Got G.A.S.? and What you might not know about Michael Jackson

Hans Selye 1907-1982

Hans Selye 1907-1982

…and, of course, by GAS, we’re talking about the General Adaptation Syndrome discovered by endocrinologist Dr. Hans Sylye.  To me, this guy comes across as almost a prodigy and certainly a cerebral powerhouse.  Hans Selye entered a German Medical School in Prague at the age of 17 where he graduated first in his class.  Later he earned a doctorate in organic chemistry.

Bust of Hans Selye at Selye János University, Komárno, Slovakia

Bust of Hans Selye at Selye János University, Komárno, Slovakia

The clinician teaching board reviews, Dr James, had a fun way to describe the GAS and it’s effect on the body by using a somewhat benign example involving a couple who had broken up but are currently at odds and fighting over their DVD collection.   There may be a knock at the door, a fight ensues and the fighting may bring a person from say a calm baseline of zero to an exacerbated 10 on the stress scale.  The thing is, when the fight is over for that day and people go their separate ways, the persons stress level doesn’t necessarily go back down to zero but rather, stays elevated at maybe a 4 or a 5 – kind of ready to jump back into action should the need arise.

"Stress plays a factor or role in any disease"

“Stress plays a factor or role in any disease”

As with many things in life, the stress Dr Selye talks about doesn’t have to be real so, any perception of chronic stress would constitute a state of Alarm which can eventually cause a neuroendocrine response, often from the pituitary which suppresses the thymicolymphaticus system and reduce the resistance of the body to disease.  Other contributing mechanisms would include lymph involution, decrease in WBC, increase in eosinophils, increases in (adrenocorticotropic hormone) and increases in cortisol.

Essentially, with regards to survival, it’s more important to be able to fight off a lion than to fight off a cold which is why immunity decreases in patients with chronic stress.  Dr Selye’s work goes a little beyond the basic flight or fight notion.  As a chiropractor, we learn about Selye because he shows a direct link between the immune system and the nervous system.

I think most people are aware  that we have a brain and a spinal cord.

The brain and spinal cord make up the Central Nervous System

The brain and spinal cord make up the Central Nervous System

once nerves leave the Central Nervous System (CNS) they become part of what’s known as the peripheral nervous system (PNS) and innervate with every organ and muscle in the body.

Peripheral Nervous System (PNS)

Peripheral Nervous System (PNS)

But, there’s also another set of nerves that run parallel to the spinal cord known as the sympathetic chain ganglion which are also known as the intermediolateral cell columns.   I was trying to find a simple picture of the sympathetic chain ganglion.  This was the best I could do for now –

Sympathetic Chain Ganglion with organ innervation

Sympathetic Chain Ganglion with organ innervation

Admittedly, this model is a bit more confusing than the CNS and PNS but it does give a little better idea of how our nervous system controls so many functions and organs of the human body.  The Sympathetic Chain Ganglion in this picture is shown running from T1 to L1 – or from the first thoracic vertebrae to the 2nd Lumbar vertebrae, about the middle portion of your back.    That ganglion of sympathetic nerves and the whole fight or flight system is to the human body what nitrous oxide is to a car.  In a fraction of a second heart rate & blood pressure increase, pupils dilate, sphincter muscles in arterioles that precede capillaries can constrict to shunt blood away from lower priority areas of the body (we don’t care about digesting your food when mama bear jumps out of the woods and attacks you)  smooth muscles in the lungs relax to allow more oxygen into the lungs and so much more – it’s quite a well orchestrated and impressive chain of events.

By the way – that spinal cord is rather small.  Take two of your favorite #2 pencils and put them together, look at the two eraser heads side by side.  That’s about the size of the spinal cord.  It is bigger in some places and smaller in other places but still much smaller than one might imagine.  I never realized the size until I saw it for myself along with transverse sections of the cord during gross anatomy.

I can’t find any pictures online which show with any relativity the transverse size of the spinal cord so, you’ll have to take my word for it.  It’s absolutely mind boggling – the degree to which scientist have dissected that little cord to learn what every little column & tract does and what everything is connected to.

Cross Section of the Spinal Cord

Cross Section of the Spinal Cord

I have absolutely no idea how all of that was figured out but I’m sure it would make fascinating reading 🙂

If you think of a fuse box in your house, it has wires that go from the fuse box to your air conditioner, stove, washer & dryer, the bathrooms, etc.  This is much like the spinal cord which has wires in the form of nerves which go to your arms, legs, fingers, toes and also (as we have seen above) to your heart, lung, kidneys, bladder and reproductive organs.

So, if you come into my office and we want to check the wiring in the posterior columns of your spinal cord we might strike a 512 Mhz tuning fork and press the handle against your big toe since the sensation of vibration is conducted through the wiring of the posterior column.  We may also check two point discrimination and position sense to further evaluate those posterior columns.  Elderly people often lose the sense to vibration first and that has been what I’ve found with geriatric patients I have tested.  It’s all pretty amazing.

Michael Jackson’s Birthday!

