Support the healing process: Be a gardener not a mechanic

Six years ago, I had a bilateral hernia repair, the surgeon was highly recommended and recognized as an expert in his field. Although the surgery was a mechanical success, the failure of the post-operative care resulted in severe urinary retention, multiple emergency room visits, and ongoing urinary difficulties. Six weeks after the surgery, I was still lugging a Foley catheter with a leg collection bag that drained my bladder. The surgeon had stated I could be back doing physical activities with a week (Peper, 2019).   From my perspective the surgeon was a mechanic and not a gardener. The moment the mechanical structure was fixed in surgery, he had completed his work even if post-surgical complications arose.

Being a mechanic in medicine is an important role. The concept of being a mechanics is not limited to surgery, it can be applied to any treatment strategy when the practitioner focuses narrowly only on the presenting issue. A broken bone > align and put on a cast; hip pain due to the breakdown of cartilage > hip replacement surgery; depression > prescribe antidepressant medication; diabetes > prescribe medications to reduce blood sugar; hypertension > -prescribe anti-hypertensive medication; pain > prescribe opioids, etc. In many cases, healing is much more than mechanical interventions, it often includes post-operative care, exploring factors that may have contributed to disease onset, and retraining such as ongoing physical therapy for hip replacement surgery or teaching stress management, exercise, diet and lifestyle changes for people with diabetes.

Much of healing, especially for the treatment of chronic conditions, needs  much more than a mechanical intervention.  For example, type 2 diabetes, depression, or hypertension are triggered and maintained to a large extent by socio-economics inequalities and stressful lifestyles. Treatment needs to focus on healing and reduce the factors that created or now maintains the illness and support those factors that enhance healing.  This is similar to the role of a gardener.  Once planted, a successful gardener needs to be aware of, and support, all the factors that facilitate the plants growth (enough sunlight at the right time, appropriate watering and fertilizer, soil conditions, etc.). 

These concepts are discussed in the superb article by Gavin Francis, MD and seminal book by Wayne Jonas, MD that describes how medicine needs to change and incorporate an holistic perspective to support and nurture the healing process.

Superb article by Gavin Francis, MD:  ‘We need to respect the process of healing’: a GP on the overlooked art of recovery. (Francis, 2022)

Seminal book by Wayne Jonas, MD: How healing works (Jonas, 2018).

Additional resource to optimize health and healing when needing surgery

References

Gavin, F. (2022). ‘We need to respect the process of healing’: a GP on the overlooked art of recovery. The Guardian. https://www.theguardian.com/world/2022/jan/04/we-need-to-respect-the-process-of-healing-a-gp-on-the-overlooked-art-of-recovery

Jonas, W. (2018). How healing works. New York: Lorena Jones Books

Peper, E. Surviving and preventing medical errors. (2019). Townsend Letter-The Examiner of Alternative Medicine. 429, 63-69. https://www.townsendletter.com/article/429-surviving-and-preventing-medical-errors/

Digital fatigue and what to do

Erik Peper, PhD and Monica Almendras

The article was adapted from the recent book, How Technology is Hijacking our Lives, Strategies for Coping and Pragmatic Ergonomics, and was originally published on the Big Q  https://www.thebigq.org/2021/08/02/why-do-we-have-zoom-fatigue-and-what-can-we-do-about-it/

Why is it that after studying, working, entertaining and socializing at the computer screen or looking at texts, Instagram, Facebook, Tiktok or responding to notifications on the cellphone, we often feel exhausted (zoom fatigue) and experience neck, back and shoulders discomfort, or eye irritation? Time disappears as we surf the web and go down the rabbit hole by clicking on one and then another link or responding to social media. As time flies, we tend to be unaware that our muscles tighten, our breathing become shallow and quicker, our blinking rates decreases and our posture slouches forward as we bring our nose close to the screen to see the text more clearly.

Become aware what happens when you do the following experiential practices

Observe what happens when you mouse

Sit comfortable in an erect posture as if you are in front of your computer and hold a small object that you can use to simulate mousing to the side of the keyboard. With an actual mouse (or the sham mouse), pretend to draw the letters of your name and your street address backward, right to left. Be sure each letter is very small (less than half an inch in height). After drawing each letter, right click. Draw the letters and numbers as quickly as possible without making any mistakes for fifteen seconds.  Stop and observe what happened in your body.

