Posts Tagged ‘physiology’

Some gutsy learning

| May 26th, 2014 | No Comments »

vis·cer·al

adjective

  1. of, or relating to, the viscera
  2. relating to deep inward feelings rather than to the intellect

synonyms: instinctive, instinctual, gut, deep-down, deep-seated, deep-rooted, inward


 

 

I found this definition online and it perfectly encapsulates the nature of the course I went on this weekend. The course was called Visceral Manipulation I and both of the definition options above speak clearly to the nature of the work we did this weekend.

 

The course reviewed the anatomy and physiology of the internal organs – and reminded me that the lungs, heart and brain – with all their accessory bit are a part of that viscera. Our focus though was on the gut organs this time. The other definition is very appropriate to as the work requires that you use your knowledge of the structure of the body and then release it to simply feel the body. I knew going in that for myself the need to be patient and quiet my mind in favour of listening to my body would be my greatest challenge.

 

I am very aware, with a kind of chagrined pride, that I tend to over-think things at times. I often have said that I am more comfortable in my mind than in my body – but I have also said that my education and practice as a massage therapist has balance that to some degree. This weekend was, for me, another step toward embracing that balance. I do not think that I will ever be someone who first speaks to how they FEEL, I suspect I will always first go to the place of THINKING, but I do believe my life is richer for the fact that I strive to improve the balance between the two.

 

What is all this work for anyway? What will it help and might you be one of the people that experiences this work when next you are on my table. There are many indications for this work, some are emotional or life related (stress, depression, anxiety), many more physical – including digestive issues, disease process or history in the body – especially those where organs have been damaged or altered – right through to pain patterns in the body, especially those that are persistent and respond to, but do not resolve, with direct massage. Quite a few of you might just be finding yourself experiencing something a bit different in the near future. If you are interested in this work specifically feel free to ask more when you are in next time or to drop me an email or call.

 

For myself, I had an interesting time on the receiving end of all of this work and will be bringing some of treatments into my own self-care regime. I am interested to see the way this subtle and progressive work unfolds within me over the next weeks.

 

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Antibiotic Resistance…why should we care?

| April 13th, 2011 | No Comments »

MRSA bacteria

I know that I am always happy, intellectually, to have my doctor seriously look at my symptoms and bring up their own knowledge of what bugs are circulating (“…we are seeing a lot of viral infections right now…your symptoms look like that”) when I go in to see about the sore throat, achy body and fever I am suffering. I am delighted that the doctor is taking a stand and trying to be thoughtful about applying the right ‘cure’ and I will not be contributing to the next MRSA infection. Emotionally, I am less happy that I have to suffer when virus is the answer. An article in the April 2-8 edition of The Economist about superbugs, antibiotic resistant bacteria, kick started that intellectual part of me. The article focuses on the ways in which resistance evolves, the costs and risks of super-bugs, and our options for dealing with them – and whether they are palatable. One surprise for me was finding out that Alexander Fleming, the man responsible for identifying the Penicillium mold and its ability to kill bacteria, predicted this risk in his Nobel prize speech in 1945. The article also provided a very pointed reminder about the role economics and human nature play in the medical system and its problems.

The emotional dismay at having to put my life on hold and feel yucky often overwhelms my intellectual knowledge, and I am not alone in that. We know antibiotics exist so we want them to fix all our sore throats and runny noses. Antibiotics are not miracles, we and our doctors know this, but we do not like it.   Doctors lack, even today, the ability to do rapid screening of infection sources that would ensure they never give someone with a virus an antibiotic. This also mean they lack a test result to toss in the face of our emotionalism and make us accept that our aching throat is simply going to be around for 7-10 days and we need to endure.

This is one of the main options examined in “The spread of superbugs”, in The Economist. Patients need to accept that not all infections respond to antibiotics and that using them, necessarily or unnecessarily, creates resistance in bacteria.   The benefit of curing the bacterial infection does outweigh the risk of creating resistant bacteria that can, at least in the case of streptocci bacteria,

streptoccus pyrogenes

endure for up to a year. The same risk/benefit analysis does not apply to treating viral infections with antibiotics. This also ignores the possibility for yeast infections resulting from the depletion of our enterobacteria and the co-occurring impacts the depletion on our digestion and the health of our intestinal tract.

