Posts Tagged ‘chronic inflammation’

A healing sidebar – Inflammation

| November 22nd, 2010 | No Comments »

I want to elaborate on an important process that is essential to healing in the human body – inflammation. As I have moved further into my healing series I realized that it would be beneficial to take the time to fully describe the process and its role in healing.

First, why is inflammation important? Lack of inflammation leads to slow or absent healing, too much leads to poor tissue nutrition and pain. As with so many physical process, balance is a key factor in good function. In the proper degree and duration inflammation is an essential for healing. However, the constant tax on our system from chronic inflammation, and the changes it creates inside our bodies’, appears to increase our risk of cancer, heart disease, clogged arteries and autoimmune disorders.

Now, into the meat of things. What is inflammation? What trigger it? What causes its visible signs – heat, redness, swelling and pain?

Any event that the body perceives as potentially harmful is the trigger of inflammation. Local cells begin secreting chemicals that create the inflammatory process. Theses substances sensitize tissues, creating more pain and trigger vasodilation, the enlargement of blood vessels, which does two things. One, increases the amount of blood that can arrive at the area by increasing the diameter of the carrying vessels. Two, increases the size of the gaps in your vessel wall, allowing substances that are not usually able to pass out of the blood to enter the tissue. This ensures the nutrition, oxygen and immune components that the body requires to heal can enter the tissue. Vasodilation will lead to redness, heat and swelling common with inflammation.

As the blood cells, plasma proteins, platelets, fluid and healing substances flow out of the enlarged vessels swelling will occur. This is a simple physical requirement of all that extra material in the tissue. Clinically, we call this edema. Before we can see edema there is, on average, 30% more fluid in our tissue than is normal. The problem with extreme increases in the amount of fluid is that our cells are fed by diffusion and the farther apart our cells the longer energy takes to get to them. This chain reaction leads to the possibility for tissue injury or death from excess swelling. Concern over the risk of exaggerated swelling is one of the reasons ice and anti-inflammatories are often recommended post injury. Both decreased nutrition and increased pressure on surrounding structures can create pain. Occasionally the pain can be severe enough to inhibit function in the area.

The process of inflammation is generally self-limiting and usually resolves within 72 hours of the injury. Infection, re-injury, or chronic conditions in the body, may elongate this process.

There is the process of inflammation in the body. As we move forward with this healing series hopefully this helps you understand this vital portion of healing.

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Healing Series #2 – Deep Wounds

| November 1st, 2010 | 2 Comments »

You are chopping onions and your knife slips a bit and you cut your finger tip. As fingers, with there plentiful supply of blood, are prone to, it bleeds, a lot. You put some pressure on the wound, lift your arm over your head and it’s off to the band aids. When you take away your pressure the blood is still flowing but has slowed, and a quick look shows you have cut through so the length of the wound is bleeding but you haven’t really gotten into the meat of the finger. No stitches required, a tightly wrapped band-aid squishes the edges together and reduces the blood flow. Unlike that wee scratch you got on your walk last week, this cut will be there for a while, and for the next few hours the finger will throb and pulse and hurt. Within a couple weeks you will be healed, but there will be a scar. What is different inside your body for this injury compared to that scrape?

In medical-ese you have given yourself a deep wound, a wound that extends through the hard, dry (keratinized) epidermis and into, not just to, the living portion of the skin, the dermis. This is an important distinction, in the previous example the damage was able to be repaired easily in part because there was no real impingement on living tissue with extensive blood supply. Once you are into the structural part of the skin and the physical protective capacity of the skin has been broached, your body must mobilize its other protections and staunch the escape of the blood while working to restore integrity to its tissue.

There are four stages that this type of wound will pass through on its way back to normal function. These phases overlap but begin sequentially. First, the clotting phase, then the inflammatory phase (some meld these two together), then comes the migratory phase and healing finishes with the maturation phase. Different activities, chemicals and processes dominate these phases and all are necessary to restore proper function.

The cut happens and within moments, reacting to the damage of their lining cells (endothelial cells), the damaged blood vessels go into spasm to reduce their diameter (vasoconstriction), which also has the added benefit of bringing the wound edges closer together. The damaged lining cells also cease to release the chemicals they usually secrete to prevent coagulation of the blood and begin to secrete chemicals that encourage clotting (von Willebrand Factor and thromboplastin), as well as proteins (cytokines) that jump starts the immune responses of the body. Within the hour the clotting factors encourage small cell fragments in the blood (platlets) to stick to the damaged areas of the blood vessels, holding the edges together and stopping the flow of blood. Once this plug is in place a protein (fibrinogen) is converted into a non-soluble protein (fibrin) and forms a web-like framework for blood to coagulate around. Once sufficient blood coagulates around this framework the plug becomes a clot.

As clotting occurs another process, inflammation, is beginning to help clean and protect the wound and to ensure that all the other chemicals and cells needed for healing are able to reach the wound site. The first event in inflammation is the enlargement of the blood vessels around the injury (vasodilation) which both increases the volume of blood flow to and from the area and enhances movement of material through the walls of the blood vessels. The first new cells to arrive are White blood cells (specifically neutrophils and macrophages) and cells (mesenchymal cells) that transform into tissue building cells (fibroblasts). This is also the process that will cause the throbbing in your finger. More and more fluid, chemicals and cells crowd the limited space of the fingertip until you can literally feel the surge of your pulse pushing more into the constricted space. Fingertips, or any constricted space that swells will manifest this throbbing. In more spacious areas swelling of the tissue over a larger area allows these materials to disperse into a larger area and you rarely feel the pulsing. Within about 24 hours the inflammation has subsided to the point that the throbbing isn’t evident, you may not even note any swelling.

At around the 3 day mark the migratory phase becomes dominant. At this point the clot has become a scab and under that the epithelial cells are migrating across the gap (see “Healing Scrapes”). The fibroblasts migrate on the fibrin threads producing scar tissue (primarily collagen and glycoprotein, this tissue also secretes a antibiotic-like fluid) as they move. At the same time the damaged blood vessels are healing. This phase can take up to about 3 weeks.

By the 3 week mark healing moves into the maturation phase. This is when the wound undergoes its remodelling. In a house remodel this would be the painting stage, in the body this is when the new structures attain more organization, when the cells involved in healing begin to disperse or die off, and the blood vessels are fully restored. Depending on the severity of the injury this phase can be ongoing for up to 2 years. You would see this as the slow fading of the visible scar. For you body the tissue would be slightly less sturdy and perhaps have slightly altered blood flow until this process completed.

Nutritionally speaking your body will be using more Vitamin C (connective tissue production and blood vessel healing) and more Vitamin E (to decrease scarring and speed the process). In the early stage Vitamin K would be used heavily in clot production.

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