Neurological Reboot & Recovery: Explore the Stellate Ganglion Block (SGB) with Dr. Shawn Tierney

Dr. H: Hi, this is Dr. Ahvie Herskowitz again, in a series of our podcasts on the field of Hydrodissection. I’m here again with my good friend, Dr. Shawn Tierney. I want to thank, Dr. Tierney, particularly today, because we’ve just worked all day at the office. It’s now 3:30pm and it’s Sunday. So, we opened on Sunday because certain patients needed to come in over the weekend.

So, blessings that you did that, as certain patients needed to be seen on consecutive days, so we’re very grateful to have you here. The last time we were together on the same podcast was with Ben Greenfield if you can recall. You weren’t here at the time. Ben was here getting treatment and then you were kind enough to get on and talk about certain areas of Hydrodissection.

But today in particular, we had a number of fascinating types of patients that I think are relevant for everyone to understand, because Hydrodissection is relatively new to me. We’ve had it now in the clinic for more than a year. You’ve been doing this, I believe, for 30 plus years…

Dr. Tierney: No, 13

Dr. H: Okay, but musculoskeletal authority and ultrasound…

Dr. Tierney: Right.

Dr. H: …which I think is necessary and important as a teacher of this and a trainer of this. But one of the areas that I think is the most relevant for global optimization of all of us, at any time of life under stress conditions as adults, is the use of the stellate ganglion block as a calming effect on the neurological system and so to speak a neurological reset.

Dr. Tierney: Right, yeah, I’ve heard that. You know, it’s like a reboot in some sense, and I think you really have to think about it as a way for your nervous system to metabolically recover. So, if we did this stellate ganglion block, which is a very delicately guided block, you know, from either side to a nerve that runs not in the spine, but in front of the spine between two muscles. And that’s your sympathetic chain just above your stellate ganglion. And that very specific procedure takes some skill to do. But it’s also important to notice that it doesn’t really work that well, it’s a short-acting local anesthetic. So, if we used like lidocaine, which is about half-life of ropivacaine, and we don’t seem to get the result to last. It feels the same immediately afterwards.

And what we’ve noticed is that it’s really, somewhat of a metabolic recovery. So, you can imagine, if you have been running really quickly and your legs start to burn, eventually you’ll want to stop running because your legs will start burning pretty quickly. In the case of your nervous system, that’s a metabolic overload in your leg. In a case where your nervous system, part of the metabolism is these neurotransmitters that are released between neurons in the synapse.

And neurotransmitters are a little bit different because they stimulate the nervous system to run. So, at a certain level of stimulation, you may reach a threshold where the nervous system is running really quickly and using a lot of energy. And now no longer has the capacity to clear that synapse. So, whatever happened is essentially continuously happening.

Dr. H: It’s like a continuous movie.

Dr. Tierney: It’s like a movie, yeah. So, it could be a movie of a soldier’s experience on a battlefield, could be a movie of somebody’s assault, could be a movie of somebody’s severe pain, maybe a severe pain that happened in a trauma or a pain that’s been just very severe for weeks on end.

Dr. H: Right.

Dr. Tierney: Right. Could be a movie of just weeks and months of dealing with a sick loved one. Weeks or months of dealing with severe pain. So whatever that movie is, at a certain level, it’s no longer in your head. As I always would like people to know, hey, this is not your fault, it’s not your fault. It’s not something you did wrong. It’s something that metabolically happens to a human being, and you’re overstimulated.

Dr. H: Right. But what I want to emphasize today, so the average person knows something about stellate ganglion blocks, knows about its effect in PTSD. Because there’s a pretty big literature. You’ve done perhaps as many stellate blocks as anyone in the world.

Dr. Tierney: I’ve been the guiding part of it, exactly the ultrasound part.

Dr. H: Yes. Yes. Right. And at the same time, the average person doesn’t walk around thinking that they have PTSD, although many of us do have stories consistent with that. But this is, I think, applicable to the general society. And the question is why? Why is it that if we’re running under stressful conditions, that this becomes a relevant thing to think about?

Dr. Tierney: Well, I think, you know, just looking at our society, how I think we’ve kind of let down part of our society insofar as, you know, we medicate people who have been overstimulated and we allow them to medicate themselves and then we call them a criminal, or we just say you’re incapacitated because you are taking these medicines that don’t allow you to drive or don’t allow you to work.

So, at a certain, you know, level of overstimulation, you know, people want to have maybe some alcohol, maybe some marijuana, maybe some, you know, benzodiazepines, maybe some painkillers, whatever their choice is. But they take these things and “I feel like, I feel really high or I feel really drunk, this is great”. What we need to tell them is, “hey, you feel normal, but now your brain doesn’t work very well”.

