BACK TO ASK THE HERBALIST INDEX

ANSWERS FROM LORYHL:
QUESTION: My husband is 48 years old and for the past 4 months has been having chest pressure and pain going down his left arm. Was put on diet and Doctors prescribed him Coreg CR for blood Pressure and GemFibrozil for cholesterol, and an aspirin.  Has been on that for 2 months now and still having the pain. He'll fell good most of the day and then eat supper and about an hour later every night the pain and pressure starts and lasts about 30 minutes. He's done good with the diet He was 204 and now he's 185. What Id like to now is The doctor is wanting to do the thing where they put something thru the vein to check for blockage. And we are not wanting to go that route, Can he take any herbs with the medicine he's on to help with what it sounds to me is Angina. Please help,

 ANSWER: Thank you for the inquiry. Here are some suggestions, and downloads for you to read:
- I suspect he has very poor digestion, and eats the wrong foods, at the wrong times, or foods that dont agree with him at all, he may be drinking with his meals as well, and also it may be caffeine he is drinking, liquids dilute his gastric juices, also he needs digestive enzymes to help digest the foods, such as Jarrow brand
- go to Amazon.com, and look up Food Combining, buy a good book on the subject, there are several, to choose from, this is very important. They figure, over 90% of heart attacks are caused by gas bubbling up into the chest  cavity, causing angina. Yes there could be blockages too, but it is all tied into diet, stress and predisposition, genetically, When we go down the road of the wrong foods for our blood, and body type, we help cause the problem, We have to find out what it is our body wants, and how to take care of it
- also order the book, on Eating Right for your Blood Type, and listen closely to that
- in the downloads, I am sending you, it is generic for most blood types, once you find out his, you can start, by editing the cleanse to suit him, it will work for him
- most importantly, combine his foods properly, he will feel better right away, and the right foods for him also
- give him, 1/4 c aloe vera juice before each meal
- order our Life Force Fiber Food, and our Soothe blend for the stomach, and our heart tonic, Ticker Tonic, use them as suggested
- give him 800 mg COQ10, 200 mg 4 times daily, with 1000 mg Ester C each time you give him the COQ10, this will ensure, his heart will not get damaged
- you must clear his bowel, and arteries, by cleansing, and allowing the oxygen, and clean blood to circulate in his body
             This is a start for you, and most of this you can start on right away, if you read the downloads and order what you need. (downloads: life force, castor oil, cleanse, oil pulling, gall bladder)

QUESTION: Is Butchers Broom a substitute for aspirin. I'm a heart patient and know that aspirin will cause bleeding. Looking for a good substitute. Thanks.

ANSWER: If you have heart conditions, then Butchers Broom, would not be a good substitute for you. It can cause high blood pressure in certain people, prone to heart or blood pressure issues. I suggest you use garlic, fish oils, vitamin C, astragalus, hawthorne berry, bilberry fruit. High fiber, like our Life Force Fiber Food blend. This has been proven to help keep arteries clear. These would be helpful, along with a healthy diet, less meat more veggies.

QUESTION:  I was just on your site. I have a brother that had a triple bypass at 35 years old. He has had 6 more over the years. He is now 51. 5 years ago I tried to get him to stop smoking and get him on some vitamins or herbs. In June he had a major blow. His main artery is closed and the doctors say there is nothing else they can do. Now they tell him to retire. He is on tons of medicine. He gets winded real easy. I've got him taking COQ10 and he switches back and forth on Fish Oil and Flaxseed Oil. Have you heard of Oral Chelation? I've read that would really help him or can you make another suggestion? Thank you for any help you can give.

ANSWER: There are so many things he can do to help himself.  Pur herbal heart tonic, is very good, with hawthorn and horse chestnut, and motherwort. Also make sure you give him , 600 - 800 mg pure COQ10 daily with 4000 mg of Ester C, also given throughout the day, when you give him the COQ10. Also the diet sheets, below with gall bladder flush, and healthy food, Use our Life Force Fiber Food, and Giver to My Liver, also. The cleanse and gall bladder flush will do more for him, than most anything I have ever seen. It is amazing, the body’s ability to regenerate, if we give it a chance. You can lead a horse to water, but you can’t make them drink, so it is up to him, to follow through, you can only do so much.

