Tech, Healthy and business

To understand physiology, you have to understand cells. To understand cells, you’ve got to understand DNA and self-replication. And you can’t understand DNA unless you put them in the context of chemistry and physics … Atoms make the world Atoms are the building blocks of nature. They are mostly empty space: a tiny clump of protons and neutrons, like a baseball floating in the centre of a stadium, plus some electrons whizzing around the stands like peanuts. What gives it substance, then? Only the weird, extreme, and arbitrary forces of the universe hold it together. Like magic, you simply can’t wedge anything else between the electrons and the nucleus — and so they seem solid. Add a single proton to an atom, you get a different kind of atom. If you add too many, they don’t hold together well, and the structure is radioactive, and sheds subatomic particles and energy that can disrupt other matter. There are several dozen kinds of more or less stable atoms, each one of them called an...

A silent, anonymous place I was still a child the last time I’d seen it. The hospital was an anonymous place my parents had taken me to, somewhere in the big city, far from home. I didn’t know where I was at the time, but when I saw it again as an adult, there was a match with something stored in my skull: the outline of the building like a stack of building blocks, the primary colours, the silence that seems out of place around a place built for children. Medical science failed me in that hospital. I was diagnosed early with “slow growth syndrome,” and this was the first mistake that science made with me: giving it a name. Slow growth syndrome is no syndrome at all. Some people grow slowly. So what? I was small for my age. I didn’t have a pathology: I had a velocity. I was taking my time. Nevertheless, the doctor wanted to keep an eye on me, so my parents dutifully took me back every two years to be measured and the pace of my growth evaluated for more distressing signs of oddity. I...

"Pain-free range of motion’ or early mobilization exercises can help you heal" PF-ROM is physical therapy talk for “pain free range of motion.” When a therapist evaluates an injury, he or she will be interested to see how far you can move affected joints without hurting. Sometimes, of course, you can’t move at all without pain. But in most injuries, even many serious ones, you will have at least some painless movement. And whatever you’ve got, you should use. When you are hurt, the pain-free range is your new best friend: that’s the range you’ll be exercising in for a while. Pain free range of motion exercises are also known as “early mobilization.” Use it or lose it “Use it or lose it,” they say. And it’s true. While many seemingly simple medical questions are controversial, this one appears to be straightforward: plenty of recent research demonstrates that early mobilization is A Very Good Thing. A 2006 study of people with surgically repaired achilles tendon ruptures sh...

I often need to talk to clients about switching them to endurance training at the gym. Usually, they have noticed that their usual strength training workout isn’t working: it feels too intense, it feels exhausting “and not in a good way,” they don’t seem to be making progress anyway, and they are worried that training may be a problem for a current injury or pain problem. Often, they have already stopped working out altogether. If you enjoy the gym, this is an exasperating situation. You are eager for a solution. You want to get back to work! If you don’t especially enjoy the gym — if you are only strength training for weight loss, or as part of a general fitness program that your doctor put you up to — then you are eager for an excuse to stop! What’s going on here? Why do strength training workouts sometimes seem to stop working? And how can a switch to endurance training help? Quick definitions If you’ve spent any time at the gym, you will have heard people talking about “reps” f...

Patients with stubborn pain problems often want to know the odds that a proposed therapy will work. Who wants to waste time or money on another therapeutic approach without a sense of whether or not it’s going to work? Is there a 20% chance that massage therapy will resolve your hip pain? But the margin of error on that estimate is so large that the estimate is meaningless: 20% +/- 75%? In other words, it is simply unknown. Therapy may go very well, or it may be futile, or the results may be somewhere in the middle. I have seen many examples of every possible outcome. Hunches about the potential of therapy are essentially useless: they are wrong enough often enough that it’s really not worth paying much attention to them. Excellent results sometimes come from cases that seemed hopeless, and sometimes we hit a wall when for some reason it seemed like an easy challenge. The margin of error is so large that the estimate is meaningless. Battle of the (charming) experts The uncertainty ...

