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PHIlosophy(a blog)

SARS Covid 2

24/4/2020

 

RIGHT. OH, UH, YOU'LL STILL BE HERE WHEN I GET OUT?


​The first thing I want to say, is that I sincerely hope that you are doing fine?  We are at a crossroads in history and the knock-on effects from SARS CoV 2 will likely travel as both waves and ripples across life as we know it from now on.  
 
There are many ways to examine SARS CoV 2 but the issue concerning me at the moment is the social isolation that has been forced upon us.
 
Now, the circumstances around SARS CoV 2 are a serious issue, but just as in treatment sessions with you, I often pause to feel the path of least resistance within a problem, and this morning, I decided to embody the spirit of Steve McQueen.  I was thinking about the greatest self-imposed or imposed isolation movies of all time and added the ‘Great Escape’ to that list (is that irony?)
 
Take a moment to escape the gravitas of the Corona virus and imbibe the Steve McQueen cool.  Double click on the clip and cue the theme music ...



So, you’ll still be here when I get out, right?
 
The social isolation that has been forced upon us is a serious issue.  Despite having a more than reasonable understanding of the immune system and virology and having had to accept the mandate around social distancing, it is still perturbing for me, as a human being, to remain isolated for months and to have people jump back when they suddenly realise I’m in the vicinity or to be faced with the open palm upon approach; and to have to deal with the defensively raised voice and the constant wide-eyed analysis over what you’re next move might be in the shopping isle.  Little things they might be, but they have a snowballing effect on your psyche.
 
When you spend time exploring the plethora of research papers comparing social isolation with various health issues and outcomes, you realise the magnitude of this situation.  To be fair, there is research arguing both sides of the coin:  social isolation does and does not affect health outcomes.  However, the majority of evidence ups in favour of poorer health for those that are isolated.  Most of us will not need to read through research statistics to know this.
 
It doesn’t matter whether the outcomes are emotional, mental physical or otherwise.  When you analyse all-cause morbidity (this means it doesn’t matter what you die from), those that are socially isolated die sooner within a given time frame than those who have regular social contact.  You can smoke, drink, have high blood pressure, diabetes or heart disease – it doesn’t matter what you die from, you are much more likely to die earlier than if you have these issues but maintain your connections.
 
The following points I wish to stress here are highlighted in an article - Social Isolation: A Predictor of Mortality Comparable to Traditional Clinical Risk Factors (2013).
 
  • Social isolation factors predicted mortality at hazard ratio levels similar to or higher than those of several standard clinical risk factors.  The paper goes on to suggest that social isolation affects mortality just as much as smoking and more than other clinical benchmarks, including ethnicity, age, education levels, and income.
 
  • In models comparing social isolation variables, unmarried status and infrequent religious activity are predictive of mortality in both men and women.
 
  • A lack of group memberships predicted mortality amongst men and infrequent social contact predicted mortality amongst women.
 
  • A point to note: amongst socially isolated people, only smoking and high blood pressure were (constantly) predictive of mortality amongst other variables measured.  Obesity and cholesterol levels were not.
 
The point we have to understand here in relation to SARS CoV 2, is that social isolation affects your health.  Does this matter?  You bet.
 
The paper Social regulation of gene expression in human leukocytes (2007) clearly highlights some of the biological mechanisms produced by social isolation.  For example, gene expression alters when you are socially isolated.  This means the make-up of your genes change such they (and therefore, your cells and organs) produce different by-products or that they don’t produce their normal by-products at all.  To be specific:
 
  • Isolated individuals had greater expression of genes producing pro-inflammatory cytokine signalling and prostaglandin synthesis.  In short, you house more inflammation.  If prolonged, it’s a sure pathway towards autoimmune issues and chronic disease.
 
  • Isolated people had under-expression of genes related to antiviral resistance, antibody production and lymphocyte function.  This last sentence is worth reading again.
 
My point here is that there is a cost-benefit analysis to be done comparing protective biological mechanisms with social isolation.  I haven’t even touched on the mental and emotional issues, but they need to be included here, as well.  
 
This is just information, but information is power.  What you do with it is up to you.  My goal here is to have people think, and when it comes down to it, make informed decisions for the greater good around the Corona Virus.
 
I have noticed in my clinic, that people want to talk about the Corona Virus.  People NEED to talk about it.  VENT about it, even.  Whilst people are towing the isolation line, there is a sense of fear, frustration and a lack of trust.  People have questions.  And rightly so!
 
So, stay connected.  Observe reasonable and common-sense restrictions but stay connected with what it means to be human.  Get out and get some sun and exercise.  You can still exercise with another.  Grab a coffee on the way back.  Be in touch. Don’t give in to the fear.  Encourage others to do the same.  
 
I’ll still be here when you get back!

PHI Editorial:  Health & Global reality

7/2/2020

 

Hamlet's 2020 ... To be or not to be
​

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Whether or not you believe or participate in such things New Year’s resolutions or Valentine’s Day, I think they at least offer a chance to ponder and reassess life for ourselves. 

If I were to ask you, what resolutions you made for this year and you were to reply that you didn’t, perhaps because you don’t believe in them, that’s fair enough.  But, do you consider why?  Why don’t people keep resolutions?  Why don’t you keep them? What’s the deeper perspective?  What can be learnt from this perspective?  


