The Crunchy Allergist 0:05
Are you sick of the fatigue and fog fed up with unpredictable flares hangry from the super restrictive diets. Hello, and welcome to success with sjogrens a podcast empowering naturally minded and scientifically grounded women looking to reduce or even eliminate their sjogrens symptoms. Hi, I'm your host Dr. Kara Wada, a fellow sjogrens spoony triple board certified allergy immunology and lifestyle medicine physician, coach, medical educator, and mom. As a reminder, although I am a physician, I'm not your physician, and this podcast is for educational purposes only.
Well, welcome and thank you so much for joining this episode of the Success with sjogrens Podcast. I am super excited to be welcoming Dr. Martinez Ziegenbein. I'm going to let her introduce herself but she is a board certified practicing rheumatologist and an expert in fibromyalgia with which so many of us with sjogrens also have. And I'm really excited to talk with her today to learn more about fibromyalgia but also some really cool innovative ways that she is helping patients deal with chronic pain. So Martina, let you introduce yourself.
Dr. Martina Ziegenbein 1:30
Hello there. Thank you so much for having me. It's a real honor to be here on your podcast. Congratulations on getting it started. So yes, my name is Martinez Ziegenbein. I'm a board certified rheumatologist. I practice currently in Cape Cod, Massachusetts. I only moved here nine months ago, in March 2021. And I have been working here since April. And I recently transitioned I see bread and butter rheumatology we call it the bread and butter meaning general rheumatology patients but I have recently embraced a my love for fibromyalgia and I started seeing more fibromyalgia patients in my practice. So that's in a nutshell, I have been a rheumatologist since 2007. And I have been in the United States in 2001.
The Crunchy Allergist 2:27
And could you share I know a lot of the listeners who are listening to the podcast maybe already see a rheumatologist but what are some, you know, conditions that fall into that bread and butter that you see on a day to day basis in the clinic?
Dr. Martina Ziegenbein 2:43
Yes, good question. So I see a lot of patients with rheumatoid arthritis, psoriatic arthritis, gout, osteoarthritis polymyalgia rheumatica. I don't have a lot of sjogrens patients. Absolutely. I just actually saw one today earlier this morning. And sudo GAO to go to the GAO that would be bread and butter. And of course as I said, I am trying to build up my practice as a rheumatologist with fibromyalgia. So I'm seeing more and more fibromyalgia patients. Yes.
The Crunchy Allergist 3:18
And can you explain a little bit about fibromyalgia? I know, as I was starting, I graduated medical school in 2010. I have to get the dates all right. But even his latest then I think there still has been this like, is it? Is it a diagnosis? Is it you know, is it real? What is it kind of this? This question and kind of gray area around it? So
Dr. Martina Ziegenbein 3:46
I thank you. I love the question because it just underlies that there is still a lot of confusion about it. So I appreciate the opportunity to talk about it. Fibromyalgia is in a nutshell, clinical syndrome when patients hurts in multiple places in their body and it can not be explained by other findings or diagnosis. So, as you know, patients with rheumatoid arthritis also hurts in multiple areas, but they have evidence of objective inflammation. They have swollen tender hearts joints, and they're just one comparison. I'm just picking one diagnosis to compare it to fibromyalgia. patients with fibromyalgia hurts over it's above and below waist on both sides of the body. And they don't have additional explanation for the pain. They don't have any visible inflammation, any joint deformities as a reason for pain. And I should mention many times. Often, fibromyalgia comes with a host of other problems or symptoms, which includes difficulty sleeping or not feeling refreshed. In the morning, then resulting fatigue many patients, I would say almost 90% of my patients with fibromyalgia reported brain fog, which is a weird situation when they cannot quite put a finger on it, but they feel like their head is in a fog, they cannot focus, they cannot perform well, it's a very debilitating symptom and it happens. But to continue the other symptoms, they can have TMJ symptoms, irritable bowel, many patients experience bladder problems, or vaginal pain, all as part of fibromyalgia, basically, all of that kind of falls in that category, it can be very frustrating, and demoralizing, so to speak.
The Crunchy Allergist 5:45
I think that's what has been so profound for me when I see patients in the clinic in the office as well as and having dealt with some of those symptoms personally to the the quality of life, you know, that suffers. And the trouble you know, you can have going through those just regular activities of trying to make dinner or take care of the kids and get through work all of those sorts of things. What
Dr. Martina Ziegenbein 6:13
I realized that I have actually Fibromyalgia back pain, and it has been quite, I'm kind of now jumping to another topic and how long it has been, it has been very enlightening and very encouraging for me to experience improvement from methods, I'm teaching my patients and my clients. So it's, yeah, I was just gonna say that, I'm sorry that you are also a sufferer. But at the same time, I'm hopeful for you, because there is a lot of hope.
