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Hashimoto’s & Hypothyroidism

The Thyroid is a small gland at the base of your neck. It’s a part of the endocrine system, and specifically acts to affect our metabolic rate.

Hypothyroidism
If the thyroid is under-active, we can have trouble losing weight (though some of us remain thin), hair falls out more than usual (including eyebrows), both hair and nails lack lustre and can become brittle, energy and mental clarity are low, and we can feel anxious or depressed.
Clinical hypothyroidism is diagnosed using a lab test called Thyroid Stimulating Hormone (TSH). The active forms of thyroid hormone, T3 and T4, are often also tested. Levothyroxin (often called Eltroxin or Synthroid) is the most commonly prescribed medication for clinical hypothyroidism. It’s a synthetic form of T4.
Subclinical hypothyroidism is more difficult to detect because TSH, T3, and T4 are still within normal limits. Symptoms are present, but to a lesser degree than they are in clinical hypothyroidism. However much can be done at this point, before the problem manifests into a clinical dysfunction that requires thyroid medication. Body temperature tends to be lower than normal in subclinical hypothyroidism, even if a person gets hot flashes.

Autoimmune Hypothyroidism
Autoimmune hypothyroidism, often called Hashimoto’s, is a dysfunction in the immune system that affects thyroid function in some way. Thyroid peroxidase antibody (anti-TPO) is something I find quite often in blood work. Thyroid peroxidase antibodies attack an enzyme called thyroid peroxidase, which is involved in converting inactive thyroid hormone to its active form. Thyroglobulin antibody is another way the immune system can affect thyroid function. Thyroglobulin is a protein used in the production of active thyroid hormones, and thyroglobulin antibody destroys this important protein.

Hashimoto’s thyroiditis is a state of inflammation in the thyroid gland itself, which causes a gradual decline in thyroid function. There may not be any symptoms. However if you feel heat in the throat region with elevated blood pressure and heart palpitations/feelings of anxiety, see your doctor immediately.

Some believe that autoimmune hypothyroidism can be prevented by ensuring that our detoxification mechanisms are intact. This means that the body is fully capable of eliminating toxic substances such as pesticides and pollutants.

Food sensitivities have been loosely linked to autoimmune hypothyroidism. In clinical practice I consistently see people with both hypothyroidism and food sensitivities. Gluten is the food I most commonly discover to be problematic when anti-TPO is elevated. Gluten sensitivity and celiac disease are not the same thing. It’s important to note that I don’t believe everyone should be on a gluten free diet, only those that need to be.

For those of you who are familiar with iodine, it’s important to note that iodine supplementation can be harmful in some states of autoimmune hypothyroidism. It’s true that iodine depletion has been linked to both functional and autoimmune hypothyroidism, but this doesn’t mean that restoring iodine in the system is going to solve the problem. Don’t take iodine unless you’re under close supervision by an MD or ND that is well-read on the subject.

Adaptability & The State of Exhaustion
There are a number of reasons a thyroid can become under-active. One of them is chronic stress or overwork. The adrenals can come in to play with hypothyroidism, as well as our ability to regulate blood sugar.

What Seems Simple Is Not Always So
On the surface hypothyroidism can seem simple, but there is actually a lot at play, and all factors should be considered if optimal thyroid function is the goal.

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My Approach to Pain Management

Over the years I’ve learned that my approach to pain management needs to be a very individual process, and must differ quite a bit between individuals.

Assessment
With my approach, Step one is to watch your movements as you walk, sit, and move around. I’m watching for patterns of function and dysfunction in your body, for example how well your body movements flow as opposed to robotic or segmented movements.
Next, I ask about your symptoms. I ask you to describe how your function is affected in your day-to-day activities. I also ask for a detailed description about exactly how your painful body area feels.

Next I gently move the painful body area using a technique called passive range of motion. I always stay within your comfort zone. I look for tone in and around the muscles. I apply a bit of pressure to see if the tissue reflexively tenses against that pressure. Based on these types of patterns I start to put the pieces of the puzzle together. I tend to get more information from light touch than firm touch.
Next I instruct you to put yourself in a resting position based on what part of the body needs to be worked on. You may be lying on your side, your back, your front, or you may be sitting down.

