The migraine headache is perhaps the best-known special type of headache. It is really called the migraine syndrome. By syndrome, we mean that many things accompany the headache – all of them bad. Symptoms include dizziness, visual problems, and spots before the eyes, redness, and swelling, tearing of the eyes, muscle contraction, irritability, nausea, vomiting, constipation, or diarrhea.
These symptoms often arise before the headache hits. The headache itself may last for a few minutes to a few days, and the severity may range from minor discomfort to immobilizing agony. The migraine pain is most common in the temple, but it may be experienced anywhere in the head, face and neck.
Approximately 28 million Americans suffer from migraines, and millions go without treatment. Scientists once thought migraines were caused by abnormally dilated or enlarged blood vessels. Now, new imaging devices have allowed them to watch brains during migraine attacks, and scientists are discovering that sufferers have abnormally excitable neurons or brain nerve cells.
The latest migraine research has yielded a mechanism called cortical spreading depression, or CSD. Prior to the onset of pain in a migraine, researchers have observed a sudden burst of brain activity that occurs most commonly in the occipital lobes (back part of the brain). The occipital lobe will becomes very active and then there is an episode of silence or depressed activity. The resulting pain comes from either the brain stem activation or from blood vessels inflamed by rapidly exchanging blood flow – or both.
I take a different approach to the treatment and prevention of headaches and migraines. After a thorough neurological examination, I determine which part of the nervous system is not functioning properly. In many headache and migraine patients, I may find a elevated midbrain (mesencephalic) activity. There are three parts to the brain stem: top, middle, and lower. The mesencephalon is the top part of the brain stem. A high output of the mesencephalon will cause an increased pulse and heart rate, inability to sleep or waking up easily, increased warmth or sweating, and sensitivity to light.
The bottom line is that migraines are a symptom of underlying dysfunction in your body. We need to identify the cause(s) that may be coming from your nervous system, biochemistry, lifestyle, etc. and make significant changes so these headaches don’t plague you for the rest of your life.
I see so many patients that go to their doctor or neurologist and end up getting these diagnostic tersts. It is important to rule out the worst, so MRI and MRA are performed and are commonly normal in most migraine patients.
That’s good news and bad news. Good because your brain and arteries are structurally normal, bad because it doesn’t help to get to the bottom of your problem. Migraines are usually FUNCTIONAL problems, not structural ones.
We need to look at how your nervous system and metabolism are working functionally to figure out what to do!
An autoimmune condition is where your immune system is attacking a part of your body, and in your case, it is most likely attacking multiple systems in your body including your thyroid gland, adrenal gland, nerves, joints and muscles. This could be why you suffer with migraines.
Let’s start with your thyroid, because it controls ALL OF your body’s metabolism, and the #1 cause of low thyroid in the U.S. is a condition known as Hashimoto’s thyroiditis (aka. autoimmune thyroid). Your immune system is attacking and killing your thyroid. You don’t have just a “thyroid” problem; you have an “immune” problem! Unfortunately, thyroid hormones do nothing for this autoimmune attack. You will continue to lose more and more of your thyroid by taking the medications. It is a slow, progressive, downward slide.
So the problem isn’t just your thyroid if you are fatigued or your adrenal glands if you are not sleeping, or your joints, nerves and muscles if you are in pain: it is your immune system. You have an immune system problem, and you need to heal your immune system to reduce the inflammation in your body that can be causing your headaches.
I have treated thousands of migraine patients over the years and I have seen a large correlation between migraine headaches and thyroid dysfunction. Your thyroid controls your body’s metabolism–IT HAS TO BE INVOLVED!
Most likely, your doctor has only ordered only two thyroid tests, TSH (Thyroid Stimulating Hormone) and Free T4. From your doctor’s perspective, if your TSH level is within that very wide lab range of .35 to 5.0, there’s nothing wrong with your thyroid function. BUT—and this is a HUGE “BUT”—the OPTIMAL LEVEL or “functional level” for TSH is 1.8 to 2.5. So you could still be “normal” in the medical doctor’s eyes but abnormal in the functional or optimal range. It’s only when that range is above 5.0 that most doctors will put you on a thyroid hormone such as Synthroid or the generic, levothyroxine.
There are many other tests that need to be run for the thyroid and the related adrenal system, and we will get those done for you.
