Health sense: What to do about head injuries

Head injuries are one of the most common reasons people consult a doctor. The degree of head injuries can range from mild, only resulting in minor bruises or wounds, to severe or life-threatening. Moreover, the injury process can be primary or secondary. Primary injuries result from the damage done by the actual impact.

On the other hand, secondary injuries are subsequent changes that occur as a result of the initial insult. Thus secondary head injuries add further damage.

Unfortunately, there is very little that anybody can do about serious brain injury. For example, a person who sustains massive brain injury from a steamroller will need a miracle to live a productive life after the incident. Fortunately, minor to moderate primary head injuries and secondary brain injuries can be satisfactorily treated.

Secondary injuries, as mentioned, are the secondary events that occur after the primary injury. They can cause or contribute to further brain damage. Most commonly, these include bleeding, swelling of the brain (cerebral edema), and death of brain tissue (cerebral infarction) from lack of blood flow and oxygen to the brain. A speedy and appropriate management can make a great difference in determining the outcome or prognosis.

Let’s take a look at minor head injuries. A concussion occurs when there is an accelerative force to the brain greater than 200 milliseconds. Concussions can cause loss of consciousness, memory loss or amnesia, confusion with subsequent headaches, nausea, grogginess, irritability and vomiting.

The degree of concussion varies but there should be no significant long-term after-effects or sequelae if: 1) the period of loss of consciousness is less than 10 minutes and 2) the patient is well orientated with no neurological deficit when seen at the Accident and Emergency Department of the hospital.

What about major head injuries? Management must start at the site of trauma. After a neurological examination, prompt resuscitation to provide for an adequate blood pressure and oxygenation has been shown to significantly improve the prognosis.

Medical management is focused on preventing cerebral edema and high blood pressure. Since 60 percent of head injuries involve neck injuries, oxygen may be administered through a tube until serious neck injuries have been excluded. Medicines to prevent seizures are given to prevent further damage and loss of oxygen. Dilantin, the drug of choice for seizures, can be tapered off after a week unless delayed seizures occur. Hyperventilation or the rapid artificial oxygenation of the patient should not be done. This is because blood flow to the brain has been shown to be low during the first 24 hours and hyperventilation will just worsen the case. Antibiotic therapy is a good idea especially when there are multiple injuries or open wounds.

Ideally, the patient is brought to a tertiary-level hospital with well-developed head injury services and resident neurosurgeons.

An unconscious patient should immediately undergo a CT scan of the brain as well as x-ray imaging of the spinal column and chest. Should there be difficulty in maintaining blood pressure, the medical team will look for other sources of bleeding because there cannot be that much bleeding in the brain to cause a blood pressure drop.

If internal bleeding is present, it may accumulate inside space surrounding the lungs. This is called pleural effusion. Draining the accumulated fluid treats pleural effusion. Also, by providing low-flow oxygenation, the patient’s blood pressure should remain stable.

If a large clot in the brain is detected on CT scan, surgery is needed. Damaged brain tissue is removed to minimize the likelihood of swelling. Fractures are commonly present and will be treated accordingly.
Sometimes, the fractures can cause the fluid in the spine to leak out into the cavities of the nose and ears. Initially, the head will be elevated to prevent this. Antibiotics may be prescribed and the doctor may order lumbar cerebrospinal fluid drainage.

If these conservative measures fail, surgical repair will have to be done to prevent meningitis, the inflammation of the membrane that covers the brain and spinal cord.

A significant brain swelling is treated by surgically removing a large bone flap from the skull. This will afford space for the brain to expand. Another surgery is needed to correct the deformity left by the initial procedure.

In the Intensive Care Unit, vital signs are carefully monitored to ensure the brain is receiving enough oxygen. The head of the bed is elevated to at least 30 degrees to promote good circulation.

Medicines like Mannitol can be given to reduce the pressure within the skull. A comatose patient should have full coma nursing care with regular turning, chest and limb physiotherapy. An artificial airway may be done surgically (tracheotomy) if the patient is expected to be on assisted respiration. Uncontrolled intracranial pressure rise causes a poor prognosis. Medically inducing a coma can be done to correct this. However, results have been relatively disappointing, especially in children.

In summary, quick and efficient response to head injuries promote a better outcome for the patient.