Your brain’s not working very well. So, you’re doing all this to feel like you normally should. So, you get a stellate block, we shut down all that background noise. Your brain can be as relaxed as it should normally be as a healthy person, and your brain actually works better. That’s the weird thing about it, right? So not only did you feel as good as you feel if you had a couple of beers or whatever your choice of drugs are, but now your reflexes are faster, your vertical jump has increased. You’re thinking more clearly, you’re more present, you make better decisions. And it’s not unusual at all to see people get a block, and I say this especially, I can just think of a few doctors who’ve got blocks and how that block changed the whole course of their life because they had a different perspective, a different way of looking at life.

So, I have athlete friends that get these blocks because they overtrained, and it helps them perform and recover faster. And I think almost everybody at some point in their life needs a stellate block.

Dr. H: It’s one of the favorites for people that know and have experienced it. I’ve had it done twice now, and I have to say consistent with almost everybody that walks out of the room, I mean, not everyone has the full effect until days or weeks afterwards. But the effect is very rapid typically, and they’ll say, “hmmm, I feel a little bit different, my face is a little bit warmer on one side, my pupils are a little bit different and I feel a little bit nasal, but I feel really good. I feel different”. And by the time you say goodbye to them, after the 90-minute period where we’re observing people in the other room, they say, I just start laughing. These are the people who really came in that required it. But then you also have these wonderful stories that I always feel are counterintuitive. You said the athletes get it…

Dr. Tierney: Right.

Dr. H: And you have the story about some world champion that we won’t name, in multiple fields, has been world champion for 20 years in a specific set of sports.

Dr. Tierney: Well, yeah, he’s been world champion in his 20s, in his 30s and now in his 40s.

Dr. H: So, he’s a guy who’s the top athlete in the world for 20 years who gauges the next time he needs to be treated. He happens to be treated with a stellate block. He gauges it by how much distance there is between him and number two.

Dr. Tierney: Well, he did tell me that story once. Yet he overtrains because he’s doing too many sports, and he’s got a busy life. But he does well at it, and he does better than everybody else. So, you know super smart, super together person. But he would get a stellate block when he knew that he needed it because he found that it was helpful for his, not only his mental state, but also his performance. And he was telling me that, “hey, you know, they’re always sending these champions up from Tahiti to try to beat me” he says, and “I’m 200 yards ahead and then a few weeks later, I’m 100 yards ahead and now I’m only a boat length ahead. So, you know, the stellate block and now I’m 200 yards ahead again”, you know. Well, it seems like a crazy story, right?

But let’s just explain why that would happen. If your nervous system is really busy, you’re not in the moment as much, so you’re not as present to what you’re doing. And if your nervous system is really busy, there’s less connection between your nervous system and your muscles. So, your reflexes are slower, your heart rate’s a little bit faster. Your heart rate being faster, it doesn’t relax, and absolutely you lose efficiency, you lose a little bit of endurance. So, you have better reflexes, stronger, faster, better endurance. It starts to make a difference all of a sudden.

So, you know, this same person said to me, you know, in a race, another world championship race, he’s like, “you know, I think you got me too relaxed at the last stellate block” and I go “what do you mean? How could you be too relaxed?” He says, “Well, you know, I was doing the race, and I was racing, and I felt like I was just cruising along, but I was in first place. But I saw the video of myself, I was going really fast”. I said, like “that’s a good thing, right?”. He said, “Oh yeah, it is good”.

Dr. H: Well, sort of like the analogy, I think that whenever I buy a new MacBook Pro, I automatically put 30 apps on it, and I usually have them on all the time and it works fine. There’s no slowdown. Two years later when it’s two years older and the computer ages, it’s old. I have to remove all these apps in order to get the same speed, in order to get the same usage of the battery. So, we’re no different, basically, and we have so many different activities to track that we’re running our brains like computers.

So, there’s multiple different compartments, each of them has a certain piece of our lives and it’s constantly on. As you said before, the movie is always on and unless we shut it off… But then when you shut it out, in this case, with the equivalent of thousands of hours of meditation done in 10 minutes, right?

Dr. Tierney: Yeah, that’s one of my quotes that I’ll say. I’ll say, hey, this is 3-years of Zen meditation in 10-minutes, because the whole purpose of that Zen meditation is to be present and all of a sudden, you took away all the barriers to be present.

Dr. H: And then that’s when I get to take it another level and say that when your brain is more relaxed, okay, in this case, sympathetic, as you’re not in a sympathetic overdrive. And if all the athletic data show objectively that people are stronger, recover faster, that means our detox pathways are more efficient, our oxygen utilization is more efficient and our ability to create ATP is more efficient. So, we have less garbage coming out, less inflammatory state, and so how does that work? I mean, well, the brain is connected to the rest of the body is how it works. And in this case, neuromuscular efficiency is increased and so is almost every aspect of our metabolic state. Right?

