Perception, circulation, pericardial ligaments, EBM and other incongruities

One of the exemplary points, why School Medecine and Osteopathic Medecine will work together with extreme difficulty, because the look is totally different...and that is because of the Philosophy or lack of it

One can only recognize what one knows. This expression that is so self-explanatory, carries consequences which go far beyond most of us, our grasp.

A.T. Still, affectionately called Drew, stayed although with different focusses, an outdoors man in essence, even when seeing his patients.

Different focusses?

What I mean, is that your awareness, focus and perception usually changes completely by necessity according to the surroundings, if you are a soldier in the field during a war, a pot-hunter for subsistence, a tracker searching for an animal or a farmer on his field among his crops, or trying to understand how you can help a patients health. A bureacratic academic or city person can never grasp this if he lacks that type of experiences.

Nevertheless, perception is a brain thing and not an eye thing. Of course depending on the stakes at play, awareness of the nature's principles is the fundament. These principles go beyond classic physics, or even applied physics and complexity, therefore I think we can summarize it as awareness of the whole combined with focussed target awareness, and gut feel (Memorized past experiences of which probably 90% are unconcious).

In the course clinical examination that follows after the evolutionary physiology, I tried to summarize the training of this perception by two old African trackers expressions:

1. By looking for the clues you miss all the signs... and
2. Walk softly and carry a big stick...

The way these actually "North American tracker wisdoms" became African in Drews time is historical. The North American frontier men where the best known for their tracking and survival skills in Nature, by the British Empire and its Army, in those days. So forcibly during their conquests and African tribal wars, in many cases the British army and Rhodes army Corps used Colonial scouts (North American Frontier men) or "Yankee trackers" as they were called in Africa, for the Army scouting and tracking, like in the Matabele wars for instance. Immortalized in the song "The Shangani patrol" by the words: 'The Yankee tracker Burnham said 'They can't be far ahead'...So within the army, tracker and hunting African scene, these adopted trackers wisdoms became African by use.

Anyway I am sliding off track as usual when I am grasped by one my streams of consciousness, sorry for that..., ...not.

I'll come to the heart and its ligaments, promised. But, why did my mind slide into these two wisdoms? Because it is the essence, not to say the fundamental principles of what tracking is about; whatever you are tracking... thus also 'health' in a patient.

1. By looking for the clues you miss all the signs

"Looking for the clues" implies that more or less your mind is already made up. This has huge consequences on your awareness: the mind shifts automatically in "Search mode", target or scope vision. Meaning focussed like in a tunnel-vision mode, the ensuing consequence is that your mind becomes "blind" for anything in the periphery or what lays outside the target, hence the second part "you miss all the signs". In order to see the signs which are there in the surroundings, it is of utmost importance to let the mind take a step back and stay in "Scan mode", letting all the information come in... Thus in other words for your mind:

In other words: we have to be aware of and go against one of our most fundamental natural automatized tendencies.

What is this now?

It is crucial as Homo Sapiens to stay aware that we are hard and soft wired as a predator and not as a prey or flight animal! What is the difference, and why is it so crucial?

Predators have their eyes in frontal position and orientation giving them a strong binocular vision in depth , with a relatively poor surrounding monocular vision, that attracts attention and focussed vision in case of moving targets. With as consequence that as soon as they see something of intrest their mind goes on point focus, or tunnel vision while their heads keep the frontal binocular vision locked on target. Their minds shift from scan mode (see the signs) to search (looking for the clues).

Prey or flight animals are the reverse with their eyes on the side of the skull. They actually only have binocular in depth vision just in front of their mouths.

Hence, we have to be aware of and go against, one of our most fundamental natural automatized tendencies.

The second tracker wisdom:

Walk softly and carry a big stick.

This wisdom is double, 'walk softly' means merge with the surroundings, in motion and sound and be careful as too let time for the scanning mode mind to absorb everything that is out there. Careful as 'walk softly' also means, slowly let the info of the whole seep in. ( See what is and not what you think. Think of how a cat or wolf carefully, almost hesitantly enters its hunting grounds) I could throw in the other African saying here: In Africa, food runs (Thus walk softly and stand your ground)

The 'big stick' is also double, literally a big stick is a walking help, a weapon and a security in Africa's nature, but the second meaning is: carry a big package of knowledge about Form and what is out there possibly?

So, that is the summary about perception modes, now here comes the elephant in the room...

https://www.quora.com/Where-does-the-phrase-elephant-in-the-room-come-from

Medecine is an art and a science for all of us, also in School medecine. But the tendencies went opposite ways in the time of existence of Modern medical science and Osteopathic medecine. The one went tendentially towards "we only believe and reason with what we can measure in numbers", while the osteopaths went more into what we can sense, observe and reason from natural principles

(Theoretically and originally, osteopathy has devolved since, sadly enough )

This lead pretty fast to several very different perceptions and according reasonings modes, dichotomies also for the circulation in general and for the heart as we'll see as example.

Look at any medical textbook, and see how the circulatory system is looked upon, instigated by the minds perception: Their Hierarchy and Chronology

1. the motor of the circulation is the heart, as a central key and starting point, steered by its nerves and nodes. (I'll call it the electric view from hereon)
2. the aortic arc and the aorta as great distributor
3. the big arteries
4. arteries and arterioles
5. pre-capillary sphincters
6. Capillaries where the exchanges happen with the surrounding connective tissues and metabolism happens
7. venules and small veins
8. the big veins
9. caval veins
10. the heart

And as such the circle of the closed circulation is completed

We all learned this perception, but does it functionally makes complete sense? And is the electric view the alpha and omega for the circulation, my evolutionary directed mind tells me too doubt that...

