every dentist is comfortable in taking on patients who have TMJ pain. So the first challenge is finding a TMJ dentist.

Secondly, TMJ dental treatments require periodic follow up appointments so it helps to find a TMJ dentist who is fairly local. This is not always possible but because of the uniqueness of the help they provide some people with TMJ pain are willing to travel long distances for help. For example, TMJ dentist Dr. Goodfellow in the Toronto area has had patients drive as long as 12 hours for his TMJ treatments.

The unique advantage a TMJ dentist provides is that they have invested thousands of hours in post-graduate studies specifically for the treatment of TMJ syndrome. Because of this they have gotten to the point where they can use their expertise and many pieces of specialized equipment to quickly diagnose if someone actually has a TMJ disorder. If this is the case they will know exactly what treatments to provide in order to deliver quick and mostly long-term pain relief.

Old Dogs 101 - How to Help Your Canine Senior Live As Comfortably As Possible

Reaching old age for a dog is often the result of good luck, good life habits by the dog's owner, and in the end, just plain good genetics. If you already have an old dog, skip over the next paragraph and read ahead for tips on caring for your senior citizen. But if you're in the market for a new dog, there is a recipe to help improve your future pet's odds for longevity.

The list of ingredients starts with a puppy bred by a responsible breeder. Prospective parents should be screened with health tests appropriate for their breed before being bred. Add to that a nurturing and stimulating puppy hood. Next, feed a quality premium food for the life of the dog.These days there are specialty diets for puppies and seniors, giant breeds and toys, food for joint health and for dogs with diabetes or kidney disease. Feed the diet that's right for your dog. Blend in regular examinations with a veterinarian. Vaccinations are available to prevent 13 different canine diseases and dental check-ups should be as routine as an inoculations. Mix in a safe environment. That means a fenced yard or leashed walks, fenced or covered ponds and swimming pools, an I.D. tag on their collar, and protection from household chemicals, dangerous wildlife and dogs you don't know. Let this all sit until your dog is old, gray, grizzled and has more love for you than ever before.

When is a dog old? We used to think that every dog year was equivalent to seven human years. Experts now tell us that a dog's size and breed influence this answer and there are charts to be found on the Internet that are the updated versions of this information.

Once you determine that your dog is "old," what next? Let's break down the areas which most immediately impact your old dog:

Nutrition: Energy requirements decrease about 20 - 20% in senior dogs which accounts for the increased percentage of fat content in their bodies Fat dogs die younger than leaner dogs. Keep your oldster trim; It used to be believed that reduced protein spared the kidneys in older dogs. In the book, "Eternal Puppy." written by Janice Willard, DVM, however, the author shares studies that suggest that older dogs need more high quality protein, not less, to prevent muscle wasting. Optimal protein levels are a controversial topic among nutritionists, but unless your dog has kidney disease, it may not be a good idea to reduce your old dog's protein intake. Older dogs have decreased intestinal motility which sometimes make them more prone to constipation. Avoid a high fiber diet, but with your vet's consent, consider increasing soluble and insoluble fibers.Consumption of vegetables, especially leafy greens, correlate with a reduction in certain forms of cancer, so consider adding a few fruit and vegetables to your dog's diet - very slowly, at first. Give it frequently even if it isn't eaten. Old dogs don't always enjoy new things, but if offered routinely or in different form (frozen peas as a crunchy treat vs cooked ones) they may take to it.Add omega-3 fatty acids (fish oil) to your dog's diet; Studies have shown that Fish oil supplementation may be helpful for pets with inflammatory diseases including allergies, arthritis, kidney disease, heart disease, and cancers.You may not notice changes for at least six to eight weeks, so be patient, and be sure to consult your veterinarian when embarking on anything new.

Flooring: Hard flooring is not only hard on a dog's joints, but offers little traction and puts an old dog at risk for blowing out an ACL or hip. Put down small vinyl-backed rugs for those high traffic spots where the dog is apt to turn a corner or run to go outside.