Minor to moderate head injuries are easily treated in the AED. On the other hand, severe head injuries need referral to appropriately equipped hospitals.

The goal in treating severe head injuries is to prevent further damage to the brain. This is done by adequate oxygenation, relieving the pressure inside the skull, stopping the swelling of the brain (cerebral edema) and treating other injuries like fractures. Close contact nursing care is needed throughout the recovery phase of the patient.

Yogic breathing for high altitude

A couple of months ago, I was visiting a mountainous area about 4,200 meters above sea level, when yoga came my rescue. We had flown on a chopper for much of the way up there, hardly giving us any time to acclimatize, and as I sat in the car going up the mountain, I began to feel a mild sensation of discomfort.

I found it hard to breathe, and felt slightly light-headed. A person traveling in our group felt worse, she could barely stand up, felt nauseous and was eventually given oxygen.

Then I remembered the yogic breathing, I began to deepen my inhale and prolong my exhale, focusing on my breath until the discomfort disappeared as fast as it had appeared.

The few times I forgot to maintain the deep diaphragmatic breathing, I felt the discomfort creeping in again.

I was experiencing a mild case of altitude sickness, which occurs when the body runs out of oxygen in high altitude. Symptoms vary from nausea, exhaustion and hyperventilation, to cerebral edema, the accumulation of excessive fluid in the substance of the brain.

Interestingly, shortly after, I was asked to teach yoga to a group of mountaineers on an expedition to climb the world’s seven highest summits. Having climbed two of the mountains, they were intent on complementing their training with yoga to help them overcome more dangerous challenges awaiting them.

Mountaineering requires a high level of fitness and strong mental preparedness, and yoga practice is increasingly known to help climbers cope with the challenges of adapting to high altitude.

Research published in the European Journal of Applied Physiology in 2007 compares the physiological responses to high altitude hypoxic conditions in four groups of human subjects: a group of Caucasian subjects, Caucasian yoga practitioners, Nepalese native Sherpas with an active lifestyle, and Nepalese Buddhist monks who are yoga practitioners.

The results showed that at a high altitude, the Caucasian yoga trainees maintained satisfactory oxygen transport, with a minimal increase in ventilation and with reduced hematological changes. This kind of efficiency is comparable to that of the native Sherpas and the Buddhist monks.

The study concludes that respiratory adaptations induced by the practice of yoga may represent an efficient strategy to cope with altitude-induced hypoxia.

The Indian army has known this all along. In the past few years, it has incorporated yoga practice into the daily training routine of its soldiers posted in the conflict area of Kashmir.

At 11,000 to 21,000 feet above sea level and with often minus 60 degree Celsius weather, the Siachen Glacier is the world’s highest battlefield, making the soldiers vulnerable to high altitude sickness, hypoxia (deficiency of oxygen reaching the tissues) and the psychological stresses of isolation, monotony and separation from their family.

According to the High Altitude Medical Research Centre (HAMRC), the highest multi-specialty hospital in the world focusing on high-altitude medicine, yoga reduces wear and tear of the heart and produces mental tranquility, greater alertness, flexibility and enhanced tolerance of the cold.

By practicing a few minutes of pranayama (breathing technique), gentle asanas (postures) and meditation, many of the soldiers have testified to the physical and mental benefits.

But even if you’re just a casual hiker or someone who, like me, happened to be on a brief visit to a high-altitude area, you could benefit from the deep breathing technique used in yoga practice to avert hypoxia.

Here’s a pranayama practice that might come in handy when preparing yourself for the challenge of high-altitude breathing, as well as to help you cope with it when you’re there

Complete breathing
This is a simple deep breathing exercise that uses all respiratory muscles to their fullest. To do this, you can lie down on your mat or bed in a comfortable savasana position but without a pillow, or sit on a chair, or cross-legged on a cushion.

If you’re sitting, find a comfortable position to sit upright without being rigid, allow your shoulders to drop and your hands to rest anywhere comfortable, then close your eyes gently.

First empty your lungs by extending your exhale. Now slowly breathe in allowing the belly to relax and enlarge, the diaphragm to lower, allowing the air to enter the lungs.

Continue breathing the second stage of your inhale by expanding the ribcage without straining.

The third stage of your inhale must allow the lungs to fill completely by raising the collar bone.

When the lungs are completely full, breathe out in the same sequence as when inhaling.