Now, this may seem like it’s taking up too much hard drive space six beers deep on New Year’s Eve, but it has wider implications for our evolution and survival as a species and for our planet. 

We tend to define socio-cultural aspects in relation to decades, so I spent some time recently contemplating the 10’s and wondered what the next decade will bring?  Aside from deciding what I will wear to avoid embarrassment in decades to come (back to short shorts, guys, really?) I explored the current reality we are facing as individuals and collectively.  Our health is intrinsically linked with a global reality, and our reality is the world is becoming more unstable and unsustainable.  But, we do have a choice to invest in a hazy, dysfunctional world or a new one full of possibility?

Very recently I read the pleas of an author who, in 2007, recognised that life as we know it in ecological, economic, social, political and cultural arenas, had reached a fatal tipping point.  Change now or perish was the message.  Some 13 years on, I wondered what that author thought and felt of the world today?  Was he happy?  Have we done well?  Was his warning heeded?  The author’s name is Ervin Lazlo.  Ever heard of him?  He has written 83 books and twice been nominated for the Nobel Peace prize.

In 2017, Professor Stephen Hawking stated humans needed to colonise a new planet and soon.  We had around 100 years to keep our species alive.  His expanded theory is that the chance of disaster on Earth adds up over time and because we’ve been relatively disaster-free, it’s a near certainty to happen.  He had originally stated we had 1000 to 10,000 years but revised it down to 100 years to establish life on another planet and 600 years before we had to leave earth.   He said, ‘With climate change, overdue asteroid strikes, epidemics and population growth, our own planet is increasingly precarious.’ 

In an interview with the BBC, Hawking also said, ‘ I fear evolution has inbuilt greed and aggression into the human genome.’  

I believe there is a growing tendency for our lives to be veiled in a fearful and dramatic energy.  I don’t watch the popular news for these reasons.  With the rise of social media the term ‘disaster fatigue’ has arisen, highlighting our loss of motivation due to prolonged exposure of news coverage.  It’s important to recognise this fear factor in our immediate lives and lives at large and make a choice to move beyond it.   From a health perspective, fear is at the base of many illnesses and pain.  It starts early in life and is exacerbated by our experiences and environment.  I believe most of our search for meaning involves shedding these fears to reestablish our true sense of self that we came into the world with before it was bombarded with fears and threats to our survival.  There are enough fear based situations in our early lives that we already take on as part of who we are.  These don’t need to be accentuated by social and environmental factors as we grow older.  Conversely, we also don’t want to make individual contributions to a global consciousness of fear, because it affects entire countries and the planet as a whole.

Anyone who doubts the planet, and therefore our health, is changing, needs to get seriously invested.  The fact that our lives and the climate are changing, is beyond doubt.  The debate seems to exist around whether this is a natural cycle of things or whether we as humans, are contributing or causing this?  The earth is now the warmest it’s been in 120,000 years.  Part of the consequence of this is rising carbon dioxide concentrations.  However, are we as a species contributing to this?  The answer is yes.  For example, 18 of the last 19 years have been the warmest on record and concentrations of carbon dioxide are the highest they’ve been in millions of years.  Despite attempts to reduce carbon footprints, in 2018 carbon dioxide emissions rose 3.4 percent in the US over the year prior.

We, in Australia, don’t need to look to far afield to notice the effects of climate change.  This summer, the devastating effects of a significant proportion of the country being on fire has been overwhelming.  The collective response by everyday Australians to disaster relief has been outstanding.  I believe this is in large part because it’s who we are as a nation, but also because so very many have been unable to escape some personal association, whether it be because of the heat levels this summer, the sensationally poor air quality and smoke laden skies, the lack of rain, dust storms, reduced crop availability in supermarkets or rising vegetable prices … 

What if, in the near future, you order your morning latte and your barista says to you, ‘that’ll be $20 thanks’, will you hand it over?  Currently 60% of the planet’s wild coffee species are facing extinction due to disease and pests (higher temperatures), climate change and deforestation.  Whilst it hasn’t yet affected the world’s coffee supply, it’s likely it will.  This will imply developing (genetically modifying) the coffee bean to resist the consequences of these changes.  You may still be able to get your fix, but just not as nature intended.

Change is no longer something that may happen in the future,  It is here now and we are experiencing it on a daily basis in one form or another.  Change is not an option and it’s something that you and I have to make a reality for not only for generational survival but for our current state of health.  To assume that things will take their course and be ok, is suicidal. 

Please think about this as we begin our new decade.

​
​                                                To be, or not to be: that is the question:
                                                Whether 'tis nobler in the mind to suffer
                                                The slings and arrows of outrageous fortune,
                                                Or to take arms against a sea of troubles,
                                                And by opposing end them?

cambridge Anti-pollution mask

28/6/2019

 
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Back in the February edition of the PHIN Review, I wrote about the mask I was about to use on a flight to the US.  After that trip and use since, I thought I would give some feedback on how it went.

Before I get fully into the verdict, if you hadn't already checked it out from the newsletter link, here's some information from the Cambridge Mask Co. website ...

