By Richard P. Holm M.D.
The word pain has many definitions. In general, pain represents an unpleasant and harmful physical or emotional experience with a purpose. It is something to be avoided, helping us withdraw from destructive circumstances, protecting our bodies while we are healing, or encouraging us to avoid from danger. Helping people deal with pain is the most common reason people go to the doctor and I should add is also the most common reason people use alternative medicine. It is important to realize that people have different kinds of pain. A 50 something year old man came into my office this week with abdominal pain. It was dull, cramping, nauseating, and drove the man to stand up from his chair and walk around the room ineffectively trying to find a comfortable position. The differential diagnosis included gallstones, pancreatitis, appendicitis, or an intestinal obstruction. With testing I defined the diagnosis in order to eventually give him relief. A 20 something year old blond woman came into the Emergency room with severe sun burn. She forgot to put on the sunscreen before she climbed into the boat, and three hours later after all that beer and fun she realized she was in trouble. Her bright red color and blisters indicated the extensive first and second degree burns and it didn’t take a medical degree to tell that she was miserable. Pain medicines and salve helped. A 30 something year old with a ten year history of migraine headaches presented to the office with another pounding one-sided headache, and as I entered the room she was curled up on my examining table, the light was off, blinds were pulled, and her eyes were squinting and watering. I gave her a combination of pills, which helped put her to sleep, allowing the vessels and muscles in spasm to let go and give her relief. A 70 something woman lost her husband to a month long struggle with multi-system failure starting with heart, then brain, and then the tough decision to stop life support and let go. I watched how she deeply suffered, dove back into work for distraction, and finally came to relief of pain through connectedness with family, spirit, and friendship. The word pain has many definitions. By Richard P. Holm MD
In 1974 in Ethiopia’s Awash Valley, a 3.2 million year-old skeleton of an ape was discovered that was different than other ape skeletons. The knee bone shape, along with pelvic architecture, indicated that this ape walked upright. As the Beatles music “Lucy in the Sky with Diamonds” was playing in the background, archeologists speculated that this could be the long sought link between apes and humans, and the upright walking individual was famously nicknamed “Lucy.” Her brain was small and ape-like but she walked upright. This was evidence that the upright position might have come first. They speculated that standing tall allowed for the evolutionary advantage of having a better view of approaching enemy or mate and all the rest followed. Could it be that the special design of an upright knee allowed for the first big step toward the evolution of humanity? And what is so special about this design? The knee is a hinge joint mostly held together with four ligaments. The two “collateral” ligaments run along the inner and outer sides of the knee keeping our legs from bending inward (knock-kneed) or outward (bowlegged). The more noteworthy structures however are the two tough fibrous ribbon ligaments, which cross each other, front to back, on the inside of the knee forming an "X.” This explains why they are called the cruciate or cross-like ligaments. The anterior cruciate ligament or ACL starts at the back of the thighbone or femur above, crosses to connect at the front of the shinbone or tibia below, and keeps the lower leg from sliding forward. The posterior cruciate ligament or PCL starts at the front of the thighbone, crosses to the back of the shinbone, and keeps the lower leg from sliding backward. What is so ingenious is how these crossing ribbons provide for such stability, and yet at the same time, allow for the bending of the knee. So it is as Gerard Manley Hopkins the Priest poet said: “The world is charged with the grandeur of God.” |
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