The World’s Best Walker!
I don’t know how many times in my 44 years of sitting with patients in my office someone has said to me that they have back trouble because humans just aren’t built right to be upright. After all so many people have back pain. It seems that there is a back pain epidemic. Low back pain alone is among the top five reasons people see doctors. Is it really because there is some kind of flaw in our structure? Should we really be trying to walk on all fours?
This topic was confusing to me until I met Dr. Arthur Pauls, the English Osteopath who taught me Ortho-Bionomy 30 years ago. Dr. Pauls was fond of saying that we are such efficient in walking that we barely use any energy. He would assert that, “walking is falling forward, barely averted”; meaning that just by leaning forward and initiating a step we use gravity along with our leg muscles to propel ourselves along. It is sitting in chairs for long hours at various tasks that is the reason for our pain, that along with the lack of corrective exercise to make our walking the healing activity it can be. But more about that later.
First let’s explore humans and locomotion. I was recently stunned to see a show on public TV that brought the issue of our capacity to walk and run into sharp focus. The video follows two Kalahari Bushmen on a traditional hunt for antelope at: (http://www.youtube.com/watch?v=826HMLoiE_o ). They first separate a young buck from the herd and then start to run after him. Over the rest of the day with great skill at tracking and amazing endurance at running the main hunter actually runs the brave beast to ground. His final spear thrust seems almost an act of mercy as the Kudu collapses onto the ground from heat exhaustion and dehydration. The chase lasted eight hours. The advantage the hunter had was that he could sweat thereby dissipating the heat of exertion, he could carry water to replenish his body, he could run for great distances, and he could use his brain to track the animal and learn and develop successful strategies. There is no animal that these hunters cannot run to ground. Native Americans are known to chase down everything from jackrabbits to deer, bison and even the swift pronghorn antelope.
We are the greatest walker/runners on the planet. This kind of “persistence hunting” has been a main tool used in our evolution to insure our survival as a species. Studies of these hunts show that the hunt usually takes 4-6 hours over about 12-20 miles. So is it overall endurance and not bursts of speed that determine the outcome. That is what humans have over the other mammals: endurance and guile. We have brains that figure it out, skins that sweat, hands that make spears and water vessels and BACKS AND LEGS that carry us further and on average faster than any other beast over distance.
So how does the best walker on the planet wind up in the doctor’s office so frequently with back pain? It is our generally sedentary lives sitting in chairs more suited for the task at hand than our bodies. Here is a good graphic that shows the strains that the seated posture causes: http://apps.washingtonpost.com/g/page/national/the-health-hazards-of-sitting/750/
While sitting is restful in some ways it does stress and stretch for prolonged periods of times the muscles and ligaments and tendons of our low back and hips. Just stand up and then bend forward until your body is at the 90 degree angle like when you sitting and you will see what I mean.
Studies routinely show that walking is beneficial at all ages. Infirm elders can improve their mood, decrease hospital visits and live longer just by walking as much as they can even if it is as little as down the hall and back in a care facility. Those of us who are able can get the same benefits on mood and overall health with regular walking. Walking strengthens and tones important muscles, massages all of our internal organs and invigorates our hearts and lungs. Getting out of our chairs for 5 minutes every half hour is a useful way to reverse the health hazards of sedentary work and leisure activities.
Humans have three great powers that have made us the top mammal on earth: our brains, our hands and our ability to walk and run. All three need to be fulfilled if we are to be healthy. Our bodies demand their use for integration and health.
Important Drug Warning (Osteoporosis) ….. again!
Every week or two I receive in the mail an envelope with a big red box on the front that says: IMPORTANT DRUG WARNING. The FDA forces the company making the medication to send a letter to every doctor when “post marketing experience” demonstrates some new usually fatal effect of the drug. It is quite common that medications harm patients in ways unknown because the first clinical trials include a few thousand people and it is when millions take the drug that more comes to light.
Last week’s warning was about Boniva, one of the medications used to treat osteoporosis in the elderly. The warning advised that Boniva can cause a fatal allergic reaction called Anaphylaxis especially if administered by injection. This new finding adds to the list of serious effects of this kind of medication that include: severe ulceration of the esophagus; severe and incapacitating bone, joint and muscle pain; necrosis of the jaw; unusual fractures of the hip and asthma; and less serious troubles with indigestion, diarrhea and headache.
Certainly it is true that the bone weakening illness of Osteoporosis is an important condition of the aging population. 35% of old women and 20% of old men have bones with low mineral content. And hip and spinal fractures occur more frequently in those who have Osteoporosis. In general of those who broke a hip only 15% will be able to walk across a room without assistance after 6 months. Hip fractures often dramatically change the person’s life and decreases longevity.
But the Bone Mineral Density (BMD) is only one factor that influences the likelihood of breaking a bone. Fewer than 45% of the women over the age of 55 who had a non-vertebral fracture were osteoporotic. Most had normal bones for their age.
Low mineral content of the bone is ONE risk factor, but not the only one, and not the most important in all cases. The other risk factors include: age above 85, low weight, Prednisone use, tranquilizer use, poor vision, smoking, cognitive impairment, excessive alcohol intake; poor diet for Vitamin D, Calcium and/or protein; lack of exercise, lack of attention to home safety and lack of urinary control.
Someone with poor vision and arthritis of the hands/fingers and lower extremities will have a harder time negotiating any physical space. Slippery floors, badly placed electrical cords, clutter on the floor, pets, unsecured throw rugs and poor lighting are common home hazards. The slippery surfaces of the bathroom are dangerous without proper grab bars and non-slip mats and shower/bath chairs. When mind numbing medicines like tranquilizers, narcotic pain medications or antidepressants are added to the mix falls are much more likely, especially at night.