"Cambridge Masks™ are respirators that use military grade filtration technology to filter out nearly 100% of particulate pollution, gases, as well as bacteria and viruses in a fashion friendly mask suitable for the whole family. Cambridge Mask’s™ inner filtration layer is made from a 100% pure activated carbon cloth, which was originally invented by the UK Ministry of Defence. It was extensively developed and has been made into products for use in chemical, biological and nuclear warfare protection."

"Our pollution masks help protect against gas based pollution, such as smells, benzene and formaldehyde, particle pollution such as PM2.5, pollen or smoke and pathogens such as viruses and bacteria. Ideal for cyclists, people in at risk groups for respiratory disease or anyone living in urban environments with high air pollution levels ..."
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The first thing you have to overcome with this mask is the Silence of the Lambs factor.  I suppose the multitude of colours and designs available can offset this mindset?  I found that people didn't really pay that much attention.  As far as I could tell, I was the only one on the plane wearing a mask, which is curious to me?  Having said that, I was welcomed on board the return flight by the attendant with "Wow, you've had a quick trip!"  She recognised me from the flight over.  The takeaway here, ... don't plan to rob a bank with this bad boy.

I chose a small size.  I wanted a firm fit to be affective.  I was concerned it might be too restrictive but it quite comfortable.  I thought the firmness of the ear straps may cause my ears to resemble the airplane wings, but this wasn't the case.

The fit was snug, but not as airtight as I thought it would be.  It was still effective, though.  

There is a certain freshness the mask may lack if don't plan on cleaning your teeth a couple of times over a 13 hour flight.  I dabbed 'Medieval oil' on the inside, a combination of herbal essential oils designed to provide some immunity.  I find it a pleasant smell and thought it couldn't hurt in order to prevent people from 'sharing.'   I was expecting the mask to prevent me from noticing smells and odours, but this wasn't totally the case.

My breathing wasn't restricted at all, despite the mask rising and falling slightly with respiration.  This eased "the easy fit but effective barrier" comparison in my mind.  In fact, the mask conformed so well that, in my experimentation, I was able to wear if upside down and still find it worked!

I wore the mask from the moment I sat down in Brisbane to the moment I disembarked in LA, except for eating (and teeth cleaning!). 

In the end, the major questions I had of the mask were:  would it keep me healthy and would I feel less jet-lagged?  This is important because I'm almost straight into long hours of learning and practice as soon as I'm there.  The overall verdict is 'yes'.  I felt better.  From a physiological point of view, rebreathing your own carbon dioxide should provide a parasympathetic (calming) response.  I wasn't any less tired, after all, a lack of sleep is a lack of sleep; and eating and operating in majorly different time zones is still a problem.  However, I would say that I felt 'cleaner'.  I had less brain fog and my whole system generally felt lighter.  I think this translated into a shorter adjustment period, both when I got there and upon my return.

Overall, I'd say thing if international travel or frequent domestic trips were your thing, rather than robbing banks, then check it out.

Happy travels!

Research on gallbladder surgery...

4/2/2019

 
Generally, I am moved to write an article when enough people present at the clinic with common symptoms relating to conditions that are poorly understood and not managed well in mainstream health. 

​Removal of the Gallbladder (Cholecystectomy) is one such condition, as are a number of possibly related conditions such as various types of reflux, anaemia, digestive issues, diarrhoea, vitamin deficiencies, osteoporosis and weight gain, just to name a small sample.

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Perusing the literature will reveal that somewhere between 7% and 47% (depending on the criteria) of patients are dissatisfied with the procedure.  In some cases, that’s nearly half of the people who have this surgery!  Of course the surgery is necessary in some cases (often in those who have left it too late to do something conservative about it) but questions have to be asked when a significant number of patients remain with the same complaints they experienced pre-surgery.

​Duodenogastric reflux (DGR) is a normally occurring phenomenon whereby some of the pancreatic enzymes and bile delivered to the small intestine (the first part of which is called the duodenum) from the gallbladder leaks back up into the stomach.  This normally doesn't produce any symptoms.  However, leakage after cholecystectomy can occur at pathological levels.  Studies show at least 20% and as much as 90% of patients demonstrate excessive DGR within 6 months of surgery.

At this point, note that Duodenogastric reflux (DGR) is different from Gastroesophageal Reflux (GOR) which occurs between the stomach and the oesophagus.

The problem with DGR in excessive amounts for prolonged periods is that it damages the protective stomach lining (mucosa) and can lead to inflammation or Bile Reflux Gastritis (BRG) and eventually, gastric ulcers.

At this juncture, two things can happen.  An irritated stomach will go, at least partially, into spasm.  This tension results in added stomach juices (a form of weak hydrochloric acid) being secreted from the stomach wall which can over-acidify the stomach, thus making the inflammation worse.  Naturally, the stomach will want to get rid of it, so where does it go? Back up and out, which irritates the oesophagus.

