Can You Make It Through This Post Without Yawning? - Hacks on How to Activate our Parasympathetic Nervous System.

"We are what we repeatedly do". - Aristotle.

For those who have read my past blog posts, I talk a lot about our body's natural "fight or flight" reflex. In short, our fight or flight reflex is a primal instinct that is required to survive. The instinct was triggered for our distant ancestors in order to run away from lions and tigers and bears. This reflex caused a quick change in our nervous system in order to win, survive, and procreate. It causes pupil dilation, increased blood flow to our muscles, improved lung capacity amongst many other changes. Once we run away from the bear, our body goes back to it's normal level of homeostasis, the reflex turns off and we can continue our lives, rest, and digest.

The autonomic nervous system is made up of two different systems:
1) Parasympathetic- Rest/Digest
2) Sympathetic- Fight/flight.

I see many patients who have chronic, persistent and intermittent pain that seems to continually crop out of the wood works, again, just as they are going through another life stressor. I usually always discuss how the chronic state of "fight or flight" can wreck havoc on our body, but it wasn't until recently that I also realized it's connection to digestive issues- the rest/digest system. So many of my patients with persistent pain and dysfunction also suffer from bowel and bladder issues including chronic bladder infections, irritable bowel syndrome, constipation, and diarrhea.  In very simple terms, when one system is on and activated, the other system is off. When we are constantly nervous about losing our job, worried about decisions we made in the past, anxious about the future, we are constantly in "fight or flight". So what does that do to the parasympathetic, rest/digest part of our nervous system? Well folks, it can chronically be suppressed. The parasympathetic nervous system allows for fuel storage, sleep, resistance to infection, and you guessed it, motility/digestion. No wonder the more stressed and anxious we are the more unhealthy, tired, and sick we become. 

The word "autonomic" means involuntary making one believe that we do not have the ability to directly influence which nervous system we are in. However, studies have now shown that there are many ways in which we can hack into our parasympathetic nervous system.


1) Breathe.
Lay down or sit in a relax position. Place one hand over your belly, and the other over your chest. Close your eyes. Slowly breath in through your nose for a count of four seconds causing the hand over your belly to rise, while the hand over your chest stays relatively still. If you only feel the hand on your chest moving, than you aren't breathing deep enough. Allow your belly to expand with each inhalation. After the full inhalation, hold for your breathe for a second or two at the top, and exhale slowly through your nose. Repeat this for 60 seconds. During your breathing, visualize what is happening to the heart and lungs with each inhalation- it is widening, and expanding, opening and accepting. With each exhalation, its resting, relaxing and giving.

Why it works: You are expanding your bronchioles, (which are tiny passageways for air to move into the lungs) with each inhalation. The rest/digest nervous system is naturally activated since it's job is decrease bronchial dilation, thus bringing our body back into it's resting state. Bringing awareness and being mindful to what is happening on the inside is a great way to activate the parasymphatic nervous system, replacing our constant thoughts of worry and stress.

2) Relax. 
I don't mean go kick up your feet in front of the TV. I want you to check in with your body periodically throughout the day. Put a timer on your phone to go off every 45 minutes (you can download the Stand Up! App for free. Check out my last blog post on Health/Wellness Apps for more information).
Do this with me right now.
- Check in with your jaw. Are you clinching it? If you are, check in with your tongue. What position is your tongue in? Is it placed up against the back of your teeth? Try this: place your tongue against the roof of your month, now try to clinch your teeth. Was it harder? It's much more difficult to clinch our teeth when our tongue is resting at the roof of our mouth. Now if you haven't done so already, with you tongue gently touching the roof of your mouth, left your jaw gently release with your lips slightly touching.
- Check in with your shoulders. Are they half way up your ears? Are they rolled forward towards your computer? Do 5 slow neck rolls each direction, and 5 big shoulder rolls backwards... Up, back and down. Finish that 5th shoulder roll with your shoulders resting down and back. Quickly re-checkin with your tongue and jaw.
- Check in with your belly. Are you sucking it in like you are trying to put on pants that are too tight? Are you hunched forward making a big "C" curve with your back, sitting on your tailbone? Sit towards the front of your chair, intertwine your fingers behind your neck for support, and gentle extend your back, elongating your belly. Repeat this five times from neutral position and extend your neck, upper back and lower back, maybe even arching over the back of your chair if it is low enough.
- Check in with you glutes. Are you clinching them? Not sure? If your legs are crossed, uncross your legs and place both feet on the floor. Perform 5 slow butt squeezes (contract your butt, don't literally squeeze your butt with your hand), but make sure to relax between each squeeze. After your last glute contraction and relaxation, relax again. That second relaxation is key.
- Check in with your pelvic floor muscles. This one is usually the toughest to relax because they are the muscles we usually have the least knowledge and awareness of. Perform 5 deep breathes like we did above under "Breathe". Visualize on each inhale that the diaphragm is lower and relaxing, and the pelvic floor muscles are lower, lengthening, and relaxing. On each exhale just image those muscles gently going back to neutral position.