QUESTION:  What is a natural blood thinner?  And what can I use for pain in my knee?  I have been taking 3000 mg. of glucosamine.  It seems to help.

ANSWERS FROM KAREN MALLINGER
HYPOTENSION
QUESTION: I have recently had an episode of syncope and hypotension that landed me in an ER.  I was given two intravenous bags of fluid to push my blood pressure up to normal. At one point, BP was 60/27.  ER released me when they got it up to 90/47.   All tests since this episode have shown EKG is normal, BP is now 120/75, but am borderline anemic.  Diagnosis was loss of fluids due to menses – I’ve been having heavy flow and cramping for last 10 years.  I’m looking for more information on how to stay hydrated as I typically drink enough water.  I have eliminated caffeine and am currently on pharmaceutical grade iron tablets since the episode.  Did an ultrasound as doctors thought maybe internal bleeding, maybe enlarged fibroids in uterus.  Not so.  My uterus/fibroid situation has improved over last 10 years.  It has been suggested to me that either I need to ride this out until menopause (which could be 10 years away) or have a hysterectomy.  Not interested in surgery.  This scenario has happened infrequently through my adulthood.  This is the first time it landed me in an ER.  Prior to this occasion, an episode happened 7 months ago, and prior to that one, 2 years hence. My family has history of low blood pressure.  It never raised a medical eyebrow before this.  I would like to know what diet or herbal recommendations you can make to accomplish the following:  Keep myself hydrated;  Elevate my red blood cells – increase my iron;   Keep my blood pressure from plummeting

ANSWER: OK, Let's see. First you say you typically drink enough water. I'd be willing to be you don't. Unless you are drinking close to 2 gallons a day, you don't and if staying hydrated is a problem, then you need more than normal.  Iron can be supplemented by capsules or if you want to do it totally through diet, whole grain cereals, nuts, legumes, raisins, molasses, green leafy vegetables, especially spinach, lentils, kidney beans and dried fruits are all good sources for you. Iron absorption is hindered by tannic acid, so I wouldn't recommend coffee or tea within an hour of meals and probably best to give it up all together if you can. Vitamin C will help increase the absorption rate of iron from foods, but has no effect interestingly on iron supplements. Be aware if you take supplements, they will turn the stool dark black.  
To keep your blood pressure up, again, diet is going to be your best tactic. Increase your potassium. Dandelion  is excellent for this and is also a good source of Vitamin C. Also, hyssop, golden seal, vervain, prickly ash, blue cohosh, wood betony, burnet and skullcap may help increase your vitality.  Lastly, exercise is critical, so make sure you're getting at least 30 minutes every day. (That's right, forget the 3 times a week lie. Do it every day!)

HIGH BLOOD PRESSURE AND EDEMA
QUESTION: I have high blood pressure and edema. I am currently taking hydrochlorothiazide 25mg and trying to watch my diet. The edema ( swelling ankles) comes and goes. What herbal supplements and vitamins would be good for me to start using now.

ANSWER: You should be taking Vitamins A, C, E and selenium as a start. At least 2000 mg of Vitamin C. Also non-flushing niacin is good for the circulation and to help reduce cholesterol.
 As to how the herbs will interact with your medication, I can't say. You may want to speak to your pharmacist. I'm not aware of any contraindications, but am not an expert in pharmaceuticals.