The stomach is naturally on the acidic side and this helps to start the breakdown of food and also helps to kill of any unwanted bacteria that have snuck in.  But, there is a balance:  too much acid is irritating and too little (a tendency towards alkalinity) causes the stomach to somewhat delay the passage of food until it is broken down to the digestible levels.  If it doesn’t do this, ‘undigested’ food is passed down the chain.  The digestive process is specific to each part of the digestive chain and try as it might, the intestines may never catch up resulting in undigested food in the stool.  
If the food does remain in the stomach too long, the partial fermentation that occurs feeds certain bacteria naturally present in the stomach and gut.  The body is all about balance, and if certain bacteria start to dominate in the stomach, they can irritate the mucosa in the same fashion as already mentioned with the same result, or they can further imbalance the breakdown of food.  This creates a negative cycle.

The second thing that can happen is when the alkaline bile and pancreatic juices back flow into the Antrum (see picture), the stomach then produces less somatostatin.  Somatostatin helps to regulate the production of acid in the stomach.  So when we eat, we produce more acid temporarily, but so we don’t produce too much, the stomach releases somatostatin to eventually shut down acid production.  In effect, if the stomach becomes a little alkaline (due to duodenal reflux), somatostatin isn’t released in sufficient quantities and the net affect is that acid production continues to the point of hypersecretion and hyper-irritation of the inner stomach.
​

Statistically, if there were gallstones present, nearly 13% of patients are likely to develop a peptic ulcer within 5 years of surgery.  This is only slightly more prevalent than those who had significant gallbladder irritation but didn’t have stones or surgical treatment.  One way you could look at this is to say that for a number of people the problems that caused irritation remained, despite surgery.  In fact, surgery in not aimed at a cure but only to remove the part that is causing pain. The precipitating circumstances remain and may then go on to affect other structures and functions with time.​

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​I see a skewed population of patients in the clinic on these terms.  That is to say, I see the patients whose discomfort or dysfunction has remained despite surgery and I see it commonly enough to be moved to write this article.  Figures show that 15%-20% of patients show with new gastrointestinal symptoms or the same preoperative complaints.

Further to the problems mentioned above, studies also show that antroduodenal (end of the stomach and beginning of the small intestine) motility is altered and stomach emptying is slowed following cholecystectomy. This may contribute to feelings of fullness, heaviness and distension discomfort following eating?

Other studies show that the healing and regeneration capabilities of the stomach mucosa are outpaced by the repeated stimulation of bile irritation due to DGR and may lead to chronic gastritis and metaplasia (growths, tumours, cysts, cancers, etc.)  One researcher demonstrated that prolonged GDR longer than three years after gallbladder removal led to gastric pH exceeding 3 (strongly acidic) for prolonged periods and was associated with chronic gastritis.​

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Another question that has to be asked is: with 10% to 15% of the population walking around with gallstones, why doesn’t everyone have problems?  Gallstones don’t necessarily have to be the source of pain.  Gallstones are associated with increased episodes of GDR but these don’t always correlate with symptoms.

Following surgery, removal of the gallbladder reservoir alters the cyclic pattern of bile excretion.  It also alters the neurohumoral (a process whereby neural messages are altered to or from the organ due to a change in chemical stimuli, in this case, bile) response causing motility changes in the upper gastrointestinal tract, possibly leading to DGR.

One study performed an endoscopy of the oesophagus, stomach and duodenum 30 days prior to surgery and 60 days after surgery to determine the effects of the operation.  The results were as follows:  
​

1.  In terms of inflammatory markers, 38% showed an increase pre-op and 48% post-op.  More inflammation!
2.  38% had reduced activity / motility of the organs pre-op and post-op this increased to 64% of patients.
3.  34% had atrophy (breakdown) of the stomach lining prior to surgery and this increased to 48% post-op.
4.  Intestinal metaplasia actually reduced from 46% pre-op to 44% post-op (but this still means 44% of people had some kind of metaplasia!)
5.  28% of patients demonstrated overly high levels of Helicobacter Pylori bacteria pre-op and this rose to 36% post-op.

Note:  there will be more on H. Pylori bacteria to come in future articles.

Finally, in this article, it is important to note that discussion is centred around reflux occurring at the gastroduodenal junction (GDR) and not the gastrosophageal junction (GOR).  The results at the GDR cannot be extrapolated to explain GOR.

Hopefully, this article gives you some background information on Gallbladder surgery and some of its effects.  This should act as a springboard for further articles relating to associated dysfunctions, like osteoporosis and anaemia.  Ultimately, this will also lead to a discussion on effective manual assessment and treatment options not generally considered by health providers.

Until then, good health.

Smooth as ...

18/5/2016

 
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I'm often asked about the smoothies I drink, what they are used for and what I put in them ...

Here I've decided to list a few that I've had over the last month or so.  They're not all to everyones taste, but they'll give you an idea about where to start.  Smooth drinking!
 
