Best Treatment for PTSD? SGB's Healing Touch on Trauma and Anxiety

Can a 5-minute procedure be a game-changer for PTSD and anxiety? Join us as we unravel this question with our esteemed guest, Dr. James Lynch, a distinguished physician and former senior US Army medical officer. With his vast expertise, Dr. Lynch introduces us to the world of the Stellate Ganglion Block (SGB) treatment and explains its potential to alleviate symptoms of PTSD and anxiety.

Our conversation begins by shedding light on the anatomy of the sympathetic nervous system and its role in governing our physiological responses to trauma. As we dive deeper, This virtually painless procedure, he tells us, can affect the sympathetic nervous system, disrupt circuits perpetuating"fight-flight response," and offer long-term relief and safety. We then unpack his experience of using SGB for PTSD treatment, where he shares powerful insights into how SGB can aid patients struggling with anger, hyperarousal irritability, sleep, concentration issues, and other symptoms related to trauma and anxiety.

As we conclude our enlightening discussion, Dr. Lynch passionately speaks about the importance of collaboration among health professionals for effective patient care and how SGB can augment therapeutic processes. He also shares his thoughts on the potential of SGB for treating other disorders like eating disorders and addictions. So, join us on this journey of understanding and discovery, and let's work towards creating a brighter and more compassionate world together, one episode at a time.

The Stellate Institute – Treating The Injury of Trauma

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Transcript

Speaker 1: 0:00

Welcome to A Therapist of Buddhist in you, brought to you by the Recovery Collective in Annapolis, maryland. You, or someone you know grappling with the challenges of PTSD or anxiety? Have you been searching for a beacon of hope, a potential life-changing solution? Well, you're in for potentially a transformative journey. Today, we're about to dive deep into a groundbreaking treatment that holds immense promise for those seeking relief from the burdens of PTSD and anxiety, and a treatment that could offer hope, a chance for healing and a fresh start to individuals who have endured the weight of trauma. It's a remarkable modality called the stellate ganglion block, and we'll often call it SGP, and it's at the heart of our conversation today. This innovative procedure has the potential to be a game changer, and we're thrilled to explore its intricacies with an expert who has dedicated a large portion of his career to advancing the frontiers of people suffering from anxiety and trauma. So now let's talk about why you should really listen closely today. The SGP treatment has the power to not only alleviate psychological suffering, but also stop the physiological effects that often accompany post-traumatic stress disorder. This episode is not just for medical professionals. It's for anyone who is seeking inspiration and a deeper understanding of how this cutting-edge treatment is reshaping lives.

Speaker 1: 1:26

With that in mind, it's an absolute honor to introduce our guest today, dr James Lynch, co-founder of the Stellate Institute and a leading expert in the field. Dr Lynch is a distinguished medical professional whose expertise spans in the fields of sports medicine, family medicine and mental health advocacy. He is not only a respected physician, but also a former senior US Army medical officer with over 31 years of exceptional leadership experience. Dr Lynch's illustrious career has been marked by a deep commitment to the well-being of individuals, whether they are elite athletes striving for peak performances. He's happened to work with the likes of Olympiad Michael Phelps or soldiers facing the rigors of high-stress environments. His expertise, background in sports medicine, coupled with his fellowship training and board certification, has made him a sought-after figure in the medical community. With numerous publications and engagements at national and international medical conferences, dr Lynch is a true subject matter expert in the transformative field of medicine. Welcome, dr Lynch, and thanks for joining us today.

Speaker 1: 2:35

Great Thanks for having me on, lou? Yeah, so kind of let's jump right into it. Could you elaborate a little bit more? Let's start with PTSD post-traumatic stress disorder and the physiological effects. Just kind of start there for us explain just a little bit about what happens to someone physiologically when they're experiencing trauma.

Speaker 2: 3:00

Yeah, Great question. I would suspect that some folks listening to this are experiencing some of these effects of post-traumatic or stressful experiences in your past and may be experts in PTSD, whether you're on the receiving end or on the giving end of therapies and treatments. And some of you may have heard the term stellate ganglion block for the first time and I'm going to preface this by saying thank you for the introduction too, by the way, but it is. It just sounds like a little unusual the first time you hear it and I wouldn't fault anyone for raising their eyebrows when they hear about this procedure. To me, the important thing is to understand the why and why it's helpful, and certainly I think we'll get into the evidence published in the literature, the effects, the magnitude and all of those things. But to me, the most important thing is understanding why. And why is some very simple procedure that's been around for a hundred years, that takes only a few minutes and is extremely safe and virtually painless? How does it work? So I think that's a really good question and a good place to start is what are the effects? And with the physiologic effects that can come from a traumatic experience, it's important to understand the anatomy of the sympathetic nervous system, which most people are familiar with, is the fight or flight system, and the anatomy is actually a really important part and this is something we've known for a very long time and we have really good anatomy dissections that go back over a hundred years to show this. But there's a nerve that's located in the side of the neck called the cervical sympathetic chain or cervical sympathetic trunk, that runs on both sides of the neck. This nerve has one function and its sole function is it governs the sympathetic nervous system. So in terms of the physiologic responses that we have to stressful experiences or threatening experiences or traumatic experiences, most of those experiences are governed by the cervical sympathetic chain, and the easiest way that I describe it to me this is very simple is the term the trunk. The cervical sympathetic trunk, which runs in the neck, is to me just like the trunk of a tree.

Speaker 2: 5:26

So within the brain there is the central autonomic network, which is several locations in the brain, anatomical locations. The primary one is really the amygdala, which is the fire alarm of the brain. Many of you may be familiar with that. Maybe many of you know of that as the amygdala being really the fear and threat center of the brain, but the amygdala has to communicate to the body somehow. And this is, to me, the thing that many, many of my patients over the years have missed, through no fault of their own, but maybe just nobody's really explained this to them before. And then, candidly speaking, a whole bunch of my colleagues in medicine, clinicians of various types, have kind of missed this as well.

