Barrett Dorko
20-09-2006, 07:30 PM
How wonderful it is then…that to this great monster corporeal warmth is as indispensable as it is to man…it does seem to me that herein we see the rare virtue of a strong, individual vitality and the rare virtue of thick walls and the rare virtue of an interior spaciousness…O man, admire and model thyself after the whale…do thou too remain warm among ice, do thou too live in this world without being of it…be cool at the equator and keep thou blood fluid at the poles…like the great whale, retain o man in all seasons a temperature of thine own.
From Herman Melville’s Moby-Dick; or, The Whale
Winters in central Pennsylvania are harsher and longer than those along the shore of a great lake. There the water keeps the land from sustaining any temperature simply because it so commonly changes the air above it. My siblings and I grew up in the shadow of Lake Erie but about forty years ago the eldest, Ladonna, moved to a farm surrounded by hills and the Amish and the gardens she tended. La was known to comment on the winter weather there – often.
My patients typically show up cold somewhere in their person, or, at least, uncommonly cool. This makes sense to me. Their nervous tissue is irritated, and most of us will respond to that with sympathetic increase. Any suspect held by police in a hammer lock will sweat, the involved limb will grow pale and, given time, the effect will spread. This is a reasonable response for a while, but not forever. The problem for the patient is that the only when who can truly “let go” of them is someone they aren’t all that familiar with. It is them, of course.
Before dawn last Saturday four of the remaining Dorko siblings started driving from either end of the state and arrived at the farm within a minute of each other. There we found our brother-in-law Eric waiting; facing his first winter alone since La’s passing. Without much conversation we headed for the wood pile, started up the splitter and began to work.
The persistent cooling concurrent with pain isn’t a coincidence. In The Neurobiologic Mechanisms in Manipulative Therapy (Plenum Press 1978) no less than Irvin Korr concludes that “Sympathetic stimulation modifies the inherent functional properties of the target tissue. (In chronically increased sympathetic states) the most important effect, clinically (of manipulation), is the reduction of sympathetic hyperactivity and its pathogenic, pain-producing influences.” He might more clearly have said, “Encourage movement that brings blood to the painful part.” Andrew Still, the founder of Osteopathy often said, “The Law of the Artery is Supreme,” and a century later Viola Frymann D.O. famously wrote, “The artery and its nerves must deliver constantly on time and in quantity sufficient: the venous system and its nerves must perform their function and allow no accumulations. These two demands are absolute.” I agree that for many painful problems this is certainly true.
As we worked I got to thinking about how all of this was ultimately about heat. We were doing what we could to help Eric maintain the warmth in his home and thus in himself. No one can take La’s place, but her family can help in this way. It’s the blood that connects us, of course, and that’s no small irony.
I’m told that when I was very small I once answered the question “What do you want to be one day?” by saying, “I want to be a whale.” In fact, this is one of my family’s favorite stories about me and I’ve endured it silently for half a century. Until I heard ( http://www.studio360.org/americanicons/ai_show081806.html) that passage from Melville’s classic novel recently I didn’t know what to say in response. Now I’ve a line or two - especially that one about “(retaining) in all seasons a temperature of thine own.” Sounds like good advice to me.
Years ago I wrote an essay titled “Warmth.” (http://www.barrettdorko.com/articles/warmth.htm) It said in part, “… there is a least one simple aspect of health that my patients in pain would universally like to have; warmth. By this I mean the free, full flow of blood that produces limbs that can tolerate a breeze painlessly. They want to go to bed without socks on and they want hands others are willing to hold or be touched by.”
This desire for warmth coupled with our sense of how important it is for us to provide it for others isn’t news, and therapists act upon it regularly. But too often they offer it in a transient fashion and fail to appreciate its significance. We need to understand this better, fashion ways of getting the patient to create it safely on their own, and, most of all, make it more commonly the primary focus of our care for pain.