HERBS FOR BLOOD PRESSURE AND CHOLESTEROL
QUESTION: My mother is having a terrible time being able to afford the costs of her prescriptions every month.  She is on high blood pressure medicine, plavix, cholesterol lowering meds., diuretics, etc.  She would love to go off her cholesterol medicine.  I would love for her to do plant sterols and garlic if she did but I am worried about the blood thinning properties.  My mother is stubborn and I know when she says she will quit something she will and I would like her to be on something rather than nothing.  Thank you

ANSWER: Hmmmmm. I had one of those mothers! As a diuretic, dandelion is my all time favorite. Green in salads, dried roots in tea. It's wonderful and won't deplete potassium stores. For cholesterol, many people are having amazing effects taking Niacin. Yep. Plain Niacin. Get the "Flush Free" type. Should be available at your local health food store. Buy a good brand, not generic so you know you're getting quality. Garlic is also good. I eat fresh garlic in almost everything. My husband's Italian, so I can get away with it! (Of course, I don't have many close friends!!! Just kidding!)
           Hawthorn is the best herb for the heart and a daily cup of cinnamon hawthorn tea will probably make your mom feel great. Best to start her on this regimen before she quits her meds. Also, as you're probably aware, that's very dangerous so if she's determined, try to find a doctor who will at least listen to her concerns and help her wean her body gently. I don't recommend cold turkey at all.

QUESTION: I wanted to know what's good for cardiovascular health,

ANSWER: My personal herb of choice for heart health is Hawthorn. It is the best all-around tonic herb for the heart. It may be used safely for heart weakness or failure, palpitations, angina pectoris and high blood pressure. Cayenne is also good for the heart, so if you like spicy foods, pour it on! I can make a special custom tea for you if you like. Go to www.allgoodegifts.com and in the Herb Shoppe under teas, you can select custom. In the comments section of the checkout, just put Heart Tonic Tea and I'll know what to do.

QUESTION: My wife Lisa has been diagnosed with DVT (Deep Vein Thrombosis).  She was in the hospital for a week in March 2004 where they gave her Haprin to thin her blood.  Now she's on Coumadin, but her leg still swell's up by the end of her day.   From what I understand, she still has the blood clot in her leg and from what I have researched the Coumadin will not dissolve the blood clot.   This is not the first time she's had a the blood clot.  She had one 18 yrs. ago and went through pretty much the same treatment.  The blood clot
went away then, but it's not going away now.  My wife is 47 yrs old. Is there a herbal formula to aid in dissolving blood clots??  We would prefer for her to take a natural formula medicine that be on Coumadin for
the rest of her life. Thank You for your time and effort.

ANSWER:  Cayenne(Capsicum), Butcher's Broom and Garlic are all helpful herbs for improved circulation and thinning the blood. Also, calcium and magnesium supplements will reduce clotting. Ginger, skullcap and valerian root will help to dilate the blood vessels and aid circulation. I can make a custom tea for your wife if you are interested.  Go to my website at www.allgoodegifts.com and in the Herb Shoppe under Teas, you will find personal Tea Blends. Select Custom from the drop down list and in the
shopping cart at checkout, put Thrombosis in the comments section.

QUESTION: About 2 years ago my sister was having chest pains and the doctor couldn't find
much wrong so he did a heart catheterization.  They found nothing wrong except for a small vein that they put a substance in to expand it because they thought that it had been to little from birth and needed to be larger.
After the treatment she had a terrible headache and it got worse as the evening went on. Finally she went to the hospital and they determined that she had had a small stroke.  Now she is on all kinds of medications.  Some for blood pressure, some for blood thinner, some for water retention.  You name it they put her on
it.  She realizes that these medications are killing her and she wants off of them. She asked
me if I knew a herbalist that she could ask the question, "Can I use herbs instead of medications?"  She is determined to get off of medications because she feels that one medication causes reason to take another, causes reason to take another and so forth.  We are from about 80 miles from Indianapolis, IN, 30 miles
from Terre Haute, IN.  our zip is 47833.  I so hope that you can help us.  I am so glad she is taking steps like these.