Speaker 2: 6:09

But the signal from the amygdala and the central autonomic network has to get to the body somehow. So, as far as the physiologic responses from the neck down that your body has, they have to get there, and they don't get there through a rush of adrenaline in the endocrine system or through a Bluetooth connection which is, I know, kind of a snarky thing to say, but people enjoy that. It just travels the hardwired right down a nerve in the neck and this is pretty straightforward. It has to be that way because it has to be so fast to protect us, and if our responses to a threat were not immediate and reflexive, we would die, we would not exist and our species would not have made it this long. So the physiologic responses that we have to your question, luke, are many of the things that we're familiar with If we've ever experienced driving on the highway looking down at your phone, when the person in front of you slams on the brakes and boom, your body instantly goes into fire flight mode.

Speaker 2: 7:08

Everyone's familiar with this in one shape or another, because we all experience it. Some of us experience it way more often than we would like to, but many of us have experiences as a natural response. So your heart races, your muscles clench, your lungs fill with air, your sweat glands fire. All of those things happen in an instant when you have a traumatic response and for many people, those same responses of muscle tension, sweating, an angster, an anxious sensation in your chest or your gut, those are things that can persist and for some people they'll persist an entire lifetime and they may have been, their senses, old as somebody can remember, without the actual ability to experience calm. So that's really the physiologic response to your question, luke, but to me the important part is the connection there that I think we'll come back to in a second.

Speaker 1: 8:03

And before we do that, that's a great example. Whether it's the car response where you slam on the brakes or you're leading too far back and you get that feeling and that flesh feeling. What happens when someone has whether it's a diagnosable trauma well, let's say a diagnosable trauma, what happens to the sympathetic, parasympathetic, the amygdala that you mentioned? So people understand, in a basic way, what's the difference between that healthy response and the chronic, potential chronic trauma response. What's the difference there?

Speaker 2: 8:39

Yeah, it's a perfect question, because I think that's really at the root of this particular therapy and why it works so well for many people is the normal response then for our body is the sense that there's a threat through our senses. Then the brain and the central autonomic network then has to get the body to do something fight, flight, freeze, those are your options and the signal is going to travel to the body to do that. But the key part of the anatomy and the physiology of the sympathetic nervous system is that the nerve that I describe, that travels, which is essentially just like the trunk of the tree, has the nerves to travel in both directions. So it's me I always picture a highway like I-95 or something and this car is driving by in both directions. Because as soon as the threat travels down the chain to the body, it hits a massive root network and it spreads out to travel. The sympathetic nervous system travels along all your nerves, your sensory nerves, your blood vessels, down to every little hair on your arm, all your sweat glands and all your muscles. But the key thing is, once that happens, the body has an initial response. If there's a threat, the signal travels right back up the body again, again, right through this, what we consider an anatomic funnel for all. The signals travel right through the neck and right back up to the amygdala and the rest of the central autonomic network and that's where that part of the brain and then can build and learn what is threatening and imprint on the brain. These are threatening experiences, danger. This is bad, get away from it. And that is really a deeper level than what happens in the rest of the brain, but at a very basic level, that's where the beginning of the imprinting happens. When is the signal travels back up to the amygdala, the brain, the central autonomic network bounces it right back down the neck and it tells the body stay switched on. Threat is present and for most people that will extinguish very rapidly. You know, as soon as you recover from slamming on your brakes and you pick your franchise up off the floor and put your phone back, wow, calm down. For most people that system will reset and be just fine. For others it does not and for the others that it does not. You know this. Like you can feel it.

Speaker 2: 10:58

There's something the matter where that has not reset totally and there may be just a little bit of an edge or a hair trigger to your sympathetic nervous system, where you may experience a similar type of zero to 60 response for something that should not provoke you that much. And this manifests in a lot of different ways, and some of the more common things that people can relate to is anger and irritability, where you just may fly off the handle at something. And the second you do. You realize I should not have done that and that was inappropriate. You may even lash out at people you love. This is a very common thing. You immediately realize that it was wrong. You feel bad and shame and guilt on top of everything else.

Speaker 2: 11:40

And this this is a manifestation of having the sympathetic nervous system in a position where it's fed back on itself and then remain elevated. So this is an impersonal way to describe it, but I do feel a little bit like saying there's like a circuit or a loop that develops because that's how we were developed as long as the threat is present, to stay awake and alert, and that's what's allowed us to survive. So that's our natural setting. Until it's distinguished, then it goes down. But it doesn't take much to keep that loop perpetuated and then to essentially hardwire again lack of a better term to grind a loop into that response. That's then dysfunctional, frankly, and then it just doesn't work properly.

Speaker 1: 12:26

So I started this the introduction that this is a groundbreaking form of treatment or modality. You've also said it's been around for 100 years okay, for decades. So let's, it's interesting because I'm hyping. There's a reason why I want you here the collective solution to health and wellness, and I think the listeners are going to find out. Wow, there's huge benefit to this as we dive deeper into the physiological aspects that your treatment, the SGB, how we block this and then how holistic services help. But, like, we'll also talk about wait a minute, it's groundbreaking, it's been around for decades and decades. What are you talking about? So let's get into it. What is the stellate ganglion block treatment? What are you doing? How does it help?

Speaker 2: 13:20

Yeah, what the heck is this thing we're referring to? Yeah, let me describe it please for you watching. This is a very simple procedure. It's actually an injection. It's a nerve block. Nerve block is a simple injection of anesthetic agent around a nerve that puts the nerve to sleep. It's the same thing that dentist does when they put a nerve to sleep before dental procedure or before somebody has to do stitches or some other procedure. It's using a medication that is very simple and in this case we use a medication called Ropivacaine, which has been around a very long time. It's in the same family of things like Novacaine or Lidacaine. It's just an anesthetic and there's nothing mixed in with it.