Bedding: Your senior will spend more time sleeping, so offer the best kind of bedding you can mange. Here are some of your choices:Heated dog beds can be highly therapeutic for dogs with achy joints. They work like heating pads and are especially appreciated by thin and/or tiny dogs Gel filled orthopedic beds offer maximum support, comfort and superior weight distribution. The new Gel foam beds contain heat sensitive memory foam type material that custom forms to pets' bodies, easing pressure on legs and hips. The gel helps keep pets cool in the summer by maintaining a lower ambient temperature, while the foam helps keep pets warm in the winter with dense insulation. Memory foam beds are made from (ta da!) memory foam which was first developed by NASA years ago. Foam beds are another type of body-conforming bed that reduces pressure on joints. Dog Waterbeds can provide therapeutic benefits for pain, Hip Dysphasia, Cushing's Disease, Hygromas, Allergies, Calluses, Post Surgery, Senior Canines, Post Chemotherapy, Skin Conditions, Elbow Dysphasia, and Canine Auto-Immune Hemolytic Anemia. Standard orthopedic beds are generally made with a 3" egg crate. Although these beds are probably the lowest in price, the aforementioned options tend to provide better support and comfort for an old dog.

Incontinence: It happens to the best of us. Don't get mad since given the choice, your dog would rather not have the problem, either. In many cases of canine incontinence, a hormone deficiency is the source of the problem and these are typically treated through the use of drugs such as Diethylstilbestrol. If your vet determines that there is no medical reason for incontinence other than simple aging, however, there are several solutions to combat everything from periodic "dribbling"to all-out flooding;- Just pick the one best for your dog's situation: If the problem occurs during crating or in the night when your dog is sleeping and s/he doesn't move around much, re-usable protective pads will work just fine. There are a mind-numbing array of disposable options which a Google search will display.

If the problem is more "mobile," there are disposable diapers that feature elastic, no-leak gathers and resealable Velcro tape. You can also make your own "belly bands" for boys and again, a Google search will show you how. For a "no sew" version, insert a sanitary napkin inside the length of a man's crew sock (the man should be out of the sock when you do this), and attach sticky-backed Velcro at each end. One economical solution to pricey disposables is to purchase two or three washable diapers in which pads can be inserted and disposed of when soiled.We've been impressed with the fit and durability of Simple Solutions diapers which can be found at Petsmart.

The Handicapped Dog: Older dogs, or dogs with arthritis, degenerative myelopathy (DM) and spinal problems can sometimes lose the use of their back legs. This is NOT catastrophe. A dog can still walk and get the exercise they need with a sling or dog wheelchair. To see a dog wheelchair in action, check out "Denali" on Google. For some dogs, a sling works perfectly well as it allows the dog's owner to maneuver medium and large dogs without lifting the entire weight of the dog. If this looks like a solution for you, be sure to get a sling that's ergonomically designed with adjustable handles that allow you to stand erect and maintain your center of gravity.You can't very well help your disabled dog if your own back is thrown "out.'

Hearing Loss: By the time an owner notices hearing loss in their dog - usually in the 4th quarter of a dog's life, it's probable that the loss has been progressive and has finally passed a threshold where it's now noticeable. Hearing aids are still impractical for a dog and we are left to do what we can to protect the dog. We should be especially careful when walking a hearing impaired dog off-lead. Such a dog won't hear his owner call from a distance and may well get lost and become at risk from approaching cars or other animals.

Blindness: The cloudiness we see in our senior dogs' eyes is usually sclerosis, or hardening of the lens of the eye. The light-transmitting capabilities of the lens is still intact and the dog has lost little of its vision, so think of as looking through a cheap shower curtain. Up close, you can see through the curtain, but at a distance, it's a bit more opaque. Glaucoma and cataracts do occur in dogs and any changes in vision, discharge, squinting, swelling or redness should be seen by a vet right away. If nothing can be done to reverse blindness, take heart in the fact that blind dogs adjust pretty well by using memorized routes around the house and feel the vibrations from radios, TVs and the floor to gauge where they are.