​BK Smoothie

One banana
Large handful of kale (unwashed)
Large handful of spinach
1/4 avocado
1 tbls chia seeds
1/2 a lime
1 tsp coconut oil
1 tsp matcha green tea powder
One cup of coconut water

BA Smoothie

Half a doz broccoli pieces
3 asparagus spears
1/2 a cucumber
One pear
1/2 a lime
1 heaped tsp of green powder
1 cup of coconut water

Caramel Cauliflower Smoothie

1/2 a banana
Half a doz cauliflower florets
One desert spoon of tahini
One handful of romaine lettuce leaves
A few dates
1 tbls lacuma powder
Cinnamon to taste
Vanilla powder or alcohol free vanilla
Half a cup of coconut milk
Half a cup of coconut water

Papaya Smoothie

1/2 a small papaya with seeds
1/2 a mango or 1 kiwi fruit
1 pomegranate whole (minus the skin!)
1 large passionfruit or two small
1/2 cup of a super fruit juice (pomegranate / aloe vera / noni)
1 coconut water
​1/2 cup coconut milk to taste

Choc-Berry Smoothie

1 banana
1/2 to 1 cup of blueberries (frozen is ok)
1 desert spoon of cocoa powder
1/2 cup of super fruit juice
1/2 cup of coconut water
1/2 cup coconut milk to taste
1 tsp of coconut or flaxseed oil
1 tsp maca powder
1/3 tsp of non-soy lecithin granules
Honey to taste

Tongue-tie in adults

29/1/2016

 
This post is a follow-on from the previous blog article on tongue-tie in children.  It's worth reading as an adjunct to this article for adults ...

Because a tongue-tie in children is rarely treated, I see a lot of ankyloglossia in adults.  By the time I see this in adult patients, years and decades of adaption have occurred.  Therapists will very often and repeatedly treat the symptoms of a tongue-tie, for example, a degenerative neck, without addressing the causative circumstances.


Some of these secondary adaptions include:

  • An immobile sternum.  Because of the fascial, muscular and neural connections from the mouth and jaw down to the sternal area, stiffness can result.  This may lead to circumstances like altered breathing patterns, rib problems, lung and cardiac restrictions (due to sternopericadial and sternopleural attachments) and thoracic pain.​
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  • Tightness around the base of the skull and upper neck, which may contribute to neck pain, headaches, swallowing issues …
  • Tension in the front of the neck or the muscles along the side of the neck.  One side may be more tender than the other, which can link to a tighter frenulum on the same side.
  • Tension in the bone and cartilage at the top of the throat.  This should be fairly mobile to allow for correct speech and swallowing.  It should easily move side to side and a restriction to one side may again correlate to a tighter frenulum on the side it has trouble moving away from.
  • Tightness here may also pull the bone and cartilage upward which can translate tension all the way down to the stomach via the oesophagus.  This is where reflux, heartburn and hiatial hernias can be apparent.
  • Tightness in the muscles under the jaw.  This can manifest as a straight line between the point of the chin and the throat, under the jaw.  This can pull the jaw downwards and backwards, leading to TMJ issues.
  • Tightness in the floor of the mouth.  Any of my patients who’ve had mouth work done can tell you how tight these muscles can get.  The tongue should be able to elevate towards the roof of the mouth without the floor of the mouth coming upwards.
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  • At the same time, with a tight frenulum, often only the tip of the tongue will rest on the palate (behind the upper teeth).  On the picture below left, the solid blue bar represents the frenulum; the red arrow represents the pull of the frenulum; the yellow vectors represent the resultant pull of the frenulum in the horizontal and vertical planes; the blue arrow is one of the eventual effects where the posterior tongue sits low and back, which produces an array of sucking, breathing, speech and TMJ problems.    At rest, the middle and back parts of the tongue should nestle up against the back of the hard palate (picture on the right).
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  • Tightness in the jaw muscles of the cheek.  Ropey, sore muscles here may indicate that they are working too hard.  A tight frenulum will cause the jaw to move backwards, disrupting the mechanics at the TMJ.  This can also be a problem at night, as the same backwards movement can constrict the airways and contribute to an obstructive sleep apnoea. 
  • Tightness in other associated areas in the hands, arms, neck, back, sacrum, and pelvis.
  • Speech and breathing issues.  For example, mumbling and talking quietly or developing a sore throat or gravelly voice towards the end of the day.  Also, it lends itself towards becoming a mouth breather, which leads to hyperventilation and poor diaphragm mechanics.

​Good manual therapy can go a long way towards minimising or eliminating some or most of these issues.  It will usually include a raft of home exercises, as well.

Some patients will opt for a frenectomy, which is a relatively quick procedure to release the membrane under the tongue, done in a dental practice experienced with this surgery.  It is usually performed with a laser and doesn’t require anaesthetic.  To prevent re-scarring, a month long regime of exercises is necessary.  All surgery has potential complications, but should be minimal in this case and in the hands of a dentist who has some experience.  Be careful of damage to the salivary glands under the tongue.

Post surgery, you might expect to feel or see:

  • Better tongue movement
  • More tongue relaxation
  • A wider tongue
  • The tongue sitting more on the roof of the mouth
  • Better facial symmetry in the cheeks, nose, mouth or eyes
  • Less grinding of the teeth
  • Better sleep
  • More relaxation and openness in the throat area
  • Less chest tension
  • Better neck and back posture
  • Changes to a Dowager’s hump
  • Less tension around the base of the skull
  • Changes to ease of swallow
  • Less back pain

This is a basic overview of some of the issues and possibilities surrounding a tight frenulum and therapy or surgery.  Despite such a small restriction, the repercussions are manifest.