Speaker 2: 14:01

What the procedure consists of is numbing the nerve that runs in the neck, so I already made reference to this nerve. The highway, with the cars buzzing both ways, that carries a signal. That is, the entire sympathetic nervous system, from the brain through the entire body. By numbing the nerve. All what that means is and the term block can be a little misleading, but what that means is just put the nerve to sleep, and in this case, for eight hours, which is about how long we're a Pivacaine lasts. So what would that do? Just putting a nerve to sleep for eight hours has a benefit, and this is something that we've known for many years in pain medicine that by putting a nerve to sleep you can potentially break a circuit that it's perpetuating in, and this is something that's been used for a long time in things like complex regional pain syndrome or phantom limb pain. So this is not a new technique.

Speaker 2: 14:57

The procedure itself has been performed since the 1920s and it looked like this Touch the bone in the side of the neck, that's right here, and then, without any guidance, no ultrasound, no x-ray, no, nothing. The doctors would inject right next to their finger. This was performed like this. It would take literally a minute, and it was performed like that from the 1920s for many, many years until fluoroscopy was invented, and then now it's used more safely using ultrasound. But this will give you an idea of how simple this procedure was, and even back then it was known that by targeting the sympathetic nervous system, there could be great benefits in things that we call sympathetically mediated pain, and that's really what the procedure was used for and is still used for to this day in many places is for some very specific pain syndromes.

Speaker 2: 15:48

But what happened is about 12 years ago a couple of us were investigating better ways to treat PTSD and it happened to be that I was in the military working with a good colleague of mine who happens to be my current partner and co-founder, a doctor named Sean Mulvaney. Both of us were in the special operations community and known each other for years, stationed at different places, and Dr Mulvaney was the one who had discovered that this procedure had been used and had some benefit in treating PTSD. And really we started doing some research early on and brought this treatment into the special operations community in the military in a very small few circles and found immediate and great anecdotal success but anecdotes aren't much so we really started peer reviewed, evidence based publications over many years to show that this was helpful. But the fact that the procedure has been around for 100 years and was performed blind, as we say, by touching the bone, is a very reassuring thing to a lot of people because in this day and age there are many new treatments coming out and many good ones and many promising ones, for sure.

Speaker 2: 17:03

And a lot of people's first question will be well, what are the long term effects of this? I love when people ask me that question because I say well, I'll tell you what. We have 100 years worth of data on the Steli ganglion block and it was performed safely for scores of years without any guidance. So it's a very nice feeling for people to know this has been. We have really good long term data safety data. It's a very safe and simple procedure that only takes a few minutes.

Speaker 2: 17:34

And then the next question most people say is well, why the heck didn't we figure this out sooner? Or why is it not more well known? And maybe part of that is why we're doing this podcast. But the procedure is quite simple. When performed under ultrasound it takes me maybe about five to seven minutes and I happen to go slowly and want to make sure patients are nice and comfortable and it's virtually painless, like I said.

Speaker 2: 18:00

But it really consists of about a five to six, seven minute procedure of a little injection in the side of the neck using a tiny little needle and some numbing medicine. There are different techniques to do this, but we generally block about where I'm pointing at the C6 level, and then we do more standardly. Now is treat at both the C6 and the C4 level on the right side typically. First we also discovered that there is a benefit of treating on the left side as well, which is a little deeper discussion. But the basic question is what is a stela ganglion block? It's a simple injection in the side of the neck using a local anesthetic to numb the nerve that controls the fight or flight system and by putting it to sleep for eight hours and letting it wake up, it wakes up in a less excited state or in a broken loop from that loop of hyperarousal that has been established.

Speaker 1: 18:56

There it is. An injection can dissipate or even get rid of the physiological fight or flight response that's involved with trauma right.

Speaker 2: 19:11

Yeah, I think it's probably worth noting that when we perform the procedure so it's literally done in our office setting, you know, with a typical doctor's office setting. Some other places do it in an operating room with other techniques, but in our clinic in Annapolis, maryland, we perform it in the office setting safely. I've been doing this for 13 years on lots of people and and it takes a few minutes. I like to spend a lot of time with people ahead of time to explain a lot of the why and then sit with people afterwards. So I've been able to learn a lot over the years from my patients and the therapists that we share patients with.

Speaker 2: 19:52

But what people will feel is something typically within a few minutes, which is the first question is hey, when is this thing going to start working? And because it's a nerve block, the nerve goes to sleep fairly quickly and there's actually something that shows up on the face, a physical symptom that shows us the nerve is going to sleep, because on the side we block the nerve, the eye will droop a little bit and the people will get smaller and a few other things, which is a thing called Horner syndrome. The nice thing with that is it's a beautiful physical symptom or a sign that we can look at that shows that the nerve is going to sleep and eight hours later it goes back to normal, eye opens up, the pupil goes back to the normal size. But it's a confirmation then that the block was performed properly and successfully. And right around then is when people will actually start to feel something different, and there's a variety of things that people will feel.

Speaker 2: 20:45

But some of the words that I hear are physiologic symptoms within a few minutes, like I feel lighter or calmer or my muscles have relaxed or melted, people will say. And then even in thoughts, many people will say my thoughts feel clearer or quieter. Those are really the two words that I hear frequently. Several times today people said my thoughts are quieter as the sympathetic nervous system goes to sleep. There's effects then on the physiology, where the body will relax, but the thoughts will relax as well and many people feel emotional and cry after the procedure.