ANSWER: Your sister's right to want to get off all the medications. More and more we are seeing that modern medicine treats the symptoms and not the disease. Thereby keeping us dependent and sick.  I would not, however, recommend she stop taking her medications without the advice and guidance of a medical professional. It can be very dangerous, especially with the conditions you mentioned. I looked up Naturopathic Doctors in your neck of the woods and here's what I found:  

Marcia Prenguber, ND
CENTER FOR CANCER CARE
200 High Park Ave.
Goshen, IN  46526  
Phone: (574) 535-2961 Fax: (574) 535-2890
Email: mprengub@goshenhealth.com
Areas of Emphasis: Cancer, Family Practice, Homeopathy, Women's Health

I don't know how close she is to you, but perhaps she could refer you or even speak with you over the phone. There are many herbs for blood pressure, blood thinning and water retention. For Water retention, Cornsilk, Parsley leaves, Uva Ursi, Cleavers, Juniper berries, Queen of the Meadow root. For Blood Pressure, Buckwheat, garlic, gingko and hawthorn. For Blood thinning, Burdock, and gingko

QUESTION: I am a 42 yr. old woman.  I have been taking the drug inderal for 21 yrs. to control a rapid heartrate.  I have simple tachycardia, nothing life threatening.  I was wondering becasue of the cost of going to the Dr. for the prescription 2 times a year and the expense of the drug, if there was not an herb that might help with the rapid heartrate.  I have read that hawthorn is for some advantages for the heart, but am not sure if it would help with my specific problem.  At this time I am also trying guggul for slightly elevated cholesterol.  Do you have any suggestions for me?

ANSWER:  First, please don't even consider stopping your medication without speaking with your health professional. That can be extremely dangerous. If you can't talk to them about your concerns and desires to go to a more natural treatment, find a holistic practitioner.  The one herb that comes to mind immediately is Hawthorn. It is THE heart tonic herb and my research says it can be safely taken with heart medication. Though I encourage you to discuss that with your doctor. Other herbs to help heart health, particularly tachycardia, are: Motherwort, Oats, Passionflower and valerian.

ANSWERS FROM DAVID BRILL
WHITE CELL COUNT
QUESTION:  I have a 2.7 red cell count and a 1.7 white blood cell count   could you please tell me if there is a herb that could build these cell counts up?

ANSWER:  Herbs used in the past for this include:

Codonopsis also named Dang Shen, Latin Name Codonopsis Tangshen

Ligustrum Fruit also name Nu Zhen zi and Shiny Privet LatinName:    Ligustrum lucidum

Small amounts of Myrrh

Also a formula called Fu Zheng

POOR CIRCULATION
QUESTION:  I have poor circulation, to my hands in particular, which really aggravates the RSI (from keyboard/mouse overuse) I suffer from.  I have fairly low blood pressure and very low cholesterol levels, am not overweight and do a weekly yoga class.  Although I do admit to having a fairly highly strung personality. Are there any herbs you can recommend?  I currently take garlic, gingko biloba, cod liver oil and glucosomine with chondroitin.

ANSWER:  Herbs traditionally used for this issue and heart/circulation issues include:
Gingko
Cinnamon
Prickly Ash
Lycium
Dan shen
Ginger
Hawthorn

Stress can also cause constriction of blood vessels you may want to employ some adaptogen herbs, such as fresh oats, siberian ginseng, etc.


HEART PALPITATIONS
QUESTION:   I have read in Jethro Kloss "Back to Eden" first printing 1939 that Tansy was very good for Heart palpitations?  Is there any new herb recommendations for these symptoms?

ANSWER: Dang Qui, (Tangkuei,  Dong Quai), Latin Name:  Angelica sinesis
Fu ling, (Hoelen Fungus), Latin Name:   Poria cocos
Reishi mushrooms, Latin Name: Ganoderma lucidum
Bugleweed, Latin Name:  Lycopus virginicus
Hawthorn, Latin Name: Crataegus oxycanthoides, C. monogyna: this one is food for the heart and any heart conditions
Motherwort, Latin Name: Leonurus cardiaca for palpitations associated with anxitery, stress or female reproductive issues like menopause


HIGH CHOLESTEROL
QUESTION: 
I'm 51 and generally in good health - but I have high cholesterol levels.
I'm looking for natural treatments for this condition.
Is there a product available that combines the best herbs and vitamins without having to buy 15 different items?