How do you know if you’re autoimmune? How do you know if your immune system is attacking your body? Well… we just talked about the fact that we can run tests on your thyroid, specifically anti thyroid antibodies, to see if your immune system is attacking it. The reality is…most people already know that they’re autoimmune just from the fact that they may already suffer from a current autoimmune disorder, such as psoriasis, rheumatoid arthritis, ulcerative colitis, Sjogren’s syndrome, celiac disease, scleroderma, and/or lupus.
Another way that people will know if they’re autoimmune is that their symptoms may wax and wane. Symptoms that wax and wane are a sign that you are suffering from an autoimmune condition.
The third way to know if someone is autoimmune is that they will come in with a basket of supplements–I mean a truck-load. I’ve had people bring in so many bottles of supplements it wasn’t funny. In many cases, the supplements that they are taking were actually making them worse!
Number four…their life has been a struggle since they got sick. They’ve been to 8, 12 or 15 different doctors and they have a stack of medical records sky-high, all because of an undiagnosed autoimmune condition.
One of the most common questions I get is… “How did I develop this autoimmune condition?” Well… it’s pretty much genetics and the environment. It’s a matter of which came first, the chicken or the egg? We all know that genetically, you may be at risk for developing certain problems and/or conditions.
Then there are environmental factors, one of them being chemicals such as cigarette smoke. There are over 519 chemicals in cigarettes. Here are just a few of them…
TSNAs: Tobacco-specific Nitrosamines (TSNAs) are known to be some of the most potent carcinogens present in smokeless tobacco, snuff and tobacco smoke.
Benzene: Benzene can be found in pesticides and gasoline. It is present in high levels in cigarette smoke and accounts for half of all human exposure to this hazardous chemical.
Pesticides: Pesticides are used on our lawns and gardens, and inhaled into our lungs via cigarette smoke.
Formaldehyde: Formaldehyde is a chemical used to preserve dead bodies and is responsible for some of the nose, throat and eye irritation smokers experience when breathing in cigarette smoke.
So chemicals in general can trigger an autoimmune response, like the latest chemical that’s hit the news…BPA. This is a very nasty chemical called bisphenol A. It’s used in a lot of plastics, and BPA is extremely bad for thyroid health; it can trigger Hashimoto’s Thyroiditis aka autoimmune thyroid.
Rocket fuel is another! You heard that correctly; I said rocket fuel! You may ask… “How am I exposed to rocket fuel?” Studies have shown that 30 to 40 percent of women in America have remnants of rocket fuel in their body. It gets into the ground water and it stays there for a very long time.
Another chemical that people are affected by comes from dry cleaning fluid! It is in the water from so much illegal dumping.
One of the biggest triggers for an autoimmune thyroid is iodine. When it comes to Hashimoto’s autoimmune thyroid, iodine is probably THE BIGGEST trigger!
Chemicals such as pesticides can trigger an autoimmune response as can toxins in household products like DEET in insect sprays or heavy metals in vaccines.
Many female patients who suffer with migraines have related to me that their migraines began about the time they hit puberty, when massive hormonal changes were taking place in their body.
Prolactin is a hormone that’s made by your pituitary gland. High levels of prolactin suppress TSH or Thyroid-Stimulating Hormone. Prolactin is balanced by progesterone and dopamine, so when people have a dopamine deficiency, or progesterone deficiency, their prolactin will increase, and that will decrease the function of the pituitary’s production of thyroid-stimulating hormone. Remember when I stated the thyroid controls ALL of your body’s metabolism?
The imbalance will show up on your labs, if you’re lucky, as the TSH is low, but not quite out of the reference range. This is why it’s important to know that there are “optimal” or “functional” levels. .
Prolactin also suppresses luteinizing hormone (LH) in women. Excess prolactin can cause infertility. In men, excess prolactin depresses testosterone so they have low libido. High prolactin can cause tumors that are called prolactinomas.
Another common female hormone disorder is PCOS, or Polycystic Ovarian Syndrome. It affects 5-10 percent of menstruating women, and it is one of the most common causes of infertility. PCOS symptoms include the inability to lose weight, hair loss, and fatigue after meals, hormone imbalances, and sugar cravings.