While I was escaping the realities of my life via blogging it came to my attention that today would have been Michael Jackson’s 56th birthday.  Back in 1982 MJ’s Thriller album was the only album by any artist that I had to buy twice.  At that time the music medium I used was cassette and I played his Thriller cassette so many times that the tape eventually wore out and broke which is why I had to buy a second Thriller cassette.

MJ had a form of Lupus called Discoid Lupus Erythematosus (DLS).  The more common variant people are usually referring to when they mention Lupus is Systemic Lupus Erythematosus (SLE).  The DLS and vitiligo give some insight into some of the changes the public would witness over his lifetime and judge without really known what the heck they were talking about.

Week 32 Weigh-In, First 100 Mile Month

I was coming home from Kansas along highway 70 and had been driving for about an hour and a half when I got to Columbia, MO and noticed on my GPS that I still had 3 hours to go before I would get home.  Then I checked my GPS again to find that I was only 1 hour away from the Lake of the Ozarks where my parents have a condo and quickly concluded that I would head South for the shorter trip to a place to sleep for the night.  It was still early enough that I knew I could get there, maybe see a nice sunset over the lake and still get in a jog before the night was over.

I thought the reviews on Wednesday night would last until about 6 or 6:30 so I had bought a ticket to see the Royals play the Twins at Kauffman Stadium.  I’d seen both these teams play before …  ….  huh …..well, as a St Louis Cardinals fan, there are some rough memories of the Cardinals playing both of these teams back in the 80’s.

1985 – The I-70 Series when both the Cardinals and Royals went to the World Series.  After the first four games of the series the Cardinals were up 3 games to 1 and only needed one more win to clinch the series then dropped the last three games of the series to the Royals. 😦

1987 – The Cardinals played the Minnesota Twins in the world series …..ugh again…. After 5 games the Cardinals were up 3 games to 2 but lost the final 2 games.

Still – getting to the World Series is a heck of an accomplishment and both of those series went 7 games.  AND – I was at Busch Stadium in 1982 when the Cardinals did win the World Series against the Milwaukee Brewers!  🙂  HA!  🙂

Cardinals Win World Series in 1982!

Cardinals Win World Series in 1982!

Earlier in the week I was checking out different things to do in the Kansas City area and found they had a pretty cool looking King Tut exhibit in town through September but the times conflicted with my board reviews but not the baseball game.  🙂  I’d never been to Kauffman stadium and guess I wanted something fun to look forward to to help get me through the remaining days of board reviews – StubHub to the rescue!

I figured ticket prices would be comparable to St Louis with some less expensive seats available on Tuesday and Wednesday and, sure enough, I found a Field Box seat at Section 141 for only $15!  These same seats were going for $200 on Monday night when the Yankees were in town.

2014-08-24 00.53.25 2014-08-27 21.28.03

I did learn something pretty cool since I didn’t have a printer to print off tickets like I normally would – there is an app for StubHub that can be downloaded and a section of the app allows you to pull up your tickets and just show your phone and a picture of your ticket to get into the game.

The last day of board reviews finished up around 3:30 that day and I’d already checked out of my hotel that morning so I went straight to the ballpark.  I learned the gates didn’t open until 5:30 and didn’t want to hang around outside in the hot sun for an hour an a half to see the inside of the ballpark or 3.5 hours for the game to start, especially since I knew I could be almost all the way home if I were to leave so, I took some pics of the two stadiums and headed out.  I didn’t know that both Arrowhead Stadium and Kauffman stadium were located in the same area.

Arrowhead Stadium

Arrowhead Stadium

Kauffman Stadium on the left and Arrowhead Stadium on the right.

Kauffman Stadium on the left and Arrowhead Stadium on the right.

So, I never stuck around for the game but it made me realize again that there are a lot of things to see and places to go not too far from St Louis.  Iowa was only 4 hours North and they had a pretty big festival going on up there over the weekend when I was there.  I know one event was trying to set a new world record for the most number of Kayaks (or maybe just rowboats in general) for being on the river at the same time along with some concerts, fair activities and a few concerts.

Memphis and Nashville are within 4.5 hours to the South and KC was just under 4.5 hours to the West and with my gas sipping car less than two tanks are needed for any round trip.

Week 32 Weigh-In
Anyway – I was wearing my shoes during Thursday morning’s Week 32 Weigh-In since I needed to leave by 6:30 a.m. to get to Chesterfield, MO for another round of board reviews and was running a bit late so I just stepped on the scale fully dressed to get my weight for that week.

2014-08-28 06.35.15

Week n - 2nd 12 Week Session Week 32 - Copy


I was bummed that I lost my one little square with my fantasy car so I just added a whole new strip.  The marketing folks at Chevy did a great job when they named the color of that car Metallic Rock Red.   Very nice guy appeal 🙂

For the next two weeks I’ll probably be a little liberal with my diet – and for me the word diet simply refers to what I happen to be eating as opposed to any caloric deficit or fad type of plan pertaining to my eating.  When I was up in Iowa and had that 13.1 mile training run I had plenty of energy to get me through that run and I was simply eating normal meals – That day I believe I had a breakfast (homemade waffles from the hotel) then ate during my first break during reviews, then had an actual lunch a few hours later then a protein shake, grits and some naturally organic nutrition bar I’d gotten from my brother.  Just ample and fairly good eating but, what a difference it made on my run.  After so many talks about hyperinsulemia or hypoglycemia I tried a simple candy bar prior during our reviews and it did make a difference and NO, I did not experience any crash later on during the day but I was more alert and didn’t fall asleep at all during the reviews.  I just need to maintain being sharp and alert mentally these next couple weeks and keep up my study intensity to have the best chance possible at passing this Part III exam.

