Pages

Welcome to my blog

Hello. I am iciclehunter and this is my diary. My job title is "osteopath", and my work is hunting for clues, detective work, problem-solving. These things involve reason and science, but are not limited by them. They also involve the eye of experience, and "hunches". Thus, some would regard my activities as those of a quack, a title I assume here with irony. I am writing this blog because I like writing. I am quite opinionated, and perhaps I suffer from a repressed need for expression. I have no particular prior "agenda"; if I have any bees in my bonnet, no doubt they will make themselves apparent by their buzzing. All names and identifying details of any people featuring in these anecdotes have been changed. Thank you for reading.

Saturday, 17 September 2016

Stress - how to survive and thrive

I have written a book about stress, how it affects people and what people can do about it. I wrote this book because I realised that many of the health problems presented to me by my patients have an important emotional component, in which stress is a main player. Indeed, my book started off life as an educational pamphlet for patients, but it developed and grew into a comprehensive guide to overcoming stress. Here is what I say in my book, reduced to fit into a nutshell...

Stress is not what happens to us - it is a tension caused by an interaction between us and the outside world. It is due to a mismatch between the demands placed upon us and how well we feel able to respond to them, in which either the demands are too great or our capacity to respond to them is inadequate. How things affect us depends on our attitude to them. Our capacity to respond depends on our resources and our resourcefulness.

Often we intuitively know what stress feels like for us, but stress symptoms differ for different people and different kinds of stress. Stress affects our thinking, emotions, physical body and behaviour. Methods have been developed to assess how much stress we have experienced or are experiencing.

Stress is not what happens to you, it is what happens with you when you attempt to meet a challenge. Three stages are involved in assessing the challenge: we first become aware of a potential threat (it announces itself), then we weigh it up, then we weigh up our options. How a challenging event or situation affects you, depends upon an array of things:
  • About you: your background, personality, experience, beliefs, values and self-belief.
  • About the situation: its nature, proximity, magnitude and duration.
  • About your resources: the material, personal, social and spiritual help available.

Nobody knows the trouble you've seen, because your own experience of stress is unique. Contexts in which stress develops can be daily hassles (“bothers”) or major life-changing events (“earthquakes”). Stress may be sudden and intense (“lightning bolts”) or long and drawn out but less intense (“desert crossings”). Selye's General Adaptation Syndrome describes three stages of stress: alarm, resistance and exhaustion. We shall call them "modes". Stress involves mental, physical and behavioural changes.

Stress can enhance or harm. The bodily effects of stress are regulated by our hormones and by the nervous system. The bodily and mental responses to stress have biological and evolutionary purpose, but ill health can be generated by long term stress. Our beliefs, attitudes and behaviour can make the difference between experiencing the negative effects of stress, and enjoying meaningful, fulfilling lives.

You cannot change your stress without first knowing your stress. Knowing your stress means knowing:
  • What triggers it.
  • What you feel when you are stressed.
  • What kinds of thoughts you have when you are stressed.
  • What things you tend to do when you are stressed.
  • This knowledge will allow you to change.

There are many ways of coping with a given situation. Our habitual ways of coping can be counter-productive and detrimental in the long term. You can learn to recognise your habitual coping strategies and change them into better ones. To do this you must change your world within.

Behaviour experiments can help you to learn the benefits of new ways of coping. First observe your habitual ways of coping. A coping diary can help you to do this. Question yourself about the appropriateness of your responses. When you recognise the cues that make you stressed, stop your automatic responses, take your time and choose better ones. Review results, adapt and improve.

Problems are only as big as our attitude to them allows them to be. Beware of the thought goblins in your mind! You can change the way you think. Be prepared to question your beliefs. Imbue your mind with thought allies.

It is easier to have a healthy mind if your body is healthy. First get the basics right:
  • Healthy diet and good hydration.
  • Manage alcohol intake, cut out smoking and other "recreational" drugs.
  • Good rest and sleep.
  • Appropriated activity and exercise.