Speaker 1: 21:27

So there's a real physical thing going on, and to me that's an example of chicken or the egg, I don't care what came first, right? So if you can quiet the mind and the body calms down, or if you can calm the body and then the mind calms down, the body is to me the most magnificent puzzle, where the mind, body, the thoughts are affected by emotions and the physical aspects, the somatic aspects, can affect the thoughts and the emotions, and to me, your example is just that this procedure appears to empirically you've got plenty of research, you've got anecdotally that when you do this injection, people with this kind of chronic circuitry of fight-or-flight response, physiologically at least. Certainly what we'll talk about too is the psychological. It slows the physical symptoms and you're explaining that people what today, in your, in your procedures, their mind begins to quiet down. What a relief, what a relief. I've talked to you.

Speaker 1: 22:40

I wanted to get you in this podcast because no brainer to me right that this form of treatment can help people with acute, complex, trauma, intensive anxiety. This can help people treat them, recover and even heal. This is one aspect to it. Talk about that a little bit more yeah, I think.

Speaker 2: 23:07

I think I suspect there's probably a few people. It sounds like you know, and I'll be candid here the first time I heard about this was many years ago and I stopped listening. I thought it was a little weird and it didn't really make sense to me. I couldn't get my head around. How can a shot in the neck help treat PTSD? It just seemed weird. There was nothing, sure, consistent with how I had been trained and I pride myself on evidence-based physician. I do evidence-based medicine and so I suspect that there are people just seems a little too weird and and frankly, some people will just say it just sounds too good to be true. I've had plenty of patients who have said it sounds too good to be true until they eventually have heard enough other people's testimonials or heard of have a friend of its experience that before they finally step forward and say, okay, I'm here, here to get some help.

Speaker 2: 23:56

But the point that you made I think is really important to me is that this is not a standalone procedure for me. There may be some other physicians who perform the procedure who may look at the still again we block as some kind of a thing you do that fixes everything or or something like that. But that that, to me, has never been my my attitude and I have always practiced as part of a team and most of what I've learned about how I I treat my patients I've learned from from therapists and my patients themselves over the years. So to me, what the block does is it allows someone to disconnect that circuit, stop this signal that goes brain to body, body to brain reflexively, meaning instantaneously, so that your responses are no longer in your control and the the slow driver in the left lane makes you lose your mind and you don't seem to have any control over it. Or your kid drops a plate or spill something and you completely lose your mind and you have zero control over it. These are these are common things, but certainly not the only things.

Speaker 2: 25:01

What I think the block does is it buys you some, some headspace and a little bit of leg room by disconnecting that immediate response. And what that does is it doesn't make the world perfect. It doesn't make the driver in the sleep, the slow driver in the left lane, no longer annoying, because, because that's not going to happen. What it, what it allows you to do, is not go zero sixty and lose your mind and what it does do is it cracks the door open I think really nicely for some good gains in therapy, and and what I've experienced in my profession is that there are many people who are trying their hardest to get into therapy or through therapy or dig into some difficult things and it's just physically too painful or uncomfortable or difficult to do it because you don't have the bandwidth in your head, because you're dealing with too many other things.

Speaker 2: 25:53

So what I look at the block is being as a tool, just like other tools in therapy, that will allow you to dial down the immediate and uncontrollable sympathetic response or fire flight, and take away that the angst and the on-edge feeling in your body that many people with anxiety have, and then allow you to really dig into therapy or, frankly, make some lifestyle changes and that that comes up.

Speaker 2: 26:18

You know people will treat anxiety as many of us know other ways and you know substance abuse is a really obvious one and there's some. It's actually, like you know, I dare to say, almost virtually acceptable that people will say like I have a couple of drinks or something before I go into this public setting or something. What can happen is if we can dial down that angst or the anxiety that comes from something and the something doesn't matter. I'll come back to that, but if we can dial that down, it may be the kind of thing that allow people to make some better, healthy choices and engage in therapy. So I see this as as complimenting, not replacing, what other people are doing.

Speaker 1: 27:01

You're not saying that this is a cure to cure the hyper intense anxiety or PTSD. So I imagine a lot of people are going well, how long does it last? How long does this last if you do, you do this SGB, this injection? What is the range for people to have these physiological symptoms? Yes, maybe the the brain comes down, but specifically the black. How long does the physical symptoms tend to dissipate or be gone completely from PTSD and anxiety?

Speaker 2: 27:39

So there's a ton of individual variation in responses. So these are this is based on many of our publications in the peer-reviewed literature as well as years of anecdotal experience and taking care of people. But a couple of things the the top three symptom cluster type things that are helped by a Stelling Ganglion block, when we study the effects of specific symptoms is probably anger and irritability. Number one also sleep and concentration, which is weird if you think about that. But both of those things have a huge impact on other things and both of them have a lot of things that impact them. But those are. Those are some of the high yield benefits. Now, if you look at all your symptoms and you total up the scores whether it's your anxiety score or your PTSD score and we look at the numbers when we publish this data, about 85% of people with a single right-sided Stelling Ganglion block will have a 50% drop in symptoms the next day. So this is this usually will make people's eyebrows grow up because there's nothing else that does that.

Speaker 2: 28:56

It's just it sounds like that it clearly does. And if you look at the literature over 20 something original research published in the peer-reviewed literature it's fairly consistent and whether we're looking at anxiety scores on a GAD7 or PTSD scores on a PCL5 or PCLM, back before when we were using DSM4 and these are just measurement tools, just for the listeners yeah, yeah, I'm sorry.

Speaker 2: 29:24

So just measurement tools with numbers associated with them. We really see a 50% reduction in total symptoms, and when I say the next day, I mean people literally will feel better within a few minutes to a few hours. The big question that you asked those? Okay, that sounds wonderful. How long does it last? It can be all over the place, frankly, but there are people that I treated over 10 years ago that did fine, like really well, after single treatment, and they what's key to say first of all is what matters most is what you do afterwards, right after the block.

Speaker 1: 30:02

So we'll get there, we'll get there we'll get there.

