all posts, eczema, women's health

on biomechanics and katy bowman

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Photo by luizclas on Pexels.com

I’m combining all my other blogs’ content to this site. Please bear with me as I post older content.  🙂

I haven’t posted in a while because “times [but mostly things in my life] they are a-changing”. What I mean by that is that I have a bunch of exciting things I’m trying to get involved with that are still centered around my various beloved themes, including:

  • community
  • women’s health… and now, a throwback,
  • biomechanics!

Let me catch you up. Once upon a time I was a confused undergraduate trying to narrow down the vast world of supposed choices to figure out my next step post-college. I knew I had splashes of talent in various areas, but that I was also relatively unskilled overall in a whole larger host of things, making me not a great candidate for any job (at least that was the opinion I had of myself). I remember I came to a point where I narrowed the choice down to two respective options:

  1. go to graduate school for biomechanics. Specifically comparative (non-human) biomechanics, but with the desire to see if I could follow in the footsteps of those inspiring people who learn from nature and then connect that learning to something in the human world (e.g. the tensile strength of sharks’ skin as a model for bulletproof vests, or the boxfish’s shape as a model for the most aerodynamically stable (and ugly) car), or
  2. go to physical therapy school. Essentially PTs are the biomechanists of the medical world (so in this analogy an orthopedic surgeon would be more like a biomechanical engineer). This therapy path would allow me a more direct way to give back to the people and help others.

As you may know, I ultimately chose physical therapy, and then ended up leaving it about halfway through the program because the physical contact (manual therapy, measurements, etc) with patients was not conducive with my skin condition. This  ultimately made physical therapy less than an ideal career for me.

So then, the deluge. How am I full circling back to the idea of biomechanics (though not necessarily comparative this time)? Well, first I started working in the field of women’s health a little over two years ago, which has since led me to undertaking the process for a prenatal and postnatal coaching certification (I actually just finished this past week and am officially a certified prenatal and postnatal coach!). I am also tying that field of knowledge to a few other movement-related initiatives, including the current co-creation of a course for single mothers of color (but I’ll go into more on that when it’s further along). I also am in the process of figuring out if I have the time to set up and lead stroller/carrier friendly walks in a local nature reservation.

While in the midst of these various endeavors, I also ended up finding Katy Bowman, a biomechanist and movement educator known for her Nutritious Movement company, which builds on her nature-based movement ideologies/passions. She believes in modifying our every day human environments (along with many movements we do) to better promote health and wellness, because movement-optimized environments require us to move better by their very nature. An example she gives is not having a couch in your home. This then requires you to do more squats (if you end up sitting on the floor, or chairs of lower heights), and forces you to move your hip, knee, and ankle joints in greater ranges of motion. The no-couch life also facilitates less sitting time by virtue of there not being any comfy furniture to sit upon, thus increasing your NEAT which helps your body even at the cellular level.

As I delved more into her material, I realized I had found someone that encompassed that overlap in my interests that I didn’t know existed; she is not a practitioner of health or medicine therefore not subject to the insurance whims, nor is she just an academic  stuck talking only to other academics/writing scholarly papers while being removed from the direct societal implementation. Bowman also intersects nature with the manmade world, bridging the choice I was stuck between (loving the idea of physical rehabilitation and the like while having a passion for being involved in natural environments, but unsure of how to make either a thing). Even more excitingly, after some light searching I discovered she too has a masters (in health studies, while I’m health sciences, but close enough) so I know it’s possible to straddle the academic world even in a health-esque field while not being a PhD or MD.

This is endlessly inspiring to me because now I’m starting to think it isn’t impossible to focus on prenatal and postpartum women and work with them and their babies/ young children to create lifestyle changes and increase our movement, while doing it all in nature. Though I’m not fully sure of the direction I’m going to end up going to get it started, all in all, things are looking to be very promising in the near future.

