I picked up a copy of the "Adverse Childhood Experience (ACE) Questionnaire: Finding your ACE Score" handout when Chris and Cheryl Young of Behavioral Health and Wellness in Grand Junction (Colorado, USA) were displaying a poster at last week's  Integrated Care Council of Mesa County mixer and presentation.  

The presentation was very well done, there were five experts on integrative care, the first four of which were the most important piece in the 'puzzle', being the consumer/patient/client. All were clearly a bit nervous and honored to be asked to speak and "be part of the process" of educating health providers. The fifth and final was a physician researcher who presented an hour-long talk in the remaining 40 minutes, which accommodated the previous speakers' time and allowed for an on-time ending. However, ALL in the room stuck around when given the option to go overtime to give him a full hour and question/answer/discussion.  

The 'keynote' was an administrator from CU Medical Center in Denver, where many of our continuing medical education presenters are employed. He credited Grand Junction with being the foremost place in the US on the progressive and upcoming 'integrated care' that will become more a part of primary care in the United States in the future, it appears.  This is a good thing. Dr Mark Hyman, MD, one of the leading, popularized MDs in the world today, has stated that functional medicine will replace allopathic medicine by around 2025 he projected. Based on his connections, from what I've been able to observe, he's likely an 'insider' with 'the scoop'. 

Just as seeing a 20 year old being "on track" to become a potential future leader in our country some day, I was relieved and pleased to see the MD's from 'the systems at hand', so to speak, 'getting it' and professing it related to the current system and what would work much better in the future. Suffice it to say there are MANY in the top ranks who 'get it', the system is just needing to catch up with them, and as he pointed out, we all need to give up our weekends and our evenings more often than we would otherwise to 'make this thing happen.' An excellent resource (as of their adding in late 2013, I am adding/editing this topic 5/7/14) is the CDC, suprisingly. They have the questionnaires easy-to-find, and much supportive material, so I encourage a trip to see the site... www.cdc.gov/ace/index.htm .

I first learned of ACE in the fall of 2007, when the Youngs' collaborated on presenting to a group of people who had an interest in fibromyalgia; Dr Young and I had collaborated earlier that year to form an educational group related to fibromyalgia. I'm pleased to see they now have a poster display and handouts to be 'on the sidelines' at events, which clearly 'reminds' us of their strong belief that treatment for childhood adversity is a key to changing health and health care for children and adults and the future adults of our country. Naturally, prevention is ideal, early intervention is preferred, and in reality, much of the work of recovering from such events is dealt with throughout adulthood, by those inclined to learn and grow. I hope this piece is a starting point for any and many who find it.    

The ACE Questionnaire provided with the Young's display had been obtained from a website showing in the upper right hand corner as www.theannainstitute.org.  I encourage you to take a look at the website and find the ACE questionnaire.  Anna was born the same year I was, 1960, and died in 1992.  

In 1992,  I took the final steps to 'undo' the mis-steps I had made in my young adulthood after spending quite a lot of my free time from 1989 'unraveling' my history; my health and teetered all through my 20s and in 1989, it 'crashed' into chronic illness in the form of a disabling case of chronic fatigue syndrome.  I count my blessings that my 'nature and nurture' in this life have eventually lead me through a recovery of my health, allowing me to complete a degree in occupational therapy.  While my health issues returned in the form of fibromyalgia while I was in OT school and that has affected my work in some ways since, all things combined lead me to developing Lumigrate.  I knew when I saw the Youngs' presentation in 2007 that many more people wanted to be present in the room than were able to attend, and I felt developing a health education website would have been the next logical step for me professionally. 

I got to thinking that exactly fifteen ago, I was starting my internship at the Denver VA's psychiatric unit, after completing a challenging internship in physical disabilities there. I'd worked in many different facets of therapy since -- skilled nursing, hospital, outpatient, home health, and driving rehabilitation, and appreciated after the 'learning curve was over', how each environment and system provided a LOT of learning -- often times in management and business operations which had both positive and negatives.  Once you're out of such situations, you learn as much from the negatives as you do the positives, really.  Much of the time I felt there was a 'mismatch' of my values and ethics, and how to treat patients.  