Taste: A geriatric dog may have only 25% of the taste buds he had at a year old, so if your senior is losing weight for no apparent reason that a vet can determine, food may have become tasteless for your dog. Try increasing the tastiness of food with eggs, seasonings, shredded cheeses (especially the "smelly" kind), a sprinkling of fish bits or a "schmear" of Braunschweiger over the top of the food.

Arthritis:Because cartilage cannot repair itself,it is impossible to heal arthritis once it has begun.At best, we can slow degeneration, reduce inflammation and limit pain. Most of us are familiar with Rimadyl, a steroidal anti-inflammatory drug used for the relief of arthritic symptoms in geriatric dogs. Aspirin, even low dosage or buffered, is NOT a good option for pain management in dogs. Studies show increased risk of stomach bleeding. Don't do it. Currently, early research looks promising with glucosamine and chondroitin combinations and omega-3 fatty acids. In our own house, each adult dog gets 1,200 mg. of fish oil, and a table that combines 1500 mg of glucosamine with 1200 mg of chondroitin daily. Our veterinarian is fine with this, but always check with your own vet before starting anything new. Substances such as MSM, hyaluronic aci, New Zealand green-lipped mussels and other antioxidents may also benefit cartilage and joint fluid, but the jury is out on how they work and because these substances aren't regulated by the FDA for dogs, dog owners have to be careful.

Dentistry: By four years of age, 85% of dogs will have some form of periodontal disease. Older dogs are at an increased risk for dental disease because they have reduced salivary production. With a drier mouth, food sticks to teeth more which increases bacteria. Bacteria can enter the bloodstream and travel to places it doesn't belong. Periodontal disease has been implicated in the development and acceleration of diseases in the kidneys, heart, liver and brain. CLEAN YOUR DOG'S TEETH. If your dog's teeth have been neglected, a professional cleaning may be in order. Ask your vet about putting the dog on a course of antibiotics before the scheduled cleaning to combat bacteria, and make sure they are aware of the dog's age. Anesthesia has come a long way and isn't quite as risky for an old dog as it used to be. But it's still anesthesia and should be seriously considered before using, particularly if your breed has issues with anesthesia.

IVD or Idiopathic Vestibular Disease is the most common disease on old dogs that you may not be familiar with. Characterized by symptoms that almost resemble a stroke, these signs include a head tilt, nausea and rapid eye movement. To learn more about this syndrome, check out the January 2008 issue of KnobNotes in our archives to read more about IVD, also known as the geriatric disease.

Boredom: Most dogs are active by default, hunting, show and performance dogs even more so. But when physical abilities diminish and a dog becomes less capable of their former tasks, other ways must be found to keep their minds active. Toys are only toys if the dog interacts and plays with them, otherwise they become just more "stuff" on the living room floor. Food puzzles are rewarding because they invite interaction. The Molecuball, Buster Cube,Busy Buddies and Canine Genius all offer interesting food puzzles that help stimulate a dog's mind as they reward effort.

We're just scratched the surface of issues that confront senior dogs and their owners. If you are blessed with an "oldster" in your house, you'll want to investigate some great books that offer additional information:

"Eternal Puppy" by Janice Willard, DVM;
"How To Make An Old Dog Happy" by Olivier Lagalisse;
"Speaking for Spot," by Dr. Nancy Kay "The Senior Dog" by Heike Schmidt-Roger/ Susanne Blank;

What You Need to Know About Anterior Hip Replacement

Anterior hip replacement is fast becoming the preferred approach to hip surgery, out favoring the traditional approach and offering faster recovery with less pain. If you have been told you need a hip replacement, or have been suffering from chronic hip pain, you may be the perfect candidate for this procedure.

What is the difference between approaches?
In the traditional approach, a large 7 to 8 inch incision is made in the back (posterior) or the side (lateral) of the hip. With either of these approaches, the gluteus (buttock) muscles must be cut. Much of the pain following hip replacement surgery is due to detachment, repair and healing of these cut muscles. With the anterior approach, a smaller 3" incision in the front of the hip is made. There is no need to disturb the muscles- - instead, surgeons work through the natural opening between the muscles. As a result, recovery is faster and there is far less pain than with the traditional approach.