I have also used Bowman as an entry into foot health (using her book Whole Body Barefoot), subsequently contemplating the health of my own feet on a more regular basis. Since I left the category of a nulliparous woman (a woman who has never given birth), I’ve been thinking about how my body alignment changed during pregnancy and how now I still often feel joint laxity and generally less in-tune with my body. This has resulted in me walking more duck-footed than I had previously. I am testing out her suggestions to improve my foot (and global postural) health presently, but honestly ,uch of her program is just good practice for regaining balance and better alignment generally (like doing calf stretches and one leg standing balance exercises). I’m already noticing that I am more able to abduct my pinky toes further since starting. My personal goal is to retrain my feet to be able to wear minimalist shoes (or shoes that alter the natural foot mechanics the least). This includes working my way to comfortably wearing shoes with no heel lift (which normal even sneakers and many types of sandals have).

Before that book, I also read Bowman’s book called Diastasis Recti: The Whole Body Solution to Abdominal Weakness and Separation. Though the content is obviously useful for postpartum moms, the condition of diastasis recti (DR) can impact men and nulliparous women too.

In this book Bowman talks about how our modern lifestyles put a lot more pressure (force) on our cavities (diaphragmatic, stomach, and pelvic) and so to combat that we need to make environmental changes in our lifestyle. This includes actions like sitting less in the day and returning to using our bodies to move more (rather than always having appliances and tools to help us).

The point isn’t to remove all modern conveniences entirely if it’s not possible in our lives, but to balance out those convenient factors so our bodies have a chance to regain better mobility and functional strength while we continue to go about our daily lives.

The most crucial exercise Bowman suggests as a takeaway from her book is better rib engagement. This is done by drawing our ribs down and back without just sucking in our stomachs. We need to get our ribcage muscles and joint attachments to be less stiff because it impacts our ability to use our arms in their full range, and can cause issues if we move our pelvises with our ribcages all the time. Anyway, the book is definitely worth checking out to hear Bowman explain all of this (she does a much much better job).

The last thing I read by Bowman was a paper she put out about Movement Ecology. She addresses movement in multiple avenues, highlighting how we as a species gravitate towards decreased movement, which means more than just decreased exercise. She investigates movement as a broader topic, looking at how our daily activities and the environment around us help move and change our bodies in multiple ways, including at the cellular level (e.g. literally deforming our cells as when we lay on an object and our cells flatten). It’s cool stuff!

The fun thing about Bowman’s work (and I’m just talking about the books/papers I referenced in this post, so foot health techniques, diastasis recti prevention, and movement ecology practices), you can already come up with a fairly comprehensive program for prenatal and postpartum mothers to help them stave off lifestyle-related aches and pains, and regain more function respectively, while building foundational blocks of strength and mobility. And that’s what I’ll be playing around with next with my own routines.

On a tangent, I wonder how much of the severity of my topical steroid withdrawal would be alleviated  if I moved more?

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all posts, women's health

on racial differences in maternal care

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I’m combining all my other blogs’ content to this site. Please bear with me as I post older content. 🙂

Way back a few months, Fi and I visited my parents, and as a result she got her fill of dog exposure. Studies are still looking into the impact of early dog exposure (e.g. the first year of a baby’s life) on the child’s risk of asthma, allergies, and eczema later in life, and preliminary data seems to suggest that dogs have a positive effect in decreasing the risk of all three.

One study even found a higher correlation of eczema reduction for black children as opposed to white children from dog exposure, which could be useful as black people statistically have a higher risk for eczema (especially women).

These kinds of studies highlight the need for analysis of subgroups (e.g. race, gender, type of birth) to really understand who is being affected specifically. However, subgrouping is only useful so long as the studies are done through non-biased non-reductionist lenses. If accomplished, such specificity would allow for more applicable research to come out that could help promote better health, wellness, and medical decisions.

Which reminds me, I also listened to a webinar from the Black Mamas Matter Alliance. It covered a lot of material, but there was one particular point that stuck out to me (besides the need for a lot of policy reform across the country). It was the need for doulas, particularly those who live in the communities they serve (called community-based doulas).

Doulas act as support people for mothers, providing nonjudgmental (and non-medical) advice to moms from pregnancy to postpartum, making sure moms understand their rights and options. A doula from one’s own community would invaluable as they would understand the dynamics behind the community, as well as having firsthand experience with how the medical/clinical facilities are.