Regular exercise is an important preventive measure. Not only are muscles and bones strengthened, but exercise improves equipoise which is ability to recover balance and equilibrium due to better reflexes and grace of movement.
Fractures of old age can be avoided by having good nutrition, by avoiding mind dulling and bone softening medications, by doing regular exercise that includes training in balance and by initiating a home safety program. Food can be supplemented with Vitamin D and with a particular calcium supplement that has been shown to increase bone mass in the elderly. Once all of these tools are in place the person can be accessed for the risks and benefits of medication like Boniva, Fosamax, Actonel, Atelvia, Binosto, Didronel and the like. Usually homeopathy is enough.
NOISE AND MY EARS
Every time I spend a day in the forest I am stunned by the quiet. Slowly I realize that I am listening intently. My auditory senses reach out to find sound. There is a rustle of the wind in the trees, then the buzz of a bee, a bird’s call or a crack of a branch as a deer jumps away from by presence. It is sweetly soothing to be in an environment so rich with life, so alive and simultaneously so still.
And when I return to the city, the concrete slab, I can hear the hum of its confused mechanics. There is no straining to hear something. Instead the city assaults my ears and brain with a barrage of noise. And if I add to the volume by listening to loud music, going to sporting events or some exercise classes or concerts that feature blaring noise, my ears can actually ring afterward from the damage.
Certainly loud noise is a common cause of early hearing loss and contributes to age related loss of hearing called Presbycusis. Loud noise fatigues the protective mechanisms of the middle ear and finally damages the delicate organ that receives the airwave sound pulses and translates them into nerve impulses. It is the damage to this transducer called the Cochlea that is the most common cause of deafness.
To see what my ears have to cope with every day I purchased a simple decibel meter at Radio Shack and carried it around for a week. My findings have to be compared to standard values known to be quiet, to be annoying, to be possibly damaging or to be seriously damaging.
50 Decibels is like a quiet suburb or conversation at home
60 Db. might be like an office or quiet restaurant
70 Db. is like being in a living room with music on. Upper 70s begin to be annoying.
80 Db. is twice as loud as 70, and like being near a diesel truck, garbage disposal or in an average factory
90 Db. is four times as loud as 70 and like being near a motorcycle, power mower or newspaper press
100 Db. is eight times as loud as 70 and will cause pain.
Exposure to 80 Db. for eight hours might cause damage, and 90 Db. will likely damage the ears.
MY DAY OF NOISE:
MUNI Bus = 82. BART 75-83 in the station and 90-100 while running (90-94 in the tube). City streets = 66 – 87 depending on trucks passing. Restaurant at noon = 70. My living room = 50. Bank = 62-68. Senior Lunch program 62-72. Walgreens = 62-64. My kitchen = 64. Café 70-74. Windy street = 72-90. Loud spin class at the Y = 92. Regular spin class = 76 Bar at noon = 74-81(for research only)
The damaging levels of noise in the 80-100 range were not completely avoidable. I will not do the spin class with the teacher who thinks we have to be pumped up with ear splitting noise, and don’t ride motorcycles. But I often ride BART and MUNI, or am out on city streets, or in a noisy restaurant or occasional bar.
Some years ago I started wearing ordinary compressible foam earplugs during airplane flights. It just helped me cope with the constant engine noise and focus on my own needs. Since then I carry earplugs in my briefcase, shoulder bas and coats. I put them in whenever I ride BART, am a t a loud concert or bar or am riding on MUNI. Some clubs even make them available to patrons at concerts. In this noisy industrial world in which we live a long time it makes sense to protect our ears. Eye doctors and eye wear marketers have made a big deal of wearing glasses that protect us from the sun’s glare and reflection off the many shiny surfaces in the modern urban landscape. It is probably more important to protect our ears against harmful noise that is ubiquitous in cities and in many workplaces.
I don't mind being the guy walking around with blue foam things in his ears, because I want to be the old guy who still enjoys music, has ease in conversations and is able to appreciate the nuiances of my clarinet playing.
The Concrete Slab
Returning, it’s ever on returning.
And only if coming back on the road.
The megalopolis, the concrete slab
gives forth its hum, its noisy code.
After three weeks at the forest or coast,
senses attune to a natural sound.
The wind in the trees, the patter of rain,
bird calls and critters make noise all around.
At first it seems quiet, no sound is heard.
So dull the ears on the slab have become.
The blare of the streets fade slowly away,
a shroud lifted to reveal where I’m from.
The whoosh in the trees and croak of the frog,
A crow’s caw, song bird’s tune, and a hawk’s screech,
To attract, defend and announce I’m here,
nature’s orchestra my numb ear does breech.
What joy there is in simple quietude.
A pleasure on which my soul thrives so well.
A bliss that lets thoughts bubble up from deep.
A touchstone from which some beauty can swell.
The hum of the road, the sound of return,
Is the first to break my sweet reverie.
Gasoline horses drag me up the hill.
The crest bares the city’s cacophony.
Horns blare, doors slam, steel clangs, electric hum,
together the volume becomes a drone.
Millions of fans whirl and more motors roar,
a city’s pulse, carbon, nuclear moan.
A week on the slab and I think again,
how I do crave the river’s slow sweet sound.
An owl’s hoot, rooster’s crow, squirrel’s foot step,
the redwoods, blue jays, noisy life abound.