So when I became the occupational therapist in the medical building which the Young's practice is in, we seemed to gravitate toward something familiar to me -- "collaborating" to discuss mutual patients so we can provide the most effective treatment.  Dr Young's history included military medicine, and we all benefitted from our taking time out that we couldn't bill for, in order to have the best care for our patients.   

It therefore is really interesting to see how we've each gone about working 'our corner' of the integrative health world and still have a place to collaborate today. I consult related to the occupation of health care and function, including my work bringing others to Lumigrate to write and provide content.  Dr Young and Cheryl Young have continued to forge a pathway in their building for advancing 'integrative care'.  

We might all take a moment to ponder the present and future and our efforts with the benefit of looking at the past with Anna, who had been institutionalized for mental health issues which were never resolved and she suicided in 1992; The Anna Institute's website is not very fancy looking but it has a LOT of VERY GOOD information, including breaking down the cost of her health care. I've written elsewhere at Lumigrate about the cost of my health care over the years and my belief that IF supplementation of nutrition and hormones in a biologically identical way were included, when appropriate, in insurance reimbursement, it would be a cost-effective way to increase people's wellness.   

Recently, I was asked by someone I was meeting with for an in-person consultation, about mental health issues, specifically bipolar disorder.  This was with people who are basically 100% in the 'conventional' boat in terms of medicine, eating, etc. My response was to start with the concept of nutrition and the brain; there was a study recently reported upon in a weekly news magazine where high school staff was educated to pick up on the early signs of schizophrenia in young people and the identified students were put into different groups.  The group which received nutritional intervention with family-based cognitive-behavioral therapy to change the stressors coming from the family had a MUCH lower incidence of becoming schizophrenic! This 'synches up' with a study related to bipolar disorder and fish oil which demonstrates similar results for people taking fish oil with people who take only the pharmaceutical medications typically provided by conventional medicine in the US.  (See Links, below, for a resource about the brain and nutrition to support this paragraph.)  And you'll find much 'nay-saying' about these isolated studies; I suggest people learn to look at who has to gain from such things and go from there in forming YOU opinions, as I have.  

In the same room where last week I was educated by an MD from CU Med Center, I'd previously attended a seminar from another CU Med Center doctor related to bipolar disorder in primary care.  I asked about the fish oil study and the presenter responded that it was a ridiculous amount of fish that would need to be consumed -- clearly he was not in favor of that study but I was pleased to hear that he knew of it and was respectful of my question in the way he responded. I'm more pleased to offer the LINK, below, related to nutrition and the brain because they bring that information CURRENT -- unfortunately the man I'd heard speak had clearly not been impressed enough to stay current on the developments involved since that first initial study related to fatty acids and the wellness of the brain/mind.  

I hope that any 'Annas' out there today are getting better nutritional strategies with "foods first and supplementation second" than what Anna of 1960-1992 likely had available to her.  I hope that ALL people out there will open their ears, eyes and MINDS and learn if they have any type of interest in conditions that affects the mind of the mind/body/spirit 'whole person'.   

I hope that each person who has the interest in reading this piece is seeing the common theme of body, mind, spirit being INTEGRATED and inseparable. No matter where you and your loved ones are on the wellness/illness continuum, there is so much to acknowledge and embrace related to the WHOLE of what connects people within their own bodies.  The Anna Institute has MANY good pieces, so I encourage you to look at their website.  

It has been well-documented that childhood traumatic stress translates into long-term health effects related to substance abuse, mental illness, sexually transmitted diseases, suicide attempts, and ischemic heart disease.  I'd been looking with Cheryl and Dr Chris Young's assistance this past winter at ACE information related to fibromyalgia specifically, since there are so many users at Lumigrate who have this specific concern and condition. I'll provide the link below to one of our first Lumigrate podcasts from winter 2009, with Dr Young and I talking about our history in Grand Junction and introducing the ACE information.  We have a GRATE and fun time in the podcasting studio and they're really easy to listen to while doing something else on your computer on with a portable electronic gadget. 

I was looking for anything at The Anna Institute website related to fibromyalgia and saw nothing specific to that, but was THRILLED to see something close, and unique compared to the other studies I'd found so far about ACE: "Cumulative Childhood Stress and Autoimmune Diseases in Adults" -- and I've supplied the link to that, below.  Again, please go and read other pieces they have at their site, and follow other links they provide as I believe this is a core concept to wellness worthy of quite a lot of study. 