ANSWER: I would start with diet, eliminate cholesterol and bad fat containing foods, increase daily fiber intake to 30 grams a day, this is a lot compared to today's normal diet.  Look for veggies and fruits which are crisp and make them part of the  mainstay of your foods, also supplement with bran and fiber from grains such as oats, pysllium seed, flax seed, etc.  Increase use of Garlic get as much in your daily diet as possible and supplement with the pills.  We also sell a great pickled garlic which two cloves a days would probably do you.  It tastes like candy to me.  Daily aerobic exercise lowers cholesterol levels get at least 20-30 minutes of fast walking in, up to an hour if possible.  Finally the supplement Niacin has been used effectively to lower cholesterol, start low and up dose, it can cause a skin flush for some.  Read the other answers here on the subject.

BLOOD THINNERS
QUESTION: I have a friend that wanted to know if there are any herbal blood thinners. The doctors want him to take Coumidin, but he'd rather take something natural. He takes garlic, gingko, green tea, multi vitamins. Do you have any recommendations?

ANSWER:  These herbs have been used to thin or move blood:

Angelica, Latin Named:  Angelica archangelica, A atropurpurea

Dan shen, Red Root Sage, Latin Named: Salvia miltiorrhiza

Dang Qui, Tangkuei,  Dong Quai, Latin Named:  Angelica sinesis

Gan jiang, Ginger, Latin Named:  Zingiberis officinalis

Garlic, Latin Named:   Allium sativum

Ginkgo, Latin Named: Ginkgo biloba

Gui pi,    Cinnamon (Chinese cinnamon not Ceylon), Latin Named: Cinnamonium cassia     

Mu dan pi, “cinnabar skin”, Tree Peony, Latin Named: Paeonia suffruticosa

Prickly Ash, Latin Name: Xanthoxylum americanum or  X. clava-herculis

Rue, Latin Named: Ruta graveolens

Sweet Melilot, Yellow or White Sweet Clover Latin Named:  Melilotus officinalis, M. alba

800 IU of Vitamin E a day can thin blood, up to 1200 if it does not cause hypertension for the individual.

Also increase parsley in the diet.

If you cannot find them locally we mailorder everyday all over the USA please call.  I would use a alcohol based extract as the form.

AORTIC STENOSIS
QUESTION: Interested in the above subject because it one of my Mom's problems. I found in a recent book entitled Miracle Food Cures from the Bible by Reese Dubin on page 97 the following information. He cites a Dr. Crawford R. Green of Troy, NY in an article from the Homeopathic Recorder in May 1908 regrding hawthorn: "Its action in valvular heart conditions is truly remarkable, whether the mitral or aortic area be affected. It seems to have positive power to dissolve valvular growths of calcareous or vegetative origin". In the same book, on page 103, in a 1969 study by a W. Starfinger, M.D., he states that 100 heart patients requiring continuous therapy were given the liquid extract (hawthorn) with fine results. "Marked subjective improvement was noted in patients with mitral stenosis"....

I have searched and search to no avail to find case studies reflecting positive influence of hawthorn on aortic stenosis, however, Mr. Dubin obviously was a better researcher than I will ever be. My intense interest is personal and a last resort type of solution to a major problem.  My Mom is 80 and surgical repair is not an option.

Can you provide any information regarding the effect of hawthorn on aortic stenosis?
Any information is greatly appreciated.

ANSWER: If she were my mother I would give her Hawthorn, Hawthorn is food for the heart.  Literally what is referred to as a tropho-restorative, meaning it can repair both structural and functional problems.  Since Hawthorn is a berry and considered a food herb, it is appropriately given for any heart or circulation problem.  I would suggest a fairly strong tincture or tea be given 3-4 times a day.   Additionally their is a solid extract available which would be eaten on cracker or spread on toast or simply consumed by ingesting 1/4 to 1/2 teaspoon a day. 

HERBS FOR THE HEART
QUESTION: My mother wants to know about any herbs that is good for circulatory problems of the heart? She is in her 50's and concerned. 