Treatment
Passive Range of Motion
The first part of the treatment involves passive range of motion as well, but in a therapeutic way. The affected muscle groups are moved around within your comfort zone. The purpose of this technique is to start releasing muscle tension in both deep and superficial layers. This is a little different from some approaches, which start at the superficial layer of muscle and work inward.

Manual Stretching
Next I incorporate manual stretching, which means that I apply specific stretches in specific directions to the affected muscles. This normally involves stretching the muscles around the painful area first, working my way toward the central area of pain according to what your body allows. This prevents me from forcing your tissues in any way, which I find hinders the effectiveness of this technique. I continually monitor for reflexive tension to occur, and if I notice this occurring I know that I’m either moving too fast or being too assertive with my treatment. Everyone needs a slightly different approach; while some need a very assertive type of treatment, others require a very slow gentle approach.
The goal with passive range of motion and manual stretching is to encourage the affected muscles to tremble and twitch. Not everyone notices when this reflex occurs, but it’s apparent to me when it does. This reflex is a process that muscles use to release perpetual flexion (tension) and painful trigger points. I’ve learned that this is an important part of normalizing function in joints, muscles, fascia, nerves, and circulation.

Cupping
Once the trembling and twitching settles down it’s time for the next step of treatment. If you’re comfortable with it, I’ll do cupping. Cupping is a traditional Chinese technique that I’ve found to be effective in achieving long term pain relief. It uses suction instead of pressure to treat the deeper layers of muscle and fascia. The cupping technique I use is not painful and does not involve heat. More trembling and twitching occurs, and the cupping portion of treatment is finished when this reflex settles down. Cupping often leaves painless red or purple marks on the body, which can last for 3-14 days. If you feel it’s needed, I’ll provide you with a document that explains these markings.

Acupuncture
Acupuncture is the next step, if you’re willing. My approach to acupuncture is interactive, it’s not a matter of simple needle insertion. The goal is to give muscles the opportunity to move out of the state of flexion and return to a state of neutral. A muscle that’s tense and sore is in a state of perpetual flexion. In this state a muscle is shorter and thicker. This has a negative effect on the surrounding fascia and joints as well as circulation of the area’s nerves, lymph, and blood. When a muscle releases its flexion during acupuncture, it twitches. This causes a momentary state of discomfort, and commonly causes feelings of muscle fatigue after the treatment.

Education
When the treatment is complete I explain your body’s unique patterns of dysfunction according to the subtleties I discovered during my treatment. I then recommend specific movements and body positions to correct the patterns of dysfunction. These individualized self-care techniques are an important part of achieving long term success and empowering you to manage your own pain patterns.

The Ultimate Goal
This treatment process is meant to enhance the muscles’ ability to flex and release in a functional way, thus improving strength, balance, and flexibility. The goals are optimal functioning and a pain-free body.

Pinched Nerves, Circulation Problems, and Venous Insufficiency
Nerves, blood vessels, and lymph vessels must traverse around muscles of all different shapes, sizes, and directions. As mentioned, perpetually flexed muscles are shorter and thicker. This makes areas of circulation more narrow, which can lead to nerve impingement and other kinds of circulation problems.

Joint Problems
Muscles are attached to bones by tendons. When muscles are in perpetual flexion (shorter and thicker), tendons will be pulled tightly, similar to the way ropes would be pulled tightly. Many of these tendons are located around joints. For example, some thigh muscles attach to the bone below the knee and some calf muscles attach to the bone above the knee. This creates movement in the knee, but when dysfunctional can cause compression or torsion (subtle twisting) of the joint. This can lead to joint pain and contribute to arthritis related discomfort.

 

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Understanding Stress

Stress takes a toll on the body, and the field of stress management has become quite a money making enterprise. I find that many different kinds of stress management techniques are helpful for my patients. Which techniques are most effective depends on the individual. However, most people I talk to lack a basic understanding of the stress response from a physiological point of view. The mental side of the stress response is much better understood.

Here are some things that I think you should know:

The Stress Response: Prolonged Fight-or-Flight
The stress response is a high energy state that most of us call “fight or flight”. It’s a normal thing, and actually good in small doses. What we generally call “stress” is a prolonged state of low grade fight-or-flight. We can’t thrive to the best of our potential if we’re stuck in low grade fight-or-flight. Instead we’re tired, cranky, and forgetful. We also have heightened senses, meaning that annoying sounds are really annoying and bright lights can seem blinding. Bad smells can seem nauseating, quick movements can make us gasp, and crowded places can be overwhelming.