Speaker 2: 30:05

Yeah, we all know that life matters, so it's hard to predict what will, what everybody will do. But why don't I just say that most people will get about a six month to 12 month relief when I say a 50% drop in symptoms, six months to 12 months would be like a bulk of people. There are people who will get relief for much longer, meaning one and done, or many years. There are some people who get relieved for a long time and then they might hit a rough spot whatever that is, marital, financial, substance abuse, another triggering event, significant, something like that. There are some people that may require more than one treatment. I think that's important to say because I've had people ask me that and this is possible. And there are people with very, very, very, very significant depruded symptoms who have been experiencing daily the angst of anxiety, despite many other therapy attempts, and sometimes it might take a few treatments to actually break through that chain. That can be difficult to predict who that is. Sometimes experiences earlier on childhood lasting for a very long time can be a little more refractory.

Speaker 2: 31:17

But there isn't a particular type of trauma or level of symptoms that the block has not been shown to be helpful, for I actually had someone that I treated today or yesterday, but great response for about three years and then had a significant life event and, like I say, life happens. They were doing great hit a rough spot. We're doing all the right things, but things just kind of bubbled back up on them. They called and said, hey, can I come back and do the thing again? I said, by all means, come on back.

Speaker 2: 31:52

And what we know and what we found in our research is that subsequent blocks are equally effective. So there's not this kind of thing like medications where you have to increase the dose or you develop resistance or tolerance. And in fact the Steli gangland block, when it's used for other things like there's some cardiac conditions or some other pain conditions you can actually repeat it safely. I know it sounds crazy, but you could do it every other day for a couple of weeks. It's that safe. So there's not like a limit to how many you could do because it'll wear off or something like that.

Speaker 1: 32:26

It's just a it's not eroding the nervous system, it's not eroding the muscles, the ligaments. It's an injection that numbs it.

Speaker 2: 32:35

Yeah.

Speaker 1: 32:37

If I could paint a picture for people, imagine your nervous system being in the emergency room and it's that paramedic, that fight or flight response, and that's part of the nervous system and specifically the ganglion block is. It can reduce some of those symptoms in half. So and this is where I get you stuck in your you're taking me there. I'm so glad you were. You talked about anger, irritability affecting sleep and concentration. What about hyperarousal?

Speaker 2: 33:09

Oh yeah, when you look so hyperarousal. If we look at the whole cluster E of the category of PTSD, they have to do things with startle response, feeling on edge, the jumpiness, irritability problems. I alert, yeah, just feeling on edge all the time, that hyperarousal. That cluster is the one that's most impacted by stallion ganglion block.

Speaker 1: 33:38

That's been fairly interesting. So now, what you were saying, which I love, which got me so excited to talk to you, when you receive this treatment and you've been suffering from this response, this physiological response, this hyperarous, this heightened state, and all of a sudden that is cut in half, can you imagine the type of treatment, therapy and work you can do in therapy when you don't have that hyperarousal, powerful hypervigilance, that exaggerated sense of threat and danger, that hypervigilance and constantly scanning your environment and not feeling secure. All of a sudden that hypervigilance goes down and can you imagine you have a level of a little bit more comfort, increased by 50%, so you can address whether it's complex, whether it's an acute, a single case, big T, trauma, and you can begin to address that in therapy Disassociation. You see where I'm going here. Talk on that a little bit, keep going.

Speaker 2: 34:52

Yeah, actually, just to dovetail on that, I have been performing this procedure now for almost 13 years. I have presented on it, discussed with I can't tell you how many hundreds of therapists over the years from a variety of places where I've lived and been stationed and where I've worked, and currently people fly in from all over the country and several other countries to our clinic in Annapolis. So I interact with a lot of people therapists who refer to their patients here. What I can't figure out is those who are not, and I get it Like. I understand that it sounds different and sounds a little bit weird, but it's almost universal, I think, to me, when I treat somebody and they go back to their therapist which is what they do because I refer everybody to do that they go back and they engage in therapy and they get better and they're pleased and their therapists are happy, and then they refer somebody else because they think, oh my God, this is great.

Speaker 2: 35:54

We were kind of stuck and we were rehashing things that we couldn't get past a certain point. So, candidly speaking here because I don't know who's gonna listen to this, but it's been a little surprising to me of the therapists just around our area where we are here in Annapolis, that around the Delaware, virginia, maryland, dc area that there aren't more people that share patients with us, when I have had people fly from New Zealand. I've two people drive down to Canada today for this week, so it's a little bit. There's some mystery to me why there's not more collaboration here, and I think our patients, I think people who are suffering, ought to demand that. Like, I think this is one of those things where I want my doctors to reach across and collaborate and find different things that can help me, if they exist, and that that type of teamwork should be the norm, that that should be the kind of thing that I would expect. So I do think it's really important.

Speaker 1: 37:04

You've explained the safeness, the efficacy, the ethical, the years and decades of empirical research that shows not only the safeness but the reduction in symptoms. Now we're now talking about how this can augment the next step, which is the therapy process. Why not right, and maybe that will change, because we're seeing such well around here, because we're surrounded by Johns Hopkins and all these research centers and NIH and all these places that are doing micro dosing in different forms to potentially do the same thing for trauma. Now, in some ways it's a very quick injection, a very safe injection, in some ways really not invasive In terms of not mind-altering it's just numbing to allow the ability to rewire the brain through therapy and a reduction in symptoms and give the ability to the mind and body to begin to process in a different way where it was in that fight-or-flight response. And you can add to it by adding therapy to it.

Speaker 2: 38:18

Wow, yeah, so it's funny I guess you said this at the intro but I'm not a psychiatrist. My training, my basic training, is in family medicine and, like many people watching know that a great deal of psychiatric and behavioral healthcare is delivered by family medicine docs across our country. So that's really where I got a lot of experience. But I see things slightly different than a psychiatrist or a psychologist.