A second issue is the lack of new antibiotics, especially those to treat drug-resistant bacteria, being brought to the market.   Here is where economics start to come in.   Unlike anti-depressants or blood pressure medications antibiotics are a self-eliminating drug. Once you take it you should not need to take it again for some time. The other aspect that cuts into profit, especially for the super-bugs antibiotics, is that the majority of infections occur in poor countries. We tend to hear about outbreaks in hospitals and care facilities, which are the primary hotspots here in Canada, but in poorer countries the problem can be more widespread. Where lack of education about antibiotics and the sale of poor quality and strength drugs are problems, the development of resistant bacterial stains is more common. The same lacks which allow these practices to flourish impede the ability to afford the more expensive treatment needed to treat infections.

Another issue that will directly impact our quality of life here in the first world is the elimination of many non-vital but life improving and functionally beneficial operations. I had never thought of what the potential consequence of an increase in frequency in antibiotic resistant infections in our hospitals might be in terms of our medical care beyond the increased costs. Tummy-tucks and eye lifts are not the procedures I am talking about. I mean cataract surgeries and what the article calls “orthopaedic surgeries”, which I suspect include knee arthroscopies and joint replacements. In a world with an ageing population that has come to expect a level of physical function into their golden years this is daunting prospect.

MRSA - what it looks like to you....

 

 

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Healing Series #5 – fractures

| February 22nd, 2011 | No Comments »

Have you ever broken a bone? Felt something go crunch and known that there were things moving against each other inside you that shouldn’t be?   Did you have the trip to the emergency room, the inspection by the doctor and radiology?

not so bad as this picture though...

Say a person breaks their tibia and fibula, that both bones have completely, but cleanly snapped.   They are sent into surgery and have some combination of plates, screws and rods inserted in your leg. You are given a walking cast, told to take it easy, and given follow up appointments. So begins the bone healing.

This is a simplified story of a significant, though straight froward, fracture. You are far better to snap your bone cleanly and completely than to have a crush injury or a significant displacement – both of which have larger risks of complications than a clean break. Though surgery was required to stabilize the fracture site the bones stayed close to alignment and there were no small fragments or jagged ends to contend with. This means that the healing will be relatively easy, with the internal stabilization they will be mobile (avoiding a lot of muscle loss) and should not have issues with alignment or leg length discrepancy.

Internally the healing process has both similarities and differences to soft tissue healing. Bone is well vascularized compared to ligaments and does heal more quickly, but the structure is quite complex and there are several stages between basic reconnection and complete restoration. With bone tissue, like skin tissue we will see regeneration more than scarring. With good healing there can be healing that is almost impossible to detect.

In the first 6-8 hours the blood that is being released by the torn capillaries in the bone forms a clot called a fracture hematoma. This clot means that the to ends of the bone are divided by dead tissue. Any cells within that clot will die and need to be carried away before repair can be carried out. Within a week the torn capillaries work their way into and through the fracture hematoma, reconnecting the to separated pieces and bone and begin delivering osteoclasts (bone destroyers), to dissolve the dead bone fragments. Phagocytes also arrive to carry away the other dead tissues. In this stage the fracture hematoma is transformed into a procallus, a proto-scar tissue made up of granulation tissue,

Over the next two weeks fibroblasts and mesenchymal stem cells invade the procallus. The fibroblasts build a latticework of fibrocartilage across the fracture site and the mesenchymal stem cells become osteoblasts (bone builders). This structure is called a soft (fibrocartilaginous) callus.

From 3 to 6 weeks the spongy bone begins to develop. This process begins close to the healthy bone tissue and works its way across the gap. As the spongy bone is deposited it begins to transform the fibrocartilage into bone too. This stage is the development of the hard (bony) callus stage. Many of you will notice that it is at this point that casts and other fixation devices (internal or external) are removed.

After 6 weeks (really between 4-8 depending on the age and health of the patient, the bone involved and the type of fracture) there is new bone uniting the fracture site, but the healing is not done.

