From the Heart - Who is Healing Who?

Apologies for the lateness of this post.  It should have been out on Thursday but as you will see while you continue reading life has been a hectic lately.

Being able to heal athletes and patients and getting them back to sport, work or their regular daily activities always brings me joy.  Being able to help my family and loved ones brings me even more.  I always want to be able to fix what is wrong with you.  Be it stretching and working out any tightness or providing exercises to ensure proper strength.  However for the last three years I have not been able to "fix" someone most dear to me.  Three years ago my dad was diagnosed with liver and lung cancer.  From day one we always knew it was terminal and were grateful for all the time we have been given since that day.  Watching him go through rounds and rounds of chemotherapy, trying to ensure that his quality of life remained at a level he wanted has been difficult.  In saying that, he was blessed for the majority of his treatment, he did not have many side effects and until the last year still golfed and helped out at the farm.  It has been in the last six months where I have felt useless.  During his final round of chemotherapy he became very tired and lost his appetite.  It finally came the time where he started to open up to different options.   I am very thankful for all my colleagues who have helped me grow as an athletic therapist.  For teaching me about nutrition, acupuncture, and all the medical stuff that I now know to help understand what is going on with him.  

Unfortunately two weeks ago my dad took a turn, his body just could no longer fight the cancer and handle the chemo going through his body.  He has spent the last two weeks between two hospitals, wanting to come home.  I live away from my parents and for the first week getting the information on his condition through phone calls and emails made it very hard, seeing and hearing the numbers and knowing what was going on in his body made me ache to help him more.  Knowing that he was in no condition to come home and not wanting to be the one to tell him that.

This is where I am not sure if he has given me a gift or I have given him one.  He has extremely swollen feet and legs.  The edema is putting lots of pressure on his nerves and causing phantom pain.  He describes it as though his feet are being drawn together like magnets.  So the man who never asks for treatment, or pain meds wants me to work on him.  The first treatment didn't go as well as I had hoped.  I thought he was sleeping and he was wanting me to use less pressure.  Compared to normal pressure I was going pretty light, so I thought that was that.  However, it helped a little and he wanted it more.  I need to send a huge thank you out to my cousin who helped guide me in regards to some better acupressure treatments.  So today was the fourth treatment.  I was able to do full leg flushing and moved a bunch of fluid out of his feet and ankles.  Being able to see noticeable results and having even the doctor notice was a huge goal for me.  What gave me even more was when he said he felt better and that the phantom sensation was gone.

Dad I hope that me being able to help relieve your discomfort while you are still with us is a gift.  I do know that you have given me a great gift, being able to help you feel better while I can.

Why Ice?

As you can gather from the name of this blog, I fully believe in icing injuries.  Any athlete or patient will tell you that I don't believe in heat only ice when it comes to treatment of musculoskeletal injuries.  There has been a lot of new information coming out saying that icing an acute injury is detrimental to healing.

When dealing with an acute injury the use of cryotherapy (application of cold) to the area is important for the first 24-48 hours.  The use of ice decreases pain and muscle spasm as well as blood flow, inflammation and edema.  This is due to the stop of tissue hypoxia and additional tissue injury.  When managing an acute injury the reduction of all of these aids in recovery and rehabilitation.

Reviews of research done on cryotherapy shows that more detailed studies need to be completed.  The research has proven that the application of ice on acute injuries does decrease pain, which will decrease spasm caused by the pain-spasm cycle.  Since muscle spasm decreases range of motion, this decrease in pain will lead to earlier improvement in range of motion and subsequent earlier start to rehabilitation.

The principle of RICE is still the standard when dealing with acute injuries.  Rest, ice, compress and elevate the injured area for the first 24-48 hours.  When icing on average for topical application the ice should be applied for around 20 minutes depending upon the size of the area needing treatment and the depth of soft tissue.  Topical application will reduce tissue temperature to a depth between 2 - 4 cm.

When applying ice, no matter the mode there are 4 sensations that you will experience.  Starting with cold, progressing to burning, achy/dull and finally numb.  When determining how often to apply the ice, the area needs to come back to normal body temperature before reapplying.

No matter the type of soft tissue injury, be it sprain, strain, contusion or post operative the application of ice is the still the best way to decrease pain and inflammation without the use of medications after an acute injury.

Articles used
Hubbard, T.J & Denegar, C.R. Does Cryotherapy Improve Outcomes with Soft Tissue Injury? Journal of Athletic Training. 2004 Jul-Sep; 39(3): 278-279
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC522152/

Nadler, S.F, Weingand, K, Kruse, R.J. The Physiologic Basis and Clinical Applications of Cryotherapy and Thermotherapy for the Pain Practitioner Pain Physician.  2004;7:395-399, ISSN 1533-3159
http://www.painphysicianjournal.com/2004/july/2004;7;395-399.pdf