Speaker 2: 38:47

I think I just I see things at a little different angle and I think in family medicine what I learned really early on is as kind of a primary care provider or clinician for people is that medicine is a team sport, like you gotta figure out who else can do what for your patient and figure out how to reach over and consult people and learn new things and stay up on the science. And it's not easy, it's very, very hard and in my opinion I'm not enough of that teamwork in medicine these days. There's a lot of barriers that prevent that. But I think another point that I see is that with some of the newer things coming out and I'm glad you mentioned that, because there's some wonderful things going on at Johns Hopkins or at Shepherd Pratt in terms of newer cutting-edge therapies, and I think there's a lot of excitement when you hear about something new and people are really asking questions like, hey, how does that work and how will it work, and I think it's great. I think there's some very promising things coming.

Speaker 1: 39:46

But that will work. A perfect excitement, yeah, a perfect excitement for it.

Speaker 2: 39:50

It's legit, I think. But then I'm quick to remind people that the Stelly Gangland Block ain't new, like it's not one of those things. In fact it's been around a while. And look in the literature there's over 20 peer-reviewed original research articles that already show that it works. So it's not one of the next thing coming.

Speaker 2: 40:10

I think that people will always be looking for another level, one study and someone to do a meta-analysis. At some point those things will happen. We're currently doing a randomized control trial with Ohio State and our clinic that's combining Stelly Gangland Block with CPT or cognitive processing therapy. So we're gonna continue to do research. We're gonna continue to publish our evidence. But I think that while some people are looking for what is the best answer, I think that's the wrong question to be asking. I think it's really like what combination of things work best for the individual in front of me right now and for some people, just what? I would even talk about anxiety.

Speaker 2: 40:55

But for the diagnosis of PTSD. Some people will call it PTSD, you'll hear that terminology, but as far as DSM is concerned right now post-traumatic stress disorder the thing that is horrifying if you haven't heard this before is how heterogeneous that can be, but if you look at the criteria that can give you the diagnosis of PTSD, there's 636,000 variations of symptoms that all equate to PTSD. I'll say it again 636,000 variations. It'll blow your mind. You have to go through and get a math genius to show you that that's actually accurate.

Speaker 2: 41:39

But if you look at it and you say, okay, if there's that much heterogeneity in this particular diagnosis and we're looking at evidence-based research to show what treatments work best or better, it's almost an impossible task. Not like we shouldn't do it or we shouldn't try, but it really begs the question of how do I apply or generalize the data that I can read in the peer-reviewed literature to the person sitting in front of me who's suffering? How do I treat that person? And I don't think it's as black and white as many other areas of medicine and we know this and I don't think we should try to do that too hard, because the brain is not a femur and we don't treat PTSD like we treat hypertension. They're very, very different and I think that gets lost on some people and they're looking for the best thing for everyone or the number one type of therapy, and I think that's the wrong way to go after it.

Speaker 1: 42:39

Yeah, and one thing that you're certainly not saying. I'll say this we're often a quick fix society. So what is the pill, what is the medication to get rid of my symptoms? Well, this modality reduces significantly the symptoms for up to months and years. But what you're so clear on is that this augments the overall treatment process to actually minimize, reduce or not just recovery but healing in a way that can be so profound. And to me, that is what integrative treatment, that is what holistic care and treatment is and should be. And I wanna touch on just this in terms of after you get this SGB, this injection, and your mind slows down and the symptoms cut in half, if not more.

Speaker 1: 43:36

The emotional dysregulation, this trauma, this intense anxiety, can lead to difficult emotions and regulation. And if that's gone and these overwhelming emotions and you said anger and irritability well, who wants to process when you're anger? For me, I always say anger is a secondary emotion, meaning you got to feel something before anger. So anger can be somewhere, you can direct it and project it outwards. Well, if that is gone, it creates a pretty good environment to do therapy and you won't be flooded in the therapy session and then, all of a sudden, you can process and begin and create this change in your life when that emotional dysregulation might be minimized significantly. I'm just like. I hope people are listening and going. This is a wonderful first second step to long term healing that they get to have some power in. It's just not a pill, it's just not a surgery. It's an augmented form of holistic, integrative treatment.

Speaker 2: 44:46

Yeah, I think there are people that come to see me and they specifically want to get off their medications, and I'm very clear that I say that's not my business, as not your prescribing clinician, to wean your off your medications. But the last, is that possible? Yes, absolutely possible, because people do it all the time and they write me a letter afterwards and say they did, but it's under very careful overwatch by their prescribing clinicians. Pretty machine, yeah, absolutely. However, many people will come and I'm actually amazed at how many people will come that have been on Benzos for years and I mean I get it. It's a useful class of medications but it's not without risk and it's a little surprising that there are people that are on for a long time and it's just. Again, I don't want to.

Speaker 1: 45:40

Dr Lynch, don't get me going, I can get passionate about that topic. I can't be oversubscribing, prescribing and yeah.

Speaker 2: 45:48

I don't want to. I guess I'm trying to walk the fine line of I prefer not to badmouth anybody else's particular way of treating things. What I can say is there are things that have been used historically that people continue to use just because they don't know that there's another way of doing things. Sure, and again, I think I'll make the point that I think if you're involved in treating complex diagnoses like posttraumatic stress disorder, which is extremely complex, and you're not keeping up with the literature and you're calling yourself a trauma expert, you're not a trauma expert. And I see it out there, because there are people that are out there that call themselves experts in things and maybe they have great experience and maybe they are specialists in certain areas. But to be an expert in something, you better know everything about it, which doesn't mean you have to ascribe to it all. You certainly don't. That doesn't mean that at all. But you certainly have to be aware of what's in the published literature and you can't say, well, I've never heard of that.