Dr. Tierney: Yeah, so we have this, you know, overall, I mean, what gets better? Well, your heart rate is better, your digestion is better, sexual function is something that gets better as well. And I think that for soldiers, it can be, you know, kind of a devastating thing because you’re young, super masculine soldier. You’ve been through something bad, probably bad experience, probably TBI along with it. And now all of a sudden it just doesn’t work. And it makes a lot of sense because what we’re doing with stellate block is we’re blocking the sympathetic side of our nervous system so that our parasympathetic side could work. And when we think of sexual function, you know, I used to think like from school, like, point and shoot. Parasympathetic is point, sympathetic is shoot.

So, if you’re sympathetic is overriding your parasympathetic because your nervous system is so spun and stressed, you might not be able to point as well, right? Which is a devastating thing for a young, likely married or involved soldier. So that’s nice to not have to take those medications. And not only that, they would say, hey, not only is it not working, but then they give you medications like SSRIs or whatever that may be even worse. Right? So how do we get through this? And that’s just one of those things that it seems to be very effective.

Dr. H: And also, it seems to be a very natural approach. To me, it’s a gap in the marketplace. It’s just, then why is that? I mean, that’s because it’s not that you can’t look at a book and find the stellate ganglion and theoretically come up with an idea of how to get there, because the formula itself is not complicated. It just has a lot of ropivacaine and some other diluent, but it’s really, doing it safely is a fascinating exercise in anatomy because you said before in other settings that only 20% of people conform to the anatomy books, everyone has got a bit of a difference and you never want to make a mistake in the neck, there’s too many vital organs there.

So why is it, though, that a Hydrodissection with this anesthetic is important. And I’ve noticed that in a number of patients, because we don’t routinely see professional athletes here, although we have our small group, we don’t typically, we see more master athletes. But almost everyone that we see lives an inflammatory lifestyle and so we’re known how to navigate that universe. And when you look at the ultrasound in the neck, you find a lot of enlarged lymph nodes at very close proximity to cranial nerves, and I want to discuss the use of Hydrodissection in headaches and so on with that, and a lot of our patients have mold and have an inflammatory response in the lymph nodes in the neck.

So, there’s a lot of traffic going on and you don’t want to mess up. So, it’s really an anatomist’s expertise in ultrasound and that takes years to develop. It’s much more complicated than being an invasive cardiologist like I was. It’s not as easy. So, you can’t study this, and I don’t think you can study it in a weekend course and do….

Dr. Tierney: Oh no. I mean, I think that the issue that I see, you know, I’ve been teaching this for well over a decade, is that when you start to see how different everybody’s anatomy is, you know, it kind of shuts a lot of physicians down. That’s too much, it’s too much to know and it’s too scary. But I think that you just have to be exposed repeatedly to all these different things and know, hey, I want to know where that radicular artery is, I want to know where that thyroid artery is, I want to know where the, you know, I want to know where the… You want to go through your list and say, okay, I see everything. It’s in a different place slightly on everybody, but I’ve identified it and I know that this is safe.

Dr. H: But that’s looking at one structure, okay, when you’re finding a ganglion. Now when people come, and we’ve seen people like this today and the last few times you were here, with neck pain or neck pain referred to various parts of their body, to the shoulder, to their scapula, to their various parts of their arms and hands and fingers and so on. And what was the revelation to me was the tortuosity of each of the nerves coming off of C4, C5, and C6.

Dr. Tierney: Oh yeah.

Dr. H: Because we have to be able to move our necks from side to side and finding that choke point you have to be able to track the nerve all the way down. And that’s something that you just can’t do from the books.

Dr. Tierney: Yeah, you know, you will see nerves kind of they come out and they do a little loop getting through different connective tissue and you’re like, okay, well, if there’s a problem with that nerve that might be the issue, so we got to make sure we clear that loop. And when we think of Hydrodissection, we were just thinking of, hey, nerves need to move through muscles and part of that is the nerves are one thing in the neck are fairly large. You look at things that are bigger than a large shoes shoelace, for sure, and they also need to move inches.

So even that, like a nerve from your brachial plexus, as you move your neck, it’s got to move, you know, inches through muscles and it’s going to be popping around. So, if you can identify those and decompress those adhesions or webs that are stitching things together as a result of maybe a cold or an inflammation or arthritis, then we can resolve things.

And even with the sympathetic chain, a lot of times I’ll say, there’s actually something I think we need to talk about called, anatomic PTSD. It’s like, what do you mean? Well, that’s the way the anatomy, the way there’s a bone spur here, the way there’s a lymph node there, the way, you know, that there’s less space and more likely that that sympathetic chain is going to be irritated. So, there is some anatomical association that we need to think about, maybe not in a young person, but certainly in somebody who’s lived a life. If you have a bone spur that’s sitting on your sympathetic chain, that’s usually not a good thing. So, are we going to take care of that bone spur? Well, there’s some things you can do for that.

