[Life Style Coach]

Hi

I'm in a flare since my dental work and have a couple of broken blood vessels that happened for no reason.

Does this happen to you since you got RSD?

Pam

[Coffeebean]

Are you taking 500mg of vitamin C each day? I did this for 50 days after my root canal to help control RSD flaring and to aid healing. I read it somewhere on the Internet. Not sure if it made a difference, but it may be worth a try. I get broken blood vessels all the time. I think the vit-C really helped me, but that is just my system.

Also, the tooth that had the root canal hurt like crazy (really sore and hurt to touch with a toothbrush) for a good three months so don't get discouraged if you have pain and soreness for a while. Mine has really just now started to calm down this past month.

Did you take something for pain so you weren't hurting a lot after the surgery? I didn't take anything more than my usual.

[fmichael]

It's funny, I've noticed the same thing for years and having even had the bruises photographed (always at the same spot near the site if the initial injury) but none of the doctors I mentioned this to had any idea what was going on.

On the Vitamin C question, I went to Ask the Dietitian (Joanne Larsen MS RD LD) http://www.dietitian.com/vitaminc.html and got the following:

Q: I have a question regarding bruising. I am a very active person, but I bruise a lot easier than I've noticed on other people. Also, when I do bruise, bruises stay for quite a while. I have started taking my multivitamin at the recommended dosage, but I am wondering if I am lacking a certain vitamin or mineral that I should take additionally. I always try to have a very healthy diet. Is there a solution? It is almost embarassing to have bare legs and arms.


A: Are you on a drug called Coumadin or taking a herbal supplement like ginko? These are blood thinners and can increase the ease of bruising or severity of the bruise even from a slight injury. If you are on coumadin, then your doctor should be checking your clotting time (prothrombin) periodically to make sure it is not too long. If you are on ginko, perhaps you should review with your doctor the need for ginko. Persons on Coumadin should not take ginko as their bleeding time would be too long.

Bruises appear darker and more readily on people with fair skin. People with darker skin have more melonin pigment in their skin, so bruises don't appear as easily. Taking a multivitamin with 100% of the Recommended Dietary Allowances is fine and one pill probably contains 100% of the RDA for vitamin C. Read the bottle label to be sure.

Vitamin C makes small blood vessels less fragile and helps reduce bruising. A vitamin C supplement is not necessary in addition to your multivitamin, however, if you follow the recommendations of the Food Guide Pyramid for 5 fruits and vegetables each day, you can get more vitamin C. Eat foods that are rich sources of vitamin C like orange juice, citrus fruits, kiwi, green peppers and broccoli, which may reduce the severity of your bruising.

Vitamin K helps improve clotting time and good foods sources of vitamin K are green vegetables, soybeans, dried beans or peas. Do you get enough of these foods each day?

And this from a site called NaturalNews.com http://www.naturalnews.com/021924.html

How to Tone Your Blood Vessels and Reduce Your Risk of Heart Disease
Saturday, July 07, 2007 by: Jack Challem

Personal trainers have long praised the health benefits of toning your muscles. Now, medical researchers are looking at a similar approach for toning of your blood vessels.

Think of it as getting really buff blood vessels.

So, what's blood-vessel tone got to do with your health? The better the tone of your blood vessels -- your total circulatory system -- the less your heart has to work to pump blood. When your heart pumps your blood smoothly, without resistance from your blood vessels, your risk of heart disease drops.

Although exercise is important for muscle tone, your eating and supplement habits may have greater sway when it comes to blood vessel tone. Eating fresh wholesome foods and taking antioxidants are the best ways to maintain tiptop blood-vessel tone.

How do you say endothelium?
The concept of improving your blood-vessel tone centers on the endothelium, a thin layer of cells that line the inside of your body's blood vessels. Researchers know that endothelial cells are major players in regulating blood flow, blood pressure, and even clotting. These cells secrete a variety of chemicals that signal blood vessels to dilate and constrict, which helps regulate blood flow, as well as to activate cells involved in blood coagulation.