Stress & Triggers
Triggers are also called stressors. The body perceives stressful situations in the form of triggers. Even without us knowing, the body can go into the fight-or-flight state as a result of a trigger. We’re not always aware that we’ve encountered a trigger. We may simply start feeling unwell and not understand why. If this occurs, take a moment to look at your surroundings. Was there a sound, a movement out of the corner of your eye, or an odour that may have triggered you? Are you in a place where something bad happened to you in the past? We all have triggers, they’re hard to avoid. When your system triggers, give yourself a moment to become aware. This awareness will decrease the intensity of what you’re feeling.  After being triggered, the nervous system must re-set back to a state of neutral (wound down mode). This is a process, and it’s common for the nervous system to remain in wound-up mode, especially if we’re unaware of what’s happened.

Trauma
Bad experiences are often called traumas, especially when they’re really bad experiences. The body’s response to a trauma is similar to its response to a trigger. The nervous system goes into a state of fight-or-flight, and hopefully gets the chance to re-set back to neutral after the trauma is over. If you suspect that your system never got a chance to re-set properly after a trauma, come in and talk to me about that. I can help. If you suspect that a past trauma is causing your system to trigger on a regular basis, I may be able to help you with that as well. Even when triggers happen on a small scale, they can affect our ability to function.

What to Expect After You’ve Experienced a Trigger
The nervous system will be in a state of fight-or-flight. You may notice a rush of adrenalin. You may feel an upward or downward movement in your stomach. Your senses will be heightened until your nervous system is able to re-set back to Neutral. If you’re at the grocery store the lights/colours will seem brighter, the smells stronger, the people moving faster than usual, and you’ll feel over-stimulated. Your muscles will be flexed, meaning your body will feel heavier and you won’t have the flexibility or balance that you’re used to having. If you already have pain somewhere in your body, it’s likely to flare up at this time. You’ll startle easily; you may gasp if a bird flies too close to you. Some people may get the sensation that there’s bugs crawling on them, or water trickling on their skin.

Places where something bad happened will be places that produce the largest triggers. If you find yourself triggered, remember that awareness is key. Until we can get the nervous system re-set back to neutral, awareness & understanding will make us better able to stay functional during the trigger response.

Use the Felt Sense To Keep Yourself Out of Panic Mode
The Felt Sense is different from our thoughts and emotions. It’s the body’s wave-like responses to our experiences. Examples of the Felt Sense are nausea or tingling. To better understand the Felt Sense, here are some descriptive words you can choose from:

“I Feel”:
Dense Thick Flowing Breathless Fluttery Nervous
Queasy Expanded Floating Heavy Tingly Electric
Fluid Numb Wooden Dizzy Full Congested
Spacey Trembly Twitchy Tight Hot Bubbly
Achy Wobbly Calm Suffocating Buzzy Energized
Tremulous Constricted Warm Knotted Icy Light
Blocked Hollow Cold Sweaty Streaming Disconnected

“Where?”
Upper abdomen Lower Abdomen Thigh(s) Feet Hands
Head Upper Back Mid Back Lower back Eyes Buttocks
Knee(s) Penis Vagina Testicles Urinary Tract Anus

Note: sensations are different from emotions and different from thoughts. Locate the sensation in your body.

Once You’ve Identified Your Felt Senses, Bring Your Awareness to Your 5 Senses.
Listen carefully, hear what’s going on around you.
Smell what’s around you.
See what’s around you. What colours stand out? What’s moving and what’s standing still? Focus on the things that are standing still.
Notice if you have any taste in your mouth, or if the mouth is moist or dry.
Feel the temperature of your environment and the air currents. Is there wind? Are you sweaty? Feel the fabric of the clothes you’re wearing.

For those of you who have severe stress and have experienced severe trauma, you’re well aware of how complex your stress responses are. I encourage you to look much farther than this document for insights and help. I’m really just scratching the surface here.

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Understanding Pain

Muscles can do quite a bit more than simply flex and release. They can become protectors. Unexplained pain is often because of some kind of past trauma, such as slipping on ice. Mental traumas, such as almost being hit by a car while walking across the street, can also cause pain. Repeated exposure to something while under stress can cause pain, such as wrist pain every time you go near a computer.

