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!
michael-jackson-mus-jy-0182_61285906

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.

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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