If you are like almost all participants you tightened your neck and shoulders, stiffened your trunk, held your breath and most did not blink.  All this occurred without awareness. Over time, this covert tension can contribute to discomfort, soreness, pain, or eventual injury.

Observe the effect of low static muscle tension

You probably felt discomfort in the muscles of your hip.  As you lifted your knee up, you most likely also held your breath and tightened your neck and back.  Holding your muscles in a static position for more than a few minutes creates discomfort. Yet, when you walk you use the same muscles and usually do not experience discomfort.  The main difference is that during walking you sequentially tighten and relax these muscles. Each time the muscle relaxes, blood flow is restored to remove the waste produces of metabolism and supply nutrients and oxygen to the muscle tissue. For more information, see the blog, Reactivate your second heart.

From the evolutionary perspective, people typically shifted between sitting, walking, and moving in varied ways during specified forms of labor which tends to tighten and relax different muscles.  Therefore, incorporate dynamic movement’ during the day: Stand up, wiggle and move several times an hour. To avoid sitting disease, install a break reminder program such as StretchBreak on your computer or other digital devices.  When people implement taking breaks, they report having much more energy at the end of the day.  As one participant stated: “There is now life after five”.  What he meant was that at the end of the day when he got home, he still had energy to other things.

Observe how breathing and opening eyes affect tearing

Inhale with a gasp as you open your eyes. Close your eyes, then exhale and inhale with a gasp as if you are surprised and at the same time open your eyes then look as if you are quickly responding to a notification. Repeat one or two time and be sure to open your eyes wide the moment you gasp as you inhale

Exhale and slowly open your eyes. Close your eyes, then inhale by allowing your abdomen to expand and begin exhaling and slowly open your eyes. Repeat one or two more times as you open your eyes midway through the exhalation, while your shoulders relax. What did you experience?

Most likely when you opened your eyes while exhaling you found that your eyes felt more relaxed with more tearing moisture in the eyes, while gasping and looking the eyes felt tense and more dry.  In most cases when we focus without awareness intensely at the screen we create eye tension. Thus, practice blinking by resting and closing your eyes then gently open your eyes as you exhale and then looking at the far distance relax the muscles of the eyes. For detailed instructions see the blog, Are you encouraging your child to get into accidents or even blind when growing up?

We are usually unaware that our bodies respond automatically and that these patterns occur covertly and totally without awareness while working at the computer or responding to texts. We only notice when symptoms of discomfort occur. Fortunately, it is possible to monitor the degree of muscle tension with an electromyograph (EMG).  The unaware muscle tension can be identified by physiological recording of the electrical activity produced when they contract.  With biofeedback and coaching people can learn to become aware of the covert tension and as shown in Figure 1.

Figure 1. A representative recording of a person working at the computer. Note the following: 1) forearm and shoulder (deltoid/trapezius) muscle tension increased as the person rests her hands on the keyboard without typing; 2) respiration rate increased during typing and mousing; 3) shoulder muscle tension increased during typing and mousing; and, 4) there were no rest periods in the shoulder muscles as long as the fingers are either resting, typing, or mousing. Reproduced by permission from Peper & Harvey, 2008.

Even though the physiological recording showed increase tension when the hands were resting on the keyboard, the person reported being relaxed.  The person was also not aware that her neck and shoulder muscles stayed contracted without any momentary rest and recovery periods nor that her breathing rate and heart rate significantly increased.  The covert muscle activity and shallow breathing will also interact with the person’s stress level, as well as ergonomic equipment use and the posture throughout the day.  Similarly, we tend to be unaware that we slouch which would increase neck and back tension as well as, affect breathing as illustrated in figure 2. 

Figure 2. The effect of slouching on neck and shoulder muscle tension and breathing. Reproduced by permission from Peper, E., Harvey, R. and Faass, N. (2020). TechStress-How Technology is Hijacking our Lives, Strategies for Coping and Pragmatic Ergonomics, Berkeley, CA. North Atlantic Books.