Think of muscles as having minds of their own. Your job is to convince your overly protective muscles that it’s safe to release the state of perpetual flexion and return to a state of neutral.

Stress Responses to Triggers Can Manifest as Body Pain
Triggers have also been called stressors. The body perceives stressful situations in the form of “triggers”. Even without us knowing, the body can be reacting to a trigger by going into fight or flight mode. When this occurs, the body must then re-set the nervous system so that it goes back into wound down mode. It is common for a nervous system to remain in wound up mode, which you could think of as the nervous system’s version of perpetual flexion.

We’re not always aware of when we’ve encountered a trigger. We may simply start feeling worse and not understand why. If this occurs, take a moment to look at your surroundings. Was there a sound, a movement out of the corner of your eye, or an odour that may have triggered you? Are you in a place where something bad happened to you in the past?

Central Sensitization: Nothing Medically or Structurally Wrong
This has also been called tension myositis syndrome and mind body syndrome. This is a reaction to a trigger.

Stretching is Putting Yourself in a Position and Letting the Muscles Work Themselves Out.
It’s important that you stretch properly, otherwise you could end up with more muscle pain and fatigue. Stretching requires patience. Breathing deeply helps greatly when stretching. Be very relaxed, like a rag doll. Relax into your stretch for at least 1 minute. I normally recommend body positions that my patients rest in for 5-10 minutes.

You don’t want to feel discomfort. Imagine your muscles to be like thick elastic bands; you don’t want to pull them too quickly, bounce them, or release them too quickly. If they bounce on their own, that’s probably fine. You want to stretch when you’re warm, not cold. You want to feel a comfortable stretch that feels refreshing. You’re looking for a small-medium stretch. If you notice the stretch getting too intense, ease yourself out of the position.

Don’t Make Your Joint Click or “Stretch Muscles Out”
It’s fine if a joint clicks. You may be used to hearing sounds coming from your neck, knees, or ankles for example. The body gives itself adjustments all the time, but that doesn’t mean you should be giving yourself adjustments. Self-adjustments tend to create more problems than they solve, even though we feel some immediate relief from them. Leave the adjustments up to the experts; your body and your chiropractor or osteopath.

Listen Carefully. Is your Body Saying No?
Just because someone tells you that a stretch or exercise routine is good for you doesn’t meant they’re correct. Listen to your body. Ask your therapist lots of questions to make sure you’re doing the right self care techniques for you.

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Food Sensitivities – What You Need To Know

The immune system is a complex system that is closely related to every other body system. Food sensitivities are commonly a result of inappropriate immune function. Of course, if there’s a dysfunction in the digestive system such as IBS, this can create reactions to some foods. For the purpose of this article, consider these kinds of food reactions to be in the category of digestive dysfunction.

If the immune system is reacting to a food that is regularly consumed, symptoms of this reaction can pop up in any body system. It really depends on a person’s weak spots. We all have our own weak spots; some examples are headaches, low energy, skin problems, digestive problems, weight gain or loss, and problems paying attention.

Food sensitivities are common, and when one or more are present, the body is susceptible to states of inflammation. When this occurs the body will not be able to reach a state of optimal balance until sensitivity-foods are eliminated from the diet. If the body is in a reactive state it will be using precious energy to produce inflammation. If we then think of energy as money, we realize how much we’re losing by failing to manage food sensitivities.

What Are the Most Common Foods to Be Sensitive To?
The most common foods I find on an IgG food sensitivity blood test are casein from cow’s milk, gluten, and egg white.
It is believed that food colourings and refined sugar tend to affect the nervous system primarily. This may be the reason that I don’t tend to see these showing up on the IgG blood test, which tests for immune system reactions. However just because they don’t show up on the IgG test doesn’t mean they aren’t a problem. Follow your instincts. In my experience, food reactions to refined sugar and food colourings tend to manifest as anxiety, depression, moodiness, or hyperactivity.
Currently the most effective way to determine food sensitivities seems the be complete elimination of suspected foods from the diet.