Speaker 2: 46:47

I've sometimes been published multiple times, including level one evidence and JAMA psychiatry. So I hear that all the time and it makes me ruffle up a little bit when people are using, in my opinion, antiquated techniques and just not keeping up with the science. And they say things like oh, I haven't heard of that before. I think I'll pick up a journal. Your clients are counting on you, your patients are counting on you and to keep up with what's going on and not just doing what you learned in school many years ago. That may ruffle someone's feathers. You may take offense to me saying that, but I mean it, and I think our patients should demand that. I think it's exceedingly hard to do that, but that's what being a good clinician is all about, and it's also what being a good team may clinicians all about, because I can't expect to know everything. I rely on something that you're going to tell me, luke, by some new thing that I've never heard of. So that's where that comes in as well.

Speaker 1: 47:46

And if clients in this country can watch a commercial about a medication that says ask your doctor, I think it's completely okay to go to your therapist, your doctors to go. Hey, I heard about this thing called the cellulite ganglion block. Do you know anything about it? There's been many times in my career that I go. I don't need to look in that, I don't know.

Speaker 2: 48:10

And if we?

Speaker 1: 48:10

can do that for medications, we can do that for different forms of potential treatments that can benefit a collective solution to health and wellness. That's what we're all about. I have two kind of more questions before we wrap up, and thanks for being with me today. Dr Lynch, I can just only imagine there's some people going well. I don't think I have PTSD, but I've got this anxiety and I don't think I have to the level of panic attacks or I've had panic attacks. You see what I'm getting at. There's a full spectrum of anxiety and stressors and triggers that people have and, whether they've been diagnosed or not, whether they've had panic attacks or anxiety attacks. Can I be a candidate for this form of treatment?

Speaker 2: 49:01

Yeah, great question. So a couple of months ago we published our study on PTSD, on the Steli Ganglion Block for anxiety. So, independent of PTSD and again I said this earlier. But to refresh, the Steli Ganglion Block is extremely effective for anxiety and what we looked at is what kind of a drop is that on the score? Again, the metrics that we used to measure that, so the generalized anxiety disorder seven or the GAD7 score sheet. What's considered the minimal clinically important difference, or what we call the MCID, is agreed upon. Successful treatment is if you can change the GAD7 score by four points or greater. You can drop a GAD7 score by four points. That's a pretty good drop in anxiety from whatever therapy you're using. What the Steli Ganglion Block showed is about a 10 point drop in GAD7 scores, which is over twice the minimally clinically important difference. It's actually quite a bit because the GAD7 maxed out scores 21.

Speaker 2: 50:10

Frequently we have people come to our clinic that seek treatment and they'll say, well, I don't have PTSD. And I'll say, well, here, fill out the symptom scores, let's see what your symptoms are, because to me that's more important. Again, back to my comment about the heterogeneity of the PTSD diagnosis. Again, if you look at the symptoms of PTSD. They're all over the place. So what I do is I look at the actual symptoms and if I see a lot of elevated hyperarousal symptoms on a PTSD, regardless of the total score, I know you're going to do well with the Steli Ganglion Block. If I look at your GAD7 scores and you have feeling anxious, nervous or on edge, maxed out at a three, and you say extremely difficult, meaning how bad is this bothering you, I know you're going to do well. I know it because that is the target of the Steli Ganglion Block and it's going to be beneficial.

Speaker 1: 51:08

Let me give you more if I can jump in really quickly.

Speaker 1: 51:11

Let's make this a hypothetical. Let's say there's someone listening that all of a sudden they're driving to the barber shop and then they start to sweat and they go well, sitting in that chair and someone's cutting my hair or they're going down Richie Highway or Route 50. And then all of a sudden they go oh man, I'm feeling these physiological symptoms and like who? Or they're out to eat at a restaurant and then they get this whoosh feeling and maybe it doesn't ever go to a level of a quote-unquote panic attack. Could this individual potentially be appropriate for this treatment? Definitely.

Speaker 2: 51:45

And I think it's a yeah. So yes is the short answer, and I think-.

Speaker 1: 51:53

Backing that up with the measurements. Yeah.

Speaker 2: 51:56

Yeah, and I think that's it, because I think anytime you hear some doctors say, yeah, sure this will help you, I think you really got to go back to that hammer and nail analogy.

Speaker 2: 52:05

Oh sure Doctors hammer and everybody's the nail. What I think is I look at the symptoms and not the diagnosis. And if I can look at the symptoms and say yes, I think that the Steli ganglion block will treat your symptoms. Because the final common pathway for a lot of things is this nerve is disrupted, whether it's PTSD or anxiety or panic disorder, generalized anxiety or a huge stress response, or people that are just wound tight and they bend that way since birth and they don't really even have a diagnosis. Yeah, there are people like that walking all around us all the time. Some of them thrive in particular professions like first responders or some military people do really well if that's the personality type. But it makes it kind of tough to relax with your kids on the weekend sometimes, and that is a very appropriate thing to seek treatment where I say is this the kind of thing where I can just make my fight or flight system reset so it works properly? And, to be clear, when we block the nerve it wakes up again. And, to be very clear on this, it wakes up functioning properly.

Speaker 2: 53:15

Sometimes people think, oh, you're blocking the nerve, it's going to blunt my fight or flight response. Oh heck, no, if that were the case, it would be dangerous and we wouldn't do that, and particularly if you're someone that needs your fight or flight system and you've honed it to a sharp edge. That's not at all what we want to do. I've done this on special operators two weeks from deployment to Afghanistan. That have done wonderfully, and before we did that, we studied it carefully, published our results to show that there was not a detriment. So this is one of those things where it's not like someone's smashing on your brake pedal. It's not even like they're putting a governor on your accelerator, just taking your foot off the gas pedal and then they go back to where it works properly. That's kind of the analogy that I like. That I think, makes sense to a lot of people.