Perhaps we should remember that our warm blooded nature is something we share with the greatest creatures on this earth. When we do, we’ll meet the patient wherever they might be, make sure they understand what they need to do in our absence, and then carefully leave them to their own devices.
Stack the wood; spend time together remembering what sort of warmth we’ve all known and drive gently away. This, I believe, is what those in pain need more than anything else.
From Herman Melville’s Moby-Dick; or, The Whale
Winters in central Pennsylvania are harsher and longer than those along the shore of a great lake. There the water keeps the land from sustaining any temperature simply because it so commonly changes the air above it. My siblings and I grew up in the shadow of Lake Erie but about forty years ago the eldest, Ladonna, moved to a farm surrounded by hills and the Amish and the gardens she tended. La was known to comment on the winter weather there – often.
My patients typically show up cold somewhere in their person, or, at least, uncommonly cool. This makes sense to me. Their nervous tissue is irritated, and most of us will respond to that with sympathetic increase. Any suspect held by police in a hammer lock will sweat, the involved limb will grow pale and, given time, the effect will spread. This is a reasonable response for a while, but not forever. The problem for the patient is that the only when who can truly “let go” of them is someone they aren’t all that familiar with. It is them, of course.
Before dawn last Saturday four of the remaining Dorko siblings started driving from either end of the state and arrived at the farm within a minute of each other. There we found our brother-in-law Eric waiting; facing his first winter alone since La’s passing. Without much conversation we headed for the wood pile, started up the splitter and began to work.
The persistent cooling concurrent with pain isn’t a coincidence. In The Neurobiologic Mechanisms in Manipulative Therapy (Plenum Press 1978) no less than Irvin Korr concludes that “Sympathetic stimulation modifies the inherent functional properties of the target tissue. (In chronically increased sympathetic states) the most important effect, clinically (of manipulation), is the reduction of sympathetic hyperactivity and its pathogenic, pain-producing influences.” He might more clearly have said, “Encourage movement that brings blood to the painful part.” Andrew Still, the founder of Osteopathy often said, “The Law of the Artery is Supreme,” and a century later Viola Frymann D.O. famously wrote, “The artery and its nerves must deliver constantly on time and in quantity sufficient: the venous system and its nerves must perform their function and allow no accumulations. These two demands are absolute.” I agree that for many painful problems this is certainly true.
As we worked I got to thinking about how all of this was ultimately about heat. We were doing what we could to help Eric maintain the warmth in his home and thus in himself. No one can take La’s place, but her family can help in this way. It’s the blood that connects us, of course, and that’s no small irony.
I’m told that when I was very small I once answered the question “What do you want to be one day?” by saying, “I want to be a whale.” In fact, this is one of my family’s favorite stories about me and I’ve endured it silently for half a century. Until I heard ( http://www.studio360.org/americanicons/ai_show081806.html) that passage from Melville’s classic novel recently I didn’t know what to say in response. Now I’ve a line or two - especially that one about “(retaining) in all seasons a temperature of thine own.” Sounds like good advice to me.
Years ago I wrote an essay titled “Warmth.” (http://www.barrettdorko.com/articles/warmth.htm) It said in part, “… there is a least one simple aspect of health that my patients in pain would universally like to have; warmth. By this I mean the free, full flow of blood that produces limbs that can tolerate a breeze painlessly. They want to go to bed without socks on and they want hands others are willing to hold or be touched by.”
This desire for warmth coupled with our sense of how important it is for us to provide it for others isn’t news, and therapists act upon it regularly. But too often they offer it in a transient fashion and fail to appreciate its significance. We need to understand this better, fashion ways of getting the patient to create it safely on their own, and, most of all, make it more commonly the primary focus of our care for pain.
Perhaps we should remember that our warm blooded nature is something we share with the greatest creatures on this earth. When we do, we’ll meet the patient wherever they might be, make sure they understand what they need to do in our absence, and then carefully leave them to their own devices.
Stack the wood; spend time together remembering what sort of warmth we’ve all known and drive gently away. This, I believe, is what those in pain need more than anything else.