Over the next 3-4 months the body will be industriously remodelling this new bone. Destroying and rebuilding cells, increasing the deposition of the calcium and phosphorous to make the bone harder. In long bones the creation of Haversian canals will occurs as will the redevelopment of a central marrow canal.

This stage is when the bone becomes customized to your usage patterns and habits so that it is strong where and when you need it to be. This type of process is occurring in healthy bones all the time and until it is complete a fracture site is not completely healed.

How can this knowledge of healing help someone recovering from a fracture? By increasing their dietary intake of calcium, magnesium, phosphorus, the primary minerals needed to build bones, they can help encourage speedy and thorough rebuilding. By understanding the importance of circulation in moving cellular, nutritional and waste products to and from the area of injury they can choose massage therapy, acupuncture or physiotherapy to encourage fluid movement without increasing physical activity past safe levels.

 


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Healing Series #4 – Sprains

| February 14th, 2011 | No Comments »

I was trying to stop my toddler from running about the parking lot while coaxing my slightly lame dog into the back of the minivan. In frustration, I bent forward, wrapped my arms around the dog’s middle and lifted him into the back of the vehicle. I felt a funny twinge in your back but nothing seems to come of it – until later. Stiffness and pain began in my low back and radiated down into my butt.  I had sprained my ilio-lumbar ligament (it is right at the base of the spine and goes from the ilium to the 5th lumbar vertebrae). It was a mild injury, a moderate grade one. The grading for sprains is similar to strains, which were roughly outlined in the my muscle strains post.

As with all the other healing processes we have looked at there will be the clearing out of damage and the repairing of the tissue. In a ligament we see scar tissue fill in the ruptured area, restoring the continuity of the ligament. The differences comes from the fact that this is the first avascular, poorly innervated structure we will be looking at.

First, let’s look at what a ligament is and what it is supposed to do. Ligaments are sheets of tightly packed, closely aligned collagen cells.  Structures with little elasticity or extensibility, they are the brakes on the engine of muscular motion.

Without direct circulation, ligaments will be slower to send out the chemicals that signal the need for healing. The exchange of healing materials for waste products will be slow and inefficient. This slow fluid exchange will create and prolong irritation and inflammation. The lack of innervation will further slow healing.  The body’s ability to know when it is being re-injured is be limited. Most of the pain will come when surrounding tissues become over-taxed, irritated and inflamed.  The ankle and low back, two of the most frequently sprained regions, also have the highest rates of re-injury and chronic acute conditions (basically when the area is so regularly being injured it never truly heals and is always painful).

the ligament fibers end up looking as messy as these twigs

How long is slow? A year. It takes a year for a ligament to fully restore itself. If there is no intervention you will be lucky to get 50% functional integrity at the injury site.

For the first three months you are especially vulnerable to re-damaging the healing ligament. After three months most of the basic repair is done and the new scar is in place. We are entering that retraining period I talked about in the muscle strains blog. This is one of the most tricky times, you need to be active, you are generally pain free, but your ligament is just not capable of what it once was. Directional stress tells scar tissue fibres what direction they need to line up and be strong in. To be functional, ligaments need proper structure, something that can only be achieved through safe movement. By six months or so you might be okay in most activity but be aware that you are still at risk. The wrong move at the wrong time can spell a reversal back to the beginning.

 

How much of a difference can proper care make? Immensely, think 98% integrity vs the aforementioned 50%. What is proper care? In

with good healing the fibers flow together smoothly in line

the early stages RICE is the answer. If an activity brings on pain, stop it. Get help or modify for safety activities you need to do. Once you are moving without pain through normal activity, return to more vigorous pursuits. If the activity creates similar risks to the injury, tape the injured area. Tape creates some small physical stability, and, more importantly, it brings your brain’s attention to the area.

The other aspect of proper care is some professional assistance. Help to keep compensating structures healthy and ensure optimal circulation using massage therapy, physiotherapy, or acupuncture. The first two, along with a kinesiologist can help with rehabilitation exercises. The kinesiologist can help with bad movement patterns too, as can Alexander technique instructors or Feldenkrais practitioners. You do not have to use the whole spectrum of care, but think about what you need help with and what you have to invest in your health and match that to the practitioner best suited to assist you.

Finally – be patient. This is a long haul situation, if you try to shortcut it you will make it worse.