Speaker 1: 54:07

Okay, I'm going to briefly open up Pandora's Box, because we're not going to go deep in this, but I want to open up Pandora's Box. Okay, what about this medallion, this treatment, this injection for eating disorders, addictions, other forms of diagnoses, conditions, yeah, Try to answer that shortly. Yeah, there's a good one.

Speaker 2: 54:32

I think I got a pretty good short answer to that Now and I hope there's people that are listening, that are experts in disorder eating and substance abuse disorder substance use disorder because it matters. The question is how did you get there? How did you get there? What happened before, without going to, is fueling angst, anxiety, a discomfort and anxiousness that's either brain or body in your way of coping with. It is one of these dysfunctional things, whether it's using substances or restricting or things like that. Then it does make you wonder if we go upstream to treat the thing that's the root issue what will be the effect? And I don't want to say too much because I think it would be.

Speaker 2: 55:23

I don't want anybody to miscarry and says Dr Lynch says we can use SGB to treat alcoholism.

Speaker 2: 55:28

What I will tell you is I have a good number of anecdotal responses from many of my patients who, after they've gotten a stela gangin block, will write me a letter back and say hey, doc, I don't really feel like drinking as much anymore. I don't feel like I have to take a gummy every time I go out or have to go to bed. And they say have you ever thought about treating substance use with this or that kind of thing, and I have not explicitly gone that direction. But it makes sense to me that the same reason that people will use substances or abuse substances may have originated from anxiousness or anxiety whether you want to call that a clinical diagnosis or not and if that's the case and we can reduce some of that that's living in the autonomic nervous system, that may have an effect. That's probably the best I could say. But I definitely think that that area is ripe for research and there's no shortage of people that are hurting out there. That could benefit.

Speaker 1: 56:29

Yeah, and the listeners know my philosophy that there's a benefit of treating things holistically the same examples you gave for PTSD and anxiety, and treating PTSD in multiple facets, multimodal if you will. The same thing with addiction or needing disorder. Yeah, this can be one really important or advantageous treatment for the whole thing. Yeah, that's great. That's great. Thanks so much. I don't like to go past an hour or so. I think that's a good place to stop. I know you and I probably got a couple more things in our brains that we could talk about.

Speaker 2: 57:13

It might be helpful if I at least say what's on our website and where people could go to learn more.

Speaker 1: 57:18

Let's do that. I'll put that in the notes too, but please tell us about the Stelate Institute.

Speaker 2: 57:23

Yeah, well, I just I think it's worth mentioning because I've said a few things on here about referencing things in the literature On our website. We've tried to make things useful on our website, which is TheStelateInstitutecom it's the word TheStelate, which is S-T-E-L-L-A-T-E Institutecom, but the website has a few things on there and on the FAQ tab we've tried to make this useful for both patients and clinicians and there's several YouTube videos that will elaborate on many of the questions that people ask, like where are the risks? What about this right side versus left side? Where did it come from? What does it treat? Where are the symptoms that benefit? All those things are kind of elaborated on a little bit more. But on the Evidence tab we've hung on their full text journal articles of all of our literature that's published. So I do say things like, hey, if you want to read the articles, they're there and you don't have to go searching on PubMed or have some access to a medical library, they're all hung right on there and there's a summary graphic slide on there and everything. So if you just want to get a quick snapshot and say, all right, show me what's really out there in the peer-reviewed published literature and for something to stand peer review and get published. It has gone through scrutiny. It's not like somebody wrote an article for a magazine or a leaflet or a white paper or something. So we feel strongly that our evidence is on there and I would point you to that as well. There's several videos on YouTube that you can look at, but really our website we're hoping to build and we continue to add to it Things that can be helpful for people that are trying to learn more about the procedure, and there's a whole ton of testimonials on there.

Speaker 2: 59:12

There's a lot and a lot from people from very different backgrounds whether it's anxiety or PTSD, from all different backgrounds, and just because I came out of the Army, many people are under the misperception that PTSD is somehow a military thing.

Speaker 2: 59:30

Certainly, there are those with military and veteran backgrounds that have PTSD, but in the US that's really only about a third. Two thirds of Americans with the diagnosis of PTSD come from a lot of other backgrounds and really at these days at my clinic in Annapolis, I treat probably more women than men, by a final maybe 60% to 40%, and the vast majority of trauma backgrounds are probably not military, but I see a lot of childhood abuse and neglect and a lot of sexual assault survivors and there are tons out there and don't necessarily have the advocacy groups that we see in the veteran community. So I want to make sure that's clear because sometimes people will look at my background and say, oh, that's an Army guy, they take care of combat related PTSD, but no, like I said, the stellate ganglion and the sympathetic truck, they don't care. They don't care what the trauma came from, it doesn't matter, it's just biology to him and we're happy to help with that.

Speaker 1: 1:00:39

Yeah, and I'll second that. Dr Lynch's website, through the Stellate Institute, is wonderful and easy to look at in terms of the Q&A, the empirical research, the videos. It's well done and can answer even more questions than we touched upon today. So, dr Lynch, thank you for joining us. Yeah, great, thanks a lot, yeah.

Speaker 1: 1:01:04

And in closing our conversation with Dr James Lynch, has unveiled a promising frontier in mental health and wellness. The Stellate Ganglion Black treatment, with its potential to address both the psychological and physiological aspects of PTSD and anxiety, presents a ray of hope for those who have long suffered, often in silence. As we explore the horizons of medical advancement, it's evident that collective solutions to health and wellness are not only possible but essential. Sgb stands as a treatment and a testament to the power of innovation, research and compassionate care in transforming lives. We encourage you or, dear listeners, to stay informed about the latest developments in SGB and to share this episode with anyone who may benefit from its insights. Together, we can contribute to a world where mental health challenges are met with understanding, support and groundbreaking treatments like the Stellate Ganglion Black. Thank you for joining us on this enlightening journey and remember when we come together in pursuit of wellness, we create a brighter and more compassionate world for all. Till next time. Thanks so much.