You can prepare yourself for stressful situations by:
  • Practising basic positive responses in a safe environment.
  • Learning some positive self-instructions.
You can negotiate stressful situations successfully by:
  • Stopping your automatic responses.
  • Taking your time and choosing an appropriate response.
  • Being aware, calm, flexible, brave and fair.
You can promote relaxation by practising:
  • Slow abdominal breathing.
  • Imagination and visualisation.
  • Voluntary muscle relaxation.
This will relax you if you feel stressed, relax tight muscles, and promote more general, long-term relaxation, by a number of mechanisms. Exercises only work if you do them.

You can apply the principles of learning to change your thought patterns. Also, get used to asking yourself why you thought a certain thought (meta-thinking). You can swap thought goblins for thought allies by knowing yourself, questioning yourself, stopping your habitual responses, taking control, reviewing results. Behaviour experiments will set you on your way. See what happens if you approach things differently for a while.

A better ability to solve problems will reduce your stress. Problem-solving is a skill you can learn. Problem-solving requires method. A ten-step procedure for rational roblem solving is given. But intuitions and strong gut feelings can also provide valuable answers or insights.

Chronic stress deadens emotional experience. Emotions have useful functions and enrich our lives.It is not healthy to suppress emotions nor to allow them unbridled free rein. Allow yourself to experience emotions without interpreting them or attaching value judgements to them. It is normal for intense emotions to pass quite quickly. They do so if you do not dwell on them. All head or all heart are not healthy, they need to be balanced.

Good communication helps avoid tension and conflict between people. Good communication involves a number of skills which can be learned, and perfected through practice. A strong and balanced ego is an asset in good communication.

Help and support from other people is a major buffer against stress. It may be emotional, practical or material. Help and support are available to everyone. It can come from family, friends, support groups, charities, or government organisations. The Internet is a great resource.

Coping has the fundamental goals of reducing, simplifying, and/or sharing the challenges you face. Basic options: Alter, Avoid, Accept, Adapt. Challenges may be practical and/or emotional, from without and/or from within. Ask yourself:
  • Does the challenge require solutions to practical problems or emotional ones?
  • Do I have better leverage acting on the outside situation, or acting within myself? 
The stress-busting tool box: Organisation, Emotional expression, Modifying responses, Self-nurturing and development, Seeking help, RRE (Rest Relaxation, Entertainment). Use the right tools for the job!

Inner strength is a quiet confidence that you possess the capacities and resources to be able to deal effectively with the situations life confronts you with. Inner strength comes from mastery and belief. You can develop it by:
  • Keeping good health.
  • Positive thoughts and optimism.
  • Being inspired by positive people.
  • Personal development.
  • Recognising your affinities.
  • Keeping wise words in mind.
  • Keeping an inner sanctum.
  • Believing in something bigger.
  • Loving.

Self-awareness empowers all your other efforts to live without stress. Some questions to ask: What is the nature of my pain and what is my deepest need? What am I like? What are my affinities? What are my strengths? What are my limitations? What are my valued principles of living?

My book ends with a chapter of "reminders, golden rules and tips". Obviously I recommend my book. It is called Stress: Survive and Thrive. You can buy the Kindle version from Amazon. The paperback version will be available shortly.

Thursday, 18 August 2016

Spiritual reflection II

There is an oft repeated mantra among my fellow practitioners of alternative medicine, that holism acknowledges/addresses the unity of the body, mind and spirit. While I consider myself to be a spiritual person in my way, I have problems with this. Firstly, my way is not everybody's way, and my conception of spirituality is not necessarily that of yours or another person's. But the above proposition falsely and a little presumptuously assumes a shared belief.

The belief it assumes is the existence of some immaterial or energetic aspect of the human being other than anything that can be encompassed by the words "mind" or "body". This is purely belief, because the existence of such a "spirit" is not a universally accepted fact. The spiritually inclined but open-minded have also to consider at least the possibility that an entity called the spirit does not, in fact, exist. A patient might well ask, "In my book, there is no "spirit", does this mean I cannot be treated holistically?" At this point the practitioner, to care for that patient, would have no choice but to act as if. As if, "The spirit is there, you are just unaware of it". If that patient got wind of this, it would be just about as annoying to them as being talked at about the real "truth" by a pair of Jehovah's Witnesses. (They always travel in twos). Even if there were a shared belief, between those interacting, in something called "spirit", there is no guarantee that the thing believed in would have the same description, meaning or connotations. It is clear that different people who believe in a spirit may give very different definitions or descriptions of it.