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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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Healing Series #1 – Healing Scrapes

| October 25th, 2010 | No Comments »

You are out walking and you get scraped by a branch. You feel it and when you look you can see that the skin is just slightly torn and rough. In a couple of spots you can see blood oozing to the surface. You might put a bit of pressure on it, mutter an expletive or two at your own clumsiness or the branches, and go on your way. A few days later you wouldn’t be able to say where that branch got you, unless you have a tear in your shirt sleeve to show for it. The hole in your shirt is never getting better unless you get out a needle and thread, but the tear in the biggest organ your body has is gone. Have you ever wondered what actually happens inside your body to make that tear go away?

That little scrape from the branch is classed, in medical-ESE, as a superficial wound. You have torn the bloodless outer layers of your skin (epidermis) and impinged on the the live part of your skin (dermis) at the deepest points (where you can see a bit of blood).

The first thing that happens is the cells that grow your skin (basal epidermal cells) let go of their anchor point (basement membrane) and begin to enlarge and migrate into the gaps the tear has left. They will continue to move and enlarge until they come into contact with other expanding edge, at which point they stop (this is called contact inhibition). While the cells closest to the gaps release and begin to move, your body begins to release a protein (epidermal growth factor) that makes your skin growing cells (basal epidermal cells) reproduce faster. Once contact inhibition has occurred the cells will reattach to their anchor layer and quickly reproduce to recreate the skin that was scraped away (epidermis).

During this process your body is using extra energy, oxygen, protein and Vitamin A (encourages epithelial production). All of this happens within 24-48 hours and leaves no scar.

NB. – lack of contact inhibition is one of the identifying marks for cancer cells and is believed to be the reason cancerous cells will invade adjacent tissues.

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Introduction to healing…nutrition

| October 25th, 2010 | No Comments »

The fact that we are not a patchwork of seeping wounds, gaping holes and that we do not bleed out from a stubbed toe comes back to healing. I am going to cover the healing process in a number of tissues but here I am going to lay out a few of the basics. The factors that determine the quality of healing your body does.

There are three basic factors that impact healing: nutrition, circulation and age. Depending on where we are on the spectrum for these three factors we will heal at different rates and to different degrees.

Nutrition is about having the building blocks that you need to heal. For any kind of wound healing you need the components of the cells that need to be repaired or replaced and the energy to do those repair, this means proteins (for cell structure), B vitamins (needed for communications pain reduction and cell division) and glucose (sugar – which your body gets from all your food) are the bare minimum of nutritional requirements. As I look at specific injuries I will discuss the nutrients that are important to the process of healing that sort of tissue.

The second factor is circulation. We need our blood to be moving around to the stuff we need and take away the stuff we do not. Inadequate circulation can slow or prevent healing an can even lead to more damage due to there being too much fluid at the injury site. When this happens you end up with cells literally starving to death, or being poisoned by the build-up of waste products. Age, fitness level and disease can all impact the effectiveness of circulation.

The third factor is age. As we age our ability to heal is diminished. Fitness, disease, and genetics can modify the impact of age. Not all 16 year olds, or all 70 year olds, heal the same. Overall though as we get older our bodies become less efficient, our circulation more sluggish, we have a higher chance of having compromising illnesses and a longer history of previous injuries and illnesses that may impede our body’s ability to regenerate.

I hope you enjoy following along as I explore the amazing ways that our bodies heal us.

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A new healing series….

| October 4th, 2010 | No Comments »

Enough about food for now. Have you ever wondered how your body heals? I started thinking about an article on how bones heal and got so excited that I have decided to expand to include skin, muscle, and ligament too. If you have some other type of injury you are curious about let me know and I will add to the series.

I am going to be looking at the actual physiological processes that your body undergoes as it heals. What chemical and cells go where, what they do, how the more observable healing events come about (scabs, swelling) and why how they contribute. I will also look at how intervention can help the healing process go well.

This series of articles comes, as so many of them do, out of my belief that understanding what is going on in your body helps you. Makes you better at helping your body and increases your patience with being a patient. I believe knowledge leads to you do the things you can to help make the most of our bodies remarkable healing processes.

So stay tuned as I explore the wonders of the healing body…..

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