Overview of Paper: Objective: To examine whether childhood traumatic stress increased the risk of developing autoimmune diseases as an adult.

Method overview: 15,357 adult HMO members enrolled in the Adverse Childhood Experiences (ACE) Study from 1995 to 1997 in San Diego, California and eligible for follow-up through 2005 were studied.  ACEs included childhood physical, emotional or sexual abuse, witnessing domenstic violence, growing up with household substance abuse, mental illness, parental separation or divorce, and/or incarcerated household member. The total number of ACEs were used to determine cumulative childhood stress, with an ACE score range of 0-8. They then selected 21 autoimmune diseases and 4 immunopathology groupings from hospitalization data for those in the study group. 

Conclusion: Childhood traumatic stress increased the likelihood of hospitalization with a diagnosed autoimmune disease decades into childhood. These findings are consistent with recent biological studies on the impact of early life stress on subsequent inflammatory responses. 

Highlights I found in the eight page paper: Conservative estimates show that about 80% of people with autoimmune disease (AD) are women because the basic immune response differs between men and women.  Higher antibody production to respond to infection, immunizations or trauma occur in women, whereas inflammation is usually more severe in men.  These sex differences in AD are also likely linked to sex-specific differences in glucocorticoid levels in females, whereas testosterone decreases glucocorticoid levels in males. 

On the first page of this paper (page 243, Psychosomatic Medicine 71:243-250 (2009)), "there have been few studies that examine the contribution of childhood traumatic stress to the risk of developing an AD. A recent study by Danes and colleagues examined the association between childhood trauma and C-reactive protein (CRP), a biomarker of inflammation that may play a role in AD (36,37 referenced at back of paper). After controlling for current stress, they reported that childhood maltreatment was associated with elevated CRP levels in adults 20 years later, suggesting that childhood maltreatment independently increases inflammation later in life (36)."

In the 'Discussion' section on page 247, I find this the most 'highlightable" to bring to share through this piece: 

"as the number of ACEs increased, the linkilihood of hospitalizations with Th1, Th2, Th2-rheumatic, and any of 21 types of AD also increased. Moreover, the relationship between the ACE Score and AD hospitalizations was stronger among younger adults. To our knowledge, this study is the first to demonstrate a relationship between multiple types of childhood adversity on hospitalizations for AD during adulthood.  

Research on nervous, indocrine, and immune interactions has revealed that these systems are anatomically and functionally interconnected (11-13). Stressors, such as infections, toxins, and/or psychological trauma, stimulate the hypothalamic-pituitary-adrenal axis to release corticoid-releasing hormone (CRH), resulting in elevated systemic levels of corticosteroids, such as glucocorticoids.  Acute stress initially may increase inflammation through acute-phase mediators like IL-1, IL-6 and CRP that are eventually downregulated by glucocorticoids, thereby maintaining homeostasis (46), Chronic stress has the opposite effect and decreases glucocorticoid levels.  A recent epidemiologic study confirmed the link between childhood abuse and long-term changes in immune response (36); in this longitudinal study, childhood abuse was associated with elevated CRP levels, white blood cell counts, and other markers of inflammation 20 years later (36). 

.....

These findings and the present study suggest that childhood stressful events may increase ADs independently as well as amplify the effect of other environmental factors, such as infections.  Thus, a possible explanation for the increased prevalence of ADs in females is that females respond to similar stressful events differently than males due to sex differences in their physiology and neurobiology (i.e., greater TH2 and glococorticoid levels that are further amplifed by stress)(13,50). 

In addition, physiological and anatomical changes in the brains of individuals who have experienced childhood abuse have been documented.  .....

This repeated "dosing" of the developing central nervous system by repeated "dosing" of the developing central nervous system by adrenal catecholamines and corticosteroids may contribute to centeral nervous system- and endocrine-mediated differences in immune function that result in an increased risk for AD.

.... 

{The final paragraph before the wonderful References section states:}

This is the first study to find an association between early childhood stressors and the development of AD decades later. Our epidemiological findings, coupled with the documented immunopathology of AD, provide preliminary evidence of the relationship between early childhood stress with the human physiological and immunological response, which may also contribute to and expand on the theory of developmental origins of adult disease and health (59).  Because childhood adverse events are common and ADs are chronic and often debilitating, expansion of research in this area may further elucidate the impact of stress on adult chronic disorders such as ADs. 