Secondly, I would ask what special skills the people who repeat the mind-body-spirit mantra, over and above those who don't, have in ministering to the spiritual side. I would hazard a guess: on average, none. No doubt they would argue that treating the patient as a whole person (whatever that means to the individual practitioner) is enough. Body, mind and spirit being facets of the one whole, any improvement in any one of these facets will automatically bring about improvement in the others. Mens sana in corpore sano, stated Juvenal. Being a wise man, he left out the spirit, so great is the complexity and controversy of the argument. But let us ignore that omission. There is that school of thought that our body, mind and spirit find health or ill health as a whole. That is, for example, one cannot be unhealthy in body and be strong in mind and spirit. I am not of that opinion. History is full of examples of extraordinary people who despite the ravages of illness or age, have shown a strength of character and a determination of spirit that has transcended physical weakness. Nevertheless, these people are exceptional, characterised by their extraordinariness. Their psychological and/or spiritual characteristics are so strong that they can overcome severe physical limitations.

On the other hand, while physical health may not be an absolute requisite for inner strength, it cannot be doubted that for most people, lack of the former may detract from the latter. Good health and feelings of well-being and energy can only enhance our ability to feel effective and confident within ourselves, to think clearly and to persist determinedly in adversity. So that is why attention to healthy living, such as diet, fluid intake, sleep, rest and exercise help to lay down the physical context in which inner strength can develop, as well as the physical energy to carry through our will. Let us never have to reflect that the will is strong but the body weak!

But where does the spirit fit into this general consideration. A while ago I had a discussion with some colleagues about this. Most of them stuck to the point of view that spirit, mind and body find health in parallel. My own point of view was that if "spirit" has any kind of special meaning of its own, it must transcend the limitations of body and mind, limitations such as disease, for example. I do not know if such a spirit exists, so I have to find a lower level explanation that will allow for it but not depend upon it.

Myself, so far as medicine and holism are concerned, I regard the spirit in a much more down-to-earth way. For myself, I would define the spiritual dimension of healing as all things that "lift the spirit" in the colloquial sense. By that I do not mean good cheer or temporary enthusiasms. I mean feelings of deep and enduring enthusiasm, energy, joy and love of life. The word "enthusiasm" comes from the Greek en ("in") and theos ("God"), which produced enthousiasmos ("divine inspiration"). Let us say, for simplicity, that enthusiasm is a particular state of love. Different people may find this in a cathedral or in a cave, at Lourdes or Mecca or Benares, in the wild wood or by a wild sea, up a mountain or in the desert, in poetry, prayer or dance, in deep attention to the performance of one's craft or in full song, in group worship or in quiet meditation. In this sense, I urge everybody to seek to enrich the spirit.

Tiredness and the right dose of enjoyment

I have a burner for essential oils in the corner of my waiting room. I usually use lemon balm essence, which gives off a lovely fresh, energising aroma. While I was lighting the burner's tea candle this morning the fan happened to be directing air towards it, and I noticed how the air flow made lighting the candle difficult. It was not strong enough to put the flame out, but neither was the flame strong enough to take easily in the flow of the air. I reflected on a question a lady asked me just the other day. The lady is chronically fatigued, although I am not using that term as a diagnostic label. However, she confided that she loves to dance, and on those occasions when she goes out, has a glass of wine and a good time, the next day she feels full of energy. The question was, should she do this, or is she putting her health at risk. My answer was yes, absolutely, to do things she loves doing, but that it must be dosed. If you are in such a situation, you need to learn, by graded steps and through trial and error, what dosing is positive (amount and frequency) and what dosing is a toxic. Just as a flame needs oxygen, and blowing on embers will brighten them, a too forceful wind will blow a flame out and scatter the embers.

Saturday, 13 August 2016

Osteopathy - general plan that is tolerant of our ignorance

One of my patients needed written clarification of the things we discussed at our first meeting. She writes:

Could please tell me what your working hypothesis is of what is happening in my body to cause my symptoms? Also, what is your approach is for treating this?