At the beginning, inhale and exhale for the same amount of counts, for example, if you breathe in five counts, breathe out also in five counts.

Later, as you gain more strength and your lungs increase in capacity, try to exhale twice as long as you inhale. So if you inhale for five counts, exhale for 10 counts.

Make sure you breathe easily without straining, and your body continues to be relaxed. Ideally, keep your respiration deep, slow, silent and easy.

You can practice this breathing technique every day as part of your daily training before you practice yoga asana or other physical exercises, or as a standalone practice in the morning or evening.

This is not meditation, but after a while, you can let go of the controlled part of your breathing and just watch yourself breathe naturally for a few minutes or more. Then you will enter a more meditative practice.

I did not include an asana practice here, but basically all yoga poses are beneficial as integrated training for climbing, trekking or mountaineering.

You can begin your practice with a few rounds of sun salutations, then proceed to do some standing poses, followed by some backbends, some core strengthening, and then wind down with some twists, forward bends, deeper hip openers, inversion and then savasana.

Being in nature induces a meditative state of mind. And what better way to cultivate this state of mind then by connecting to your breath? Namaste.

Frequently-asked questions about Yoga

One of my regular students came up to me the other day after a class, and asked: “Is yoga stretching?”

There are many ways to answer this question. What it showed me, however, was that yoga remains a mystery to many, even to regular practitioners.

So in this issue, I’ll address some basic frequently asked questions about yoga and hope this will help clear some misperceptions.

1. Is yoga a religion? No, yoga is not a religion. Although yoga came out of ancient India, it is not a form of Hinduism.

For over a century it has been practiced by Christians, Buddhists, Jews, Muslims, atheist and agnostics a like (some of my students and fellow yoga teachers are devout Muslims, some are women who wear Islamic headscarves).

There is a certainly a spiritual side to yoga, but you don’t have to subscribe to any particular beliefs to benefit from it.

Yoga allows you to have a “take what you can use and ignore the rest” approach.

Meditation, which is an integral part of yoga (and often thought of as a Buddhist practice) is beneficial but you don’t have to do it either if you don’t feel a connection to it, at least in the beginning.

The same goes with chanting. So, if your yoga teacher chants “Om” at the end of the class because it is part of her discipline’s tradition, it doesn’t mean you’re worshipping someone else’s God.

And you don’t have to sing if you don’t feel like it. I usually tell my students to just enjoy the vibration.

2. I’m not flexible, can I do yoga?

Of course! Some people avoid yoga because they think they will never be able to touch their toes or do those backbends and roll up into a shoulder stand.

How silly! In fact, if you feel you can’t possibly do yoga, then more likely yoga will be helpful to you. Yoga is a process and a journey. The key is consistent practice.

3. I am not young/ I have chronic medical conditions (asthma, high blood pressure, etc). Can I do yoga?

Yes, yoga isn’t only for those healthy people you see at the gyms or studios. For many years yoga has been used to treat people with various medical conditions. People with all kinds of physical, mental and emotional problems, elderly people, people with years of chronic disease, people in pain, people who are depressed, all have come to yoga to seek help.

Yoga has been used successfully on schizophrenics and on children with Down syndrome, cerebral palsy, and autism. Wheelchair or bed-bound people can practice a modified type of yoga for their needs and abilities.

There are people in their 80s and 90s who are still doing yoga, and, chances are, if you keep your yoga practice consistent you might reach that age and still be doing yoga.

People with special conditions need to seek a special yoga therapist, however, so it is not recommended that they attend a general yoga class. So, talk to a dedicated yoga studio at your place to see whether they have a teacher who is qualified to teach yoga therapies to address your problems, because not all teachers are.

4. Can you lose weight with yoga?

Well, this is a question that often puts me in a dilemma. I don’t want people to start doing yoga with unrealistic expectations they will lose weight after a couple of weeks.

Having said that, of course, yoga has been known to help people lose weight, especially some more dynamic types of yoga such as asthanga or power yoga or bikram yoga.

Practicing any type of yoga will build strength, but some types may not raise your heart rate enough to make them the only form of exercise you need to include in your weight-loss regime. It depends on the type of yoga you select and how frequently you practice it.

In order to lose weight you must eat healthily and burn calories by doing exercise that raises your heart rate on a regular basis. If yoga is your primary form of exercise, take a dynamic 90-minute class at least three times a week.