But if we can also make sure that all the adhesions that are between the nerve and the bone spur are broken so the nerve can move around it, then we can make some nice changes.

Dr. H: So far here we are talking about 15 minutes or so, we haven’t mentioned a single sports injury that Hydrodissection is profoundly good at, and I don’t want to talk about that today. Frankly, because again, I think intuitively you think that it’s smarter to look at a joint while someone is not stuck in an MRI machine or a CT scan because they’re stuck, they cannot move, and they are not supposed to move. And here, every time you do a diagnostic on someone’s knee, you get in front of the knee and the side of the knee and the back to the knee. Does this hurt? Does this compression hurt the neck the same, the lower back? And you find things that you can never find on a static image. Because they say, that’s where it hurts. That’s exactly the preferred pain that I have in my everyday life. And then you’ve had the diagnosis. You don’t need to inject lidocaine or steroids to identify that when you’re with a live person rather than treating an image.

Dr. Tierney: Yeah, and they always say that it’s, if we want to get closer to a good diagnosis or close to the truth, I think it’s almost any field so I think that anybody can relate to, this is we want to have more perspectives and more data, you know, and sometimes the perspective is, you know, I’m looking at it from a different way so I can see what happens when you move, I can see what happens when you turn, I can see what happens with the nerve, I can see what happens to the joint, I can see what happens to the muscle. So that’s a perspective. And also, another perspective is can I talk to you and other professional about it? Can I talk to other people? So, as we add perspectives and we add data, it’s not that MRIs aren’t great, and CTs aren’t great, and x-rays aren’t great. But if we’re lacking perspective, we have to recognize that and say, oh this obviously isn’t solving the problem. So, we just add the next perspective, right?

Dr. H: One of the fascinating groups that I see can benefit a great deal from thinking it through, in this particular way, are our cancer patients. As you may know, we have an active integrative cancer care center here, and we saw two cancer patients today. One of them came specifically from out of town in order to have one side of the stellate ganglion block today and the other side tomorrow, because we don’t do both in one day. And while the other one was here for a very significant 10/10 pain syndrome, and the cancer is under control is the point. So, the quality of life is miserable right now due to pain.

But on the cancer side with the stellate blocks, this is a group that is equivalent to someone who’s taking care of a loved one for years and is under great stress or a mom taking care of an ill child. They have to wake up every day as the patient told us today, thinking about things that you don’t want to be thinking about, meaning thinking about their mortality and losing hope because the system is not very helpful when you have a stage IV cancer. So, we’ve seen them come back over and over again, come back for, let me do the next side, and let me do it a third time for different reasons, not because they’re losing the race, but they want themselves back. So, to me it’s, I want your perspective on this and, it’s almost like it takes us back to a less complicated state where we can focus on what we’re here to actually do and our authentic nature, so to speak. And maybe when we were kids, when we weren’t as worried as we are about everything. What do you think about that?

Dr. Tierney: I think that when you’re in that state, obviously your mind, you’re trying to save your life, you know, and you’re facing, you know, possibly your death. And you want to do everything you can do not only for yourself, but for your family and everybody that’s around you. So, I think all those things are vitally important. So, it’s not unusual for somebody to have PTSD from that. And just the fact of telling you, somebody told you they had cancer, that’s probably enough to give you a little bit of PTSD. Then somebody tells [that] you have stage IV cancer, and then you have severe pain on top of that. So, all those things are like a little movie of a stress, a little movie of a stress. And on top of that, you have severe pain. So, the severe pain is also going to overwhelm the nervous system.

So, then we have two questions coming in is, okay, where is the pain coming from? And then is the pain real or is the pain Memorex? Because some of the pain is probably Memorex, some of the pain is probably a movie of the pain. So, we can kind of clear that up by doing a stellate block and whatever was in movie of the pain goes away and they’re surprised. Sometimes somebody will say “that was the most pain-relieving thing you did”. And we took away the actual cause of the pain and it was good, but it wasn’t as good as the stellate block. So, we can take away the cause of pain dramatically because cancer pain is usually nerve pain. So, we can hydrodissect, you know, we can identify where the nerve is impinged, we can hydrodissect that and a lot of times alleviate the pain. But if they still have that Memorex pain, that memory of that pain, that movie of the pain, then the stellate block becomes vital.

Dr. H: Well, I think we live in particularly unique, stressful times now, right? I always say that every decade, whenever I get a chance to talk, we have to choose what our stress du jour is. But now we’re post pandemic, okay. People have been sort of locked into this movie that life is going to be difficult, and life is difficult, and getting back to normal. How are we ever going to do that? And now that we’re back to normal, is the government going to change that and change the rules again? And will I have to wear a mask again and so on? So that adds to the movie.