Using blood chemistry tests, PCOS can be identified by insulin resistance. Again, insulin resistance (pre-diabetes) is a blood glucose level from 100-126. This is a fasting blood glucose level. PCOS is also indicated by elevated triglycerides and cholesterol, especially IF THE TRIGLYCERIDES ARE HIGHER THAN THE CHOLESTROL LEVELS.
Insulin resistance is a condition in which the body cells become resistant to insulin due to a high-carbohydrate diet, which leads to excess testosterone production, and this leads to Polycystic Ovarian Syndrome. As testosterone levels rise, the cells become further resistant to insulin, and it’s a slow downward spiral. Cell resistance to insulin in turn promotes testosterone elevation, which continues that downward spiral.
Insulin resistance also promotes inflammation and immune system problems, which predispose the person to an autoimmune disease. You factor in all of this with Hashimoto’s, and, now, can you see why it’s important to address Polycystic Ovarian Syndrome (PCOS) when addressing migraines?
The bottom line is that excess levels of any hormone can cause migraines in both men and women!
Anemia is another causative factor. Anemia in and of itself is a deal-breaker for nutritional support of any kind, including migraine support, since anemia literally starves your body of oxygen.
Oxygen is very important in healing your body. Your brain and nervous system need two things to survive: fuel and activation. Fuel comes in the form of oxygen and glucose. When you deprive your body of oxygen, you deprive your red blood cells (RBCs) of oxygen. The basic function of the RBCs is to maintain, regenerate and heal the body. With low oxygen in your RBCs, the body simply cannot operate adequately!
From a medical standpoint, normal blood glucose levels have a broad range of 70 to 100, while functional or optimal blood glucose level ranges are 75 to 85. According to the American Diabetic Association, a blood sugar level reading of 106 to 126 is termed “insulin resistance” or “pre-diabetes,” and anything above a reading of 127 is diabetes.
Supporting migraine headaches nutritionally is futile if your blood sugar level is too high or too low.
A reading below 70 is termed hypoglycemia and a reading above 99 is termed hyperglycemia. This altered blood sugar level is called dysglycemia, and this is a stepping-stone to diabetes. Hypoglycemia is a condition in which the blood sugar level repeatedly drops too low in response to high carbohydrate foods. Refined sugar is a good example of a high carbohydrate food. Hypoglycemia can also be a result of going too long without eating: too many Americans skip breakfast.
If your blood sugar is below 70, it’s important that you eat every two to three hours. You should have a breakfast, a snack, lunch, a snack, dinner and a light snack before bedtime. The snack can be vegetables, fruit, nuts, and/or seeds but it SHOULD be something healthy.
Insulin resistance is high blood sugar that hasn’t yet reached the point of diabetes. It’s called “pre-diabetes” and is a result of your cells becoming resistant to insulin, so that no glucose can enter the cell to make energy. Getting glucose into your cells is a vital, important part of life. Your brain and nervous system need two things to survive: fuel and activation. Fuel is oxygen and glucose. You see, glucose travels in the blood stream until it’s turned into triglycerides for fat storage.
As I have mentioned previously in other secrets, brain dysfunction is the cause of migraine headaches!
Your brain needs two things to survive: fuel and activation.
Fuel is glucose and oxygen, which is why we use Exercise With Oxygen Therapy (EWOT) in our office. We have addressed the glucose end of the equation: now let’s address the importance of oxygen.
As you age, your ability to utilize oxygen decreases by one percent per year each year after the age of 25. If you are 50 years old, you’ve lost 25 percent of your ability to utilize oxygen in your body. This is called oxidative phosphorylation, which is a big fancy three-dollar term meaning you’re not using oxygen as well as you did when you were younger.
Please be aware of what’s happening to your body because once you start asking other doctors WHY you’re taking all of the medications that they have prescribed for you, they’re going to look at you like you’re crazy! They will tell you that you have a psychosomatic illness, which means to them… “it’s all in your head” and the only thing you need is an antidepressant.
The biggest influence on serotonin is blood sugar. If you’re hypoglycemic, insulin-resistant, or diabetic, it is vitally important that you maintain your blood sugar levels within an optimal range. This is why it’s important to eat healthy. Don’t skip meals. Quit eating junk food! Every time you eat junk food you are literally eating away at your body and you’re making your migraines worse.