WHY?

Because in nature an organic or living organism, functions according how it organized or developed. This is one of nature's principles that is easily recognizable. In Medecine, it was blinded out by the dogmatisms that characterizes the last 200 years of evolution in Medecine and of which evidence based medicine is the culmination.

The EBM group called for greater reliance on up-to-date published research, especially clinical trials, and proposed that the value and reliability of evidence should be considered in a hierarchy, with trial data trumping other forms of evidence.

In particular, it argued that authoritative opinion, clinical judgment, and mechanistic reasoning are less reliable and should be relegated to a lower position.

Ironically, these ideas were put forward on the basis of fictional clinical presentations (Basic algorithm errors worsens with each iteration leading to catastrophic system failure)

Sir William Osler said, “He who studies medicine without books sails an uncharted sea,

but he who studies medicine without patients does not go to sea at all”?

https://www.sciencedirect.com/science/article/pii/S0735109716331370#bib2.?

Because in nature an organic or living organism, functions according how it organized or developed. This, is one of nature's principles that is easily recognizable.

Ok, let's do that for circulation in animals from a Phylogeny and Ontogeny point of view, very funny because it is one of the few cases where onto and phylo really go in parallel and not just in principles...

Hierarchy and Chronology of how a circulatory system came into being, from function - behavior to structure or Form, as our old Drew recognized already.

1. The central motor of any form of circulation in a living organism is: the polarities organized between the cellular metabolism and environment or surroundings, the changes in molecular concentration, the heath developed by the mitochondria setting the fluids in motion etc etc etc
2. These polarities set the fluid carrier of the molecules in motion, with a clear direction (away from the polarity). Intracellular and extracellular.
3. The extra cellular fluid in motion is a shape former (ATS withering fields, and the gullies formation after the rain)
4. In bigger multicellular organisms this fluid motion with a direction creates trajectories, which are structuring or Form shaping motors (ATS, the description of the flow of Yukon and Klondike rivers)
5. In more complex organisms with a third germ layer the forms that are generated are capillary networks that self-organize in the fluidic flows, mainly forming in the strongest - longer lasting trajectories (always the way of ease)
6. As the organisms become bigger and more complex these capillaries will generate bigger trajectorial structures which closely resemble what we will call later venules and lymphatics
7. As the multicellular organisms grow bigger, some of these circulatory tubes (veins) will develop stronger muscle walls and will at some point be called arteries
8. The main central arteries in time will have a size that is clearly major, and we change their names to aorta's
9. In mammals (highly complex and bigger organisms with a spine and developed central nervous system) the spectacular rapid spine growth, centralizes the two aortas and by pressing them together make them partly merge into one huge aorta (abdominal and thoracic)
10. The explosive growths of brain and liver-billary system compresses and twists the central aorta in a spiral coiled something we call heart.

Importance of this hierarchy - chronology process: the heart is not the starting point but rather "the last new kid on the block" within the circulatory system. Its development is the result of all antecedent steps.

In other words the basics that lead to the heart formation and its functioning is the metabolic polarities that provoke flows, and how these flows and structures are influenced by the surroundings, tissues and growing organs.

Fast forward towards the pericardial ligaments:

The pericardium alike the pleura and peritoneum are in continuity with their surroundings, but this so called attachments are relatively flimsy, actually no more than mesothelial cells (very comparable to endothelium: long expanded thin cells that form more a filter, than a sturdy barrier like the skin for instance.) These cells have a lamina basalis and reticularis which continues in a structured connective tissue, all flimsy and and will structure more densly by the functional strains on it. As said many times before in previous babbles and articles, the inner tissue or connective tissue when submitted to mechanical - electrical and chemical strain will organise its matrix away from fluidic permeability towards more ordered viscosity or density, at the same time it will self-organize a denser network of fibers which at some point become so dense that they will even be called ligaments or fascia's by anatomists. And so we arrive at the very first badly plagiarized drawing of this babble namely

This drawing is largely and enthusiastically shared and propagated in the osteopathic community and believed to be the real fascia anatomy...

Why plagiarized? Because it is clearly a simplified copy from the original from Testut 1899, look at the original and decide for yourself...

But the moron that took and simplified the drawing either could not read, did not understand French or simply did not bother? Free translation of the text next to the picture:

" I have searched in vain on five or six subjects, the disposition indicated by Teutleben (German anatomist) : I have never found it, neither the form as described by Béraud (French anatomist). I have seen, in the subpericardial region, around the big vessels of the heart, around the oesophagus, around the trachea an athmosphere of connective tissue, that departed from the pericardium and ascended to the top into the aponevrosis of the neck. I have seen that this connective tissue is more dense and thicker in certain places even forming in certain points some tractus more or less long and more or less resistant. But never, and I repeat it, I have never seen it differentiate in a real ligament, as described by Béraud or Teutleben."

So, one of the most respected active and producing anatomists of all times, in the period where anatomy was at its top period, says the drawing is a hoax, and most osteopaths gullibly swallow it and propagate this drawing as being reality... Think of it, and reason? By the way, the Fascia Bronchopericardiaca of von Hayek is also missing as in most anatomy atlases.

O Tempora O Mores... ("Oh the times! Oh the customs!")