Dr. Tierney: Absolutely.

Dr. H: And I’m asked all the time as a so-called longevity authority to opine on, I want a 30-year, 40-year or 50-year plan. But I see people skipping the step of neurologically resetting their perspective because you can do intermittent fasting, you can do cold plungers, you can do biome work, you can do metabolic health work, but the brain is ultimately controlling a good deal of every moment-to-moment autonomic system. The things that we don’t think about but are there and are sort of affecting our need for energy and our need for, you know, of putting energy where it belongs. And this seems to be the best way to do it, I think.

Dr. Tierney: I think it’s, yeah, vital, right. If we can reset them and we can decrease their pain and even with some of this technology, even that’s available here or even decrease their cancer growth. So, there’s amazing technology out there. But if you don’t address the mental, the emotional and the peripheral nerve issues, then we don’t get anywhere. And I think, generally, in health care that the peripheral nerve issues are huge and they’re huge because well, it’s not addressed in standard medicine. I mean, standard medicine is really good at addressing spinal nerve issues and it’s good at addressing, some are good at addressing connective tissue issues –joint, tendons, ligaments.

And it really doesn’t do well at addressing pain coming from peripheral nerves, which is turns out to be, well, conservatively, at least a third of all pain, right? Probably much higher but let’s say a third. So, when we’re not addressing this big portion of pain and people are left suffering and they lost patients. Not only that, but we have left our most suffering people, probably is these cancer pain patients, and they’re just left to suffer when simple Hydrodissection and some stellate blocks can get them out of pain. And they’re literally going from a 10/10 pain, to not having pain. It’s just not being offered.

Dr. H: So, let’s move ahead to other areas that I think are again, in this podcast, I want to focus on things that we normally don’t end up talking about. Because you have a huge YouTube channel of your own that people are invited to go to. Can you tell them what site that is.

Dr. Tierney: Yeah, it’s Dr. Shawn Tierney as my whole thing, DCRMSK@yahoo. If you get to Dr. Shawn Tierney, you get me though. Go to Dr. Shawn, that’s S-H-A-W-N @yahoo.com and you got me.

Dr. H: Well, we’ve seen folks talk about.

Dr. Tierney: I’m sorry, not @yahoo, @youtube.

Dr. H: @youtube, right?

Dr. Tierney: Yeah, YouTube, right. Sorry, go ahead.

Dr. H: We’ve seen folks come back and say, “oh by the way, I came here for this particular procedure, but I have some things that I want to tell you about have improved”. And one of them is sexual function. And that’s again, not intuitive, but there is an anatomical set of thoughts that you go through when you think why that would end up working.

Dr. Tierney: Right. Yeah. Well, sexual function is you know, it’s a big problem and there’s a lot of treatment out there, like the P shots and the O shot and medications and all of those things have their use, but it’s hard to overcome a nerve that’s not working. And I think a lot of times it turns out that’s what we’re dealing with. So, I have a process of thinking through everything, if I go through everything. So is your pelvic diaphragm working, is the nerve that controls your pelvic diaphragm working. That’s your pudendal nerve. And then there’s other nerves that control the blood flow and the entrance of things into your genitals, like your inguinal canal, your genital femoral nerve and your ilioinguinal nerve, which surprisingly are one. So almost everybody in medicine is looking at the pudendal nerve and they’re thinking, what about the upper lumbar nerves? And if the upper lumbar nerves are out and you have a sexual function like, I wonder if the diaphragm is not working.

Dr. H: Right.

Dr. Tierney: So, if your diaphragm isn’t working, then that tends to irritate your thoracolumbar nerve roots, T11, T12, L1-L2, sometimes all three. And because those nerves are coming down into the lower abdomen and going to the external genitalia, a lot of times all of this, you know, pelvic pain is missed. Well, you know, the nerves that constrict blood flow are maybe more from the pudendal, they hold blood flow in the penis, but these other nerves are vital. I’ve seen a lot of people that have had, you know, just rectus abdominis injuries where there’s vessels that come through the rectus abdominis called the lower hypogastric rectus abdominis vessels have an impact on sexual function. So, I have a lot of guys that, you know, they have those injuries, and they lose their sexual function. A young guy and things are not working. And then also I do see people that go on EECP, which is a machine that compresses your lower abdomen and then they have an erection or a woman will have an orgasm with that. So, it tells you that even though we know a lot, we don’t know the exact mechanism of that rectus abdominis nerve and those vessels. There’s something going on there, so we end up usually treating that. So, when somebody has sexual dysfunction, we’re looking at their pudendal nerve. Hydrodissecting that, is it in the sacral plexus, is it in the glute. It’s usually around the obturator internus. We think about even the phrenic nerve that controls the thoracic diaphragm, that’s C3, C4, C5 nerve roots, is it that function.