The Crunchy Allergist 6:47
For that, that's why I was so excited to connect and here. So Dr. Martina and I met through kind of through serendipity, both involved in some leadership, and physician empowerment, activity activities. And I was so excited to hear kind of her journey in hearing and learning and bringing these treatment options to, to my attention and to the attention of a lot of patients. And so I would love if you could share kind of with us. What that is kind of how it works. Walk us through.
Dr. Martina Ziegenbein 7:31
Yes, of course I'll I'll try to kind of keep it simple, because that's how I try to explain it to my patients. But basically, just to compare it to like traditional rheumatologists or the traditional training is that we examine the patient, we ask them questions, we become suspicious about symptoms, when they tell us they heard over and there is not enough or exam to be suspicious about inflammatory process. So we suspect fibromyalgia, we do sometimes run the test. But then the way we have we have been explaining it to patients is that it's central sensitization syndrome, when the brain is has volume on pain, like on high volume, basically the there is increased pain sensitivity. And that's correct. But we have not been really given as rheumatologists super effective ways to manage it. And the new way I discovered starting discovering over this past summer, is that brain is responsible for production. So it's not just that it increases the volume of pain, but it also can generate the pain. And the mechanism behind it is that it's on high alert, when the brain is on high alert, it can produce pain, and I give an example of so it's basically a body, mind-body syndrome. An example of a short acting body-mind syndrome is when I blush as a response to embarrassment or mostly embarrassment or when when attention is given to me my face turns red. And you know, and that's everybody accepts that this is a physiological reaction, it's not a disease, and it goes away when the emotion of embarrassment goes away. Well, in the same way, the mind body syndrome can be chronic meaning the brain can be producing physiologic symptoms. That's but they last longer. And in order to turn them off, we have to turn off the mechanism that causes brain to go on high alert and to what causes that is several things but the current leading theory is that it's either unprocessed emotions or repressed emotion. So anything that happened to us in our child since our childhoods that have not been processed properly, and it just accumulates accumulates and at some point it reaches the point when the brain cannot deal with it effectively goes into high alert and produces pain. And so the pain reprocessing therapy that I have been working with patients primarily includes mechanisms to how to teach patients how to soothe the brain. And I, if I may just share something very brief. So I had a patient that the patient with Sjogren's syndrome who came today, and we discussed her dryness, but she was mostly concerned about her head pain that started literally, like two or three months before this appointment, it was completely new. And it was like vice almost sensation around her head, it would be there every day. And they checked her blood pressure and blood pressure medication may be help a little bit. Basically, it was there every day. And it would vary, it will go up and down. But it was there. Every day, she had some blood work done, nothing was found. And when I started talking to her, I realized there was something off in the sense that she did come across as a very perfectionistic brace that she puts a lot of pressure on herself to perform at home to have her house clean. She when she doesn't perform well, she feels bad about it. So she, I don't want to say beats herself up. But basically, she's perfectionistic, she puts a lot of pressure on herself. And it has been shown that people with certain personal characteristics like perfectionism, or putting a lot of pressure on themselves, they can have higher risk of developing these chronic symptoms. So I just offered to her, I didn't talk to her about fibromyalgia before, because she doesn't have a formal diagnosis of fibromyalgia, but I recognize just the brain being on a high alert or stress, chronic stress. And she agreed, so we did a somatic tracking in the office. And it was so beautiful, because within minutes, so I started somatic tracking means that people take a few deep breaths to ground themselves, they close their eyes, and I asked them to recognize their pain, or basically tell me about their sensations they have and just sitting with them. And then as we describe as she describes the pain, I have the patient then talk to her brain, telling the brain that this is okay. And it may sound silly as we talk about it. But basically the point was that she was sitting with a sensation of pain and telling the brain she's not afraid of it, she was kind of really fine their relationship with the pain and she started crying, it was it was series of hope. But she was overwhelmed with the feeling. And she was happy that there was hope for her. And this the all of her symptoms associated symptoms of pulsating eyes, and pressuring her head and all of them went away. So I was able to show her that it was just a few minutes of deep breathing. And just getting in touch with the sensations and sitting with them without fear was able to change the landscape, so to speak, of how her brain was processing the pain. So they just the most recent example and kind of summarizes is the example of what I do with my clients. I explained to them what neuroplastic pain is or this body mind syndrome. I confirm the diagnosis first. Then I talked to him about it. And then we tried. We are trying techniques that are meant to suit the brain. So somatic tracking is one of them. Then we do also talk about self compassion, which you might have experienced as part of the same group that we were in the coaching group and then it just keeping at it. And there are a couple of things I meant I mentioned to them as healthy I can mention that later. I can mention it now. One of them is a Curable apps. C-U-R-A-B-L-E it's app used by 1000s of providers and I I'm not sure what I was allowed to say that here. I do a podcast but it's basically my patients. My patients use it on their own at home. It's very interactive, and it helps them promote this pain reprocessing therapy. And the other is the book by Dr. Alan Gordon. That actually led me to this and I started reading it this summer, five months ago now. It's called way out. So that's in a nutshell.