The webinar also talked about the need for insurance coverage for doulas (especially under Medicare), so that more mothers can afford them. I couldn’t agree more, especially as doulas correlate with better outcomes and statistics for the mothers overall.

The webinar is up on the BMMA site if you want to listen to it.

And lastly, I also read a book by a black midwife called Listen to Me Good, which was a book about a less well known figure in women’s history named Margaret Charles Smith. She was a midwife in Alabama who worked from the 40s to the 80s.

She never thought she’d become a lay midwife, as the hours were terrible and the pay even worse, especially for a black woman in the south. She learned traditions of birth and postpartum care through her grandmother and other “wise women”, and then later got standardized training through the nearest hospital, which allowed her to assist more women in a systemically recognized and medically approved fashion. She still continued to serve women as best she could without putting her neck on the line (she also helped deliver white women’s babies, which was a contentious point at the time).

The book also reflects on the various struggles black women faced in trying to work as midwives in Alabama, first due to explicit racism, but in later years, also due to systemic racism and prejudice through the worlds of healthcare and medicine, as doctors sought to get rid of lay midwifery (and devalued nurse-midwifery too in some areas). Many women, like Miss Smith, continued to try to care for women regardless, as they were the only option for hundreds of miles, and because white doctors were generally not interested in making the trip to aid poor black women give birth.

It really puts into perspective that even today, black women in America are still three to four times more likely to die during childbirth (or the first week immediately after) than white women. Food for thought.

One thing that could help bridge this increasing gap is better sensitivity training and education for medical practitioners. I was curious about different traditional practices and beliefs around postpartum care which led me to some interesting studies. One such study covered a few Central American countries and their beliefs around both the perinatal and postpartum periods.

I do think it’s important to know of the different roots behind postpartum treatments to help understand why a family may act/react the way they do to particular medical practices in western birth facilities (like hospitals). This is the way, in my opinion, to create a culture of care that uses a mom’s background/culture along with the medical evidence based practice to put the best interests of moms first, rather than of healthcare premiums.

 

all posts, miscellaneous

memory blast from the past (the “invincible” days)

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When you’re young you fly on this invisible tether, unaware of the fleeting nature of your adventure, how you will not always be there, balanced confidently but precariously.

I often think back on my journey living with severe eczema and immediately I remember the onset of the first cascade of knocked-me-off-my-feet-and-never-found-solid-ground-again topical steroid withdrawal symptoms and think that was where it all began. But it’s just not true. Even when I was young (under 14), active and energetic, there were moments when eczema was already blossoming under the surface.

I remember hiking the presidential range with my uncle, his girlfriend (now wife), his cousin, an uncle-esque family friend, and my sister. When we reached the last cabin closest to Mount Washington, I recall the cold as a storm rolled in and remembered vividly when I washed my face in a cold bathroom in the morning with chilly water, I felt the creep of a growing itch under my skin.

Nowadays I know that there can be many triggers for eczema including temperature changes, but then, eczema was a weird seasonal rash that showed up only on the insides of my elbows, not on my face. I think my thoughts at the time were something along the lines of “oh, I must have eaten something that was contaminated lightly with peanut fragments”, because in my head, face itching had to be a sign of an allergic reaction.

It’s also non-humorously funny to look back and realize I was already becoming paranoid of food allergies (and sensitivities) as the culprit to my skin woes.

I also recall having (and to some extent still have) the belief that because I possessed any abdominal fat, therein lied the reason I had eczema. It wasn’t yet possible to accept that I wasn’t infinitely healthy and majestic, that my body wasn’t perfect, that I had my own personal dis-ease I would have to reckon with that would change my whole game plan. It was easier to think that I was just eating too much and therefore making myself less than perfect.

It’s interesting because I can still so easily transport back into that mindset and remember how vital I felt, how alive, how healthy. I didn’t feel disappointment that my body had betrayed me yet.