Watch this quick video demonstrating this connecting between breathing, the diaphragm and the pelvic floor muscles. You at least have to check out how they made the pelvic organs look like a little piglet.



If you are like most people, you were probably tensing most of those areas we just went through. In fact, studies have found that 70% of individuals who clinch and tense their jaw also have some type of pelvic floor dysfunction (ex. pain with intercourse, pain with urination, etc. See my past blog post Let's Talk About Sex Baby! for more information).

Why this works: Activating the body's relaxation state sends signals to the brain that we are calm, decreasing the brain's natural "alarm system" that is chronically triggered with stress, anxiety, worry and fear.

3) Yawn.

Scientists aren't sure exactly why yawning activates the parasympathetic nervous system. What they do know is that yawning is "contagious", meaning when others yawn, we can quickly and involuntary jump on the bandwagon. They believe it's a way that we show empathy towards others (dogs do this as well to humans). Also, it has been found that when our body gets a little warming than our normal, it is common to yawn, thus putting us back into our normal homeostasis. Tell that to your boss or  teacher next time they catch you yawning!

Can you make it through this video without yawning?




Summary: The sympathetic nervous system is imperative for survival- we see a car coming directly at us full speed, we run out of the way without thinking twice about it. It is when we are unable to get out of this state of fight or flight that it takes a toll on our body. It's important for our health to take the time to activate the parasympathetic nervous system during your day. Set an alarm on your phone and do a quick body scan every 45 minutes. Practice deep breathing for 60 seconds intermittently throughout your day. I would suggest once before getting out of bed in the morning, before lunch, before leaving work, and lastly before you go to bed. We cannot control all life stressors, however we do have control over our body. We have the conscious ability to relax and let go, we must first be aware (hence body checks) of these habits and have the discipline to prioritize our health.

"Little by little, a little becomes a lot". -Tanzanian Proverb

Keep Calm, I Know CPR & First Aid

"If you are prepared, you will be confident, and will do the job". -Tom Landry

As a healthcare provider, it is mandatory to be CPR/First Aid certified. Therefore, every 2 years comes that daunting day that I have to take one of my precious days off to sit in a small, stuffy room, with 10 strangers, renewing my certification.

Well folks, that lucky day… was today. 8:30am-3:30pm. As annoying as it can be to be in a mandatory class on your day off, I really left that room ready to save some lives! Thank goodness I’ve yet to be in a 911 situation, but at least I feel that much more confident if one does occur. (BTW, for those who are freaking out since you forgot the ratio of chest compressions to breaths, it’s still 30:2. But if you read this and forget again, just do chest compressions!)

For those who are required to have CPR/First Aid training, sweet. For those who aren’t, I highly suggest that you take at least a basic course in it. For those mom’s and dad’s who have young kids, without a doubt, become certified. And offer to pay for the course for your child’s nanny or babysitter.  I’m actually pretty surprised during all my years of babysitting, not one time was I asked if I had CPR/First Aid training.