The Crunchy Allergist 14:27
No and that book I just finished reading it within the last probably few weeks and I couldn't put it down after I saw you had mentioned it in your podcast. No. Once you're done listening to this episode, you need to also go and find Dr. Martinez podcasts which will have all that information linked but it's an incredible resource really and you break down kind of talking about and defining kind of okay, what is this neuroplastic pain and how does it work and really put things into a way that's very understandable. And because I think, you know, as you've mentioned, and I've, you know, I talk with my patients about to their patients will come to us many times, having been told that the symptoms are in their head. So when we tell them that they actually, quite literally are maybe coming from their head that that takes some nuance in discussing it and getting because for so long that had been, you know, this, this, this scapegoat. And it turns out that actually, some of it might be, but not for the reasons that people were brushing you off.
Dr. Martina Ziegenbein 15:47
Right, and I appreciate you actually bring up that point, because it is relevant, the nuance you mentioned, and what we tell them, what I tell my patience is that the pain is not in your head, it's in your brain, and it still takes there. So most of the pushback I get from my patients is when they don't believe that's a good enough explanation. So and some patients, you know, they will never accept it. But most of the time, when I start talking to patients who have been struggling with pain for a long time, and they sometimes they have been given the diagnosis of fibromyalgia sometimes have not, it's really just chronic pain that starts it off. Most of them are very receptive of this information, because it gives them hope that it can change it. And that's what I wanted to point out here is that any type of body mind symptom is, I don't want to say good to have because, like, ideally, you don't have anything, but it's good to know that it could be body mind, because you don't have power to change it, you have power to improve it, I am approved of it myself. And it really works. As opposed to when you have gout, for example, and you have, you know, swollen raging gout, it's like swollen toe or swollen or breath or hand, you have to take medications, you have to make it better, because it doesn't usually go away on its own with. And measures you can use on your own to make yourself better. And that is so empowering. And as I said, most of my female patients respond extremely well in terms of accepting to information. It's not an overnight process, it takes time. But it's very empowering. And I didn't want to, I will just mention so that male patients don't get or men don't get upset. I have only three patients right now with fibromyalgia that are males. And one of them is completely accepting of it as bodymind syndrome and is working really hard to improve it. The other two are a little reluctant. But I think they just need more time. Because for some reason, in a man's world, it's they don't consider it like sufficient. Like it's considered to be weak when you have a body mind syndrome. And I'm working on figuring out how to explain to them that it's not that is. So I'm working on that.
The Crunchy Allergist 18:21
I think one of the things that really sold me on it or kind of helped me to understand it and reading kind of the way out and listening you know, your explanations of it too is that we have science to show the before and after. So kind of with maybe speaking to like the functional MRIs or like me, yes. Yay.
Dr. Martina Ziegenbein 18:45
Thank you for letting me into it. So the Alan Gordon in his book, he mentioned so one of his like his case study, the first patient that he had, or the most famous one, he had a young teenager who had severe abdominal pain. And this was still at the beginnings when the pain reprocessing therapy was not as famous so to speak, but he was already doing Alan Gordon is a psychologist, a director of the pain psychology center in LA. And he he took this under this young teenager under his wing, so to speak, and he met with him I think they said twice a week for eight weeks. And then once a week for a few more weeks. They did a functional MRI before onset of pain reprocessing therapy and then at the at the finish they were like three months apart. And it was really truly remarkable the changes that are seen on functional MRI of his brain. So for clarification, functional MRI is an MRI that only shows activity of the brain. It doesn't necessarily show us exact structures or anatomy problem. It just shows activity electromagnetic activity. And in his case, there was there were profound changes Just in amygdala, and changes in appearance of the prefrontal cortex, kind of supporting the idea that brain pain centers are truly responsible for the landscape of the chronic pain experience. And one more thing I was gonna say is that the pain is real, the pain is always real. And I always say that to the patients. So that even if I say that, yes, the pain is coming from the brain, but it's a real pain, like there is no, there is no imaginary pain and real pain, there is just a real pain and that I try to drive the point home every day, or every time I talk to them, because I had one patient react when I was excited talking about what neuroplastic pain is. And she's like, Well, do you mean my pain? Is not real? I'm like, no, no, no, it is. So it's important to mention that to patients early on, so that they understand the pain is real. And we know that now. So yeah,
The Crunchy Allergist 20:58
just where it originates from is different than we thought.