Clients often ask me how we are going to know whether or not massage therapy is “working.” Sometimes it’s easy: you know it’s working when you feel better! But many cases are not so straightforward … Consider the example of iliotibial band syndrome, a common injury that stops runners in their tracks. Resting is a crucial part of therapy, yet you can’t tell whether or not it’s healing without trying to run. How are you supposed to tell what’s happening without testing it out? Here are some technical indicators that we use to evaluate progress in massage therapy. Symptom relief Symptom relief is absolutely the bottom line! If your symptoms aren’t improving with a reasonable period of time, therapy isn’t working. There is some “wiggle room” for things getting worse before they get better (see below). As a general rule of thumb, though, you should question the value of any therapy if your symptoms aren’t improving, whatever they are. About 3–5 hours of massage therapy, give or take, sh...

You are a biological entity. A living thing. An animal. An organism. You are a great galaxy of cells, the smallest units of life, a community of ten trillion. They all breathe together. You are ten trillion life forms, the sum of which is entirely different from the parts. Do the stars added together have a mind? Is the cosmos awake? Your community is alive with communication. Your cells talk to each other, intricately, intimately. You are filled with the whispering of microscopic lives. What language do I speak to myself? The language of nerves and glands, at least, but probably even more subtle dialects exist. We do not know the secrets of tumours yet, nor the detailed gossip of undifferentiated cells. No one on planet earth can say with the slightest certainty how consciousness arises from the ruckus of ionic currents in our skulls, or even if it does; the brain may be but an instrument, a lens through which we study ourselves. You would likely die without the quiet energies tha...

When confronted with two things said to be true, one actually true and the other false, each of them said by someone who seems to have authority, how can anyone tell the difference? The naked claims have equal weight … unless you know how each of them came to be! If one was generated by careful experiment and logic, and the other by wishful thinking and pride, then we can judge them. If we teach only the findings and products of science — no matter how useful and even inspiring they may be — without communicating its critical method, how can the average person possibly distinguish science from pseudoscience? The demon-haunted world, by Carl Sagan and Ann Druyan Ultimately, only actual training in logic and science — only some concept of how real knowledge works, the kind of knowledge that can build bridges and cure polio, the kind of knowledge that makes lasers and moon-landers possible — can somewhat reliably distinguish between truth and fiction. Even then, it’s usually necessary ...

Incredibly and tragically, this article has been removed from the website for legal reasons, to minimize the risk of offending some of my thin-skinned colleagues and readers. Some of them believe that critical thinking about practices in health care — asking reasonable questions like “Does it really work?” and “How do we know?” — is actually insulting and unprofessional. For instance, the word “quackery” has become an emotionally charged and politically incorrect word, despite the fact that it refers to something that truly exists and needs to be discussed. There is fraud in the world! It’s a sad but clear fact. This article originally presented many strong criticisms of health professions — including physicians, by the way, who have many faults as well. It was supported by numerous references to expert opinion and scientific research published in major medical journals. It attracted an astonishing amount of hate mail, and legal threats, and was simply too controversial to continue s...

If you’ve had chronic low back pain for less than a year, I’ve got great news for you: your ordeal may soon be over. A new Australian study has shown that “prognosis is moderately optimistic for patients with chronic low back pain.” This evidence is the first of its kind, a rarity in low back pain research, a field where almost everything has been studied to death. “Many studies provide good evidence for the prognosis of acute low back pain,” the authors explain. “Relatively few provide good evidence for the prognosis of chronic low back pain.” Their research differs from past studies of chronic low back pain, which tended to focus on patients who already had a well-established track record of long-term problems: in other words, the people who had already drawn the short straw before they were selected for study, and are likely to carry right on feeling rotten. But what if you study fairly new cases of chronic low back pain? How many of them fade away, and how many of them really drag...

Samuel Homola. Inside chiropractic: a patient’s guide. Prometheus Books, 1999. Pros: relentlessly rational, reasonable and compelling, with fascinating anecdotes about some questionable practices in the chiropractic profession. Cons: possibly throws the baby out with the bathwater here and there, but nothing serious. This book review praises a book that criticizes chiropractic, and in so doing I imply criticism of the chiropractic profession. However, I do not believe that all chiropractors are “bad,” and this review expresses only my opinion, based on my own professional experience, training, and interpretation of the evidence. On with the review Many chiropractors do not like Samuel Homola. He is a chiropractic Judas, a thorn deep in the side of old-school chiropractors. As Homola has written, “The chiropractic profession has little tolerance for dissension.” But as much as he has irritated some chiropractors, he must be something of a inspiration to others, as he is to me. I ...