And then we think about L1-L2, the ilioinguinal and the genitofemoral nerves, they go in and innervate the lower abdomen and also the external genitalia. So, all those things need to be addressed and when we address all those things, it is surprising how effective, you know, that sexual function, you know…

Dr. H: It returns, it returns back to normal.

Dr. Tierney: And it’s devastating. And a lot of young athletic men and women have those issues and they’re like, I have all the money, I have all the looks, I’m super fit, it doesn’t work, what do I do and how do I explain this to the people in my life? Right?

Dr. H: Yeah, and also, how do I deal with the fact that, while I really love everything that’s written about longevity and I want to participate, well, how happy am I going to be if this particular problem doesn’t go away?

Dr. Tierney: Right.

Dr. H: Well, not as happy as you could be if it was fixed. So, I mean, I just wanted the audience to understand that there’s another perspective on how to think about this. And I think that you’ve taught me that and I appreciate that. Thank you.

Dr. Tierney: Oh yeah. I think a big thing to think about there, too, is even I’m not sure to what extent it is associated to prostate and uterine health but I think there’s a pretty big extent, the pelvic diaphragm and the thoracic diaphragm are your big lymphatic pumps. So not only they are pumping lymph, you know, out of that area. If you [have] a slow lymphatic flow, I would be concerned a little bit about infections. I would be concerned about blood flow. But I’m sure you’re concerned about potential abnormal growth and maybe an enlarged prostate cancer. What’s going on with these organs? Right? Because they’re not getting the proper perfusion, right?

Dr. H: Yeah, one of the most devastating poorly understood syndromes for women is Endometriosis. So, if there is a connection on this particular side, it would be, I mean fundamental to, instead of doing laparoscopic surgeries to have an analysis done on this level. And for men the version is really chronic prostatitis, which is again, is a mystery illness to a certain extent because months and months of antifungals and antibiotics appear to work at times and other times they don’t. So, is there a nerve component? Well, for most men, and certainly for myself, as well as getting into the, you know, last important decades of life is there is a mental component to that part of the body.

Dr. Tierney: For sure.

Dr. H: And the question is, how is it being perfused? How are the lymphatics working, is it optimized? And if there is no optimization sort of program other than injection, you know, other sort of things that are peripheral to the actual flow. Is the flow proper and that’s under neurological oversight, right?

Dr. Tierney: I would like to see that. Hey, the first thing you do, and most physicians don’t know how to do this, the first thing you do is you check their pelvic diaphragm and the thoracic diaphragm. If their pelvic diaphragm is not working, well for the one thing it’s the muscles that control the blood flow there. That’s constricting the blood flow out of the penis. You’re not going to have an erection without that. But if your pelvic diaphragm isn’t working and this is what I typically really commonly see with young people is they have this combination of pelvic diaphragm and thoracic diaphragm things. It would make a lot of sense that your prostate would get congested.

Dr. H: Yes.

Dr. Tierney: Because nothing is pushing fluid around there. So, you have a lack of lymphatic flow. So, if we can just get people to start saying, “how’s your thoracic diaphragm –working, how’s your pelvic? –oh that’s not working on that side”. And when you learn how to do it, it’s really obvious. It’s like literally there’s nothing happening on one side or on either side or else, boom, it’s just working like a great machine. Right?

Dr. H: And that’s what you did with the patient a few weeks ago, who was a young gentleman around 50 years or so that was an athlete, multiple different sports but wasn’t competitive but just ran, it was a big part of his life. He just couldn’t do it for two reasons. One was he had a pain syndrome that had to be taken care of, which was taken care of by you with a lumbar spine injection.

But the real thing is that you measured his thoracic diaphragm and noticed that one side was paralyzed and that came from the C-spine. And it was completely, would have been missed by me. And his wife tells me weeks later that that night they had the procedure done that released his thoracic diaphragm back to normal, he went on a 6-mile jog, and he came back, he says, “you know, I still have a lot of energy, I want to do more and more”. And he went back to himself with a mood effect. And that’s what’s interesting, your ability to go back to the life that, you know, you can do, particularly when you’ve seen the light at the end of the tunnel and you know what it feels like is what you lose when you can’t do that anymore.

So having musculoskeletal health has become much more profoundly important to me as I age from 40 to 50, 50 to 60, and so on, because then I can’t be myself anymore. And so, I can look a certain way, I can stay fit, I can intermittently fast, I can, you know, cleanse. But at the same time, am I doing what I really want to do?