Tongue-Tie in children

24/1/2016

 
In practice I sometimes come across adults and children who suffer from a tongue tie.  This relatively common affliction refers to the membranous structure underneath the tongue, called the frenulum linguae.
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​There is some suggestion that this structure shouldn’t be apparent at all.  Embryologically the right and left sides of the tongue come together, fuse and then the tongue extends outwards during development.  At this stage it is suggested the frenulum should recede completely.  If it doesn’t, and it retains a degree of tension, this small structure has the capacity to effect an enormous number of issues in our lifetime.

A tongue tie is a poorly diagnosed and treated affliction.  Mostly, it is never picked up and if so, reluctance to treat it is common.  For the purposes of this article, it may be better to break down the issues in relation to what I find in a paediatric population compared to adults.  Although the anatomy is similar, I commonly treat either group for entirely different symptomology. 

The Anatomy

The tongue is a group of muscles (technically, it’s an organ) that have significant attachments and substantial fascial (also known as ‘connective tissue’, it supports and connects structures throughout the body, often forming networks that traverse large distances) planes.  It attaches to bones in the throat (hyoid), the jaw (mandible) and the skull (temporal bone).  The tongue has as much ability to affect any of these structures, as they have to affect the tongue.
The tongue is innervated by no less than 5 cranial (brain) nerves.
The tongue is involved in functions of speaking, swallowing, posture and alignment.

Children

Here I will outline some of the more common reasons that parents will bring their children to see me.  Not all of these cases are related to tongue tie in that there are other potential causes, but tongue can can produce the following issues.  When the mobility and therefore function of the tongue are affected, it won't be able to extend for long periods of time and may recoil (a possible cause of clicking when feeding) when the baby lowers the jaw during sucking.  This results in breaking the seal and poor suction.

Sometimes there are problems breastfeeding.  Some of the factors to consider include:
  • ​Not latching on properly
  • The latch cannot be sustained for long
  • Sliding off the nipple
  • Prolonged feeds
  • Restlessness after prolonged feeds
  • Falling asleep on the breast
  • Gumming and chewing on the breast
  • Not gaining weight
  • Unable to utilise a dummy

Given the problems above, potential results that may ensue include:
  • Nutritional deficits
  • Colic
  • Reflux
  • Spilling from the side of the mouth
  • Stimulation of the gag reflex
  • Sleep apnoea
  • Altered sleep patterns
  • Speech problems
  • Impairment of facial and jaw development
  • Dental decay
  • Teeth gapping
  • The teeth either growing away from the tongue or inwards towards it

To breastfeed well and without pain requires a good and correct latch.  This means:
  • That the chin should rest on the breast, below the nipple
  • The lips should roll outwards
  • The lower lip (if not both) should be hinged outward
  • The jaw is open wide (130-160 degrees)
  • The top lip should be just above the nipple (not the areola) 
​
Picture

​Some of the more common issues from an improper latch include clicking noises from tongue recoil, colic and reflux.

If excessive amounts of air reach the stomach (Aerophagia) because of an improper swallow, the results can include:
  • Abdominal distension
  • Burping
  • Flatulence 

Colic (pain in the stomach or small intestine) usually produces crying and screaming and manifests within the first couple of weeks.  It may last for several months.  The exhaustion that comes from it can also be a reason why breastfeeding fails.  Mothers are sometimes advised to wean but similar problems can also occur during bottle feeding.

Reflux can have colic type symptoms but usually involves regurgitation of milk or food.  The pain and symptoms are usually worse on laying down flat, after feeding or when sleeping.  It may result in the baby arching the back or neck to relieve the pain, coughing, gagging, drooling, problems swallowing and hiccoughing.  The baby may refuse to feed (or conversely, constantly feed).

Unfortunately, treatment is often delayed to see if they symptoms will resolve themselves over 
a few months.  In a percentage of cases, infants may be placed on medications like Mylanta to reduce the reflux.

Is your child tongue tied?

If you were to sweep your finger across the floor of your child’s mouth, under the tongue, the floor should be smooth, which is great and indicates no problem.  A small speed bump under the tongue may indicate a potential problem and a large speed bump will likely develop into issues.  If you encounter a membrane under the tongue, problems are manifest.

The membrane itself may be very strong and feel like a piece of wire.  If you push on it, look for a tongue tip indentation and bending of the tongue tip downwards.

The tongue tie will not correct of its own accord and will likely go on to affect breast feeding, breathing and speech - most likely the “l” and “th” sounds.

Treatment

If the problem is diagnosed and treated early enough, there should be minimal repercussions for the infant.  Up until approximately 12 years of age, the bones of the face and cranium as still quite malleable.  If the tensions created by the frenulum are allowed to exist over this period, the craniofacial development can be altered remarkably.  There are many, many times I wish I had the chance to correct some adult issues when they were in childhood.  In fact, the consequences in adulthood are so rampant that you could build a career out of treating them.  I have written an article on adult tongue tie, which  I would encourage you to read them as it provides different and more detailed information than I have written here.