In my reply, as premises to the comments specific to her case, I made the following points:
  1. We don't know everything (nor even a small part) about the way the body works, so we need an approach which is tolerant of our ignorance.
  2. In osteopathy, the working hypothesis is not as important as the general plan. The general plan says: "Be faithful to osteopathic principles and treat the patterns you find." The beauty of this is that it allows you to do useful work even if your working hypothesis may actually be wrong.
  3. Especially in chronic cases, chasing a single, clear "cause" is a wild goose chase. It is much more realistic and useful to think in terms of a network of multiple, reciprocal influences, each of which contributes to the maintenance of the whole (dysfunctional) system.
  4. The more you focus on detail, the less you appreciate the basic general patterns.
  5. As an osteopath I approach all problems in the same way (see number 2 above). The most important principle for the osteopath is to reduce at least one kind of stress and strain from the body (the mechanical kind), so that the whole organism, unloaded a little, frees up some resources for healing.


Thursday, 11 August 2016

Snakes, migration, and ecological change

Josephine hurt her arm bashing a snake with a stick. She tells me she and her husband have seen snakes several times in the garden of their house in the campo, of two different kinds. There were once no snakes on this island, but they have become increasingly populous in the past ten years, probably introduced in the trees and plants that are imported for people's land and gardens.

The The Montpellier Snake (Malpolon monspessulanus): 
a mildly venemous snake now present here

The official and popular line is that this is a bad thing. The introduction of new, alien species will change the ecology. These snakes will eat all the lizards. The Wall Lizard, for example, which used to be unique to these parts, but in its turn has now migrated and become naturalised in parts of the mainland. Then, who knows what will happen?

A Wall Lizard - Threatened by snakes? 

People are afraid of these new inhabitants of our island, thinking them to be dangerous. In fact, only one of the three species of snakes known to exist on Ibiza carries any venom, and then only mild and of a small quantity. But I think the reason why Josefa bashed the snake on the head with a stick has more to do with an ancient, atavistic fear buried deep in the collective psyche of humanity. When Adam and Eve (and the snake) were cast out of the Garden of Eden, God dealt with the evil serpent thus:

“Because you have done this, 
“Cursed are you above all livestock 
    and all wild animals! 
You will crawl on your belly 
    and you will eat dust 
    all the days of your life. 
And I will put enmity 
    between you and the woman, 
    and between your offspring and hers; 
he will crush your head, 
    and you will strike his heel.” (Genesis) 

So Josephine attempted to crush the serpents head.

But is the introduction of new species to an environment necessarily a bad thing? It is certainly true that a single species can have far reaching and dramatic consequences for an ecosystem. The video on this web page will probably amaze you at to what extent the reintroduction of wolves to the Yellowstone National Park changed the environment.

Nevertheless, nature has a way of adjusting to change. Species will always invade new territories, and compete with the existing species. The fittest will survive and in doing so, change the environment. That is the way it always has been and always will be.

What may happen as a result of human activities is that we aid the transportation of plants and animals from one part of the planet to another, so the process happens faster. But quite apart from this aspect of our activities, humans are changing their own ecology more than any snake could be responsible for. We spend a great deal of time and effort clumsily attempting to undo the inconveniences we have ignorantly inflicted upon ourselves.

Then, good and bad are human constructs, they have no meaning outside a human perspective. Places we call "tropical paradises" are, for the creatures that naturally inhabit them, both abundantly generous and cruelly perilous environments. John Steinbeck (in The Log from the Sea of Cortez) described the region of Magdalen Bay in Baja California thus:

"The abundance of life here gives one an exuberance, a feeling of fullness and richness.... The sea here swarms with life, and probably the ocean bed is equally rich.... There was food everywhere. Everything ate everything else with a furious exuberance."

In nature, everything eats everything else. For this reason people who profess to "love animals" tend to find nature disturbing: it confounds our human notions of "good" and "bad".

Beyond what we think about it or do to it, nature can look after itself, it will always adjust, but not necessarily congenially to our desires or ideals.