So, the last thing I wanted to do on this particular podcast was talk about another group of patients that can’t get to the point where they have the reliability of waking up in the morning and knowing that they’re going to have a normal day. And on another podcast just right after this one, we’ll be talking about what’s COVID has done to change the landscape. But the headache patients, I mean, the patients who don’t know whether that day is going to be dominated by a headache. And then you go to a headache specialist who I deeply respect and okay, he’s a migraine type, he’s a non-migrate type, but the therapies are sort of good and sometimes they’re just not good enough. And the reliability part of everyday life gets destroyed. So, you can’t be a C-level person and operate like that. So, you don’t necessarily seek that type of position and certain athletics and certain, you know, things that you’re going to plan for that night all go off. So can you explain why it is that when you talk to an expert like yourself and we’ve talked to others who say the same thing, that they could generally find the location of the great majority of headaches and release that source.

Dr. Tierney: Yeah. It’s actually unusual if they can’t get rid of the headache. I can only recall one patient that I know of that, who can’t get rid of their headache, which is a big surprise because there’s thousands of patients. So that one patient was actually my nephew, which was not good for me.

Dr. H: Not good for the family.

Dr. Tierney: Yeah, but, you know, we did actually get rid of his headaches. And you know, I’ll go into that if we have time. But there’s about three nerves that tend to cause headaches. And we always had thought, hey, all these headaches come from the brain, it’s blood flow and it is blood flow. You have to think when a peripheral nerve passes through your body, especially in the occipital area, there’s vessels that go with it.

So, if the nerve is entrapped or irritated and that vessel is pumping, then it’s going to kind of irritate the nerve every time it pumps large. So that’s what a migraine headache is, from my perspective. So you have three nerves that seem to be related to headaches and like I said, I’ve got thousands of patients that I’ve seen that kind of support that fact, at least from our perspective, and that’s the greater occipital nerve that kind of comes out between C1 and C2 and actually goes to midline and then it comes back about halfway over and it goes around the head. And the reason it does that loop is that whenever I turn my head this way now that nerve is going straight, right? It’s going straight, there’s no loop in there. So, it has to have a loop so you can move your head because nerves don’t have that kind of a stretch. So, it’s literally moving inches, right?

So, from a loop here to open, it has to move so you can move your head. And then the next one is even more interesting and that’s the lesser occipital nerve that comes out from C2. So, it’s almost the same level from that and C2, but because you get to turn your neck and it’s in the front, now it goes all the way down to C6 and wraps around this muscle and then it comes out and it wraps on another muscle here, darn it. So, this wraps around the SCM and then at the SCM you have a lot of lymph nodes. If you have an infection or cold or something like that, well, that can get really caught down here, right? If you have a problem with C1-C2, C2-C3, it can get really a caught here, right?

So, is it a C2 nerve root problem or is it a lymphatic chain problem? Well, it could be or it could be that it wraps around the longissimus capitis along with the occipital artery, oh that’s another problem, the same nerve. So, then it goes, the nerve comes out, goes down, goes around all the way to C6, all the way back up, wraps around above the C1, then it wraps around at the exact same place right next to the occipital artery that’s also next to the greater occipital nerve. So, now we’ve got two nerves right next to them. So, is that a migraine headache? I guess it could be. But if I don’t address the whole picture, the third nerve is also called the third occipital nerve. Another word for the same nerve is the least occipital nerve. It comes from C3 nerve root. And that nerve is a little bit smarter in its path. It’s more direct. So, it just goes right and kind of going down or up. It just goes straight back to midline and it runs around the midline. So, it’s a least likely one to get caught so far as moving through muscles.

But it does get caught if there’s a facet joint problem at C2-C3. So, it’s more associated to like a facet joint injury. So those are the three nerves. They all are coming through this superior nuchal line and coming around and symptomatically, I can’t tell a difference. Pain that wraps around my head, goes to my eye and like, it’s one of those three. There’s another nerve that’s very closely associated called the greater auricular nerve. I call it the toothache nerve or TMJ nerve. That nerve comes same as the lesser occipital. It comes down and wraps around C6 and it comes back up and it goes to cover this whole part of the face. It’s a toothache. So, the reason I say it’s a toothache nerve is because if you have a toothache, the tendency is to think that your pain, this pain in your whole face is because of the tooth. And it turns out, well, maybe not. Because what happens is you have a toothache, you have a tooth infection, and the infection is draining down into this lymphatic chain, so nerve is usually caught in that lymphatic chain. So usually what happens if they have a toothache, we hydrodissect that nerve coming through one of the SCM and the toothache pain goes away. I’m like “You still have to fix your tooth. You still have the infection. It didn’t go away”. And you can have some pain in the bone, but that’s just less common.

So that’s my thing with dentists is I like, hey, let’s recognize this is where it’s at. Hopefully you guys will learn this eventually. But until you do recognize that it’s there and know that a lot of times when you fix somebody’s tooth, they still have the same pain, you don’t have to fix their tooth again because the pain is not there, it’s probably here, right? So, let’s just be, you know, more comprehensive in our approach. So, is that a headache? I think it’s a headache, but that’s a different type of headache. And then the other type of headache, obviously is something in the brain. And then that’s, you know, for another time.