Now don’t get me wrong, I can still get optimistic about my skin’s healing progress and feel I have come a huge way along the path of recovery. But my confidence of almost immortality that I had once before, is not there.

Part of that makes perfect sense. I have grown up and matured, and since realized essential concepts like that my body is no longer growing up, that I have to maintain health by eating right and moving and controlling stress or I will grow outwards in a horizontal direction. I get that. But there is also this, I think what I used to call “the Peter Pan effect” that I recognize is gone. It was akin to the moment I turned 12 and had to firmly accept the idea that I was never getting into Hogwarts, not because it was fictional, but because I had aged out of my chance. I adjusted to change of aging in asymmetry, non-smooth block jumps.

I think that’s the hard part of it all. You have to accept that time moves forward and one day you are on the other end of the growth curve, in what I now like to call the maturation phase, giving in to the adage of us ripening well like rare vintage wines. But it is hard to accept that where you were once full of epiphyseal (growth) plates, you now have the potential for osteoporosis; where hyaline cartilage once ran amok, we now see arthritis. I don’t know, I think sometimes the reality of aging, even if it is done amazingly, is still a bitter reminder that our lives are meaningful because they end, and so it’s important to accept the ride and always strive for better and better days, even if there are road bumps, like severe eczema in my 20s; here’s looking to flawless skin in my 30s!

all posts, eczema, nutrition

my new(est) regimen

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Photo by Pixabay on Pexels.com

I successfully (so far at least) staved off a flare! Generally as the seasons change towards their colder demeanor, my skin freaks out. As I have gone through topical steroid withdrawal for about 4 of the last 5 winters, I’ve learned that this time of year includes symptoms such as:

  • a baseline of my skin getting redder,
  • little pimple-looking marks on my arms and legs especially,
  • thermoregulation issues at night especially, which start with what I liken to non-menopausal hot flashes of the skin while my core feels freezing,
  • a thickened and discolored layer of skin developing all over, and
  • an insatiable itch thats origin is probably more related to the inflamed nerves as the itch can travel.

On worser years there was also skin weeping and other gross exudate but luckily this time around, as I haven’t used steroids in about 11 months (and when I was using them they were not a strong), this flare’s symptoms seemed to be more benign. That being said, I also am a seasoned TSW sufferer now so I know more or less how to handle the onset of a flare.

Firstly, diet. I luckily am in the midst of multiple dietary changes for the sake of Fi and her developing digestive system, and so I have already been avoiding dairy, soy, gluten, and eggs (all as per suggestion of the pediatrician), and coconut and corn for good measure.  Then I recently eliminated rice and oats, which apparently are other common allergens a breastfeeding baby can have (which I learned by word of mouth from a physicians assistant’s coworker). I’m at the stage where everyone, especially pediatricians, joke about how I have nothing left to eat but air, and it’s getting old. Essentially my diet just means I have to (aka Jake has to) cook all my food at home. My meals have become neither meat- or carb-based, which completely confuses the majority of people I meet. Here’s an example of what I ate yesterday. I had 6 separate food dishes that I rotated around to make 3 meals. They were as followed:

  • a cold salad of chickpeas, cucumbers, red cabbage, vinegar, and some peppers
  • a pulled chicken with a graoefruit sauce in lieu of BBQ, cooked with onions, kale and other spices
  • a quinoa dish with poblanos, dried apricots, and spices
  • braised rosemary potatoes
  • baked and salted chickpeas
  • chorizo, “riced” cauliflower,  pinto beans, onions, garlic, kale and other spices, and
  • a warmed apple with cinnamon for a sweet treat

So clearly I still have plenty I can eat. But I digress! My point is, my diet is currently avoiding a number of inflammatory and common eczema-inducing foods.

So now that we’ve gotten past food, the next factor in my skincare during a flare (that rhymes!) is figuring out the topical stuff. First, I end up taking much more frequent baths. The pimple looking stage is what triggers me to take a bleach bath, the redness drives me towards Epsom salt baths, and the residual heat or skin discomfort and dryness warrants apple cider vinegar baths. Epsom baths tend to dry me out so I use them after bleach baths when I know the bacterial overload has been decreased and now I need something to dry out the dead crusty exudate layer.