Healthy blood vessels are elastic and flexible, accommodating changes in physical activity and stress levels. But in endothelial dysfunction (pronounced en-doe-thee-lee-uhl dis-funk-shin), blood vessels stiffen and reduce blood flow (that is, circulation) by 15 percent or more. Your heart has to work harder to make up the difference.

Although doctors understand that endothelial dysfunction is a major risk factor for coronary heart disease, it's not easily measured outside of university research environments. Instead, you have to infer the health of your endothelium based on your eating habits.


Fast foods make for flabby tone
One of the first significant studies linking diet and endothelial dysfunction was conducted almost 10 years ago at the University of Maryland School of Medicine in Baltimore. Gary D. Plotnick, M.D., and his colleagues compared the effects of a "high-fat" fast-food breakfast and antioxidant supplements on 20 healthy men and women. They used ultrasound to measure changes in blood-vessel tone and blood flow in the brachial artery, the same artery used to measure blood pressure in the upper arm.

Plotnick found that a typical McDonald's breakfast led to a significant and rapid decline in normal blood-vessel tone and blood flow. The changes lasted for two to four hours (until about when the average person might be hungry enough for another fast-food meal). But the good news was this: taking 800 IU of vitamin E and 1,000 mg of vitamin C prevented the dangerous changes in endothelial function.

The study clearly demonstrated the benefits of vitamins E and C, and Plotnick concluded that antioxidants help maintain normal endothelial function. But Plotnick erred in describing the fast-food breakfast as one high in saturated fat. While such a breakfast provides a hefty amount of saturated fat, it is also high in trans fats, refined carbohydrates, and sugars -- all of which can have a disastrous effect on blood-vessel tone.


Healthy diets help
Endothelial dysfunction -- again, think of it as poor blood-vessel tone -- is intertwined in inflammation and male sexual impotency. A variety of lifestyle factors increase the risk of endothelial dysfunction, including smoking tobacco, being overweight, and having either diabetes or prediabetes. Elevated blood levels of cholesterol, oxidized-LDL cholesterol, triglyceride, or homocysteine (yet another risk factor for heart disease), also increase the chances of having endothelial dysfunction. And so does feeling stressed.

In a study conducted at the State University of New York, Buffalo, researchers found that a similar McDonald's breakfast increased both inflammation and endothelial dysfunction in otherwise healthy subjects. Blood levels of a variety of inflammatory markers, such as C-reactive protein and "nuclear factor kappa beta (NFkB)," rose after the meal. NFkB promotes both inflammation and endothelial dysfunction in the body, according to Emmanouil N. Karatzis, M.D., of the Red Cross Hospital in Athens, Greece.

And yet dietary changes and supplements can help you maintain normal blood vessel tone. In a follow-up study, Plotnick and his colleagues reported that many of the components of the Mediterranean diet, including fish and antioxidant-rich vegetables, improved endothelial function.

A separate study, conducted at Harvard University, found that a variation of the Mediterranean diet (e.g., avoiding dairy and starchy potatoes) and a modified food-pyramid diet (allowing for multivitamins and moderate wine intake) led to substantial reductions in both inflammation and endothelial dysfunction.


Supplements for toning your blood vessels
Several supplements have been found beneficial in maintaining or restoring normal blood-vessel tone.

Vitamin E. Numerous studies have confirmed the benefits of vitamin E in improving endothelial function. This ability to maintain normal blood vessel tone may partly account for vitamin E's benefits in preventing cardiovascular diseases. In an extreme case, focusing on " acute" endothelial dysfunction in smokers, researchers found that 600 IU of vitamin E daily led to significant improvements in blood-vessel tone. A combination of 400 IU of vitamin E and 500 mg vitamin C daily enhanced endothelial function in children genetically predisposed to heart disease.