ANSWER:  Hawthorn is the answer read on...
Hawthorn, Latin named Crataegus oxycanthoides or C. monogyna, Hawthorn should be considered food for the heart. The berries of this flowering shrub/tree are incredible herbal medicine. Hawthorn berries, taken as a tea or tincture help the heart muscle pump stronger emptying the heart chambers completely and increase oxygen to the heart by nourishing the arteries within the heart muscle. This herb is considered an Amphoteric to the heart action. It will slow a fast beat, increase a slow beat or help the heart fill in missed beats, (i.e. arrhythmia or irregular heart rhythms). An Amphoterics herbal medicine normalizes function increasing hypo and lowering hyper conditions. Hawthorn can be used for all heart conditions or diseases. For congested heart failure it helps reduce edema and fluid buildup in the lungs by its actions on the heart. Hawthorn can also mildly lower hypertension (high blood pressure). It does this by lowering the bottom number in a blood pressure reading, the diastolic pressure, the resting pressure. This number has been normally considered the more important number. Hawthorn is a food herb and should be taken for a long period of time, years to prevent or stave off heart disease that runs in families and could be inherited. It can be used to support an already weakened heart after Myocardial Infarction (Heart Attack) or conditions leading or during Congested Heart Failure. Hawthorn can be taken for a long time and should be, when taken in tonic quantities. For conditions or diseases states that have occurred years before it can take 3 to 6 months or longer to see results. For immediate results consult with a qualified herbalist to try higher doses. Hawthorn should be considered a tonic and can safely be taken a long time for its best results. Solid extracts of Hawthorn are now available and are consumed like food, spread on toast in the morning for breakfast, these are concentrated herbal extracts of the berry. The down side to solid extracts are they are currently very expensive.

THORACIC OUTLET SYNDROME 
Question: My brother spent 6 hours in emergency yesterday with a heart problem
called 'Thoracic outlet syndrome', its been an ongoing problem and
climaxed with huge pain yesterday. One of his vessels across his heart
gets its circulation cut off which is impaired long enough to starve
muscles of oxygen. Any herbal help other than cayenne for him? 

Answer: 
The simple answer for your brother is Hawthorn. It is food for the heart.
           Hawthorn, Latin named Crataegus oxycanthoides or C. monogyna, Hawthorn should be considered food for the heart. The berries of this flowering shrub/tree are incredible herbal medicine. Hawthorn berries, taken as a tea or tincture help the heart muscle pump stronger emptying the heart chambers completely and increase oxygen to the heart by nourishing the arteries within the heart muscle. This herb is considered an amphoteric to the heart action. It will slow a fast beat, increase a slow beat or help the heart fill in missed beats, (i.e. arrhythmia or irregular heart rhythms). An amphoterics herbal medicine normalizes function increasing hypo and lowering hyper conditions. Hawthorn can be used for all heart conditions or diseases. For congested heart failure it helps reduce edema and fluid buildup in the lungs by its actions on the heart. Hawthorn can also mildly lower hypertension (high blood pressure). It does this by lowering the bottom number in a blood pressure reading, the diastolic pressure, the resting pressure. This number has been normally considered the more important number to reduce. Hawthorn is a food herb and should be taken for a long period of time, years to prevent or stave off heart disease that runs in families and could be inherited. It can be used to support an already weakened heart after Myocardial Infarction (Heart Attack) or conditions leading to it and additionally during Congested Heart Failure. Hawthorn can be taken for a long time and should be, when taken in tonic quantities. For conditions or disease states that have occurred years before; it may take 3 to 6 months or longer to see results. For immediate results consult with a qualified herbalist to try higher doses. Hawthorne should be considered a tonic and can safely be taken a long time for its best results. Solid extracts of Hawthorn are now available and are consumed like food, spread on toast in the morning for breakfast. The tinctures and extracts on the markets today are concentrated herbal extracts of the berry, flower and/or leaf.
        He should also try Garlic get as much in daily diet as possible. He should stink like Garlic. Garlic, Latin named Allium sativum, should be considered a designer drug for heart disease and the associated risk factors. Today's scientists couldn't improve on Garlic's perfect properties. Daily use of Garlic in the diet; adding it to foods, eating it fresh or ingesting it as a nutritional dietary supplement is associated as a panacea to heart disease. Garlic use is associated with the prevention and correction of cardiovascular disease and; it additionally effects cholesterol levels by raising the protective high-density lipoproteins (HDLs) and at the same time lowering the bad low-density lipoproteins (LDLs). Garlic also lowers another bad blood fat called triglycerides. Finally Garlic has a slight ability to lower hypertension (high blood pressure). In today's modern world scientific testing continues to prove Garlic's medicinal health benefits by showing that Garlic elevates an enzyme found in the liver that helps to detoxify carcinogens (cancer causing chemicals) that have been ingested or which come in contact with the body through other methods such as breathing polluted air. Garlic evidence has also been found which suggests the reduction of some types of cancers with regular use and when used in medicinal quantities Garlic increases T-cells and helper T-cells ratios in the blood. These cells are part of the body's natural defense system destroying and scavenging foreign bodies and cancers cells.
         In addition to all this Garlic is truly a natural antibiotic and works against many micro-organisms including bacteria, viruses and fungus infections. The immediate introduction of plenty of Garlic into the diet helps reduce duration of colds and flues. You need to smell like Garlic. Many have been know to consume freshly crushed whole cloves every hour or two during the first days of a cold. Let the crushed Garlic set 15 minutes or so to increase potency.