Maintaining and optimizing health at the computer means re-envisioning our relationship with technology—reclaiming health, happiness, and sanity in a plugged-in world.  We have the ability to control everything from our mobile phones without needing to get up from our seat. Work, social life and online learning all involve the mobile phone or some type of smart devices. A convenient little device that is supposed to simplify our lives has actually trapped us into a vicious cycle of relying on it for every single thing we must do.  We spend most of our day being exposed to digital displays on our smartphones, computers, gaming consoles, and other digital devices, immersing ourselves in the content we are viewing. From work related emails or tasks, to spending our free time looking at the screen for texting, playing games, and updating social media sites on a play-by-play of what we are eating, wearing, and doing. A typical thing to do on our devices is to click on one hyperlink after the other and create a vicious cycle in which we are trapped for hours until we realize we need to move. As we do this, we are unaware how much time has frittered away without actually doing anything productive and then, we realize we have wasted another day.

Transform digital fatique into digital health (adapted from https://news.sfsu.edu/news-story/professors-share-tips-healthy-tech-usage-during-pandemic)

Get up and move                              

About every 20 minutes, stand up and move your body. Consider doing a quick dance to a favorite song or taking a walk around the block. “It will feel silly, yet actively moving is one of the quickest energizers,” Stretching and moving will also relax those muscles that you tense constantly when working at a desk. Think you’ll forget to take a break? Install the free Stretch Break app as a great tool to remind you. For more background information, see the blog, Sitting disease is the new health hazard.

Blink and look far off

Our blinking rate significantly decreases while looking at a screen, which contributes to eye strain. A good way to address this is by blinking every time you click on a hyperlink or after you finish typing a paragraph. To relax the eyes, look at the far distance. “Looking out into the distance disrupts constant near-focus muscle tension in the eyes.” For more suggestions, see the blog, Resolve Eyestrain and Screen Fatigue.

Avoid phones and screens right before bed

Many people use their phones before bed, which can make it more difficult to sleep. Take a break from your phone half an hour or more before bedtime. Electronic screens emit blue light, which can send a signal to your brain that it’s daytime. This suppresses your body’s production of the hormone melatonin, which helps your body know when it’s time to sleep. In addition, keeping up with social media and watching digital media tends to be thought-provoking or anxiety-inducing may stimulate the mind and promote wakefulness. For more suggestions, see the blog, Are LED screens harming you?

Optimize ergonomics

Make sure your computer setup is ergonomically friendly. Your desktop keyboard should be positioned so that your forearms are a few inches above your waist. The top of your screen should be around eyebrow level, which should naturally cause your eyes to look slightly downward at the screen.

Unfortunately, using a laptop or a phone causes people to look down in an unhealthy way that can make them slouch and induce neck or back pain. The solution is to get an external keyboard along with a laptop stand. Getting an external monitor can also help. For more detailed suggestions, see the blogs, Cartoon ergonomics for working at the computer and laptop and Reduce TechStress at Home.

Sit erect and stop slouching

As we work at the computer, we unknowingly tend to slouch which increases the risk of neck and shoulder discomfort and evoking thoughts and feelings. Take control of your slouching with a posture feedback device and app such as UpRight Go [3] that reminds you when you slouch as shown in Figure 3. Each time you the device signals you that you slouch, sit up straight, move, breathe, and think of a positive thought. For more suggestions, see the blog, “Don’t slouch!” Improve health with posture feedback.

Figure 3.  Using posture feedback to become aware of slouching. Reproduced by permission from Peper, E., Harvey, R. and Faass, N. (2020). TechStress-How Technology is Hijacking our Lives, Strategies for Coping and Pragmatic Ergonomics, Berkeley, CA. North Atlantic Books.

Practice slow diaphragmatic breathing

Breathe deeply and slowly to restore a natural rhythm. As we work, we tend to breathe more shallowly, which increases anxiety and our heart rate. To counteract this, take three deep breaths for five seconds, then exhale very slowly for six seconds. For more instructions on slower diaphragmatic breathing, see the blog, Healing irritable bowel syndrome with diaphragmatic breathing.

Give undivided attention and be present

Phones have become so ingrained in our lives that we use them constantly throughout the day. Harvey stresses that people should make a conscious effort to limit phone usage, especially when socializing. When we respond to a phone notification during a Zoom hangout with friends or while talking to our family members, people may feel dismissed. This often increases a sense of social isolation, so give people your total attention when interacting with them. For more suggestions, see the blog, Configure your brain to learn and avoid Zoom fatigue.