In addition, the longer you practice, the more you cultivate a mindful way of living. This means you’ll start looking at how you treat your body, what you put into it as this affects your practice too.

Then you become drawn to more healthy and nutritious food without any elements of self-denial. Believe me, it’s much better than dieting.

5. Is yoga just about stretching?

Yoga does involve stretching your muscles, but it is different than just the warm-up and cool-down stretches you do at the gym. Yoga places importance on alignment. This means how you touch your toes is more important than whether you can actually touch them or not.

Most yoga poses are not stretching an isolated area but rather involving the whole body in both stretching and strengthening. Some yoga styles use the technique of vinyasa or flow where there is movement from pose to pose with an awareness of the breath.

And last, but not least, here’s one of my favorite questions:

6. How come I always seem to fart in yoga class?

Passing gas while practicing yoga is actually very common. You’re moving your body in ways that will stir up your belly, which is good for you.

Farting is perfectly natural, (I’ve had students do it in my class, and I’ve done it also as a student and — ahem — while teaching).

If you happen to do it, just pay attention whether it has caused an effect in the class. Acknowledge it casually or light heartedly — or even apologize — if it seems to bother or disrupt the flow of the class.

But chances are nobody will notice, or if they do they will choose to ignore it, as I’m sure that has happened to them too.

If you have any questions, however embarrassing, just write to me, I’ll be happy to address them. Namaste.

Keeping the heart soft with loving kindness

The one thing I’m most grateful for with my yoga practice is that it helps me navigate life’s fluctuating dynamics – its ups and downs – by softening my heart.

Yes, all those bending, twisting, balancing, lifting and inverting maneuvers do something to your muscles, joints, bones and organs, but it is the contemplative aspect of yoga that touches the deeper inner muscles of a person — those of tolerance, courage, love and compassion. I’m talking about meditation.

One of my meditation teachers called this spiritual journey a “revolution”, a journey toward our inner self, the part that is unchanged. It is not always easy, in fact it can be pretty arduous, painful and confusing at times. But in the end, any form of contemplative spiritual practice will awaken the gentle part of you that celebrates happiness in others, making equanimity a more accessible state of mind.

When you have equanimity, even the most powerful anger does not seem to linger long. The Buddhists call this compassionate quality loving kindness.

This came to my attention as I watched and observed sad news of natural disasters that have been rocking the country over the past week.

As a journalist, I had been witness in the past to a host of both manmade and natural disasters, from the string of bombing attacks, the 2004 tsunami to air crashes.

Back then I kept myself detached, as I had to move around to do my job with relative ease.

But since leaving full-time journalism, it has become harder to sit through the news on disasters without being overwhelmed with sadness and the yearning to do something to help the victims.

Of course nothing is wrong with this. After all, our capacity to feel compassion for other beings may be the most redeeming quality about us, the one thing that may help the earth’s survival, just as its opposite has sped up the planet’s decline.

And so we do what we can to help ease the sufferings of others, by donating money, organizing aid, becoming a volunteer or drawing attention to the tragedies.

Being kind goes deeper than meets the eyes, however. It starts from within by regularly kindling the flame of loving kindness or metta in Pali and maitri in Sanskrit. Loving kindness is the quality of goodwill, sympathy and kindness to others. It is love without clinging.

The cultivation of loving kindness (metta bhavana) is a popular form of meditation in Buddhism. But it has been practiced by many non-Buddhists and followers of other beliefs for ages, and its benefits
have been studied in the new field of study on contemplative practices.

A Standford University study suggests that a short 7-minute practice of loving-kindness meditation can increase social connectedness.

Clinical scientists from Duke University also found that loving-kindness meditation has been shown to reduce pain and anger in people with chronic lower back pain.

A researcher at the University of North Carolina at Chapel Hill found that loving-kindness meditation could help boost positive emotions and well-being in life.

An EEG study also from Stanford University focused on people who do metta meditation with a minimum of 10,000 hours of practice, and showed that compassion meditation could lower the participants reaction to inflammation and distress, both of which are associated with “major depression, heart disease and diabetes”, in response to stressors.

So here I share a simple guide on loving-kindness meditation. It can be practiced before or toward the end of other meditation practice such as vipassana or mindful meditation, or as a standalone practice in itself.