If You Are Sensitive To A Food, Elimination Won’t Always Be Easy
For most people, the most difficult part of food elimination is the social consequence.
For example, eating different foods on pizza day is difficult for a child. He or she may have to deal with comments like, “Your food looks wierd, what are you eating?”. Even the most confident kid can get tired of hearing “that looks wierd”. However, bear in mind that eliminating sensitivity-foods can have tremendous benefit for children, including a decrease in anxiety.
For an adult, a primary issue lies with making a fuss in front of other people. Many of us will end up eating an entire meal that contains a sensitivity-food, just because we can’t bring ourselves to say “Aunt Ruth, are there graham crumbs in this dessert? I guess you didn’t realize graham crumbs contain gluten. No problem.” Or, “Excuse me, are you sure this late was made with almond milk? It tastes like it has cow’s milk in it. Can you double-check please?”.
Bear in mind that if we choose to eat a food we’re sensitive to, we may not feel like ourselves for 4-5 days. If you find yourself particularly moody, weak, or tired during this time it’s probably part of the recovery process. The immune system is rebalancing.

The “Ignorance is Bliss” Factor
Over time the body does something called down-regulating. This means that, while it still expresses symptoms, we stop noticing them. Most people with food sensitivities end up in my office knowing something’s wrong but can’t identify exactly what. They just don’t feel like themselves. Reactions to sensitivity-foods tend not to happen immediately, I find that they happen 4-12 hours later. There is also a build-up effect, meaning that sometimes we notice a food reaction and sometimes we don’t. This can get quite confusing.
Think of food elimination as information gathering. If we discover our sensitivity-foods and eliminate them from the diet, we’ll feel better and have the opportunity to continue life as a more balanced and functional individual. Most of us find ourselves saying, “Wow, I didn’t even notice how miserable I was feeling. I feel so much better about myself now”.

Eliminating and Re-introducing Foods
The immune system needs time to rebalance, especially if we’ve been eating a sensitivity-food for years. An adult may need up to 8 weeks of elimination before s/he can get reliable information from the body via re-introduction.
When we re-introduce a food we want to be on the lookout for anything that looks like a symptom. Maybe we get tired. Maybe we’re more flatulent. Maybe we feel like we’re catching a cold. Maybe old symptoms return. Watch carefully and follow your instincts.

Don’t Eliminate Unless You Have To
The most common foods to cause immune-mediated sensitivities are important sources of nutrients. My opinion is that, in an ideal world, we’d all be able to eat these foods. Unfortunately for some of us, elimination of a food is necessary for our own version of optimal health.

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Vitamin D, Winter, and the Power of Moonlight

Vitamin D is a nutrient that’s commonly deficient in Canadians. It’s important for all body systems, including the immune system and nervous system.  We’re not likely to absorb enough vitamin D when we’re outside in the winter because we’re all bundled up. Many of my patients who have had their Vitamin D tested have been deficient. In my opinion, it’s a good idea to get vitamin D tested every fall. Vitamin D is a fat soluble vitamin, meaning you can do yourself harm by taking more than your body can handle. Be smart about your Vitamin D dosing, make sure you know exactly how much your body needs.

However, It’s Not All About Vitamin D.  Vitamin D has been nicknamed the “sunshine vitamin”. However Vitamin D does not equal sunshine and sunshine does not equal Vitamin D. An example of this is that sunlight exposure has been shown to boost serotonin levels. Serotonin is a neurotransmitter that helps us feel calm and happy. We can absorb serotonin through a window, but we can’t absorb Vitamin D through a window.

Sunshine does not equal outdoors either. Though it’s more difficult to be outdoors in the winter, it’s also more refreshing. Short spurts in the outdoors have more of an impact in the winter. Some of us will get sick if we’re out for too long, especially if it’s cold and damp out. However in my opinion, 10 minute intervals outdoors can actually strengthen most people’s immunity if we’re dressed for the weather, moving around, and keeping our feet dry.

Many of us miss the sun a lot during the winter because by the time we can get outdoors it’s dark. However, moonlight has its own mysterious powers. Though I can’t support this statement with research papers, I think if you pay enough attention, you’ll discover several health benefits of moonlight.

Getting outside will be uncomfortable at first, because it’s a little bit like doing a workout. The first few minutes are unpleasant, but we never regret doing it.  I challenge you to go out and discover the power of winter cold and the power of moonlight. Get some warm clothes that you love wearing and a really great pear of boots. Consider it “Vitamin Fun”.