Vitamin C. By itself, vitamin C can also improve blood vessel tone. In a study of patients with heart disease, researchers found that 2,000 mg of vitamin C protected against endothelial dysfunction after a high-fat meal. Similarly, 1,000 mg of vitamin C blunted the endothelial dysfunction caused by elevated blood levels of homocysteine.

L-Arginine. This amino acid is the precursor to nitric oxide, one of the key regulators of endothelial function. Nitric oxide increases endothelial flexibility, and studies have found L-arginine supplements (6 to 15 grams daily) helpful in angina pain and congestive heart failure. Lower doses, such as 2 grams (2,000 mg) daily can help treat erectile dysfunction. L-arginine works the same way as prescription drugs for erectile dysfunction -- that is, by increasing nitric oxide levels and improve blood-vessel tone. Vitamin C may further improve the activity of L-arginine.

Garlic. Long revered for its health benefits, garlic is rich in antioxidants and increases nitric oxide production. In a study of 15 men with coronary heart disease, researchers found that 2.4 grams of aged garlic extracts reduced endothelial dysfunction by 44 percent.

Alpha-Lipoic Acid. This antioxidant has long been used in Europe to treat symptoms of diabetic nerve disease. In a recent study at the Emory University School of Medicine, Atlanta, researchers reported that 300 mg of alpha-lipoic acid improved enthothelial function by almost 50 percent, and the antioxidant also enhanced the benefits of a drug used to treat heart disease.

Flavonoids. Flavonoids are a family of more than 5,000 potent antioxidants found in fruits and vegetables. In a recent study, Mary Engler, Ph.D., R.N., found that blood-vessel tone improved after subjects consumed 1.6 ounces of flavonoid-rich dark chocolate daily for two weeks. The improvements appeared related specific to increases in epicatechin, one of the antioxidant flavonoids in dark chocolate.

In sum, the health of your total circulatory system has a major effect on your overall risk of developing heart disease. Research on endothelial function has clearly shown that eating deep-fried foods can have a disastrous effect on your blood vessel tone. In contrast, healthier foods and certain supplements can help you stay buff inside. And who wouldn't want to be buff?


Scientific Citations
Plotnick GD, Corretti MC, Vogel RA. Effect of antioxidant vitamins on the transient impairment of endothelium-dependent brachial artery vasoactivity follow a single high-fat meal. JAMA, 1997;278:1682-1686.

Whincup PH, Gilg JA, Donald AE, et al. Arterial distensibility in adolescents: the influence of adiposity, the metabolic syndrome, and class risk factors. Circulation, 2005;112:1789-1797.

Schalkwijk CG, Stehouwer, CD. Vascular complications in diabetes mellitus: the role of endothelial dysfunction. Clinical Science, 2005;109:143-159.

Ronco AM, Garrido A, Llanos MN, et al. Effect of homocysteine, folates, and cobalamin on endothelial cell- and copper-induced LDL oxidation. Lipids, 2005;40:259-264.

Rozanski A, Blumenthal JA, Kaplan J. Impact of psychological factors on the pathogenesis of cardiovascular disease and implications for therapy. Circulation, 1999;99:2192-2217.

Aljada A, Mohanty P, Ghanim H, et al. Increase in intranuclear nuclear factor kB and decrease in inhibitor kB mononuclear cells after a mixed meal: evidence for a proinflammatory effect. American Journal of Clinical Nutrition, 2004;79;682-690.

Karatzis E. The role of inflammatory agents in endothelial function and their contribution to atherosclerosis. Hellenic Journal of Cardiology, 2005;46:232-239.

Vogel RA, Corretti MC, Plotnick GD. The postprandial effect of components of the Mediterranean diet on endothelial function. Journal of the American College of Cardiology, 2000;36:1455-1560.

Fung TT, McCullough ML, Newby PK, et al. Diet-quality scores and plasma concentrations of markers of inflammation and endothelial dysfunction. American Journal of Clinical Nutrition, 2005;82:163-173.