Another interesting thing I learned about that exam is that someone who say, scores a 65% might pass the exam while another person who gets 80 or even 90% of the answers correct might fail the exam.  That’s because after the exam is taken and all the exams world wide have been submitted, the governing body who puts out the exam (NBCE) then decides exactly which categories each question falls into.  Then, each section will have a minimum number of questions that have to be answered correctly.

This exam also varies the most from year to year.  Heart, Lungs and kidneys are kind of staples in the exam but, one year the eyes might get asked about a lot and maybe not at all the next exam.  Neurogenic diseases might be hot one exam but not so much on the next so, one kind of has to know everything just in case.

I am feeling more confident in my ability to pass this exam, time will tell.  But, confident enough that I’ve started checking out Part IV which is actually still given this year in November but, I had my sights more on taking it in May of next year since that exam runs close to $1,500 now which has to be paid in cash …no credit cards accepted.  I’ve got an extra couple hours this morning so I think I’ll email Dr Laura and start inquiring about taking Part IV reviews a couple times.  There are some reviews in November.  Currently, I’m taking reviews for Parts II, III and PT because all that has to be known for Part IV and 8 days is usually enough time for all three of those reviews but, with Part IV it takes an entire week for just that one exam …and …of course, we’re still expected to know everything from the previous reviews which, isn’t exactly unreasonable to get licensed as a doctor.

I’ve also been looking into the NRCME – Nationally Registered Certified Medical Examiners which is something I’ll be eligible for once I have a licence.  There’s some good videos on YouTube about the NRCME and I did a search for the Illinois and Missouri areas and learned the range of prices charged for giving a DOT physical are ranging from $50 to $280.  I was hoping to be able to travel to various areas where over the road truck drivers get their own license for driving and maybe offering a service where I would drive to them to administer these physicals and perhaps be able to get 10 or 20 physicals completed in a few days time.  Maybe I could work out a deal with some of these truck driving schools where they can include the physical as part of their tuition then offer a price break.  Maybe $120 for a regular physical and offer a special deal of $80 or $90 for having the quantity.

There’s still things to look into but, here is a great thing – the exam to become a NRCME is only 80 bucks!  🙂

Eat Your Veggies?
I was looking at an article in the HuffingtonPost called “6 Vegetables That Might Save Your Life” and the first line starts out, “If there’s one food that no one — not your doctor, your nutritionist or even your mother — will tell you to eat less of, it’s leafy greens.”

uh – I don’t think so –

The average standard of care would indicate that the types of leafy greens advocated in the article are actually contraindicated for people taking blood thinners.  Also, these leafy greens, especially the super healthy looking dark green ones are contraindicated for people prone to kidney stones since the majority of those stones are calcium oxylate and foods containing high quantities of those substances should be avoided.  Unless, of course, you like getting kidney stones.

First 100 Mile Month
I’m at 96 miles for the month and perhaps, could be getting a bit lazy since I had three straight days earlier this week without running.  The focus on studying has been rather intense so running hasn’t been on my mind quite as much but, there’s also pure exhaustion which has kicked in a couple of times and had me passed out and sleeping by 8:30 some nights.

Still, there are 3 days left in this month so, hitting 100 miles with only 4 miles left to do will be pretty easy – basically one more run and I’m there.

Upcoming Events & Marathon Ponderings – 
A week from tomorrow I have my first Half Century (50 mile) bike ride.  That should be interesting and it will be a new distance record for me.  Right now, my longest distance would be the 35 mile bike ride from the Tour de Donut.  I’m hopeful 🙂

The week after that is Part III boards ….then a week off from any races then….

could or should I do 4 straight weeks of half marathons?  idk.

I already have one in the books (the 4th one) but, dare I add three more in the preceding weeks?

I know I’ve had a running fantasy/strategy in my head before of running a half marathon distance a week – maybe for a year straight or something like that.  That distance seems to have a pretty favorable effect on me physically and maybe it’s the kind of thing that needs to be done in order to push/force my weight down into the 220’s(?)

I also know that I don’t have much in the way of long runs that exceed the 10 mile mark – maybe 2 right now?  I’ve done a double session of running which put me over 10 one day but that isn’t quite the same in my mind.

Cost is a bit of a factor but, I would be using a credit card for the additional 3 events so registration is attainable.

My scheduled long runs would be cut short since most are over that 13 mile mark in the weeks leading up to the full marathon but, as stated, I’m not hitting those distances much.  I know I’m getting closer and I am improving but that improvement does take time.

