sustaining joint health

i had an initial assessment with my physical therapist, teresa, last week.  after i had described the traction injury i incurred while climbing, she tested my strength (right versus left arm), she watched my neck and shoulders anteriorly as i articulated my head up, down, left, and right, and she watched my scapula posteriorly as i articulated my arms up and down.  after these brief assessments, teresa determined that i had most likely stretched my shoulder ligaments as well as the nerve running through my armpit.  all of these fibers have plausibly regenerated and are prepared to perform routine shoulder movement, but they are not functioning in synchrony.  for ten days i have "retrained" my arm to work as it should.  

i pull my scapula down and back so it is flat against my back and close to my spine.  then i row, extend to hip, and extend out to side.  i do these exercises without weights; i am simply training my arm to operate in the proper sequence to function efficiently.  after this sequence training, i will start to weight train the muscles so they will support the joint, even at rest.  even though i am not using weights, my muscles are sore after i articulate them intentionally for 20 minutes.  imagine the flashing neon red or lightning bolts you see on indigestion commercials...

this morning i had my second appointment with teresa.  she saw an improvement in my scapula rotation; it was no longer "winging out" when i lift my arms above my head.  but there is still some instability, so i will start to strengthen the rotator cuff muscles.  for the next three weeks, i will lift light weights and perform several weight bearing, balance exercises.  as i practiced each exercise in her office, she pointed out which muscles were being targeted - the subscapularis, supraspinatus, infraspinatus, teres minor, serratus anterior, and trapezius.  i should try not to use my deltoids and latissimus dorsi.  it is easier to understand the basis of my physical therapy now that i understand the intricacies of the joints and muscles in the shoulder.

prostate or prostrate

as i sat waiting for a dear friend to meet me for a delicious, refreshing trippel at the equinox brewery, i overheard three gentlemen very openly discussing prostatitis.  now, of course i thought i had misheard them, so i began to listen more intently.  sure enough, "i had prostatitis, too!" was clearly sung above the ambient music cascading through the speakers.

according to mayoclinic.com:
"Prostatitis, a disease of the prostate gland, can cause pain in the groin, painful urination, difficulty urinating and related symptoms. The prostate gland produces components of semen, the fluid that helps support and transport sperm. The gland, about the size and shape of a walnut, sits directly below the bladder and surrounds the urethra, the tube that transports both semen and urine to the penis."

these men, two of which had kids in tow, were complaining of these exact symptoms.  they relayed tales of pain when sitting, pain when urinating, and difficulty ejaculating.  i had to wonder if they meant to speak this openly with the whole bar audience.  the thing i found interesting was that they were not complaining of inflammation because i have learned that "-itis" is a suffix denoting diseases characterized by inflammation.

but then according to urbandictionary.com:
"Itis is the drowsy or sleepy effect linked to digesting large meals, usually high in fat or salt content."

so i didn't know what to think because urban dictionary is so accurate and reliable.

further research unveiled that the reason prostatitis is painful and causes difficulty with nether functions is because of inflammation of the prostate gland.  below is an image that shows how the urethra passes through the prostate, and how any swelling of the prostate can affect urination.

as quickly as the conversation started, it stopped.  and they moved onto man's best friend.  sadly, one of their dogs has stage 4 interstitial fasciitis.  clearly, the inflammation of fascia.  perhaps the topic for another blog...

shared values

when i study at night i teach my partner about how our bodies work in beautiful synchrony: the complementarity of structure and function, synergistic skin layers, the "fluidity" of bone.... when he studies at night, he teaches me about socioeconomic presuppositions, therapy techniques and a variety of case studies about social discontinuities. so i got to thinking about the intersect of our course work; rob is studying the social structure and i am studying the human structure. and they are not so different. both vocations focus on care of the whole person using creative, individualized therapy. both "ologies" have basic knowledge available to anyone with access to wikipedia and both have intensely deep philosophies for those curious enough to ask. both afflict rich and the poor, black and the white, gay and straight.

specifically, public health nurses must make moral decisions regarding practice in complex situations fraught with competing moral claims. nurses have practiced within a context of ethics since the beginning of professional nursing in the 19th century. the impetus for the professionalization of nursing found expression in the nightingale pledge in 1893 and the subsequently suggested ethical codes that led to the first formally adopted code in 1950. ethical codes, in nursing as in other professions, serve not only to define such groups as professional as opposed to occupational, but also to outline primary duties, responsibilities, and obligations. the most recent revision of the american nurses association's ethical code include provisions and standards that address human rights duties and obligations.

public health has been defined as what we, as a society, do collectively to assure the conditions for people to be healthy. this definition, which stresses the societal responsibility for the health promotion of the population as a whole, raises an important question about the scope of public health. is public health responsibility confined to the prevention of the immediate causes of injury and disease, or should public health be more concerned with the alleviation of the larger social and economic problems that have an impact on health and disease, such as poverty, violence, and inadequate housing?