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Inflammation and Type 2 Diabetes

Chronic low-grade inflammation is found in type 2 diabetes mellitus (T2DM), and this contributes to the development of T2DM and the associated complications of nerve, kidney, heart, brain, liver, and eye damage.  Interestingly, this inflammation is similar clinically and molecularly to the low-grade inflammation that comes with the ageing process. This process is sometimes referred to as inflammageing. This whole process of inflammation in T2DM is characterised by 4 components: long-term immune system activation, build-up of senescent cells, epigenetic changes, and changes in the intestinal microbiota.

Chronically high BG also leads to increased cellular senescence.  This is basically a state in which the cells are no longer undergoing normal cellular cycles and are not really alive and not really dead.  Consequently they have more DNA damage and seem to spread their senescence to other cells, almost like an infection.  More and more research is associating the accumulation of these cells with chronic and age-related diseases.  Fortunately these senescent cells, like many cancer cells, seem to depend on glucose to keep them alive which makes them susceptible to treatment with an appropriate diet and medical therapy.

A healthy immune system deals with challenges as they arise, increasing in activity when there is a foreign invader, and reducing activity when the challenge has been overcome. The high levels of blood glucose (BG), triglycerides, and “unhealthy” cholesterol found in T2DM lead to an inflammatory response by the immune system.  This process results in immune cells becoming senescent. This is essentially what happens in the  deterioration of the immune system that normally occurs with ageing.  This inflammatory reaction seems to be related to the degree of BG overload, which makes it possible to address by controlling the BG level. This is often done with medications but can also be done sustainably with a proper diet.  Glucose is not the only culprit though, saturated fatty acids (SFAs) produce pro-inflammatory immune responses which lead to insulin resistance as well.

Epigenetic changes are those in which the DNA sequence doesn’t change, but the expression of the genes coded by the DNA does.  DNA methylation is the process that affects the expression of a gene without changing the DNA. This process is influenced by external factors such as the environment, lifestyle, and nutrition. In T2DM the epigenetic changes appear to be mostly pro-inflammatory and the DNA methylation in the pancreas has a negative effect on insulin secretion.  Some of these epigenetic changes remain even after blood sugar levels return to normal, but DNA methylation changes may be reversible with diet, exercise, and weight control.

The connection between diet, the gut bacteria, and inflammation has been garnering more attention in recent years and this may have special relevance for individuals with T2DM.  Over time the balance of the gut bacteria, the microbiota, undergoes changes.  In people who have an imbalance or deficiency of healthy gut bacteria, leakage of bacteria and associated compounds across the gut membrane can occur and lead to chronic low-grade inflammation of the type that is associated with inflammageing. Studies on the microbiota of T2DM patients have found changes in the levels of specific species of bacteria in the gut that contribute to increased inflammation. This balance of gut bacteria can be influenced by factors such as artificial sweeteners, obesity, fiber intake, flavonoids, polyphenols, and supplementation with specific probiotics.

Current medical therapy for diabetes, which consist primarily in oral antihyperglycemic agents such as metformin, does not provide adequate reductions in heart disease and death rates in T2DM patients. Such therapy also does not adequately control the complications of chronically high BG levels.  A more effective and balanced approach should include dietary, lifestyle, and medical interventions that reduce inflammation and address the known mechanisms that result in T2DM and its complications.  Such an approach would rely on a low-carbohydrate or Mediterranean diet, regular strenuous exercise, and nutritional supplementation to mitigate the damaging effects of chronically high BG and the fluctuations in BG that occur when making diet and lifestyle changes.

References:

Prattichizzo F, De Nigris V, Spiga R, Mancuso E, La Sala L, Antonicelli R, Testa R, Procopio AD, Olivieri F, Ceriello A. Inflammageing and metaflammation: The yin and yang of type 2 diabetes. Ageing Res Rev. 2017 Oct 25. pii: S1568-1637(17)30178-2. doi:  0.1016/j.arr.2017.10.003. [Epub ahead of print] Review. PubMed PMID: 29081381.

Khullar M, Cheema BS, Raut SK. Emerging Evidence of Epigenetic Modifications in Vascular Complication of Diabetes. Front Endocrinol (Lausanne). 2017 Sep 29;8:237. doi: 10.3389/fendo.2017.00237. eCollection 2017. Review. PubMed PMID: 29085333; PubMed Central PMCID: PMC5649155.