More information: 
What is the thoracic outlet syndrome? 
         Thoracic outlet syndrome is a condition whereby symptoms are produced from compression of nerves or blood vessels, or both, because of an inadequate passageway through an area (thoracic outlet) between the base of the neck and the armpit. The thoracic outlet is limited by muscle, bone, and other tissues. Any condition which results in enlargement or movement of the tissues of or near the thoracic outlet can cause the thoracic outlet syndrome. These conditions include muscle enlargement, injuries, an extra rib from the neck at birth (cervical rib), and tumors at the top of the lung (rare). Often no specific cause is found. 
        It is felt by some researchers that the evolution of the torso of primates from a four-legged to a two-legged position may predispose humans to the development of thoracic outlet syndrome. The resulting vertical posture produced flattening of the chest cage and a shift of the shoulder joint backwards, both of which narrowed the thoracic outlet.
        What are symptoms of thoracic outlet syndrome? 
        Symptoms include neck, shoulder, and arm pain, numbness, or impaired circulation to the extremities (causing discoloration). Often symptoms are reproduced when the arm is positioned above the shoulder or extended. Patients can have a wide spectrum of symptoms from mild and intermittent, to severe and constant. Pains can extend to the fingers and hands, causing weakness. 
          How is thoracic outlet syndrome diagnosed? 
          The diagnosis is suggested by the symptoms and supported by findings of the doctor during the examination. Certain maneuvers of the arm and neck can produce symptoms and blood vessel "pinching" causing a loss of pulse. Further supportive testing can include electrical tests, such as EMG and somatosensory evoked responses (although these may not be positive in all patients). Some patients can have angiogram x-ray tests that demonstrate the pinched area of the blood vessel involved. 
       What is the treatment for thoracic outlet syndrome
         Treatment of the thoracic outlet syndrome can usually be conservative and involve a variety of exercises which effectively stretch open the tissues of the thoracic outlet. These are done with and without weights in the hands to pull the outlet into a "relaxed" open position. Physical therapists are specially trained in the instruction of exercises for the thoracic outlet syndrome. Shoulder shrug exercises and others can be done at home or at work to relax the muscles around the thoracic outlet. 
         Patients should avoid prolonged positions with their arms held out or overhead. It is also helpful to have rest periods at work to minimize fatigue. Weight reduction can be helpful for obese patients. Patients should avoid sleeping on your stomach with their arms above the head. They should also not repetitively lift heavy objects. 
         Some patients with severe, resistant symptoms can require surgical operations to open the thoracic outlet. These include removal (resection) of the first rib in order to spare the affected nerve and blood vessels from ongoing compression.