(A Critical Intersection: Human Rights, Public Health Nursing, and Nursing Ethics; Advances in Nursing Science: October/December 2007 - Volume 30 - Issue 3)

a professional opinion. or two.

i visited an orthopedic surgeon on monday afternoon. after one year of discomfort, pain, and instability in my shoulder i gave in to the subjectivity of a professional. after we talked about how we both like to climb and cycle (and how those play into my injury), we began testing the joint in question. none of the positions were uncomfortable or painful, none of the resistance exercises illustrated a difference in my right versus left shoulder strength, and neither of us could hear or feel the crackling i have frequently felt. classic, isn't it? as soon as we are ready to talk to someone about an issue, it eludes us.

anyway, when he was sufficiently convinced i was going to be okay without surgery (perhaps to his chagrin?) he went next door to get a shoulder model. i suppose not all of his patients are in physiology and anatomy so he is practiced in presenting the human structure in a really simple manner; for example, he said, "this upper part can sometimes have some abnormal growth on the end (imagine lots of hand motions) and the tendon that runs under it (more hand motions) which attaches to the bicep (pointing to my right arm) 'right here' can sometimes get pinched" i said, "so, the acromion of the scapula develops a bone spur which can put pressure on, or even tear, the tendon of the biceps brachii?" he was surprised. and said that was the basic idea. it felt good to have a grasp on the details of my injury. i am excited to visit a physical therapist next week to hear a second opinion. i also look forward to weekly therapy sessions with a woman who is as excited about the body as i am!

pain

my shoulder hurts.
i went climbing on sunday and my shoulder still hurts. what i really want to do is research all of the possible ailments and then self-diagnose. then i will determine the best course of healing and be on my way.
but we aren't to joints and tendons yet.



so i will talk about the foot instead. my feet hurt on sunday because of the silly, miniature, sticky shoes that climbers insist on wearing. i am guilty. i have more confidence on the wall when i have an unbelievably 'too small' shoe on my foot. many women are guilty of a similar, unfortunate foot pain, compromising foot (and total body) comfort for sexy high heels. what a crude invention.

the aching foot.
anytime you wear shoes that are tight or constrict the natural shape of your foot, doctors say it's bound to cause foot pain.

high heels can lead to bunions (bony protrusions that usually pop up at the base of the big toe and distort the shape of the foot), corns and calluses (thickened layers of dead skin usually occuring on the toes or sides of the foot), and "hammertoe" (a condition that causes the bone of the affected toe to curl under, leaving the top to rub against the shoe). also, as we age, we lose some of the fatty deposits that normally protect the ball of the foot. and finally, women who have worn primarily high heels for most of their lives, may experience shrinkage of the achilles tendon (the area that runs from the back of the heel to the calf) which can result in pain when wearing a low-heel shoe or even the inability to walk barefoot.

and what about the climbing shoe? some climbers are affected by toe deformity (claw or hammer toes), splinter hemorrhage under nails (collection of blood under toe nails), bruised toes, cuts, corns, mycosis (fungal infections), nerve compression syndromes, hallux valgus (big toe angled towards other toes), disorders of the traversal arch structure in foot, and bunions. projecting beyond the obvious foot issues, climbers wearing tight fitting shoes essentially force their feet to become a solid unit that cannot absorb the shock of a significant fall in the normal way. this can negatively affect the ankles, knees, hips, and back.

all the above listed conditions occur when regularly wearing any tight or irregularly shaped shoes, including climbing shoes and high heels. resulting pain and deformity can go on to affect gait and even spinal mechanics. shoeless societies do not have such deformities. (if you are a visual person you just had a beautiful vision!)

let's all agree to go barefoot! and maybe wear mocassins in the winter...

cancer of the skin

melanoma has long been a part of my vocabulary. i have always watched my moles for the risk factors associated with the abcd's (the e for elevation is new to me), i always wear sunscreen or long-sleeved shirts, and i regularly visit a dermatologist. this is particularly important for me because my father passed away from melanoma in 1989, just before his 39th birthday and just before my 5th. melanoma has been a very real disease with very real consequences in my life.

the mayo clinic has this picture on their website which i think beautifully illustrates the dichotomy between sexy, romantic sun bathing and it's very serious consequences.