Then comes the moisturizing stage. Lately I have been using two products. Eczema Honey Company’s product Eczema Honey Original Natural Healing Cream, and Chuckling Goat’s kefir lotions (first the rosemary, now the lavender one). I think the Eczema Honey Co works a bit better. It tends to provide a better barrier and seal in moisture better, plus the honey works as a light and natural antiseptic. It’s downside is that it separates from the oil in the mixture pretty quickly so I have to stir it a bit before use, and that it is so sticky! The Chuckling Goat lotions are better for the inflamed days as it seems to help dry out the excess heat and redness.

Lastly, there is the stress factor. I have gotten pretty good at distraction (as mentioned in one of my previous posts), which truly does help keep my flares under control. I just don’t let them get to me for very long. It’s really a godsend right now because I haven’t been sleeping so well (partially because I’ve been under the weather, partially because my skin heats up like crazy when I’m under a blanket, and partially because a few days ago Fi started randomly waking me up every 2 hours to feed. Apparently it’s possible that I was producing less milk while sick and so she needed more feeds in to get the same amount as usual. Anyway, the point is that my sleep has been compromised.

Instead other things I’ve done to try to help my skin include drinking a lot more water (something I am historically terrible at), and taking probiotics and the daily prenatal. I have also been making sure to do some kind of physical activity, usually the True Blood Fitness Game (see the post here), but also yoga when my insomnia gets bad, and generally just passing around the house holding Fi for “cardio”.

It’s slow going, but I seemed to have been able to skip over most of the worst of the inflammation phase, save for a few elephant skin wrinkles and the telltale cuts in my hands as they dry out. I’m hoping the difficulty with sleep (and the whole aggressive skin heating up in bed) dissipates. Work in progress with that.

Ugh. Overall my feelings (mostly formed based on how my skin reacts) are that I am not a fan of when the cold seeps in and it feels like nothing can stay warm. Until I can consume copious amounts of hot tasty beverages and treats for fall and live dressed in a thick comfy blanket, this time of year is bleh! Sometimes I think I was meant to be a bear because hibernating through the cold months seems ideal.

eczema, miscellaneous

could physical therapists treat eczema?

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Back in my physical therapy student life, we had guest speaker Pamela Unger come in to talk to use about the role of wound care in PT. Much of what we talked about I applied (in my head) to eczema and ways to help treat it for myself. I’ll share some of my thoughts below meshed in in italics with things I learned from Pamela, but note: these are ideas I came up with and are in no way necessarily endorsed or supported by research.

To begin, we need to know that wound healing normally has 3 phases: inflammation, proliferation, and remodeling. During all 3 phases there is vasodilation (aka the blood flow increases to help close up the wound).

The inflammation phase: As we with eczema have constant inflammation, this made me think maybe we are having trouble with this phase of wound healing in particularDuring this phase, the wound works to regain balance of its cells, and also fights to prevent infection, the latter which interested me because people with eczema are generally more susceptible to staph and other skin infections. Is it because our systems start attacking our own good cells and not just the infectious bacteria? Cellularly during this phase, inflammatory mediators are released (so do people with eczema lack these mediators?) and various cells like macrophages/neutrophils consume the bacteria, but presumably less successfully if patients with eczema get staph frequently. The intended results of this phase are that the bacteria and other foreign materials are cleaned out of the wound, and that inflammation is controlled.

During the proliferation phase, the wound starts to fill in and close. Cells called fibroblasts start making collagen (collagen is an important building block for skin cells), the extracellular matrix (a molecular substance that supports the structure of cells) is made, and there is new development of blood vessels (called angiogenesis). The intended results of this phase are that new blood vessels are made, the template for new cells is made (call the scaffold), and re-epithelialization occurs (which means epithelial cells move to form a barrier between the environment and the wound).