“Everyone has some therapist they swear by, either a chiropractor or a physiotherapist or a massage therapist,” a patient once told me. “Everybody’s got their guy.” It’s true, almost everyone who has been through a lot of chronic pain has tried several therapists and sooner or later settled on someone as their favourite. Many times in my own career as a massage therapist I became someone’s “guy.” I often replaced the previous guy. I was never quite comfortable with that, because I know just how misguided that loyalty can be. People like physical therapy whether it works or not. In 2010, researchers dug through thousands of scientific papers, looking for the ones that tracked both the effectiveness of treatment and overall patient satisfaction: An unexpected finding was that treatment outcome was infrequently and inconsistently associated with patient satisfaction. Unexpected? Ha! Hardly. There is a glaring disconnect between the effectiveness of a treatment and how a patient feels...

The authors found that increased neck pain is 25% more likely with SMT than if you did nothing or stuck to safe and neutral treatments. No. Wrong. Bzzz! Thank you for playing. This morning I received a note from Lisa Carlesso, PT, MSc, first author of the paper, letting me know that I got it wrong: although her data showed that 25% number, it was not a statistically significant number. And that’s significant. If there were any noteworthy increases in neck pain following this kind of neck treatment, presumably clearer data would have emerged. Thus the paper concluded that there is “strong evidence that neck manipulation or mobilization does not result in an increase in neck pain.” I’m not sure if I quite agree that a statistically insignificant number constitutes “strong evidence” so much as just generally low confidence in the results (and Carlesso acknowledges this in the paper as well, practically in the next sentence: I basically saw in the data what I wanted to see. Funny ho...

What is Neuropathic Pain? Neuropathic pain, frequently referred to as “nerve pain,” is a common pain disorder that affects almost 1 in every 100 people. Usually neuropathic pain occurs as the result of damage to nerve fibers or the canals through which nerves pass. More than 100 complex types of neuropathic pain exist, with each kind progressing differently. The impairment of any component of the nervous system can have alarming and even life-threatening consequences, since our nerves are responsible for transmitting signals between the brain and various regions of the body. Our complex, interdependent nervous system enables us to perform everyday movements such as walking, running and other activities. If the nervous system begins to break down, the rest of our body is likely to follow suit. Generally, nerve-related issues do not resolve on their own and instead require prompt, professional medical treatment. Because neuropathic pain frequently involves spine disorders like spinal...

What is Radiculopathy? Within the body, several sensitive nerves branch away from the spinal column through foraminal canals before travelling to peripheral regions of the body. These nerves relay sensory information to and from the central nervous system and enable us to interact with the world around us. Sometimes, however, nerves can begin to operate ineffectively or improperly relay information because they are being compressed and damaged as they exit the spine. The medical term for this painful condition is known as “radiculopathy.” When radiculopathy is experienced, one or more nerves becomes diseased or aggravated as the result of abnormal pressure, which generally develops in or near the foraminal canals. Nerves can become irritated or pinched in any section of the spine, but radiculopathy is most frequently seen in the lumbar (lower back) and cervical (neck) regions of the back. These two regions are most susceptible to injury because the lower back bears much of the uppe...

What is a Torn Disc? Located between the individual vertebrae that make up the spinal column are intervertebral discs that share a common purpose of providing cushioning and shock-absorbing protection to the spine. These cartilage discs support the stability of the spine and absorb wear and tear as the vertebral column moves and twists. Formed by a firm outer casing known as the “annulus” and a soft, gelatinous inner material referred to as the “nucleus,” intervertebral discs bear much of the stress and strain that is placed upon the spine by everyday life. Because of this, intervertebral discs are highly susceptible to disease and injury, especially as they age and lose water content. A torn disc, also sometimes referred to as a “slipped,” “ruptured,” or “herniated” disc, occurs when a tear or weakness in the disc’s outer layer allows the inner layer to leak into the spinal canal. This displaced disc tissue can place pressure on area nerves, which compresses them and causes pain, d...