Who is a good candidate for the anterior approach?
Almost anyone who is a candidate for hip replacement surgery is a good candidate for anterior hip repair. Typical candidates are generally people over the age of 50 who have chronic hip pain resulting from osteoarthritis or rheumatoid arthritis, where the cartilage between the head of the femur (the ball) and the acetabulum (the concave surface of the pelvis, or socket) has worn away, causing "bone on bone" pain when walking or performing other weight-bearing activities.

With the advancement of prosthetic materials, artificial joint life has been greatly extended, making the surgery more attractive to persons in their 40s.

Patients who are obese, who have had a previous hip replacement on the hip in question or who have severe hip dysplasia or overgrowth of the hip bone (heterotopic bone formation) may not be good candidates for the anterior approach.

What are the advantages of the anterior approach?

There are many advantages of the anterior approach, including:

• smaller incision


• less pain and scarring


• lower risk of hip dislocation following surgery as the muscles supporting the hip are not disrupted


• more exacting placement of the installed components, resulting in a longer lasting prosthesis


• decreased leg length discrepancy


• fewer hip precautions following surgery- patients are able to resume activities, including walking and flexing the hip, almost immediately


• Shorter hospital stay and a faster recovery- patients are often home the next day and recovery is approximately 2 to 8 weeks, as opposed to 2 to 4 months for the traditional approach

What makes the anterior approach possible? The anterior approach is possible due in large part to the use of a specially designed table that allows for specific positioning during surgery. The Hana™ table is designed to allow rotation and hyperextension of the leg and hip, which permits the surgeon to more accurately and precisely, fit the prosthetic device. The table is made of a carbon fiber, which allows the surgeon to view scan images of the operative site during the surgery, permitting greater leg length accuracy. The combination of the specialized table and the imaging system make the anterior approach possible.

How do I find a surgeon who uses the anterior approach? Not all surgeons are trained at the anterior approach to hip replacement. The need for specialized equipment and training means there are fewer surgeons who offer anterior approach to hip replacement surgery.

The Holland Bone and Joint Center in Holland, Michigan offers this less invasive and specialized technology, and treats patients from around the world who wish to undergo this hip replacement option, allowing them to return to their normal activities sooner and with less pain. The Center provides quality care, expertise and personalized service to patients from all walks of life, including Olympic athletes. The Hana™ table and a specialized imaging system are routinely used at the Center for anterior hip repairs.

If you are wondering whether you are a candidate for anterior hip replacement, physicians at the Holland Bone and Joint Center will gladly review any imaging studies you have had done elsewhere and will work with your family physician to coordinate the care you need and deserve.

Glucosamine Chondroitin Therapy for Joint Pain

Damaged cartilage due to everyday wear and tear, traumatic injuries, dehydration, and an unbalanced and deficient diet would often result to arthritis. Osteoarthritis is a degenerative joint disease that involves varying degrees of pain with no known cure. Most people will control the pain with NSAIDS and other pain relievers, which address the pain, but does nothing to go to the root of the problem. A better alternative is helping the body repair the damaged joints with natural supplements to reduce pain, without risking the dangerous side effects of today's powerful drugs.

What is Glucosamine?

Glucosamine is a naturally-occurring nutrient inside our bodies. It is an amino sugar that is formed by the combining of glucose, hydrogen and nitrogen amines in the body. Although glucosamine exhibits some properties of carbohydrates, they do not act as energy supplies but rather as building blocks of the cartilage found in the joints. Specifically, glucosamine is essential in the production of glycosaminoglycans and proteoglycans that are necessary to keep the joints healthy.

As we grow old, the production of glucosamine in our bodies tends to slow down. When this happens, cartilages in our body cannot fully recover from the strain of everyday activities such as walking, running, and the lifting of heavy loads. Hence, there is a day to day imbalance between work and rest that the cartilage in our joints is put through leading to a deficiency of the component. This deficiency then leads to the degeneration of the joints that causes the formation of bone spurs which leads to inflammation of the joints, especially in the knees, back, and hip area. Furthermore, joint pain is a result of the scarcity of the synovial fluid, thinning of the cartilage and synovium which causes friction between the bones.