I do have a couple days to decide – I think rates for most those runs won’t be going up until after the end of this month.

Kansas Review, running, shin splints, fascia, etc…

I’ve had a plethora of different things I’ve wanted to blog about over the past few weeks but hardly anything has been inked.  I was quite impressed with Overland Park, Kansas which was one of the nicest cities I’ve ever been in.  My hotel in Davenport, Iowa was considerably nicer but there was basically a highway on one side of the hotel and modest residential housing on the other side of the hotel which lead to my running path.

Davenport Iowa has a population a little over 100,000 people and is one of the quad cities.  I noticed Kansas City had a population of around 496,000.  Highway 435 is the bypass around Kansas City much like hwy 270 is the bypass around St Louis.

I do believe everything I could have needed for living the next year in Overland Park could be found within a 5 mile radius of the hotel where I was staying.  Even the two stadiums, Arrowhead and Kauffman Stadium were only 20 minutes away.  The sheer quantity and diversity of places to eat was rather impressive also.  Multiples of every kind of restaurant you can imagine.  Not just one BBQ place but maybe 1/2 a dozen including Korean BBQ.  I’m not even exactly sure what that is. Thai, Mediterranean, Chinese, Italian, Indian – you name it, it was bound to be close by.

Recalling …I indulged in Chinese, Pizza, Mexican, another Pizza place, Denny’s and Subway … a feeling I’ll be weighing in tomorrow in the mid 250’s 😉

The running path took a little more to figure out than in Davenport but, I believe the one I was on in Kansas was about 26 miles long.  In a few areas it would come up to a street then you had to know which way to go down the street in order to hook back up to the path.  I went West on the path my second time out and that direction was nicely contiguous.

I’m still having a bit of a tough time with my differentials.  A diagnosis (dx) is one thing – it’s just flat out what a person may be suffering from or what disease (dz) they have but a differential (ddx) is what you think an ailment is along with what you think it’s not.

I’m looking at x-rays and it’s pretty obvious that it’s not a case of Multiple Myeloma the same way it’s obvious that 2 plus 2 does not equal 5 but …in some cases I have to pick MM as one of the differentials.  I thought I was getting the hand of it but, in other cases we may skip cancer as a differential all together.

I did get one of my case studies 100% correct today so that was pretty cool.

idk – I’ve got a friend who is a pediatrician at a local air force base and he hated his Part 3 as well.

Shin Splits is kind of a bug-a-boo of mine – almost a nemesis.  I’ve actually heard it best described by the clinician who is teaching the board reviews I’m taking as minor compartment syndrome while inflammation in the posterior compartment or, more commonly, the calf would be a major compartment syndrome and could require emergency surgery.


In the picture above you can see an axial view with the tibia and fibula, this is around midcalf but, as we go distal, those two bones are going to approximate.  The thing with the anterior tibialis muscle in the anterior compartment is that those bones will limit where that muscle can expand.  Anybody who has ever lifted weights or tried their hand at bodybuilding knows that when a muscle is worked intensely enough that the muscle can be engorged with blood and become measurably larger.  That muscle gets worked a lot when a person runs and especially with new runners, when it does get worked, it will become engorged with blood and become larger – but, it’s only got so much room to expand, the bones and other compartments limit it’s posterior expansion so it’s going to press outward (anteriorly) and cause strain against the fascia of that compartment.   It’s my contention that the strain and pressure against the fascia of the AT muscle is what causes most of the pain in most beginning runners and, those do tend to be the ones who are often afflicted with this temporary condition.

The National Institute of Health (NIH) has stated in some of the articles I’ve read that fascia does not stretch.  Well …with all due respect to the NIH, that is wrong.  And, it’s easy to prove.  If fascia wasn’t able to stretch or expand then bodybuilders would not exist.  Bodybuilders do exist, ergo – fascia can expand, stretch and accommodate musculature of various sizes.  It’s probably more accurate to state that fascia is not elastic but, over time it can accommodate.  This is probably an area where Graston or a good massage therapist can help combat the pain and help a patient/runner adapt to the pain of “shin splints” as quickly as possible.

I’m currently sitting at 96 miles for the month of August and should be getting my first Platinum trophy from Nike Plus in the next day or so.

I’m still pondering over my back to back to back to back ideas of running a half marathon each weekend for 4 weeks straight – then having almost two weeks off before the full marathon in Wynne, Arkansas.

There’s only 9 weeks and change left before that run.  I’m having a bit of a challenging time believing that I’ll be ready to run that marathon the way I want to run it.  I still have a long weight to go but …. 9+ weeks is still a bit over two months of training.

Some Great Runs
There have been a few times in the past month were I’ve had some really great runs.  I guess it was about a week before I left for Iowa when I had a trio of runs on Tue, Wed and Thursday.  The Tuesday and Wednesday runs were 4 and 6.2 miles respectively and they were my very worst runs in terms of time that I’ve had all year.  However, on Thursday night after Karate I headed out and did a 4 mile run that I practically fell in love with.  I just ran and ran and ran …I didn’t have any need to walk any parts of it, just a nice constant running.  I think more of my runs lately are becoming more pain free which is helping a lot.  I usually put two bandaids on each foot then a strip of athletic tape around them and that helps with chaffing in the areas around the lateral malleolus and just proximal to the calcaneus.   There is a chance that my shoes might be a little too big since fat feet at a bodyweight north of 300 probably are a bit different than those same feet at 250.