Rather than treating the consequences, the most effective manual treatment will be no substitute for a frenectomy,  This relatively simple procedure can be done in a dental practice with instruments or a laser.  It doesn’t require a general anaesthetic (you can choose to have a local or nothing at all) or stitches.  You will, however, have to adhere to an exercise program with your child for a couple of weeks so that the frenulum is prevented from scarring up.  

Questions on parkinson's disease

25/8/2015

 
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A Dopamine Molecule
Last week I fielded questions from a researcher at the Australian Catholic University about the Parkinson’s Disease (PD).  At the end of the discourse I was asked, “how can I explain what you do so that PD patients would understand?”

It’s a good question …!

Traditional PD treatment follows a well worn pathway:  GP’s; Neurologists; medications; and exercise, for example.  Things progress:  new surgical procedures, new medications, and new forms of exercise.  The advancements can be necessary and worthwhile for most patients.

Many patients will comment that the nature of the work I do is a little different.  Well, perhaps that is so, but only in the context that not many people are doing it and not in terms of anatomy, neurology, combinations of therapies and connecting some of the dots.  Rather than thinking that some of the PD work I do is outside the box, I choose to nominate that I am widening the container.

Like many outward signs of most health issues, once the  symptoms appear, you can almost bet that several (or even dozens) of other things have preceded it in order to manifest signs.  For example, a tremor in PD.

I have said many, many times in practice that the human body is remarkable in it’s capacity to adapt.  It’s part of our survival mechanism and we wouldn't have gotten this far without that ability.  It is when we run out of adaptions that the dominant signs of a health problem occur.  The body has nowhere to go.

This brings me to the first general concept when treating PD (or any other health issue for that matter).  Often it is a matter of peeling back the layers (of compensation) until the body has a bit more room to  move or breathing space.

This leads on to other concepts.  The next obvious question to ask is “what are the layers that have to be removed?”

How many of you know that one of the first signs of PD is constipation?  No one thinks about this much because we all get constipated every now and again or perhaps you’ve been constipated for your whole life and in some way you consider it normal?

There has been bucket loads of research (see the library on this website) about compensatory or genetic inflammatory gut issues that lead to a heightened immune response, first in digestive tract and then in the body as a whole.  This allows for molecules to pass from the gut into the blood stream, which then cross the blood-brain barrier and affect neurological tissue.  

The way the gut deals with this inflammatory/immune issue is through the lymphatic system.  Here is one possible layer of compensation that I seek to affect.  By the time PD is manifest, I often find the lymphatic system in the gut has become sluggish, overworked and is struggling.  It’s a balance between not wanting the lymphatic system to overwork in the first place, but once it has to, allowing it to operate optimally. 

Perhaps the gut also has other restrictions or adhesions related to surgery, genetic predisposition or dietary elements?  It is possible to work manually with the mobility of the gut in order to improve its function.

Most people think of PD as a brain or neurological issue.  There are certainly compensations that occur in the brain and involve the most direct link to the tremor that occurs via a lack of dopamine production in a structure called the substantia nigra in the midbrain.  However, there are other structures in the brain, the ventral tegmental area (VTA) and the nucleus accumbens amongst them, that also produce dopamine.  It is possible to work with these structures manually in order to optimise their function in the face of their inability to produce dopamine.  I will often find secondary compensations in areas like the basal ganglia (movement initiation and repetition) and the cerebellum (balance, co-ordination, body awareness and feedback to and from the brain and body).  The question becomes, can I optimise the function of these areas given that they may have compensated their activity, either prior to PD as a result of something else, or from the disease itself?

If you like, the second concept is one of removing any secondary but related compensations that accelerate the progression of PD.

Another tertiary concept is the improvement of the actual structure itself (substantia nigra, VTA etc) beyond its ability to produce dopamine, so that it functions as best it can.

So how is all this treated?  Each structure or tissue (or even cell) has it’s own anatomical, physiological and energetic signature.  These signatures can be identified via manual assessment if you know what you are looking for.  If you know what the signatures normally feel like, you are also able to know what they feel like when they are ‘off’. 

When structure or tissue is under duress, there is a resultant physical tension.  The body has a natural tendency towards healing (you cut yourself, it heals).  If the tension of the dysfunctional tissue can be changed, often the body part / cell / tissue will reorganise itself so that it functions better.  It just needs the chance.  See Brain work and Neuromeningeal Therapy elsewhere on this website for more information.

Is this type of treatment a panacea for PD?  Certainly not.  If you are not looking at your diet, bacterial population in the gut, stress levels, and heavy metal exposure amongst many other things, then it is likely PD will continue to manifest unabated.

However, it can be very effective as part of a larger program …

updates on autism ... the brain

8/8/2015

 
Picture
Nearly 60 years after autism was first identified, the number of cases continues to rise ....
            
There are many types of disorders along the autistic spectrum.  I frequently see these in my practice amongst children and adults alike, from very mild to quite severe.  In our capacity as parents, teachers and practitioners we may have all come across people with some of the classic characteristics: difficulty with social interaction, challenges with verbal and non-verbal communication and repetitive behaviours.

Despite the vast differences in presentation of people with autism, the common factor is that the brain functions a little differently.  During development, something spurs the neurological and physiological processes to reorganise themselves away from the norm.

American figures suggest a 10 fold increase in the number of cases diagnosed in the last four decades.