For those who think the ABC's when they hear CPR, that's pretty outdated information. It would be a great idea to go to a class and learn the updates on how to be most effective incase an emergency occurs (You never know!)

Each time I take the course, it has some slightly different (and thankfully more condensed) information. This is because as studies and surveys are being performed, the Red Cross and American Heart Association reconfigure the courses in order to be more affective at saving lives.

I am going to list the things that I learned during the course today. Some of you may think, “well everyone knows that”. I will shamelessly admit that I didn’t know many of these, or not in as much detail.

EPI PENS:

Epi pens (used as treatment for anaphylactic shock) has a predetermined amount of medication for that person. In order words, one epi pen should not be used for another person.

INHALERS:

There are two types of inhalers, (treatment for asthma)- a fast acting and slow acting/long term corticosteroid. For an acute asthma attack, an individual needs their fast acting inhaler.

FIRST AID/AED LOCATION:

For my healthcare professional peers, especially those working in outpatient ortho, do you know where the AED/First Aid kit in your clinic? Admittingly, I do not. I have a pretty good guess since I have seen our First Aid kit, and I have seen my clinic manager change the batteries of our AED in a similar location as where the first aid kit is. But I can’t say I’ve ever seen it/touch it at its resting place and said, “Okay, this is where this is in case of emergencies”. So friends, do what I am going to do the second I get into work tomorrow and find out where the AED is and ask if it is the only one in the clinic. If it’s not, where are they others located?

PACE FOR CHEST COMPRESSIONS DURING CPR:

If you aren’t sure if you are doing the correct pace for chest compressions (which should be 100-120 compressions per minute), then just sing to yourself the Bee Gee’s – Stayin’ Alive (103 compressions per minute to be exact). That song’s beat is the correct pace, and also sending out good mojo into the universe. Another song with the correct pace is Queen’s- Another One Bites the Dust. But, I think we could all agree, who wants that thought going through your head while you are trying to save someone’s life!?

YOU DON’T HAVE TO CHECK PULSE!

New CPR guidelines no longer require you to check the person’s pulse. Studies have found that 1) people where doing it ineffectively, and 2) it’s taking up too much time.

CHEST COMPRESSIONS ONLY IS FINE:

I already mentioned this above, but if you are nervous to give rescue breaths to someone you do not know (not sure if they have any communicable diseases), you don’t have any protective barrier, (or you just can’t remember what the heck you are supposed to do because lets face it, this is an emergency and it’s somewhat normal to freak out), just remember, giving COMPRESSIONS ONLY IS OKAY!

WHAT ABOUT PREGNANT MOMS?

I work with a lot of pregnant moms, so my ears perked up whenever we talked about them in class. Do we treat them any differently? It depends. Can you administer an AED to them? Yep! The same exact way you would administer the AED to anyone else. What if they are chocking?? Yeah, good question. The Heimlich maneuver is modified with your fist positioned at the base of their breastbone, (rather than at their diaphragm) with the same in/upward forceful quick thrusts.

GLOVES!

The single most important tool for you to have for first aid/CPR is… GLOVES. This is something that all men and women can have on them at virtually all times. Even a women like me who has the smallest purse known to mankind, there is room in my purse for two gloves.

COMMON SIGNS & SYMPTOMS:

With more and more people living longer and staying active, it is important to recognize signs of possible distress that needs emergency medical attention.

STROKE. There is a simple acronym used to quickly assess an individual for a possible stroke. Think FAST.

F = Face. Is their face asymmetric? Ask them to smile. Look for drooping of the eyelid, mouth, or look for drooling.

A = Arms. Ask them if they are having any change in sensation of their arms such as numbness/tingling. Ask them to lift up both of their arms to shoulder height and keep them up there.

S = Slurred speech. Have them repeat a sentence, ask them questions.

T = Note the time that symptoms occurred, or if the individual was aware of when the symptoms first began.

CALL 911 or other emergency number! Every second counts.