In the beginning, keep it simple and consistent so it becomes easy and not too much effort, but try to keep it sincere and avoid it becoming artificial and mechanical.

Loving-kindness meditation

Start by finding a comfortable place to sit upright, either cross legged on a cushion or on a chair, and allow your body to hang loosely on your spine.

Close your eyes gently and allow your body and breath to soften. Then bring your attention to the area of the heart, see if you can feel your heart and breath together, as if you could breathe into and out of your heart. Feel your breath as if it comes in and out right there at your heart center.

Start by directing loving-kindness toward yourself, because it is hard to fully love others when there are things that you hate or cannot accept in yourself.

Begin to feel compassion for your struggles and sorrows. Try to embrace the sorrow with an open heart and with compassion and loving kindness.

You can start by saying: “May I be happy and may I be filled with loving kindness”.

Next, think of someone you love, someone for whom you naturally feel compassion, your spouse or partner, your kids or your parents. Try to feel their suffering and struggle and wish also for their happiness.

“May [this person] be happy, and may [they] be filled with loving kindness.”

Then open your heart a little wider to include other loved ones and wish for them the same way. Then open your heart even further to let in all of your friends and the people you love.

“May they all be happy and may they all be filled with loving kindness.

Then try to make your heart even larger, to include everyone you know, whether or not you have special relations with them; then to include someone you are not too crazy about, your enemy.

Gradually make your heart even larger, large enough to fill the entire house, the entire housing complex, the entire city, the entire country, even the entire planet. Take the whole earth in your heart, and wish all beings happiness and loving kindness.

“May all beings be happy and may they all be filled with loving-kindness.”

This practice is beautiful because it takes us beyond ourselves and it allows us to extend loving kindness to every sentient being.

Kindness starts from within. Now go out there and manifest this in your everyday actions. Namaste.

Quotations about Happiness

“Remember that happiness is a way of travel, not a destination.”

Roy Goodman

“Our happiness is greatest when we contribute most to the happiness of others.”

Harriet Shepard

“Don't cry when the sun is gone, because the tears won't let you see the stars”

Violeta Parra

“To be able to find joy in another's joy, that is the secret of happiness.”

George Bernanos

“Most of the shadows of this life are caused by standing in one's own sunshine.”

Ralph Waldo Emerson

“Before you talk about what you want - Really appreciate what you have before it's gone.”

Ethan Daniel

“Dont cry because its over, smile because it happened.”

Unknown

Quotations about Happiness

“Anyone who says sunshine brings happiness has never danced in the rain.”

Unknown

“Happiness is a function of accepting what is.”

Werner Erhard

“Success is not the key to happiness. Happiness is the key to success. If you love what you are doing, you will be successful.”

Herman Cain

“It is not how much we have, but how much we enjoy, that makes happiness.”

Charles Haddon Spurgeon

“The best way to cheer yourself up is to try to cheer somebody else up.”

Mark Twain

“There are hundreds of languages in the world, but a smile speaks them all.”

Unknown

“A happy person is not a person in a certain set of circumstances, but rather a person with a certain set of attitudes.”

Hugh Downs

“People are just about as happy as they make up their minds to be.”

Abraham Lincoln

“The happiest of people don't necessarily have the best of everything; they just make the most of everything that comes along their way.”

Unknown

“If you're going to be able to look back on something and laugh about it, you might as well laugh about it now.”

Marie Osmond

Quotations about Happiness

“Don't frown. You never know who is falling in love with your smile.”

Unknown

“Believe in yourself! Have faith in your abilities! Without a humble but reasonable confidence in your own powers you cannot be successful or happy.”

Norman Vincent Peale

“Those who bring sunshine into the lives of others cannot keep it from themselves.”

James Matthew Barrie

“No one needs a smile as much as a person who fails to give one.”

Unknown

“People take different roads seeking fulfillment and happiness. Just because they are not on your road does not mean they have gotten lost.”

Jackson Browne

“Action may not always bring happiness, but there is no happiness without action.”

Benjamin Disraeli

“Happiness is a choice that requires effort at times.”

Unknown

“Time you enjoy wasting, was not wasted.”

John Lennon

“The foolish person seeks happiness in the distance; the wise person grows it under his feet.”

James Oppenheim

“For every minute you are angry you lose sixty seconds of happiness.”

Ralph Waldo Emerson