On vitality

Certain natural health practitioners, including osteopaths and nature cure practitioners, used to talk about vitality, and some of them still do, me for instance. A fashionable term nowadays is "energy", one I avoid unless in a strict physical sense; I have serious doubts that many people in the alternative medicine world use this word with any depth of understanding. Both terms, when used in alternative medicine or "New Age" contexts have (of course) been trashed by sceptical critics. Nevertheless, I stand by the word vitality because for me it describes something real and palpable, albeit not something easily pinned down.

Vitality I would define as a tendency to health and well-being. It is, let us say, the living manifestation of your potential for life. I do not see it as a distinct "life force", but as a composite quality. To the osteopath it is evident as a certain quality of the tissues. Some parts of the body may feel more vital than others. But the most vital organisms are those in which all parts emanate vitality. If I were asked to describe that palpable quality, from my own osteopathic perspective, I would say that it feels like a lively yet contained springiness that is both fluid and consistent. Too much yielding or too much resistance, bogginess, roughness or a lack of consistency, and the tissues feel less vital. This is a composite quality because it is produced and influenced by the interplay of many biological and psychological phenomena. The fact that it is a composite and that it cannot directly be measured does not make it any less "real". But what is "real" and what is not is another story for another day.

Wednesday, 10 August 2016

Crunch time - I've a good mind to drop this technique

I had a new patient last week who was in considerable pain in the right medial scapular region. As a small component of his treatment, he received from me a technique called a High Velocity Low Amplitude Thrust, or HVLAT for short. This is a kind of short, sharp push or pull which often makes clicking or crunching sounds from the joints. My patient really liked it. His pain improved somewhat but he had to come again a week later for further treatment. He came asking for another crunch. It was as though, for him, the other twenty-nine minutes and fifty seconds of treatment were completely forgotten.

Some patients do love a good crunch. Males mostly, especially of the alpha variety, but also some alpha females. A lot of people even associate crunching with osteopathy. But this is what osteopathy's founder A.T. Still said about the joint sounds that occur during certain kinds of techniques:

One asks, “How must we pull a bone to replace it”? I reply, pull it to its proper place and leave it there. One man advises you to pull all bones you attempt to set until they “pop.” That “popping” is no criterion to go by. Bones do not always “pop” when they go back to their proper places nor does it mean they are properly adjusted when they do “pop”. If you pull your finger you will hear a sudden noise. The sudden and forceable separation of the ends of the bones that form the joint causes a vacuum and the air entering from about the joint to fill the vacuum causes the explosive noise. That is all there is to the “popping” which is fraught with such significance to the patient who considers the attempts at adjustment have proven effectual. The osteopath should not encourage this idea in his patient as showing something accomplished.

I agree with Still on this, and I would go further. Are these techniques, the ones that often make the joints go "pop" (technically), useful in any way? In my experience and considered opinion their utility is very limited. Sometimes, when a patient is in acute pain, they can bring rapid relief. But so can other, gentler, less spectacular techniques. Clearly the gentler the technique, the less risk there is to the patient. I won't go into the whys and wherefores of why, in certain acute cases I would, up to now, prefer an HVLAT to a gentler technique. But I can say, that I am considering dropping them altogether.

Why?
  1. In most cases, other techniques are just as effective even in acute pain. That is, if we ignore the favourable attitude to the crunch in certain patients, which may boost the placebo part of their effectiveness. But I am beginning to feel the drawbacks of that attitude are weightier than the benefits (see below).
  2. They confer absolutely no advantage at all over other techniques when acute pain is not an issue, for example, in lower grade but longer term pain.
  3. If you use the technique just once on patients with the frame of mind that the crunch is "good", they want it every time. If you don't do it, they consider the treatment inferior. If you feed this, you feed psychological dependency and you may be led into using an inappropriate technical approach. This is an obstacle to good case management.
  4. The crunch reinforces the idea, an idea some people are very resistant to letting go of, that osteopathy is about putting bones "back in place". It is true, I think, that this is what our founder A.T. Still held that he was doing, even though he thought the "pop" an irrelevance. But I disagree profoundly with the notion conjured up by descriptions of that kind. People aren't made of lego.