The other night in Kansas I had a 6.2 mile run and however long that took, there were only about 3 minutes of the entire run where I was walking, maybe a few minutes longer.  Once was towards the beginning of my run because my path was pitch black and I had to use my phone to help light the way.  I walked that part since I didn’t want to hit a tree.  Then after about an hour, I walked and checked my phone to figure out where i was and how to get back to my hotel.  Then one final time when I found myself running by Cleveland College of Chiropractic to take some pictures.

Without even realizing it, when the run was over and I looked at my splits I saw a 10:04 mile pace for mile number 4 🙂  There was a long stretch of path that ran adjacent to the highway and I could tell that I was moving faster but it seemed like with less effort than normal.  The form and everything just kind of flowed and felt great.  I think there was a slight decline to the path so that probably helped as well but I seem to be a sucker for nice, long straight paths 🙂

My running is coming along but it really takes a long time to reap significant improvements. That’s what it’s seeming like to me anyway.

Sometimes, it feels like when I got my first motorcycle and even though I barely knew how to ride it I would go out maybe 8 or 10 times a day just to ride it around the neighborhood because it was something new and kind of exciting for me.  It’s almost getting that way with the running again.  It’s like i’m developing a new toy or something …but, it’s an ability that I haven’t had for quite a long time so it’s very welcomed back into my life.

Just have to keep at it.

Biomechanics of Fat Runners
That kind of sounds like it could be the name of a magazine article, doesn’t it?  It is something I’ve been becoming more aware of over time.

The Japanese have a very advanced robot they have been working on for quite some time called Asimo.

Asimo Running

Asimo Running

I was watching some videos of Asimo running and realized I do about the same thing when I run.  In the picture above you can see that Asimo’s lead leg ends up striking the ground with the leg still flexed, that is, it’s bent when it strikes the ground.  With running humans, the front leg is more extended and the front leg, with the heel strike phase of running is where you have maximum pressure and force on the cushioning elements of the knee, things like meniscus and articular cartilage.  I don’t have a huge gait when I run and often the lead leg will strike the ground like Asimo and still have a fair amount of flexion when it hits the ground.

I’ve talked to a few other runners who were a bit larger and heavier than your typical runner and found out that it is common for them to also have a faster pace walking than running.

well ….looks like my two little nephews have joined me here at the Ozarks so I’ll have to finish this up at another time 🙂

Week 31 Weigh-In – 251.6

Week 31 Weigh-In
My brother sent me a link the other day about a guy who got up early for an entire year.  The blog was called I’ve been waking up early for a yar.  Here’s how my life has changed.  I liked the idea of maintaining a habit or any worthwhile endeavor for a long period of time then seeing what positive effects take place as a result.  Below is a copied except of the life improvements that guy got from getting up early for a year.

Some Life Improvements

  • I see the world through a much broader perspective
  • I have a drastically more open mind and heart toward all beings
  • Meditation is the number one habit of all, it’s the foundation
  • Reading and journaling have been huge for me
  • I’m no longer depressed, in fact I’m more inspired and driven than ever
  • I appreciate a slow walk through nature without rushing
  • I have read a ton of books, podcasts, documentaries, and YouTube videos
  • I feel more inner peace and less anxiety and fear
  • I am thrilled about my upcoming life and getting older
  • I’ve had dozens of lucid dreams and out of body experiences
  • I am learning to follow my joy despite my fears and doubts

Anyway, I’ve been weighing in every Thursday for 31 weeks now and I’m at the tail end of 20 straight weeks of my running program so I figured I could keep those things up and eventually post about the changes in my life as a result of a few positive endeavors.

This week I weighed in at 251.6 which is up a bit from last weeks 245.4 but, I’m not really concerned about it one way or another.

Week n - 2nd 12 Week Session Week 31 - Copy

Muscle Splinting Psychology & Foot Keystones

An Impetus to Psychological Splinting:
Muscle splinting is a phenomenon where the body will try and protect itself by causing certain muscles to become hypertonic or stiff in order to help protect underlying visceral or somatic tissue.  A couple examples that come to mind would be in the case of appendicitis or whiplash.

Considering appendicitis, when a doctor performs an abdominal exam they will palpate and percuss four quadrants of the abdominal region, in the lower right quadrant is an area known as McBurney’s point which is about 1/2 way between the umbilicus and anterior superior iliac spine (ASIS) or about 2/3rds of the way down for doctors practicing in Europe.  The muscles superficial to the appendix will tighten up to help protect an inflamed appendix and this point will cause pain when palpated in a pt with appendicitis.

McBurney's Point

McBurney’s Point

A similar mechanism takes place in a whiplash patient regarding the muscles around the neck.  Again, the body is trying to protect itself.