Gluten is one of the biggest culprits involved in migraines and autoimmune conditions that I see in my office. That’s why it is EXTREMELY important to be tested properly for gluten sensitivity. If you are sensitive to gluten, casein (in milk), soy, corn or eggs, consuming them could cause inflammation which could increase your migraine frequency.
Gluten is the protein in wheat, barley, rye and oats. The reason that so many people across the country are gluten-sensitive is that we’ve been eating genetically-engineered wheat since the late 1940’s. Our bodies were not made to eat genetically-engineered wheat or synthetic chemicals, and that’s exactly what we are consuming!
In order for you to be healthy, one of the best things that you can do is to avoid gluten. If you are sensitive to gluten, it can cause your immune system to attack your body, whether it’s your thyroid, your joints, your pancreas, whatever.
There has yet to be an autoimmune patient walk into my office that is not gluten-sensitive, and they could very well be sensitive to dairy, egg, soy and yeast too!
You always seem to hear in the news that there’s some new vitamin to consider or new deficiency to worry about, but when it comes to migraines – it’s very important that patients are taking Vitamin D to help their immune system.
Modern diets are lacking in Vitamin D rich foods. What are Vitamin D rich foods? Liver, organ meats, lard, many forms of seafood, butter and egg yolks (remember what I said about eating eggs for breakfast and how important it is in your blood glucose level?).
Sunlight is another important factor and source of Vitamin D. BUT, you should NEVER take Vitamin D without having your Vitamin D levels tested, specifically, 25 OHD and 1,25 OHD. Most doctors will only test 25 OHD but it is very important to have both levels tested. This way, you are eliminating the guess work. You could be low in Vitamin D or on the low side of normal; either finding would constitute a different recommended dosage.
Many women suffering from migraines trace it back to hormone problems. Healthy hormone production depends on Essential Fatty Acids (EFA’s). You’ve probably heard about these nutrients; fish oil, flaxseed oil, evening primrose oil, blackcurrant seed oil.
In our diets, EFA’s can be found in cold-water fish and in many raw, unprocessed nuts and seeds. EFA’s not only contribute nutrients for hormones but also for proper cellular communication, brain function and much more.
The ideal ratio between Omega 6 and Omega 3 fats in EFA’s is estimated to be from 3 to 1 up to 5 to 1. In the average American diet or S.A.D. (Standard American Diet), the ratio is more like 25 to 1, thanks to junk-food diets that are loaded with vegetable oil. You need to take a well-rounded, fish-oil-based, high potency EFA supplement if you intend to be healthy.
If you’re insulin-resistant, it causes a condition in which the body cannot properly metabolize the EFA’s in flax, evening primrose or black currant seed oils. This is why fish oil is the predominant recommendation. Essential fatty acid deficiencies are so common in the United States it’s estimated that up to 80 percent of the U.S. population failed to get enough essential fatty acids each day thanks to our Standard American Diet (SAD).
It’s because our diet is so filled with junk: high fat, high salt, high sugar or high refined sugar. I had a patient come in one time, and she was drinking 12 cans of diet Mountain Dew a day! I told her if she wanted to become my patient she would need to stop drinking the diet Mountain Dew immediately. She did and went through withdrawal symptoms for a week.
If you’re serious about getting healthy and you’re serious about correcting your fibromyalgia, you need to change your diet You need to eat healthy; you need to eliminate junk food; you need to be taking essential fatty acids, especially fish oil based essential fatty acids, and especially high-quality fish-oil-based essential fatty acids.
How do you know if you have high quality essential fatty acids? Well, consider more than price: if you cut one of your fish oil capsules and you put it in the freezer and it freezes – that’s not good. Oil should not freeze.
Your adrenal glands make a hormone called “cortisol”. They sit atop your kidneys and they are your stress glands. They make a lot of hormones for your body in addition to cortisol, such as aldosterone and androgens. Your adrenal glands are vital for optimal health. When your adrenal glands are not working, it causes high levels of cortisol in your system, and this is why you still have symptoms, even when your other lab tests may be normal. Cortisol is one of the main factors that regulate your blood sugar level, not insulin. Everybody thinks it’s insulin, but it’s actually cortisol. When cortisol is released by your adrenal glands, it’s accompanied by cytokines.
