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Monthly Archives: August 2011

Heimlich Manuever outdated?

I’m sure many of us have seen the Heimlich maneuver used in movies to alleviate a choking victim. For some reason I thought that this was an old practice made by some German scientist, but I was wrong. Heimlich is American and the heimlich maneuver is relatively new practice introduced in 1974 and used as the preferred method of rescuing a choking victim.

However, I was shocked to find that this practice that I had taken for granted as being the right way to deal with a choking victim was only the medically proper way of dealing with choking from 1986-2005. I could swear that I’ve seen countless movies where they use this to help a choking victim, but now that I think of it, I can’t think of a black and white film where the person uses the heimlich maneuver or refers to it. Also, the heimlich maneuver is not even the chosen protocol for dealing with a choking victim anymore, Heimlich was proven to be a fraud in other case studies (he falsified studies to prove the Heimlich was effective for drowning victims and was exposed by his own son), and he might of even stole the idea from a colleague (Dr. Edward Patrick).

First off, the universal sign for choking is for the patient to hold the open palms around their neck as if to self strangle themselves, but a better indicator for those of use medically inclined and responsible for crisis situations is if the patient is making any sound. A complete obstruction of the airway will cause a disturbing silence when the patient is trying desperately to cough, make noise, and tell someone they are choking. The next sign that the person is not breathing properly is that that their face will turn blue (cyanosis) and they will then lose conciousness leading to anoxia of the brain and then death.

What to do when you see someone choking:

1) First make sure that the person is choking and cannot breathe properly. If you hear some wheezing then they may have a partial obstruction, but can still obtain oxygen. If the choking is partial, drinking water may help to dislodge the bolus.  If the person is choking encourage them to cough if they can. If they can’t:

2) Perform 5 strong blows to the middle of the back with the heel of your hand.

3) If the patient is unconcious and laying on their back you may do a finger sweep. The purpose is to dislodge any obstruction that might be superficial enough to sweep clear with a finger. Using a pinkie sweep the back of the airway being careful not to stick your finger directly into the trachea inducing vomitting. You wouldn’t want a choking victim to vomit or aspirate into the lung.

4) If this doesn’t work, then the patient may be at the crucial point where CPR may need to be performed. The chest thrusting may provide enough vibration to dislodge the obstruction, if so lean the patient on his or her side so that gravity can help to further clear the obstruction.

 

Though the Heimlich maneuver is not taught anymore as choking rescue protocol, if all else fails, no hurt in trying it. Plus if the name and seeing it performed (ala Naked Gun movies) helps a person to remember what to do when a person is choking, then all for the better. Remember when it comes to saving lives the ends justify the means (at least in this case).

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Posted by on August 30, 2011 in Health Restorations

 

Scar Tissue….Adhesions and pain management

Anybody who has had surgery or had an injury that needed mending may have heard this term. But what does this term mean and what is that important to the discussion of health?

Tissue has a general meaning in science, a grouping of cells that have shared or similar function. Blood and bone are tissues in this regard. When doctors say soft tissue, they are normally referring to the muscle, joints, and ligaments. When these “tissues” are damaged they may tear, rip, be bruised by contusion and so may begin to swell, redden, and emit pain signals. This is normally where I give my “muscle is a sausage” analogy so I might as well explain it proper (the body is not a simple machine, so to explain its inner workings doctors use layers and layers of models and analogies to help them understand what’s going on. A doctor’s job is understanding how these models are correct but also how they are flawed).

Muscles are bundled fibers programmed to pull in one direction. Because they have a common job they are grouped together by what biologists call fascia. Think of the fascia as the casein skin of a sausage. The muscle inside is bothgrouped and directed by the casing, but the muscle fibers move independently of the skin so that there is a level of friction going on between the skin casing (fascia) and the muscle inside. But what happens when the fascia gets stuck to the muscle, then we have what in medical terms is called an adhesion. The adhesion doesn’t permit the muscle to fully contract or relax and acts as a point of inflammation.

Scar tissue is formed in similar ways. When you are injured, the body’s immediate reaction is inflammation. This inflammatory reaction is what causes the swelling, redness, and pain. After the swelling and inflammatory phase has settled, the muscle fibers need to be repaired. But as the body repairs the damaged tissue it also forms scar tissue. Ever scratched your arm and watched a small scar form only to disappear slowly after a month? Same thing happens inside your body except the result of the scar is not an unsightly blemish, but an area of tightness. This represents itself to the patient as muscle tightness and soreness.

Ok hope you aren’t too nerded out after that boring description, but suffice it to say that muscles are like living sausages the function of which are hampered by injury that forms scar tissue and adhesions creating pain and dysfunction of the muscle group.

 
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Posted by on August 30, 2011 in Health Restorations

 

Why a pullup bar is your best physiotherapy rehab tool.

Sometimes the things we need to make our lives easier and less painful are the the simplest of devices. A pullup bar can be bought in any sports store. There are various types, and the newest style requires no drilling, screwing or adjusting.