As I wake this morning there is a bit more stress and anxiety inherent with another trip and another round of reviews for my impending Part III boards testing.  In the medical community the Part III analog is called Step 3.

Steps 1 and 2 for MDs or Parts I and II for DCs are essentially test which cover basic sciences like chemistry, physiology, anatomy, biochemistry, pathology and the like.  For chiropractors I know Part 1 consist of 9 hours of testing spread out over a two day period of time and part II is a bit longer and also spread out over two days.  Part III is only a 4 hour exam with half given in the first two hours, then a 20 minute break then another 2 hours of testing to finish up.  Part III is more clinical in nature and among other things covers all the basic exams, such as the aforementioned abdominal exam.

I’m not exactly sure why but some things stick very well the first time I hear them while other things take considerable focus and effort to get in my brain.  One thing that stuck when first learning the abdominal exam is a condition known as Caput Medusa.  I guess it has a catchy name that’s hard to forget.  Caput Medusa (CM) is a distention of veins around the umbilicus and although it can be caused by increased pressure in the inferior vena cava the liver is usually what I think of first regarding CM and portal hypertension.

Patient with Caput Madusa

Patient with Caput Madusa

My writing has gone a little tangential but my original thinking was engaged in finding insight into a possible phenomenon I’ll refer to as psychological splinting.  The brain is a visceral organ but instead of thinking in terms of a physical insult or any type of trauma we may also consider psychological insult or trauma and ways we, as humans may and up splinting ourselves psychologically in order to help protect ourselves.

As mentioned earlier, I am currently in a position which allows me an opportunity to use myself as a kind of living laboratory in order to examine my own responses to increases in stress and anxiety.  In order for my brain to help figure out a scientific type allegory I was lead to the concept of muscle splinting and have just started to ponder and consider implications associated with such thinking.

However, I am pressed for time so I’ll have to allocate portions of my four and a half hour trip to Kansas for further evaluation and pondering of psychological splinting.


Foot Keystones
There are three arches in the foot; a lateral and medial arch as well as a transverse arch.

Three Arches of the Foot

Three Arches of the Foot

In each of these arches, one bone in each arch acts as a keystone to each arch, the place where maximal stress and load takes place.

In the medial arch the navicular bone is the keystone.  In the lateral arch it’s the cuboid and the transverse arch most commonly has the 2nd metatarsal as the keystone.  An interesting part about this is that those bones, particularly the navicular and cuboid bones are bones that we, as chiropractors, have specifically learned to adjust.

The second metatarsal bone is most common in people with normal biomechanics however that load might also be found on the third or sometimes even as far over as the 4th metatarsal depending on the particular individual.

Morton Neuroma is found along the transverse arch, usually between the 2nd and 4th metatarsal and most commonly between the third and fourth metatarsal.  It is a perineural fibrosis (a thickening of tissue around one of your nerves) and causes nerve degeneration of the common digital nerve.  This usually results in a burning pain (which is common for nerve injuries) and often refers to the dorsal or top surface of the foot.

High heeled shoes have been linked to the development of Morton’s neuroma.  However, it should be noted that when referring to something like high-heeled shoes we come back to a basic situation of altered biomechanics.

One type of psychological splinting discovered for myself. 
Today, it looks like I’ve managed to put off final packing for my trip by writing in this blog so, avoidance may be considered one type of psychological splinting (PS) that I employ in my own life.  Beyond that, however, I’ve taken note of the method employed for my own method of PS which would have to do with reaching out to others and communications.  I would consider avoidance to be a general manifestation of PS while the mode employed i.e., communicating, to be a subset of that general mode.

That insight comes about as a result of recalling that, in the past, when I would be driving to school and have a particularly imposing and intimidating test looming that I would often text my girlfriend at the time and that communication frequency was much higher than normal communications under less stressful circumstances.

As a further offshot and tangent, I know have to wonder if the artificial manufacturing of stressful situations in a coupled relationship is done so that increased communications does take place and as such may be somehow perceived as a benefit to the one who might instigate say, an argument when no perceivably real genesis for an argument or altercation exist to begin with.


Reference: for those interested in some of the neuromusculoskeletal (NMS) aspects of Muscle Splinting:  The role of autogenic inhibition in the reduction of muscle splinting by Herbert Miller, PhD

Metallic Rock Red & Being Average

2015 Rock Red Metallic Camaro

2015 Rock Red Metallic Camaro

This morning I woke up thinking about chalazions & hordeolums which are stys found either inside or outside of the eye respectively.  The inside the eye one doesn’t hurt and the one outside the eye does hurt.  These thoughts quickly parlayed into cotton wool exudates seen on fundoscopic (eye) examinations as I recalled that being asked about on a previous Part III exam.

Cotton Wool Exudates

Cotton Wool Exudates

The cotton wool exudates most commonly result from diabetes or hypertension.  Hypertension thinking leads my brain directly to the heart and cardiovascular diseases which kill the most people every year.