Dr. H: Another time, yes. Well, it’s a high level of complexity in terms of anatomy.

Dr. Tierney: Yeah.

Dr. H: It’s all evolved in order for us to be able to move like upwardly mobile, you know, humans, right? So, it’s taking a long time to get here, but it’s torturous and, we don’t have the same neck size as a giraffe, but it’s still complicated. I wonder why the giraffe…

Dr. Tierney: The same number of vertebrae surprisingly, right?

Dr. H: Yea.

Dr. Tierney: They all have seven cervical vertebrae in that giant, long neck.

Dr. H: We’re all wondering the same question whether giraffes ever get headaches. But it’s not a commonly asked question.

Dr. Tierney: Hahaha

Dr. H: But what I want the listeners to understand that this is not going to be fixed in your particular way by a neurologist. So, if there’s an anatomical reason and this is a persistent problem in your life, then this is one thing you should look into. And I think there are not a lot of people that you’ve trained, but I think that, at the same time, we’re always lovely to have you here once or twice a month. But there are a few other people that we could refer people to.

Dr. Tierney: Oh yea, there are quite a few people. Not as many as we would like. Just because the last place, when they learn ultrasound and I teach the whole body, the last place that people tend to get comfortable is right here because it’s a very complicated and it’s a no mistake area. So that’s unfortunately where we’re at right now and I think that’s temporary.

Dr. H: And what we’ve learned in our clinic, because again, I think we see different populations at each of our respective clinics, is since the superhighways are going through here and we carry most of our viral infections here and our myriad of chronic infections there and mold, for example. Someone told me this week we have an epidemic of epidemics. Well, one of the epidemics we have is mold infections and mold intoxication, which carries all the lymphatics in the neck. And so, you have this congestion that’s sort of focused on the neck and so unless you understand the potential effects of that you won’t really get to understand the relationship between… listen, I’ve had infections, whether it be sinus, tooth, laryngeal infections and common coughs and common colds my whole life, but do I have any residual inflammation? Well, I don’t know. You may have an enlarged lymph node or not, but have you developed adhesions that basically suck in these nerves into locations where they can’t move as well as they normally move and that’s the source of this irritation, right?

Dr. Tierney: Oh yeah.

Dr. H: And unless you fix it, it’s not going to get better on its own.

Dr. Tierney: Yeah. And I think that’s, you know, what we have to think about is that when I look at diaphragm dysfunction, who gets that? It could be a 5-year-old kid, could be an 80-year-old man. It doesn’t really matter. Now, the 80-year-old man, there may be nerve irritation coming from the arthritis.

Dr. H: Right.

Dr. Tierney: But it just tells you a lot of that is coming from these infections. So, anybody can have that issue. And it’s you know, unless you’re, even elite athletes sometimes don’t even notice it. Because if you have a paralyzed diaphragm, you probably have only a third less of lung function. So, your endurance is going to be hard.

Dr. H: Everything is going to be hard.

Dr. Tierney: It’s so much harder to do things. Not that elite athletes can compensate for that, maybe better, but that’s such a common problem. And I just would like to see every doctor have a patient come in with mid-back pain, thoracolumbar pain or chronic infections, just check everybody’s diaphragm, check everybody’s, if somebody comes in with chronic bladder infections, check their thoracic diaphragm, check their pelvic diaphragm. So, we can start to see, hey, what is the actual reality? Because in my reality, it’s very, very high, but I also see patients who already have a problem. So, I like to get more perspective from more doctors, like, hey, let’s everybody test. It looks like to me like 10-20% of the population but that’s just my perspective.

Dr. H: Yes.

Dr. Tierney: So, I want to see, hey, what’s reality here? Because it looks like it’s a big problem we’re missing.

Dr. H: Well, I knew I’ve missed it and ever since I watched you do it a few weeks ago, I’ve done it on every patient and found a few patients.

Dr. Tierney: Oh yeah.

Dr. H: Yeah. So, thank you, Dr. Shawn Tierney, for sort of enlightening us again, some more on things that you normally wouldn’t think about, at least I didn’t used to think about…

Dr. Tierney: Yeah.

Dr. H: And articulating why it would be effective to take a look at Hydrodissection. Not so much from the literature perspective, but really from practical reality. And talk to your friends about it and talk to your doctor about it. And I’m going to ask you to stay and we’re going to talk about the interaction between Hydrodissection and infection, and particularly with COVID and seeing how we can help these types of folks with either acute COVID or more likely long COVID and so on. So, thank you very much again.

Dr. Tierney: My great honor.

Dr. H: Thank you, everyone. Bye.