HEART ATTACK. The signs and symptoms can look completely different with a heart attack. We often think, severe chest pain with radiating pain to the jaw and down the left arm. In men, symptoms often times may look similar to this, or the classic “it feels like there is an elephant sitting on my chest”. Symptoms may radiate down both arms, may look like profuse sweating, shortness of breath, and not relieved with rest or antacids. With women, symptoms may look a lot more subtle,  like dizziness, nausea, and/or indigestion.

CONCUSSION. We commonly think of sports, especially football when we think concussion. Signs and symptoms may include:

-       Behavior changes such as agitation and fear/anxiety

-       Loss of consciousness (not also though!)

-       Changes in vision (double vision, blurred vision, sensitivity to light)

-       Memory problems. Have them answer a few questions like what day and year it is, who is the President.

-       Balance problems.

-       Nausea/vomiting/drowsiness/feeling sluggish.

I remember when my brother got a concussion during one of his lacrosse games. He didn’t even the five minutes before getting hit or afterwards. He was checked out by a medical professional, and was sidelined for the rest of the game. He went out with his friends that night to celebrate the big win against their hometown rivals, and my mom made sure to wake up every few hours that night while he slept. That has long been the “at-home treatment” for a concussion, but with the increase in awareness of long-term and permanent changes that can occur from a head injury, the type of treatment has also changed. If a person is suspected of having a head injury, a doctor should check them out, especially if they are an athlete and planning on continuing to play in contact sports. This is a really big pet peeve of mine, especially when professional athletes put the game ahead of their health. This just puts the pressure on kids to just suck up the pain rather than tell coach that they aren’t feeling right. Sure, maybe that first concussion was “minor”. Did you know that the brain is much more at risk of permanent injury during this critical time period after the first concussion? If you let yourself or a player stay in a game that day or let them return to play before allowing a doctor to medically clear them, you are being negligent and putting yourself or that person into a position of long-term brain trauma. So don’t use the old wives tale of waking someone up every hour to monitor for a significant head injury. Leave the game, work, park, etc., and to go a doctor.

DIABETIC ATTACK. Often times, hypoglycemia or hyperglycemia can look like someone is drunk. They may be slurring their speech, non-responsive, talking nonsense. They may be stumbling around or even worse, swerving on the road while behind the wheel. They may have problems with memory, mental changes, cold/clammy skin.

What my instructor really emphasized in class is that you don’t have to do more than you are comfortable to do. If all you feel comfortable to do is call EMS, then high five, that’s excellent. You are still a superhero. Just try your best to stay calm and comforting as you call 911.

Things to do and purchase in order to be prepared:

-       Get CPR/First Aid training

Red Cross: http://www.redcross.org/m/index.jsp#arcmobile

American Hear Association: http://cpr.heart.org/AHAECC/CPRAndECC/Training/UCM_473167_Training.jsp

-       Purchase a CPR rescue masks for $7-$14 online. They even have keychain masks! Found here: http://www.amazon.com/Ambu-Res-Cue-Mask-Keychain-Pouch/dp/B00BEPQ0KE/ref=pd_sim_121_6/183-9555781-7578840?ie=UTF8&dpID=41DD2RZCqwL&dpSrc=sims&preST=_AC_UL160_SR160%2C160_&refRID=1CXCTPZXD743Q9WSNKN3

-       Purchase gloves to keep in your purse, car, and home. They have a key chain option too! Found here:   http://www.liveactionsafety.com/dixigear-cpr-keychain-kit/?gclid=Cj0KEQjwoYi4BRDF_PHHu6rI7NMBEiQAKZ-JuOP__I8r5-xUAXNdEjy45eQK8ycDa_amxKlYjivaKn8aAoVW8P8HAQ

-       First aid kit.

-       Make an emergency backpack/preparedness kit incase of a disaster. Ready.gov has a “build your own emergency kit” list. The Red Cross has one that you can purchase.

-       Make a plan with your family in case of an emergency, and actually practice that plan (ie. Evacuating the house, where to meet up, emergency contacts).

For those overachievers who feel inspired (by my blog post.. haha), become a member of a local Community Emergency Response Team (CERT). 

Check out the website here: http://www.fema.gov/community-emergency-response-teams