For those who are reading at Lumigrate related to an interest in 'fibromyalgia' and chronic fatigue syndrome or other related issues, I'd like to close by stating that in 1989 when I had my first 'bout' of extreme fatigue, I was referred by my primary care provider not to rheumatology or neurology, but to an ENT in Fort Collins, Colorado (ear, nose and throat specialist). My physician happened to know of their collaborative connection to the Denver-based National Jewish Hospital, who were and are focused on breathing and immunological issues.  

Until recently, people with fibromyalgia were typically referred to rheumatologists because much of what was seen with fibromyalgia was similar to what rheumatologists specialized in.  But was it really an autoimmune system dysfunction? It appeared to be more neurological/brain based, so then people were routed to neurologists.

This was the case for me, and in 1995 my neurologist shrugged her shoulders after $10,000 in MRIs then the necessary lumbar puncture to see if there was myelin in the CSF (cerebral spinal fluid). More waiting for results, anxiously, naturally.  Finally seeing her for the results where she said 'I don't know what it is, it's not MS', and I had to take it from there. I asked if foods could be the culprit, that was just what was seeming a likely thing based on my family history and what the first provider I'd gone to had said (a Traditional Chinese Medicine provider thought wheat, in the quantities I was eating, was the problem, and I'd done as she said about reducing and had no changes. That is because I needed to totally eliminate it in order to get the immune response to get 'put out', the inflammation was so chronic because of daily consuming even smaller amounts of wheat.  

Today more providers would know that, such as the TCM provider, I would hope; the year was 1994/5. In 2012 I had the MD from Lumigrate of that era, Marc Spurlock, MD, look at the results from the lab of that invasive diagnostic test done long ago. In seconds he ticked an item and said 'that's in indicator, we know now if we're the kind of doctors in the know about these conditions and the causes of symptoms, of virus.' (Paraphrasing). We're ALL learning, and it's a 360, give and take, round and round. I learn things from a layperson that is something I think a provider doesn't yet know and wonder what their take on it is, so I'll connect them to the information or source. And vice versa. 

I found great relief with having progressive food allergy testing and advising done.  This is what 'functional medicine' such as I bring to Lumigrate does, it keeps us "peeling the onion", so to speak, finding the underlying reason and changing things, not simply providing medication prescriptions. With fibromyalgia, and other similar disorders, it appears that the causes and therapeutic treatments can vary from one patient to another.  This clearly was creating more gaps for people to get 'the runaround' in, and was frustrating providers and consumers alike!  

The You model on Lumigrate's home page, our 'foundational concept', was inspired by my conversation with a Grand Junction rheumatologist's drawing out on paper over lunch, his concept for what people with fibromyalgia needed, which was a rotation among many disciplines.  But there wasn't any mechanism for communicating about the patient -- collaborating. And mental / behavioral 'head shrinking', so to speak, was definitely a major provider group he included.  

What he said to me was 'it's not really an autoimmune disorder, so I can't really address a lot of what they need, if the come to me once a year or as needed is good ...  but what they DO need is (this, that and the other)."  One of the components was psychology/ mental health / behavioral health, as I just mentioned, and the other was PT/OT/ST (as well as other specialists for neurology, endocrinology -- keep in mind this is an allopathic, insurance-based provider in 2005 saying this to me, which I relate here to YOUsers.) 

Two years later, almost to the day, I talked with Chris Young when we were meeting about how to have an educational forum for our building's patients and providers (and the community at large) and we ended up with what I've used since the beginning of Lumigrate as our cornerstone concept of "The You Model" at Lumigrate.

This is what was eventually provided by a talented graphics artist in Oklahoma who I'd reconnected with in early 2009 via Facebook, Greg Mann lived a mile down the road from me in the mountains outside Denver, Colorado. His father was a celebrated aerospace engineer (he was in Time Magazine, for instance), mine a retired USAF officer and international pricing coordinator for Gates Rubber Company. Facebook has been an integral and important part of not only how Lumigrate developed with experts I'd find, but the YOUsers / seekers of information learning about SO MUCH and becoming very different consumers than we had in the general public sector back when the YOU model was being discussed and our first ACE presentation provided. 