Raghuveer G, Sinkey CA, Chenard C, et al. Effect of vitamin E on resistance vessel endothelial dysfunction induced by methionine. American Journal of Cardiology, 2001;88:285-290.

Sarabi M, Vessby B, Basu S, et al. Relationships between endothelium-dependent vasodilation, serum vitamin E and plasma isoprostane 8-iso-PGF2a levels in healthy subjects. Journal of Vascular Research, 1999;36:486-491.

Neunteufl T, Priglinger U, Heher S, et al. Effects of vitamin E on chronic and acute endothelial dysfunction in smokers. Journal of the American College of Cardiology, 2000;35:277-283.

Engler MM, Engler MB, Malloy MJ, et al. Antioxidant vitamins C and E improve endothelial function in children with hyperlipidemia. Endothelial assessment of risk from lipids in youth (EARLY) trial. Circulation, 2003;108;1059-1063.

Ling L, Zhao SP, Gao M, et al. Vitamin C preserves endothelial function in patients with coronary heart disease after a high-fat meal. Clinical Cardiology, 2002;25:219-224.

Chambers JC, McGregor A, Jean-Marie J, et al. Demonstration of rapid onset vascular endothelial dysfunction after hyperhomocysteinemia. An effect reversible with vitamin C therapy. Circulation, 1999;99:1156-1160.

Anon. Monograph: L-arginine. Alternative Medicine Review, 2005;10:139-147.

Tousoulis D, Xenakis C, Tentolouris C, et al. Effects of vitamin C on intracoronary L-arginine dependent coronary vasodilation in patients with stable angina. Heart, 2005;91:1319-1323.

Williams MJ, Sutherland WH, McCormick MP, et al. Aged garlic extract improves endothelial function in men with coronary artery disease. Phytotherapy Research, 2005;19:314-319.

Sola S, Mir MQ, Cheema FA, et al. Irbesartan and lipoic acid improve endothelial function and reduce markers of inflammation in the metabolic syndrome. Circulation, 2005;111:343-348.

Engler MB, Engler MM, Chen CY, et al. Flavonoid-rich dark chocolate improves endothelial function and increases plasma epicatechin concentrations in healthy adults. Journal of the American College of Nutrition, 2004;23:197-204.
______________________________________

The link to hemorrhages and CRPS may be anyone's guess, although it may relate to endothelial dysfunction, where CRPS is known to trigger an increase in certain inflamatory cytokines that are directly tied to heart disease. That said, theory of long standing would support the notion that a release of blood would be read by the sympathetic nervous systrem as trauma, which would trigger production of adrenaline or related substances - whether in the adrenals or specialized nerve cells -that would then cause the immediate constriction of small blood vessels, and this in turn could easily trigger a flair. In fact, I've been specifically warned by one of my doctors to be extremely careful in attempting to trim the dystrophic(?) calluses that have surrounded my RSD effected feet, lest a cut send "the wrong message" to the powers that be. Looked at another way, it's a close analagy to how stress tirgger flairs, of albeit shorter duration, by the production of adrenaline. And once that starts flowing through the system . . . .

Mike

[fmichael]

My last post had an incomprehensible concluding paragraph, which has now been corrected. And to which I would humbly beg the reader's attention.

[Life Style Coach]

Wow,

I really appreciate all the information. I've printed it and plan to read it several times. My comprehension isn't what it was before RSD.

Again, thanks so much, Pam

[fmichael]

Exaggerated Vasoconstriction in Complex Regional Pain Syndrome-1 Is Associated with Impaired Resistance Artery Endothelial Function and Local Vascular Reflexes, Dayan L, Salman S, Norman D, Vatine JJ, Calif E, Jacob G. Journal of Rheumatoly 2008 May 1.