though i have long been convinced of the importance of protecting my skin, there was more to learn about the cellular processes: i was surprised to learn that everyone has the same number of melanocytes because there are so many different skin tones in the world. but i learned that melanocytes are just the beginning... melanocytes produce melanin in response to ultraviolet radiation. melanin is accumulated in melanosomes which are taken up by keratinocytes and accumulate on the superficial side of the keratinocyte nucleus. this forms a shield for the nucleus to avoid further sun damage. thus, the color of our skin is determined by the amount of sun exposure we have (or that our ancestors had). furthermore, and most importantly, the darker color is a defense mechanism to protect our own skin, but the damage has already been done. the idea that a healthy tan will help protect our skin is false.

maybe someday we'll revert to the beauty standard of the victorian era and people will think that voluptuous, pale women are the bees knees...

a spoonful of sugar

i have often wondered about the increase of sugar consumption in our society. we now eat an extraordinary amount of sugar in the forms of sucrose (table sugar), dextrose (corn sugar), and high-fructose corn syrup which are processed into foods such as bread, breakfast cereal, mayonnaise, peanut butter, ketchup, and spaghetti sauce. today, the average american consumes an astounding 2-3 pounds of these highly refined sugars each week!

what is the physiological impact of sugar consumption? one of sugar's major drawbacks is that it raises the insulin level, which inhibits the release of growth hormones, which in turn depresses the immune system. this is not something you want to take place if you want to avoid disease. and yet it is such an ubiquitous part of our daily diet that it is hard to avoid.

even though i have a massive garden and a community supported agriculture (csa) share this year, i still find myself eating foods high in sugar; i enjoy carrots and beets, i use salad dressings and spaghetti sauces from the super market, and i love to finish dinner with a cup of ice cream or a slice of brownie! at what point do the drawbacks outweigh the enjoyment of eating these sweet foods?

here is a list of ways sugar can affect human health:
* sugar can suppress the immune system.
* sugar can upset the body's mineral balance.
* sugar can contribute to hyperactivity, anxiety, depression, concentration difficulties, and crankiness in children.
* sugar can produce a significant rise in triglycerides.
* sugar can cause drowsiness and decreased activity in children.
* sugar can reduce helpful high density cholesterol (HDLs).
* sugar can promote an elevation of harmful cholesterol (LDLs).
* sugar can cause hypoglycemia.
* sugar contributes to a weakened defense against bacterial infection.
* sugar can cause kidney damage.
* sugar can increase the risk of coronary heart disease.
* sugar may lead to chromium deficiency.
* sugar can cause copper deficiency.
* sugar interferes with absorption of calcium and magnesium.
* sugar can increase fasting levels of blood glucose.
* sugar can promote tooth decay.
* sugar can produce an acidic stomach.
* sugar can raise adrenaline levels in children.
* sugar can lead to periodontal disease.
* sugar can speed the aging process, causing wrinkles and grey hair.
* sugar can increase total cholesterol.
* sugar can contribute to weight gain and obesity.
* sugar in high doses increases the risk of crohn's disease and ulcerative colitis.
* sugar can contribute to diabetes.
* sugar can contribute to osteoporosis.
* sugar can cause a decrease in insulin sensitivity.
* sugar leads to decreased glucose tolerance.
* sugar can cause cardiovascular disease.
* sugar can increase systolic blood pressure.
* sugar causes food allergies.
* sugar can cause free radical formation in the bloodstream.
* sugar can cause toxemia during pregnancy.
* sugar can contribute to eczema in children.
* sugar can overstress the pancreas, causing damage.
* sugar can cause atherosclerosis.
* sugar can compromise the lining of the capillaries.
* sugar can cause liver cells to divide, increasing the size of the liver.
* sugar can increase the amount of fat in the liver.
* sugar can increase kidney size and produce pathological changes in the kidney.
* sugar can cause depression.
* sugar can increase the body's fluid retention.
* sugar can cause hormonal imbalance.
* sugar can cause hypertension.
* sugar can cause headaches, including migraines.
* sugar can cause an increase in delta, alpha and theta brain waves, which can alter the mind's ability to think clearly.
* sugar can increase blood platelet adhesiveness which increases risk of blood clots and strokes.
* sugar can increase insulin responses in those consuming high-sugar diets compared to low sugar diets.
* sugar increases bacterial fermentation in the colon.


our nation, as a whole, has a terrible reputation for being gluttonous and fat. how can we, instead, foster a healthy, sustainable relationship with food? in part, it needs to start with a decrease in sugar consumption which has many dramatic health implications and far too few benefits to justify its delectation. it also requires more local and fresh food, more exercise, more relaxation, and more compassion.

off to nurture a better, healthier future, for at least one family. i'm starting with mine!