Your adrenal glands make cortisol in response to a stress, whether it’s physical, chemical, or emotional stress. And cortisol also promotes inflammation, which makes your adrenal glands pump out more cortisol. As cortisol is released, the cytokines come out along with it and suppress your pituitary. There are common causes of elevated cortisol, some of them being chronic stress, post-traumatic stress disorder, or hidden gut infections, such as parasites. You’d be surprised how many people have parasitic infections. Other causes of elevated levels of cortisol include blood sugar dysregulation, high or low blood sugar, hypoglycemia, insulin resistance, and diabetes.
You need to make sure that your blood sugar level is stable. And you need to understand that, when you have these problems, when your blood sugar level is going up or down so are your cortisol levels, which means your cytokines are going up and down, which means there is inflammation throughout your body.
Remember, there are several types of blood sugar problems–not just diabetes, but also hypoglycemia, low blood sugar, and insulin resistance. Hypoglycemia is a blood sugar level of 85 or lower. Insulin resistance is a fasting blood sugar of 100-126. Diabetes is a fasting blood sugar level of 127 or higher.
Be aware, if your stress levels are high, your adrenal glands are going to pump hard, and cortisol levels are going to increase. Cytokine levels are going to increase, and it will cause massive inflammation. High cortisol will sabotage your attempt to combat your migraines.
If you are suffering with adrenal fatigue, you need to avoid refined sugar, alcohol, and caffeine because these are high stressors to your immune system. And don’t think you can get away with eating aspartame or MSG because these are the worst things you could do for your adrenal glands!
There is a new field in genetics called epigenetics and MTHFR is a gene ‘mutation’ that has been linked to headaches. the good news is that, unlike most genetic problems that are permananent, MTHFR can be treated! (It can actually be compensated for through diet and nutrition.)
You may have heard of MTHFR, but now we need to get you tested! http://www.ncbi.nlm.nih.gov/pubmed/22375693
Gut function is extremely important, and can be affected by something called “Leaky Gut Syndrome” (LGS). You may or may not have heard of it. Leaky Gut Syndrome is where the lining of your intestines has become more permeable, so it allows things like food particles and large molecules to permeate your system and create havoc with your immune system. For gut function, it’s also important to be tested for parasites. Many people suffer from parasites and don’t know it.
Some people who suffer with migraine headaches also suffer from irritable bowel syndrome (IBS). They have problems with constipation or diarrhea, or both. Repairing your gut begins at the plate. Chronic inflammation is caused by poor diet. When you have increased intestinal permeability, another name for LGS, you will also have chronic inflammation, because a healthy GI tract is a tightly woven mesh of tissue that does not allow the absorption of bacteria, harmful foods, or undigested particles in the bloodstream. When you’re suffering from Leaky Gut Syndrome, this is exactly what’s happening.
Once in the bloodstream, these particles are recognized as foreign invaders or antigens, which the immune system attacks. And, unfortunately for many people, especially those with insulin resistance, this response happens almost every time they eat, resulting in chronic inflammation or irritable bowel syndrome. This sets the stage for development of an autoimmune disease.
So the first step in repairing the gut is to remove the foods that are creating a chronic immune response: gluten, soy, milk, egg, yeast. And then it’s important to heal your body. And you can heal your body with a 4R colon program, which means removing or eliminating problems – gluten, milk, soy, yeast, or parasites – inoculating, and using a probiotic. On a 4R colon program you replace specific enzymes to repair your gut and utilize specific neurological compounds. This is why it’s important to have healthy gut function in regards to treating your migraine headaches.
Believing that all of your lab results are ‘normal’ is WRONG! I can’t tell you how many times a patient walks in my office and tells me that their medical doctor told them that all their labs are normal. Yes, they may be normal in regards to lab values, but not in regards to optimal or functional values. Remember that I said the lab value for TSH is .35-5.0? And the optimal level or functional level is 1.8-3.0? This is a huge trap that many patients fall into and they have to avoid. They believe that all of the correct tests have been done, and that all of those tests are normal, just like their MD said they were.
The truth is that functional testing has not been done. You need specific lab tests. You need a complete metabolic panel. You need a lipid panel. You need a complete thyroid panel that includes seven or eight thyroid tests. And you need a CBC with auto-differential. We can go deeper and deeper if necessary.
So it’s important that all the tests are run. Don’t get into the false belief that everything possible has been done—if you do, then you’ve missed the point and you will stop searching for answers and information that will help you.