What are glucosamine supplements?

Fortunately, scientific innovations have produced glucosamine supplements to help aid the glucosamine production process. Man-made glucosamine comes in three variants, namely: glucosamine hydrochloride or glucosamine HCl, glucosamine sulfate, and N-acetyl-glucosamine. The technical difference is that the latter (N-acetyl-glucosamine) is the neutral form of glucosamine while the first two (glucosamine HCl and glucosamine sulfate) are composed of charged anions that have been found to be beneficial when it comes to joint protection, repair, and rehabilitation. Both are more sought after than N-acetyl-glucosamine because they are easily absorbed by the body thereby nutrients are more easily digested and distributed to the cells.

These types of glucosamine can come either in pill or liquid form and are alternatives to the usual pain killers that only relieve pain. By not addressing the condition of the damaged cartilage, NSAIDS are more of a band-aid to the immediate pain, with side effects that have pulled some products off the market due to deaths attributed to them. Todays glucosamine supplements contain not only glucosamine but a combination of other nutrients that aid in cartilage and joint repair. Glucosamine often is joined by chondroitin sulfate that not only aids in protecting the cartilage and protecting the cartilage from damage but also enables the quick absorption of glucosamine in the body's cells. The combined effects of glucosamine and chondroitin and their synthesis are further amplified by the presence of manganese ascorbate in most supplements. In addition, glucosamine supplements also contain anti-inflammatory ingredients such as yucca, white willow bark and bromelain that act as analeptics.

If You Served In Desert Storm, Iraq (OIF-OEF) Or Afghanistan Read This!

I ran upon an article this morning detailing how the Veteran Affairs is streamlining the disability compensation for veterans. I have discovered after reading the article that the VA is finally recognizing certain illnesses and diseases for disabilities. The majority of these diseases relate to military veterans who served in the areas of Saudi Arabia/Iraq and Afghanistan.

I have been experiencing things that I have been summing up as merely part of getting "older". I have been waking up with severe joint pain in my back. I have been accepting the joint pain with the ideology that my boyfriend and I need a new mattress. It does not matter what surface I sleep upon because I wake up with the same joint pain.

The pain comes and goes and is most prevalent in the mornings. I always feel stiff when I wake up. After reading the list from the VA, a lot of people who have served in these arenas suffer from what is called Fibromyalgia. This could explain my joint pain.

I have also discovered that women who served in these arenas suffer from severe menstrual cramps and menstrual disorders. I recently had to have surgery to stop excessive menstrual bleeding and cramps. Women who served in the desert also suffer from severe reproductive disorders. This proves common sense to me because I had ectopic pregnancies and I lost a Fallopian Tube with currently only have one.

Most Desert Storm vets have red blotches on their skin. Some blotches are small, some are huge, and some Dermatologists have asked if I have been exposed to chemicals.

It proves sad that people who serve their country have to deal with the consequences of their service with serious health problems. Veterans with serious health problems face an organization which fights them tooth and nail to grant them disability. I gained a chronic skin disorder called Hydrianitis while serving in the military. This disease is not contagious yet never goes away. It's a severe skin problem to deal with. This is something I will have to live with for the rest of my life, and the VA only pays me 10% for it.

I would urge all veterans to keep an eye on their titles for disability. I discovered not long ago that they changed the name of my skin condition to something else which is illegal. What does it mean when they do this? This means that if your disability or illness gets worse, they do not have to pay you for it. Keep an eye on the way the VA labels your disability illnesses or diseases.

I have included a link for all war veterans who served in these arenas. Please read it. If you recognize any of the signs and symptoms happening to you, I urge you make an appointment with the VA and get it documented. I also want to tell veterans who are disabled to the point where they cannot work, please review your options with social security disability. The Social Security Administration accepts illnesses and diseases caused by military service as grounds for disability.