Upper body range of motion decreases as we get older and our joints begin to naturally degenerate. This is true for joints in the spine as well as joints of extremities. It may very well be that some patients beyond the age of 50 will have difficulty getting a full motion from their shoulder joint. Because of the incredible mobility of the shoulder joint it can be susceptible to degeneration, especially in athletes who play sports where overhanded motions are used like baseball. Even in non athletes. the shoulder complex can quickly deteriorate as old age progresses.

To keep from getting conditions like frozen shoulder (adhesive capsulitis), a pullup bar can be the answer. Most important to note is that this is a preventative exercise and not a rehab exercise, meaning that if you have a shoulder problem it might be too late and other exercises prescribed by your PT or chiropractor may be suggested instead.

The first exercise is fairly simple but with infinite variations and no correct way. To put it simply it is just hanging from the bar with knees bent so as to not touch the ground. This hanging motion can decompress the spinal joints to a degree throughout the thoracic and lumbar spines, but just as important is the shoulder complex and the relation of all these upper torso back muscles to their respective joints.

Take time to focus your attention on areas that feel tight and gradually breathe to allow these areas to “let go” their tension.

Next hold the bar with one hand allowing the other to drop at your side. (Note: be very careful with jerking motions if you have had a previous shoulder injury such as dislocation. Hang from the one arm, but with both feet on the ground for stability. Relax and turn your body approximately 90 degree and let gravity do it’s work again. The shoulder complex has infinite positions and each position can stress different muscle groups or groups of muscle fibers. Always spend a meditative moment at any position that feels tight or could use some stretching.

In subsequent posts I will talk about more variations to this, but suffice it to say that if you don’t ever put your hands over your head, you may eventually lose the ability to do that as many elderly find their joints begin to degenerate. Added flexiblity to the spine and shoulder complex safegaurds our bodies against traumatic injuries like slip and falls, car accidents, and helps to slow down the unavoidable degeneration of joints that occurs as we age.

 

 
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Posted by on August 24, 2011 in Health Restorations

 

Ganglion cysts

Had a friend ask me about an unusual bump on his wrist. It was soft and moveable and not painful or infected. A cyst is a fluid filled sac of fibrous tissue from smaller than a centimeter to the size of a marble. Some cases may be larger, but most are non-surgical and benign. Also known as “bible bumbs” becuase the treatment used to consist of hitting them with a bible. Though they are malformations of joint cartilage the greatest danger with these is if the “bumb” begins to hamper wrist motion and hand function by its size. However, ganglion cysts rarely continue growing in size and are of the non-cancerous, non-malignant type. Puncturing the fluid sac is not recommended as this rarely reduces it’s size. Why they develop is somewhat of a mystery, but some have theorized that the cysts are common around joints and that some joint material herniates or is allowed outside of the joint but not back in. They can be alarming and can give the impression of a tumor. Please have a doctor examine any lesion that are questionable.

Some guidelines you can use to differentiate a ganglion cyst from other tumors. If the bumb is moveable and doesn’t feel attached to the bone, skin or muscle in particular then it may be a cyst. Cancerous tumors usually involve a growth that attaches and invades skin, muscle or bone (even blood). So immoveable growing bumbs are a concern. Cysts normally stay the same shape and size throughout life and usually show no signs of new growth while cancerous tumor are, by definition, a proliferation of cells and so continue growing at variable rates.

Cysts also occur other places on the body, including the back of the knee (known as Baker’s cysts). But the overwhelming majority of cysts occur on the dorsum (back) of the wrist and hand to the tune of about 80%. A sac that is filled with pus is not called a cyst but an abscess and is caused by an infectious agent (for instance bacteria entering a wound).

Mostly cysts are just an eyesore and a cosmetic anomaly and no cause for alarm. But cysts may appear elsewhere on the body and are distinct from fibromas (soft fibromas are called skin tags usually appearing on the neck) and have no irritation like rashes and insect bites, in fact they are sensitive to pain only when compressing one of the superficial nerves of the skin. This means that cysts are not sensitized to feel pain and so usually lateral movement of the cyst is elicits no feeling, but direct pressure is painful.

All in all cysts aren’t to much of a worry and I say surgery is an option if they are painful or restrict function.

 
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Posted by on August 13, 2011 in Health Restorations

 

High Ankle Sprains

Now that NFL football is back, I’m sure many of us will be checking in our favorite teams to see who has suffered injuries that will affect their team’s play through the season. What is the difference between a high ankle sprain and a regular ankle sprain.

Well the terminology doesn’t note how severe a lower leg injury is, but most of us at some point in our lives have had an ankle sprain. This happens in basketball often when a player lands awkwardly on another’s foot. When the foot is put at an angle respective to the lower leg, it can stretch the anterior talofibular ligament (aka the ATFL). Sprains are graded by intensity, swelling, and joint dysfunction/derangement from 1-4 with 3 being a completely torn ligament and 4 being a possible surgical case.

A high ankle sprain involves a different muscular group altogether and though a high ankle sprain and an ATFL ankle sprain may have occurred on the same incident, the high ankle sprain can lead to chronic issues that can decrease performance for athletes and usually takes longer to heal with moe residual complications following.