Ten leading causes of death in females (2008 WHO data)

Ten leading causes of death in females (2008 WHO data)

When you see Ischemic heart disease as number 1 you can kind of think of “heart attack”  similarly, a stroke may be thought of as a “brain attack” since similar mechanisms are at work in either case just different (and very important) parts of your body.  #8 would be another cardio type of disease and if you add those three together you get about 7.2 million deaths annually while the combined total of the remaining 7 causes of death total 6.9 million deaths.

If we look at high income countries which, would include places like the US we find similar statistics.

Female High Income Country Deaths

Female High Income Country Deaths

Here we see 1.26 million deaths related to the cardiovascular system and 1.2 million for all other deaths combined.

The above list accounts for about 40% of all deaths with heart diseases accounting for 28% which is about 70% of the reason for the top 10 list.  It’s huge.  I always think about all the press breast cancer gets but a promotion towards heart health could save a lot more women (and men) each year than breast cancer.  Just from the figures above a female patient is almost 8 times more likely to die from a heart related condition than from breast cancer.

I’ll probably get an instagram post up relating this reality it just takes some thinking to post something with one picture a few lines of text and high degree of accuracy.

Rock Red Metallic
Is that about the sharpest color you’ve ever seen on a car?  This is where my brain went shortly after thinking about hypertension, the eyes and Part III boards.  I was driving back from Iowa yesterday and since I’m totally ready for a new car in my future I tend to notice everything that drives by.  I noticed a Malibu that went by and thought that was pretty sharp then I saw a newer model Impala so I looked it up on my phone and then noticed the base price on the Camaro was around $3,000 cheaper and had tons more sex appeal.

The base model 2015 Camaro pumps out 323 go with a 3.6 litre engine – that’s over 3x the horsepower I have in my Saturn right now so, I’m good with the smaller engine option.  The picture of the car up top was the final result of me playing with the online Build & Price your own car option.  I do believe I could look at that car for hour – in fact, I probably already have 🙂

Maybe I’m getting old or just a bit more practical but the first time through the build your own section the only extra add-on I picked was an extra $60 for a cargo net to help hold stuff in place in the trunk.   Some of the options are just ridiculous.  An upgraded brake system can add $7,200 and upgraded wheels & tires can add over $6,000.

For some reason, a spare tire is not included.  A can of Fix-O-Flat is included and a compact spare wheel & tire is $150.   I’m thinking the 1LT model which includes a 7″ diagonal color screen, USB port and a slightly upgraded interior might be the way to go.  Plus – with the 1LT model we can add a Premium 9-speaker sound system from Boston Acoustics which pumps out 245 watts of music!   $495 extra for the bolstered music system is well worth it in my opinion 🙂

Anyway, that’s my fantasy.

Being Average
I keep learning more and more about this Part III exam and one thing I learned new this past weekend is that, as a doctor, you kind of want to be average in certain respects.  This kind of goes towards the possibility of being in court where it is best to do, be and make decisions based on what the average doctor might conclude in various situations with a patient.

One chest x-ray we had to look at showed horizontal ribs which I was taking as being somewhat pathognomonic for emphysema and based my initial diagnosis on that (along with a few other things) but, when asked for a ddx or differential diagnosis one of the correct answers had to be heart attack which, i did not pick since that was quickly ruled out.

Well ….it looks like 90% of my online blogging time here has been spent looking at various car sites –,, …

Kelly Blue Book did give the Camaro a 9.2 out of 10 customer satisfaction rating.  The six cylinder automatic gets 30 mpg on the highway.

I LOVE that color – Rock Red Metallic – add 323 hp and a 245 watt audio system … mmmmmm 🙂

The 1LT has a 1LT Preferred Package option that gives you an automatic transmission and 19″ bright aluminum wheels for only $1495 extra – that seems awesome considering the automatic transmission option alone is around $1295 and upgraded wheels cost a fortune.   I’m not that smart about cars so I’m not sure what the increased tire size does in terms of performance but I know upgraded wheels can add drastically to the look of a vehicle.  I like the idea of alloy wheels and not something that’s painted.  So, here is my upgraded fantasy with the upgraded 19″ wheels …

2015 Camaro with upgraded 19" bright aluminum wheels :)

2015 Camaro with upgraded 19″ bright aluminum wheels 🙂 

2015 w 19 inch wheels automatic backside

yeah …it’s hard to see 2 and 3 hour runs over the next couple of weeks.  I’m only a mile away from the school in Kansas so commute is no big deal.  Back in St Louis the commute will be close to an hour each way so that 9 a.m. to 6 p.m. agenda becomes more like 8 a.m. to 7 p.m.  I’m pondering increasing frequency and cutting back on distance/time.

Originally, I was going to brag that the running helped me stay more alert during the review classes and it probably did but once we hit the 9-6 routines there was about one time each day where I dozed off a bit.  Still, that’s an improvement over times in the past.

Looks like it’s time to get back to my 105hp albeit super reliable 40 mpg Saturn and get her packed up for tomorrow mornings trip.  Other than that I’m thinking a bottle of bleach to help clean up the garage floor where the pets took some “liberties” while I was away as well as super cleaning any other countertops which …I thought I did a pretty good job cleaning before I left last week but … leave out one dish or miss taking out a single can of garbage and it’s like fly heaven!  yuck.