During the remodeling phase, the scar is developing and maturing. Cellularly, the collagen fibers start to line up and the skin becomes stronger especially to tensile stress (being pulled/stretched). The intended result of this phase is that the collagen fibers cross over one another adding strength to the wound. The only aspect of this phase that I think ties to eczema is when individuals have healed eczema scars that itch more than open or unhealed areas, but that would mean something chemical is happening and I don’t know why scar tissue would itch more than the other parts of the skin. Though I suppose it could also be assumed that if during a topical steroid withdrawal, the skin becomes excessively wrinkly, it could be a problem with collagen production? 

 

Now that we have the basics, we can talk about a chronic wound. I loosely decided that eczema is a chronic wound by this definition: a skin injury that fails to heal through the normal phases, in a normal amount of time.
A chronic wound can have one of two thickness classifications (usually applied to specific types of ulcers). The first is partial thickness, meaning the epidermis (or outer layer of skin) is broken, but the next layer (the dermis) may not be. A full thickness means the dermis is also broken as well as the fascia, and there may be a breakdown into the muscle/tendon/bone level. I believe generally eczema wounds are partial thickness, though I am sure there are some exceptions/particularly bad wounds that occur.

Generally wound healing can be stalled because of 4 main things:
1. a bacterial infection,
2. inadequate electrical potential (for we are beings of electricity! More on this and the idea of E-stim for eczema management in another post),
3. not having enough microcirculation (aka circulation of blood in the smallest vessels), or
4. too much pressure from interstitial edema (or swelling in between cell layers).

Other factors like age, nutrition, and topical/oral steroids also can slow healing. With nutrition, the biochemical aspects doctors check for wound care would be albumin, pre-albumin, hemoglobin, and hematocrit. They would also want to check that a person has enough protein, calories, and fluid in their diet. We know that when you have eczema, it is especially important to drink lots of fluid and have a balanced diet, but I am unsure if the four other biochemical factors have a correlation with eczema sufferers, though I would assume people with eczema would have decreased levels of albumin (because it’s a protein).

 

So how does one really maintain their skin health? Pamela’s big takeaways were to:
1. keep the skin clean and dry (a big reason we need to clean out the wound is because a biofilm (of bacteria) easily grows in a wound and blocks healing by messing up the chemicals needed to heal),
2. use warm water (not hot) on the skin (because hot water can cause us to have more water evaporation from our skin),
3. use daily hygiene techniques, and
4. MOISTURIZE.

For wound control, Dr. Unger broke it down to 4 steps.
1. Protect the wound surface. Think using gauze, bandaids, wet wraps, cotton clothing, etc. Wet wraps would also help keep in moisture. If excessive moisture, collagen can be useful for absorption (maybe that is why I was able to use a collagen night cream to heal my facial eczema when it was raw).
2. Control bacteria. She mentioned silver ions and slow-release iodine. I believe new eczema products are trying silver so another overlap may be indicated.
3. Control odor. Unclear if this is as application to eczema but she mentioned activated charcoal and I believe there are some eczema products that have charcoal (though I could be wrong).
4. Affect cells. She mentioned using collagen (though how it would apply to eczema wounds specifically, like if it should be orally taken or topically applied, I am not sure).

The last things Pamela mentioned in her wound care lecture that I thought tied well to eczema management were:
1. massage (it has been documented that massage can help eczema, though aggressive massage around a wound may impede blood flow and slow healing, rather than help. So if a person suffering from eczema has lots of open wounds, massage may be more detrimental than useful),
2. avoiding excessive pressure (as excessive pressure or friction can cause wounds, it stands to reason that slumping in a seat, or staying in one position for too long doesn’t help the skin of people with eczema. Getting up and moving seems to have more importance than just general health, mood boosts, and circulation!), and
3. keeping the eczema wounds moist rather than letting them dry out (in the past people believed wounds needed to air out and be dry, but Pamela explained this makes it harder for the wound to heal because it needs a level of fluid movement. I believe dermatologists would support this as I have heard /read about them saying that dry skin leads to itching, and scratching the itch is what causes the rashes).

So could a physical therapist treat eczema? Like the answer I got through most of my physical therapy graduate classes: it depends.