Do not accept “migraines” as a label for all of your symptoms. There’s no simple explanation for why you have this problem. That’s why ALL of the testing needs to be done. When you were first diagnosed with migraine headaches, you might have been happy to finally have somebody or some doctor call it, or name it, or put it in a box. Worse yet, you might have thought that you had a brain tumor because the pain was so bad!
It’s scary to have symptoms that nobody can explain—it leads your mind to worry. But don’t accept the label for all your symptoms. Remember, ALL of the tests need to be done. If you’ve been diagnosed with migraine headaches, realize that there are things that can be done to help you! There are answers out there. The key is–you need to be tested thoroughly. You need to be tested, correctly treated and retested. THAT is the only way you will achieve health!
Are you relying solely on medication to treat your symptoms? The “migraine medication,” Topamax, isn’t a migraine medication at all! It is an anti-seizure medication or an epilepsy drug. The same holds true for Neurontin. Ask yourself if you really think all of the medications that you’re taking are actually making your body functional or healthy. Is it really fixing your symptoms? Think about this: If you gave the medication that you’re taking to a healthy person, would they remain healthy or would they become sick? They would become sick! ALL medications have side effects
All you’re doing with medications is covering up symptoms. You’re also creating unwanted side effects, which may in the long run make you worse. I can’t tell you how many people I’ve seen in their eighties who started off with one or two medications in their thirties, ended up with four or five medications in their fifties, and now in their eighties, they’re taking thirteen to fifteen medications.
Don’t think that you need a medication to be healthy. And don’t get me wrong; I’m not saying to stop taking your medications this minute. But…as we test you and we’re treating you and we’re retesting you, you’re bound to improve, and, eventually, you can go back to your medical doctor, and you can ask him to take you off of these medications or decrease the dosage.
We want to work at getting to the cause of your problem. We want to reverse your symptoms. We want to get the root cause and get the problem taken care of at the very beginning.
No one is responsible for your health but YOU! Take your health care into your own hands! We’re trained to believe that medical doctors know best, and what the doctor says is the best thing for me. It’s true, medical doctors are doctors; they treat people, they want to help people, but the reality is just writing a script and throwing a medication at a person isn’t actually treating the patient and it isn’t in the best interest of the patient. Proper testing must be done.
With something as complex as migraine headaches, you have to literally grab the bull by the horns and take charge. It’s your life. It’s your body. What are you going to do for the next 30-40 years? Are you going to accept the status quo and continue to push from MD to MD only to find out that they have no answer for you? It’s up to you. Nobody is going to care about you more than you. You need to take action. You need to get the testing done. You need a thorough work-up. Nothing else is going to help you eliminate migraine headaches more than the proper testing and treatment.
Take action! Do not think it’s going to get better on its own. See, many people think that once they’re taking medication, their problem isn’t going to get any worse or there’s nothing to worry about. And this isn’t true. The reality is you’re either getting better or you’re getting worse – you’re not staying the same.
So if you sit and wait around for it to just go away on its own or you sit and think that you can’t do anything and that’ll you be just fine, you’re falling into a deep, dark well. Avoid this type of thinking at all costs. Remember to get tested, treated, and retested functionally or optimally. Remember that MDs use lab values that are extremely broad and wide. And you want lab values that are much narrower, those optimal or functional levels. Once you get properly tested and treated, then, and only then, will your symptoms go away.
Find a doctor who treats you as a whole person and utilizes complete functional neurological and metabolic protocols. You see, a functional problem can’t be treated like an acute situation. Medical doctors are great at treating acute health conditions: a broken bone, a heart attack, a stroke. But when it comes to chronic conditions, functional conditions, they are lost in a lost world.
You need a doctor who takes a step back, and looks at the big picture and does thorough testing and treats you based on that testing. You need to take control of your own health. Now that I’ve given you all of this knowledge, and explained to you that we are the office that can provide you with the functional testing and treatment, neurologically and metabolically, we invite you to call our office. We are known worldwide for our work with chronic conditions. Our care is designed to avoid all those treatment traps and help patients reverse their migraine headaches.
Because we are so thorough, we must ensure that each patient gets the proper attention that they require: therefore, we accept only a limited number of patients into our program each month.
If you are sick and tired of BEING sick and tired…call our office at 631-673-1001 for a Migraine Recovery Evaluation, Neurological Exam and Report of Findings.