I hope that you have found this piece of interest and will let others know of it being here at Lumigrate.com; your providers, your family, your friends who might have some sort of trauma history or chronic illness.  I hope that if you know someone who has a risk for developing chronic illness or it's worsening, you'll share this with them as well, as it's so much easier to keep someone 'well' than it is to bring them back from chronic illness to chronic wellness.  

Our bodies strive to have their original state of wellness, and in theory, "ideally", all is reversible if completely addressed on all facets of the mind/body/spirit body we call 'human being'. I realize that 'ideal' and 'reality' are very different things; each person has their own reality in which to operate.  I see over and over again that people who have limited financial means will throw up their hands and not try anything, rather than saying 'what can I do' and doing the things they CAN. Often there are ways to eat cheaper and better, with education and changing strategies, and simply drinking filtered tap water instead of other things can make a big difference to wellness.  

It is very difficult for a person to work their way through all the aspects of changing things related to habits and lifestyle related to water, food, sleep, exercise, interaction with people, interaction with SELF, and then maintaining all those changes in a world which has many stressors for our time, energy and money. Knowledgeable and supportive people surrounding the individual is key, and I do believe wholeheartedly that at the very least, my progress in the past is a testament which I share with others to hopefully show that even if you don't 'solve' the problems, you can make improvements and each little bit adds up and translates to much better life! That I am sure of! 

I hope that we continue to make progress in the treatment of medical disorders which play out on the mind primarily, and dedicate this piece to all the 'guys' who came in to the Denver VA psychiatric unit three times a week for at that time eight years to talk about life and what was 'on their minds'.  It was the summer of 1996 and all who regularly attended were male Vietnam veterans with PTSD, though there was a woman who had joined the group who had served in her early adulthood in the Gulf, I believe. The group was one of my greatest teachers as a new OT. I have carried the lessons learned from them and the two much older OTs who supervised me to this day and hope it helps many others in Lumigrate's piece of advancing medical information forward.  

In particular, a man, who had just been admitted to transition from a medication which had worked brilliantly for schizophrenia, but which had side effects which were life-threatening and those had, unfortunately occurred finally.  In that time between a pharmaceutical solution and it's side effects requiring him to go off of it and onto something else, he was able to complete through graduate education in mental health, and function normally.  

He described for me what a gift that was, and how he used it, and how terrifying it was to know he was going to go off of it and then have his symptoms, then be tapered onto a new medication which was in trials at the VA.  He was terrified it would not work.  

And unfortunately, it did not work for him and I will forever value the time he spent meeting with me and talking about his fears of the future treatment's success or failures, his joy at having had sanity for years due to medications, and get the experience of being part of his treatment team as he digressed into significant symptoms. Initially he would come in and try to sit with his group of buddies but he'd get up and leave -- he just couln't sit with a group of people in reality at that point.  Not long after, he came in with foil from his baked potato, and that of others, fashioned into an antennae to increase the signal from whatever he was thinking he was getting a signal from. And he thought I was his wife.  

I trust they continued with new treatments and hope he found good results; perhaps I'll check back with the VA and see how their treatments have progressed over the 15 years since I had an extraordinary internship experience there. The VA and Veterans have held a special place with me since.   

LINKS 

A topic on Lumigrate that I think is very relevant to refer people to is from Dr Christopher Lepisto, who was, with Dr Young and me and others, part of the startup group for a year or two at an integrative center that came about in Western Colorado in 2008, many connections were made through the education group forum about fibromyalgia referred to above. Or connections and ideas about fibromyalgia and the complex chronic illnesses and how we could address them were formulated or deepened.

It's a downloadable hour (plus a little more) interview he did with Cinda Crawford of the Health Matters Show (I'd connected him to her on Facebook when he left the integrative clinic and was on his own and created a new Facebook page). It's a very good overview about the many factors from mind, body and spirit related to what contributes to the "Full Barrel Syndrome" that causes a person to basically then overflow into symptoms when the body is overwhelmed. I have transcribed it for those who want to read along AND added links and tips and things too. I believe it to be a strong overview topic about complex chronic illness that often includes chronic pain and / or fatigue. The link: 

http://www.lumigrate.com/forum/my-interview-naturopathic-med...