Week 20 – Don’t Trust Yourself

I learned early on in my running this year that I can be incompetent when it comes to predicting how well I’ll do with any particular run.  Today this experience coalesced it’s way into my life and helped me get in a run.  It was about 9:20 Tuesday morning and my last day up in Iowa.  I learned checkout wasn’t at noon, as was posted on that little plaque inside the hotel room door but at 11 a.m. so, I had some time available to get in a run and take a quick shower afterwards but I wasn’t really feeling it.  Didn’t want to go.  I’m not sure where this running funk mentality came from but I was aware of the game being played in my head.

Then I realized that whatever my mind was thinking shouldn’t necessarily be trusted and a better place to make a decision about whether to run or not should be made out on the road, after I’m fully dressed and prepped to run.  If I still didn’t feel like running once I was out there on the street then at least I’d have a little more informed decision.

I taped up my feet, got my running attire on, headed out the door – started all three apps I use to track my runs then cranked up some music and …I didn’t realize this until the end of my run but, that voice in me that was questioning whether I should run or not never opened it’s mouth once.  That voice simply vanished and was never heard from again.

It reminded me of that proverbial type of advice about sticking up to bullies in order to have them leave you alone (hopefully).

Soon after I arrived in Iowa last week I found a bike path only 6/10ths of a mile South of the hotel I was staying at.

I liked the path and paths/ trails in general and always try to avoid the sidewalks.  I still remember losing both of my big toe nails when training for my first marathon 20 years ago.  The really painful part for me was continually having to pry up the edges of the toe nails as they were growing back in so they wouldn’t become ingrown.

Shortly before the trip I noticed my feet were becoming a bit bloody in certain areas.  Bilaterally under both lateral malleolus and at the heel of both feet where my shoe was rubbing.  I’ve been putting bandaids over all four of those areas then wrapping the same areas with some light athletic tape and putting cotton balls over the afflicted areas.  It’s made a big difference and eliminated a lot of pain from my runs.

I thought of one blog title while I was running called Nipples, Ankles and Sunscreen or something to that effect.  I also recalled 20 years ago that any run 15 miles or more often resulted in bloody nipples from that skin being worn away from the slight movement of whatever shirt I was wearing.

I haven’t had any 15 mile runs but, the 13.1 mile training run I did last Thursday and subsequent runs have gotten me to the point that either I run without a shirt or start putting bandaids on my chest as well as my ankles.

The inner thighs are another area to contend with and another area where skin can be rubbed away to the point of bleeding.  My 13.1 mile run was the only time that got really bad but, I’ll have to get that figured out.

IMG_20140818_121248 - Copy

Those funky mushroom fungus type things were found about 2 miles into my run when I headed to the left on that bike path.

Mentally, that half marathon distance training run I did was broken down into two 3 mile runs.  I went 0.6 miles to get to the bike path then I figured I would turn left, run 3 miles and come back to where I started then, go to the right 3 miles and come back to where I started.  Well, each 3 miles out and back was 6 miles each – times two gave me 12 miles and heading back the 0.6 miles to the hotel was 1.2 total so, viola! 13.2 miles 🙂

I did the same sort of mental game with my 8 mile run – 2 miles to the left, return, then 2 miles to the right.

I’ve already looked up trails in Overland Park, KC where I’ll be staying next and found a really nice looking 26 mile trail called Indian Creek Bike/Hike Trail.  And wouldn’t you know it – it’s about 0.6 tenths of a mile north of the hotel where I’ll be staying.

The review class schedule is a little more grueling in KC than it was up in Davenport, IA.  The first day I arrive is only 5 hours or so that evening but, every day after that is the standard 9-6 schedule.  In fact, from now until September 4th  …..I do have off on Labor day but, 14 of the next 15 upcoming days will be of the 9-6 variety.

Oh well, I’ll take it slow & easy and one day at a time.  Only 3 more full weeks before that Part III board exam.

One week before the Part III exam I have a 50 mile bike ride scheduled then two weeks after the exam ….I’m pondering.  I could – run back to back to back to back Half marathons – 4 weeks in a row leading up to the full marathon.  I would have nearly two weeks after the last half marathon and still be able to taper down accordingly.

Initially, I was thinking signing up for all those races would force me to at least get in 13.1 miles of non-stop motion in a single outing but, then I did that 13.1 miles on my own.  The first 6.5 miles of that run was non-stop jogging which was pretty cool.

Secondary thinking was to make the weekend day with the half marathon my medium run day and then make Wednesdays my long run days.  Somewhere along the line I do have to get in 18 and 20 mile runs.

Sometimes I’m still stunned by this whole ordeal.  Half marathons – well, to get through them you just kind of do it and for a lot of people, especially if you’re going to walk it, there isn’t any grandiose training required.  This full marathon thing is such a much bigger deal.  I don’t think I put in this much effort for my first marathon 20 years ago but … I was 20 years younger and considerably lighter.