From my perspective, manual treatment can help the brain to make the connections it might be missing.  

I have also begun to notice, in a significant number of autistic patients, the occurrence of lymphatic disturbances in and around the small and large intestines.  

I have also read a large number of studies recently that are uncovering the gut/bacterial connection to the disorder.  For those that are interested, I have listed several articles in the Paragon Health library.  However, the one I would suggest starting with is:

                                 Gastrointestinal Microflora Studies in Late-Onset Autism 

I will also focus on the gut-brain link in an upcoming blog article.

There are some commonalities in the manual assessment of the brain in patients with autism. However, because we see a spectrum of disorder in autism, each person can also be different.  This might be influenced by the type of presentation someone presents with?  For example, perhaps the main issues are concentration and memory; language difficulties; movement and co-ordination; or perhaps social and emotional interaction.  Each subset manifests in a different part of the brain.  Although technically, I think it is more exact to say that the particular part of the brain affected determines the presentation.  It is also common for the pathways of brain dysfunction to overlap, so that I may be treating several areas concurrently.

These parts of the brain can be affected in the absence of any noticeable physical trauma, as might be seen during the birth process, for example.  Given this, it is pertinent to ask what may have a global affect on the brain other than trauma?  It is extremely interesting to note the frequency with which these patients present with bowel and digestive dysfunction, and, as I mentioned, lymphatic disturbances in and around the intestines.

Back to the brain ...

One of the more common aspects I manually feel is the physical tightness of the cranium, the membranes lining the skull (which also attach to the brain), and the outer part (cortex/grey matter) of the brain itself.

Another aspect again involves the cortex of the brain, but more in relation to it's neurological aspects. Sometimes in an isolated area and sometimes in its entirety, the cortex can have a subtle but definite electrical hum or buzz to it's tissue.  The thought that comes to mind is "a sea of electricity".   This is happening at a cellular level in the grey matter.

When tissue becomes oxygen deprived, it also has a particular feel.  This feel tends to coincide with the sea of electricity in cases of autism.  This doesn't strictly mean that there is a lack of oxygen getting to the brain, but probably that the cells in the grey matter don't know how to use the oxygen available to them?  The cells undergo "oxidative stress" which has been defined as: "an imbalance between the production of free radicals and the ability of the body to counteract or detoxify their harmful effects through neutralization by antioxidants."   The oxidation process is essentially aerobic (utilising oxygen) and involves a cellular organelle called a mitochondrion which uses oxygen and has been said to act like a battery in the cell.  We all know what happens when batteries go flat ...

Does this sound confusing?  If so, forget all the information and imagine something we have all seen before ...

Picture

Now, this isn't meant to be dramatic and it doesn't mean the brain will look like this!  The brain is so incredibly fined tuned that even the smallest changes can have consequences.

My process is to provide the brain and cells the opportunity and space to change (and recover) if they want to.  Sometimes they will and sometimes they won't.  In the cases where the tissue is reluctant,  there may be concurrent factors at work that also need to be addressed?  My job is to give the brain opportunity and help it to integrate changes  that may involve treatment in other parts of the body, but nonetheless have an impact on the brain.  This is where the gut may come in ...



Concussion Part II

12/4/2015

 
Picture
To further the discussion on concussion, I wanted to post some video clips produced by the CBS network in the USA.  

These clips relate to the concussion study being undertaken by colleagues in the US and how it relates to two former NFL stars, Ricky Williams and George Visgner.  

The videos can be found here:







A modified transcript of one of the videos is written here:

Ricky Williams partners with local institute for head trauma treatment 
researchBy Matt Lincoln/CBS 12

JUPITER, Fla. - Former Dolphin Ricky Williams is working with the Upledger Institute in Jupiter, to prove that there's a treatment for head trauma that actually works.

The bright lights, high volume, and constant movement of a football field. 

Quite the contrast, inside the Upledger Institute, where the only sounds are some whispering and the whirring of a small fan.. 

This is not your typical huddle, but there is a football player in middle.

"I believe that this work can show change that doctors don't believe is changeable," says Ricky Williams. 

The former Dolphins running back and four other former NFL players, are undergoing Craniosacral therapy in Jupiter.  Developed by Dr. John Upledger, the therapy helps regulate the flow of cerebral spinal fluid throughout the body. 

That's accomplished by multiple therapists listening to the needs of the patient, and working with the tissues throughout the body.

"We're not coming up with an idea of what they need," says Upledger team facilitator Chas Perry.  "We're feeling their tissues and applying that, we are feeling the life of the client."

"It's just been a couple of days, and players say they are astounded how great they feel," says CEO John Upledger. 

The craniosacral therapy can fix ailments throughout the body, but it's unique in what it can do for the brain.  

"Football players have a headache that never really ends," says Williams. "This work allows my head to breathe." 

"Our feeling is the NFL will take note and say 'There is something to this'," says Upledger. "And they will help us get our work out to a broader audience.

Upledger says this treatment not only works for people who've suffered head trauma, but he's seen success in autistic children, and Vietnam veterans as well.

Thursday, July 24 2014, 12:23 AM EDT

Yours in health,

David Macdonald
Director / Paragon Health

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