A link to a website about nutrition and mental health's piece about bipolar disorder.  The site is called Food for the Brain.org  and has information about all kinds of different issues that 'go on in the head' -- ADD, Parkinsons, etc.  I selected it because they "do as I do" and give an overview then have a link for references to read more about that topic, hence distilling down the good information, sorting out the nonvalid and not so beneficial, and streamlining your process getting quality, progressive information.  

In this case/piece, above,  I'd mentioned my conversation and being asked my opinion recently related to bipolar disorder and my first thought was to ask about nutrition and specifically fish oil, I searched many well known sites (such as Live Strong) without feeling it was 'the' source to link to.  Food for the Brain's website talks about the fish oil study and how it is today there are more concentrated forms of fish oil, and links out for people to follow along and read more about it if it pertains to them.  It also talks about two OTHER aspects they consult with people on related to bipolar disorder, including magnesium, which is a 'hot topic' on Lumigrate as it's a key 'ingredient' in managing fibromyalgia symptoms.  www.foodforthebrain.org/content.asp

A link to the podcast with Dr Chris Young and me talking about our establishing live educational seminars in the past, one of which was Cheryl Young presenting Adverse Childhood Experiences, but she had a virus coming on and lost her voice so she set him up to present it and the audience's questions and 'aha's (my own included) got him looking into applications of ACE to chronic pain and fibromyalgia: a FUN listen!  www.lumigrate.com/forum/lumigrate-premier-podcast-mardy-ross-and-chris-young-history-and-future

TAKING THE ACE Questionnaire:

For those wishing to find their ACE score, it's a bit tricky to find at The Anna Institute website (link provided, above).... You'll see "Finding Your ACE Score" at this tab there: www.theannainstitute.org/ACE%20Study/RELATED%20MATERIALS.html

and the PDF of the one-page ACE Questinnaire is at this link: www.theannainstitute.org/ACE%20Study/Finding%20Your%20ACE%20Score.pdf

 Live and learn. Learn and live better! ~ Mardy

Chris Young, 2009, speaking on camera with our first crude lights we'd rigged using engine-lighting equipment from Home Depot, recording his presentation about models of medicine and the advantages of collaborative care, which is what the YOU Model is based on. The center where this was recorded ended up not supporting the work that was originally discussed by the team that helped get the place off the ground, and we sadly, have not had many interactions since aside from a few referrals of patients.  

It's difficult taking patients coming to insurance-based, mainstream, organized medicine and having them understand that I've left that model of medicine and am teaching people how to become educated and proactive about their wellness in an integrative, functional medicine paradigm. But he was inspired by what we'd gotten into and got funding to have integration of behavioral health and the pediatrician and adult physician office 'under the roof' of the building where we met in 2005 in Grand Junction, Colorado (Primary Care Partners). 

Not only did his presentation of ACE in 2007 knock the socks off of the audience, his then-psychiatric nurse practitioner speaking another week about how to medicate for chronic pain sent a video camera into my hands from an MD who could not attend.  "I could make DVD copies of this before giving the camera back if I knew how", I thought.  Then "If there is YouTube then I should be able to create a website to put video on, I wonder how much that would cost, and I wish I had the money to do it" was my thought process.  

I'd been told to go to my post office box, so I did after that and found out I'd been in my father's cousin's estate, and there was a check there which I used to start Lumigrate. It wasn't as much money as would have been ideal to get the website to be something really well-known faster than slower, so I've had to go about things DIY and it's been slow growing.  But it's sincerely done and is having it's impact on wellness for those who find it.  I will hopefully never forget the roots and people who inspired and lead to another step in the path that we've taken since, to today.  I thank you all. ~ Mardy

Podcast studio back in 2011, Dr Young (center) happened to be friends at 20-something with Rock Cesario, local 'legend' for his record store, writings and radio shows about popular music of our times (left), and me (Mardy Ross). Below, Adam Cochran of TalkingDigital who did our podcasts when we were able to do podcasts. Subject was the healing power of music. It was a great podcast too! (Check it out on iTunes, we have an iTunes channel, as well as what is provided via links in our podcast forum, however, that might end up with things being 'dusty'). It's difficult to be providing the various media today's consumers want and I've simplified and kept with writing in the forums, linking to a variety of sources and media to meet those varying demands.