Whereas normal ATFL sprains occur near the lateral malleolus (that bony bump on the outside of the ankle) a high ankle sprain may present with pain that covers a region beginning with the lower leg to just below the knee. The pain often feels as if it is deep, dull and achy. A high ankle sprain stretches the syndesmosis (thick musculoligamentous structures that holds the tibula and fibula together. These kind of injuries usually take about 2-3 weeks longer to heal because the syndesmosis doesn’t get as good blood circulation as say a muscle like the hamstring.

Though the treatment is somewhat akin to that of an ATFL ankle sprain, the important thing is not too push to return to competetive sports becuase a re-injury can lead to chronic high ankle sprains and it will be harder for the ligamentous tear to heal fully leading to instability, a dreaded word that in an MD’s office may be followed by surgical options.

 
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Posted by on August 2, 2011 in Health Restorations

 

Xenoestrogens

Xenophobia is the fear of strangers and other cultures. So what are xenoestrogens and why are they important to health and women’s halth in particular. Estrogen is a vital hormone for all humans, but especially important for women because it is one of the main mediators of the menstrual cycle, in that during a woman’s cycle estrogen levels fluctuate and peak.

The real danger is that contact with sources of estrogen that originate from outside the body can lead to what is called estrogen dominance. Increased and prolonged estrogen dominance over its counterpart progesterone can lead to a host of abnormalities in a female body. Some of the diseases that occur more frequently include worsening PMS symptoms (headaches, cramps, weight gain, water retention, chronic fatigue, loss of sex drive, mood swings), increased chances of breast cancer, fibroids, osteoporosis, high blood pressure, irregular menstrual periods, increased risk of stroke and heart disease, and gall bladder and hypothyroid problems.

Hormones and antibiotics unnaturally introduced into our livestock affects meat and diary products. Xenoestrogens are chemical components of many of the household products we use to maintain our daily lifestyle. Everything from fabric softener to plastic cups to the hormone replacement therapy prescribed by your OBGYN. In the same way that peanut allergies are a result of our society coming into increased contact with peanut related products (think plastics, oils) increased contact with estrogen-like compounds can muck up our inner hormonal balance.

Here’s a list of some common xenoestrogens in our environment:

  • Commercially-raised, non-organic meats such as beef, chicken, and pork
  • Commercial dairy products including milk, butter, cheese, and ice cream – Use only organic products that do not contain bovine growth hormone
  • Laundry detergents, dryer sheets and fabric softeners
  • Avoid Prempro, DES, Premarin, Cimetidine (Tagamet), Marijuana, and Birth Control Pills.
  • Hormone replacement therapy (HRT)
  • Progesterone creams made with paraben preservatives
  • Soy products and ground flaxseed
  • Minimize coffee and caffeine
  • Avoid reheating foods in plastic or styrofoam containers
  • Avoid drinking out of plastic cups and containers
  • Avoid chemicals that mimic estrogen in the body:
  • Sunscreens that contain 4-Methlybenzylidene camphor (4-MBC) and oxybenzone
  • Paraben containing products: shampoos, deodorants, cosmetics, skin moisturizers, shaving gels, toothpaste, etc.
  • Phthalate containing products: soft plastics, shampoos, hair sprays, deodorants, nail polish, air fresheners, etc.
  • Triclosan containing products: antibacterial soaps, toothpaste, mouthwashes, etc.
  • Sodium Lauryl Sulphate containing products: soaps, laundry detergent, toothpaste, shampoo, conditioner, etc.
  • Butylated hydroxyanisole / BHA containing products: food preservative.
  • Pesticides, Herbacides
    • Do not heat food or water with plastic in the microwave. Do not drink hot liquids in foam styrofoam cups or receptacles. Use glass or ceramics whenever possible to store food and water. Heat up your food using a glass or ceramic bowl covered with paper.
    • Change your laundry detergent because it cannot be fully washed from the clothes and can be absorbed through the skin. Do NOT use dryer sheets or fabric softener.
    • Do not use anything on the skin with parabens or phenoxyethanol in them. This includes shampoo, soap, makeup, hand lotion, body lotion, and toothpaste. Oral substances are 90% filtered by the liver. Skin-absorbed substances are 100% absorbed by the body, thus, a skin dose is 10 times an oral dose.
    • Avoid coffee if you have estrogen dominance. Avoid decaf coffee. No caffeine. No tea. No colas. Caffeine increases estradiol levels by 70%!
    • No sunflower oil, no safflower oil, no cottonseed oil, no canola oil. (Guess that leaves olive oil).
    • Avoid shampoos that are “rich in hormones” and have estrogen added to them.
    • Use cosmetics with minerals or grapefruit seed extract as a preservative.
    • Use natural pest control not pesticides.
    • Buy hormone free meats to eat.
    • Buy “Organic” produce, produce grown without pesticides, herbicides or synthetic fertilizer or hormones.
 
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Posted by on August 2, 2011 in Health Restorations