Dr. Martina Ziegenbein 21:01
Yeah, so the science is behind it. And then I don't know whether we have time, I like to decide was I was gonna mention, Alan Gordon, and Howard Schopenhauer and Dr. I forgot his name. And I apologize to I think it's, I apologize. And now the scientists at Colorado University, they did a study with 150 patients, they randomized them to three groups, one was placebo, so no treatment. Second was standard treatments, which was some psychotherapy. And I think just education about pain. And the third was the pain reprocessing therapy, these were all patients with chronic back pain. And they did the study the study of interest or the group of interest, or they did the pain reprocessing therapy that was 50 patients, and on all the participants that is functional MRIs before, and then 12 weeks. So after 12 weeks of the study, and they had phenomenal success rate. In those 50 patients who underwent PRT pain reprocessing therapy, I think 66% So two thirds, had substantial reduction of pain and about 30% complete resolution. So none no other chronic pain, chronic back pain study showed such phenomenal results. And there were profound changes in their functional MRIs, again, confirming that the brain changed, hence the pain change. And the principle people were taught how to bring down the high alert of their nervous system down to come down in the rain. So yeah,
The Crunchy Allergist 22:58
I think what I find to be so just absolutely exciting being here in Ohio, and I have a lot of patients who come from kind of rural Appalachian Ohio areas that have been tremendously affected by the opioid crisis. And so much of that driven by you know, trying people seeking treatment for chronic pain and so hearing that there are other modalities out there that are incredibly safe. Um, you know, and there are things that are tools that you can learn, you know, to to do over time you know, with with practitioners and then on your own at home, you know, kind of almost like physical I think a bit like physical therapy for our brain, you know, kind of bring me yeah, I'm like how, how incredible to have, you know, have this and feel like she let everyone
Dr. Martina Ziegenbein 24:05
know and I have to tell you, Kara, I absolutely love you said it because this is this is kind of a natural conclusion of our discussion about it all. So this is how I feel and I feel the same way about it that everybody with chronic pain should know because there are 70 million people with chronic pain in the United States and most of them don't have to be and this is a pathetic incredibly effective and also incredibly cheap like once you make the initial investment either the you buy a book You are the Curable or you work with a coach like you and I but eventually this stays with you for the rest of your life, no medications, and I'm not saying that they're you know, I'm not saying that there is no role for medication some people may have additional need for treatments like I have fibromyalgia and RA so I'm still getting treatment for my RA and I still want to exercise I'm doing physical therapy and so on. But I'll you know the chronic pain as a big group that governance, most of chronic pain patients is really up to being corrected by these very effective and self efficacy, self efficient treatments that are because people can do it by themselves. So I share your enthusiasm, and I do think is the future of chronic pain treatment, personally. So,
The Crunchy Allergist 25:21
yeah, I'm, it's hard to contain my excitement. So I don't always like it was one of those days that was reading it just really realizing the power and the potential and thinking how can we just get this information out to folks and kind of share, share the science and the information and hopefully just build on, you know, what's already been been started.