From the J. Recanati Autonomic Dysfunction Center, Orthopedic Department B, Rambam Medical Center and Faculty of Medicine, Technion-IIT, Haifa; and Outpatient and Research Division, Reuth Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

OBJECTIVE: Local regulatory mechanisms and microvascular function play a major role in the pathogenesis of hemodynamic and trophic changes in patients with complex regional pain syndrome-1 (CRPS). Venoarteriolar and venoarteriolar-myogenic reflexes (VAR, VMR, respectively) as well as endothelial-dependent vasodilatation are important contributors to local vasoregulation. We examined whether VAR and VMR as well as resistance artery endothelial function are damaged in affected limbs of patients with CRPS.

METHODS: We measured reactive hyperemic response as an index of resistance artery endothelial function, VAR and VMR in extremity soft-tissue vasculature in patients with CRPS. RESULTS: Baseline blood flow values were not different between CRPS affected and unaffected upper and lower limbs. Resistance artery endothelial function indices, i.e., values of maximal flow after ischemia and the area under the flow-time curve (AUC), were significantly higher in the unaffected versus CRPS-affected upper limbs (19 +/- 3 vs 16 +/- 3 ml*min(-1)*dl(-1) and 373 +/- 71 vs 319 +/- 70 units, for maximal flow AUC, respectively) and lower limbs (9 +/- 2 vs 6 +/- 1.5 ml*min(-1)*dl(-1) and 160 +/- 51 vs 130 +/- 42 units, for maximal flow and AUC, respectively). Flow indices reflecting VAR were lower in the lower, but not upper CRPS-affected limbs compared with unaffected contralaterals (2 +/- 0.24 vs 1.55 +/- 0.3 ml*min(-1)*dl(-1); p = 0.027). Microvascular myogenic reflex-VMR indices, however, were not different in the upper or in the lower CRPS-affected limbs compared with their unaffected contralaterals.

CONCLUSION: Impaired balance exists in CRPS-affected limbs between vascular regulation systems responsible for vasoconstriction and vasodilation.

http://www.ncbi.nlm.nih.gov/pubmed/18464300
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Continuous intra-arterial application of substance P induces signs and symptoms of experimental complex regional pain syndrome (CRPS) such as edema, inflammation and mechanical pain but no thermal pain, Gradl G, Finke B, Schattner S, Gierer P, Mittlmeier T, Vollmar B, Neuroscience 2007 Sep 7;148(3):757-65. Epub 2007 Aug 8.

Institute for Experimental Surgery, University of Rostock, Schillingallee 69a, 18055 Rostock, Germany.

Substance P is involved in nociception in both the peripheral nervous system and the CNS and has been documented to play a crucial role in the complex regional pain syndrome (CRPS). So far, however, most experimental animal models are restricted to the effect of neurokinin-1 receptor blockers to inhibit substance P and do not directly evaluate its action. Thus, this study was conducted to test the hypothesis that local application of substance P causes signs and symptoms of CRPS. For this purpose rats received a continuous infusion of either substance P or saline over 24 h delivered by a mini-osmotic pump connected to an intrafemoral catheter. Animals were analyzed at either day 1 (n=6, each group) or day 4 (n=5, each group) after start of infusion. Substance P application caused a significant and long-lasting decrease in paw withdrawal thresholds upon mechanical stimulation, while animals did not present with thermal allodynia at days 1 and 4 after onset of infusion. In addition, severe s.c. edema was observed in all animals receiving substance P. In vivo fluorescence microscopy of the extensor digitorum longus muscle of the affected hind paw revealed enhanced leukocyte-endothelial cell interaction with a significant rise in the number of leukocytes both rolling along and firmly adhering to the wall of postcapillary venules, while saline-exposed animals were free of this local inflammatory response. Muscle cell apoptosis, as assessed by in vivo bisbenzimide staining, terminal deoxynucleotidyl transferase nick end labeling analysis and caspase 3-cleavage, could not be observed in either of the animals. In summary, the present study indicates that substance P is responsible for neurogenic inflammation, including local cell response, edema formation and mechanical pain, while it seems not to contribute to the generation of thermal allodynia.
http://www.sciencedirect.com/science...56267685a9ecbb