Dr. Martina Ziegenbein 25:50
I appreciate that. And we're on the same wavelength, you know, spreading into patients and people with chronic pain, and I share your excitement like that. Yeah,
The Crunchy Allergist 25:59
I think what has struck me and kind of, really, in particular with within the sjogrens community is I stumbled upon some of the support groups online, which you know, that that community and support is so important. But there was so much hopelessness and despair and in those groups, and so to find avenues to share with our community that provide hope and encouragement, and that you can, whatever success looks like in your, in your, you know, in your mind, that we can work towards achieving that is, you know, that's kind of the mission of this work that I'm trying to do is that, you know, may have to read, I really appreciate some degree but but
Dr. Martina Ziegenbein 26:53
I really appreciate that you're doing that for your patients and clients with sjogrens. And I, if I may just mentioned something, you know, that I just realized, as you were talking about. So sjogren's is an autoimmune inflammatory disease. But it's important to mention, in my opinion, is I just demonstrate, you know, I told you earlier about a patient I saw earlier, she has sjogren's, that is confirmed by my exam and ophthalmology exam, she has positive in and I say antibodies, but she also carries this extra, you know, group of symptoms that are not related to sjogren's, but they could be blamed on sjogren's by somebody who doesn't have expertise. So it's important to have a coach or rheumatologists or physician like you provider like you who can tell them no, this this, this probably is not sjogren's, and it could be my body syndrome, because it responds to the treatment that I did with her. And there is no shame in that, like there is no people can have an autoimmune inflammatory problem. And they can have additional symptoms that are not part of the initial autoimmune diagnosis. And I think it's important for people to know that so that they can distinguish. Like, she came with a head pain. And I think she was worried initially that this was from her sjogren's. And I was able to explain to her through I mean, I did a review of systems, I did the exam. It went away. So she was able to show for herself that it was her nervous system on high alert. So it's important to know and know, so mindfulness, like when are we doing things to ourselves, so to speak, and not to beat ourselves up about it, but when are we doing things that are causing our symptoms? Because we are stressing ourselves? Unconsciously, basically, putting our nervous system on high alert? Yeah.
The Crunchy Allergist 28:48
Yeah, and there is there's so much overlap, and I think, you know, we, we see kind of on a daily basis to in patients that come in with a call misbehaving immune systems, but there does tend to be this you know, a lot of people who are helpers who, you know, put others before themselves and so being able to learn some of those skills and techniques to use along with modern medicine, you know, ways to decrease the stress, you know, turn down that pain amplification, you know, provide your body with good nourishment, you know, so that can do those different processes to repair. And to you know, as we're learning more about microbiome, all these things can work together. So I think, you know, coming from that idea of how can we use and as opposed to or
Dr. Martina Ziegenbein 29:44
I love I love your approach and it's, I don't want to say identical to mine because you probably know more about autoimmune applications than I do but i talk to patients almost about the same things basically, it's not just you know, the make the medication But let's talk about our nutrition, how we spend our time. How do we are we kind to ourselves, like all of these things play a role in how we and I love the term misbehaving immune system? I may be, I may choose, I may use that word. I love it. Yeah, well, I
The Crunchy Allergist 30:17
Well I mean it kind of encompasses is I kind of explained like allergies and autoimmune. If you look from the airplane view it's our body responding to things that it should not be making a response to. and obviously we are, you know, we could you and I on, offline can get into the nitty gritty of like how that happens and how that differs between autoimmune and allergy. But, because you know it definitely gets complicated very quickly but edit surface, you know it is, it's not doing what it was supposed to do right.
Dr. Martina Ziegenbein 30:51
I love the explanation.
The Crunchy Allergist 30:53
Yeah. Well thank you. Thank you. Thank you so much. Where can people find you if they want to think about working with you or want to check out your podcast. What is a good way for them to connect.
Dr. Martina Ziegenbein 31:10
Thank you so much for allowing me to present market myself. It's my podcast is called winning at Fibromyalgia and actually my website, I was just recently able to figure out how to link the same name www.winningatfibromyalgia.com. So when they, when they punch it in they will come to my website and I am building it with more resources. But they, that's how they can contact me. They can either schedule a consultation or write me an email which is now working. My assistant has been able to figure out. So that's the celebration and I know but
The Crunchy Allergist 31:50
They don't teach us these things in medical school.
Dr. Martina Ziegenbein 31:54
You know they,they should should, it was very stressful for a few long days but I appreciate the opportunity Kara seriously and I wish you the best with your podcasts and your business and I am so grateful that you're raising the awareness about Sjogren's about all the things that a human can do to improve his health, not just by taking medications but by attending to his or her body. It's it's priceless. Oh that's more of that needs to happen in our community. So thank you for
The Crunchy Allergist 32:28
Yeah. Well I thank you so much for taking the time to join us and I hope that we will get to talk about this more soon. Maybe one of these days will be you know on here again, you know 100 episodes from now talking about new results and how this is helping or
Dr. Martina Ziegenbein 32:45
Yeah I might do a study to study with my patients and I publish it.
The Crunchy Allergist 32:49
We'll have to chat. Be exciting. Well thank you so much and good luck with with everything and everyone please check out winning from winning with fibromyalgia It is a great podcast andstart from the beginning and work your way through there pretty quick episodes but really jam packed full of great information and I found to be really helpful.
Dr. Martina Ziegenbein 33:17
Thank you Kara so much
