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Every moment is indeed a gift …

03.10.2018 | Melinda Bekos

On October 28, 2015 a miracle that has come to impact many others began with my husband. Chris died that day. He remembers where he went. He remembers coming back. Nothing has been the same since.

Here is what I wrote a month or so after it happened …

It was a Wednesday – garbage day. Like every other Wednesday, Chris was taking out the garbage. But on this particular Wednesday, when he leaned over to pick up something that rolled under the truck, he felt something pull/tear in his chest and then had an immediate migraine. He saw lights.

My 44-year-old husband is an extremely healthy guy. He’s handsome. He’s fit. He is an at-home-dad and chases our 3 kids under the age of 5 around all day. We grow and cook most of our food. He is a martial artist. We go to acupuncturists and chiropractors. We take supplements. We meditate. We think we are really healthy people.

Although there are symptoms we can look to in hindsight, we had no reason to suspect the 7+ cm aneurysm off his aortic root. We had no idea has been in heart failure for years apparently.

So, at about 9:30am on 10/28/15 Chris unknowingly had a Type A Aortic Dissection and went to lay down with what he thinks is a terrible migraine. Nearly 7 hours later, he sent me this horrible text, “Please come Home. Feeling light headed and short of. Breath., hear a weird ripping sound when I breath”. This was 4:39 pm. I decided to take him to Dublin Methodist via the back roads to avoid rush hour highways on his ‘headache.’ On the way, he started to crash. He was clearly going into respiratory failure, congestive heart failure. He couldn’t breathe. He couldn’t hold himself upright in his seat. He was turning a light bluish green color. He was staring at the GPS counting the minutes and saying “4 more minutes, I can make that. Just 4 more minutes.” When we finally got there, I flew past the entrance and he calmly reminded me, “you just passed it, agape.”

Immediately when we got to the ER I poured him into a wheel chair. Two nurses came out to help us. I would later learn this was Keri and Jeremy. I will never forget the look in Jeremy’s eyes when he took Chris’s blood pressure and looked up at me. We both knew something was very, very wrong. From there, everything went very quickly. We are so blessed that everyone seemed to know exactly what this could be. A CT room that started with just a few turned into a room of many and I could feel the dire nature of what was going on. Everyone kept using that word all night, “dire.” Dr. Jason Schneltzer held such a perfect calm space with us while Chris continued to fall deeper into respiratory failure and they had to intubate him. A nurse with a lovely brown curl of hair falling over her shoulder told me that I had to ride in the front of the ambulance, “there is a chance your husband may not survive transport” I was told.

Arriving at Riverside I was immediately met off the ambulance by Elaine Hoover, the nurse practitioner for the surgeon, Dr. Jonathan Enlow, that would be saving my husband’s life. Then in came chaplain Herb. I unfortunately remember introducing myself to him with the words, “you are a f*#cking chaplain?!” They explained to me his 7 cm aneurysm off his aortic root. They explained his type A Aortic Dissection. They explained the situation as ‘dire’ and ‘50/50.’ Shortly after surgery began, Elaine came back and informed me that Dr. Enlow, wanted me to know that we were ‘starting from a very low place.’ Our 50/50 had just gotten worse.

It was a full moon that night. I just watched it cross the sky and prayed in ways I had never known to before.

Our 6-month old was brought to the hospital so I could nurse him. My mother in law arrives. Family and friends start arriving. All of it so surreal. There is chaplain Herb, always nearby. Somebody told me to “see him as well.” So I posted a bunch of pictures of him healthy and well on Facebook for everyone to see without any shadowing of the situation at hand. People are telling one-up stint and heart attack stories in the waiting area. Nobody seems to understand the severity of what is going on.

In the early hours of the morning, in a small nice consultation room Chris’s mom, dad and I are informed by Dr. Enlow that Chris survived surgery! He had his aortic valve, ascending aorta and aortic arch replaced. I remember the wash of relief I felt when I knew he’d lived! I will never forget Dr. Enlow in his cowboy boots leaning in toward me with this cautious look and a slight ‘no’ nod to his head – Chris had to wake up first. We should expect compromise from stroke or paralysis.

Just after the sunrise on October 29th, 2015 – Chris woke up. The way I heard the story was that his nurse, Trudy, was disheartened because Chris’s mother and I had been in and he was unresponsive to us. She put medicine in his nose that usually irritates people and he was unresponsive. She washed her hands and then turned back around toward him and he flashed his eyes open. She asked him if he was okay and he gave her a thumbs up. She asked him if he could move his feet and he did. He remembers her putting her hand on his shoulder in the most gentle, loving, nurturing way and saying, “You are going to be fine. Just rest.”

(These nurses are cut of a most amazing, angelic cloth. Trudy, then Grace, Heather, Kate, James and so many others … This is just what they do every day. They somehow hold space when fragile sutures, new body parts, medications and machines are the only tethers keeping somebody in this life. And, they held me and my family just as gracefully. I am always in tears when I think of the kind of work these people signed up for and show up to each day…)

Now I could let the wash of relief come over me. My 44 year-old husband, the father of my 3 children was going to be okay. He chose to stay. He could give a thumbs up and wiggle his toes. And so the miracle of him and the life with this new man we’ve been given began. I asked my mom to print and frame this picture of us that we’d taken just a week earlier on our son’s birthday 5th birthday for him to have in his room.

 

 

Now I could let the wash of relief come over me. My 44 year-old husband, the father of my 3 children was going to be okay. He chose to stay. He could give a thumbs up and wiggle his toes. And so the miracle of him and the life with this new man we’ve been given began.

I asked my mom to print and frame this picture of us that we’d taken just a week earlier on our son’s birthday 5th birthday for him to have in his room.

People started asking me what the ‘take home’ was from Chris’ story. What could we have done differently if anything? What did we not do? If there is an answer, there is just one and it ridiculous really … we did not get regular physicals. In hindsight, his doctors think he was in heart failure since probably 2010. We really thought we were pretty healthy people living a holistic lifestyle. Our kids have a wonderful pediatrician but Chris and I just call a friend if we need a prescription or something. If anyone had listened to my husband’s chest they would have heard the insufficiency in his valves. I have stethoscopes in my office – what was wrong with us that we hadn’t had anyone listen to his heart in over a decade?

He didn’t have to be an emergency miracle. He didn’t have to die (or come back). A huge irony in all of this is that I work with connective tissue diseases and their fallout daily. I am regularly referring people for evaluation for Ehlers Danlos or other connective tissue disorders and making sure that those I work with are diagnosed have had proper cardiovascular surveillance. It never ever once crossed my mind that my Chris was sick, much less so seriously, much less with an unknown connective tissue disorder. Never once crossed my mind that my kids would need cardiovascular surveillance the rest of their lives.

The only thing we cold have done better or different would have been to know what we were dealing with. A simple preventative health screen would have been all the difference for us.

In those first months, all I wanted was to celebrate my husband and raise awareness. I wanted to thank all of the medical staff that took inspired and expert care to save his life and love us like family. I wanted to give back to our community of family, friends and colleagues that supported us in so many gracious and thoughtful ways. I wanted to bring together other families that had been impacted by vascular diseases and individuals that have come back to share their near death experiences. On Saturday January 23rd, 2016 (1/23 if you know me well enough to understand the significance) we held a celebration benefit that was the catharsis of these wants.

At that time, I was the director of a community center where we launched our ‘Integrative Health Screening Initiative’ and the beginning of many Integrative Health Screening Days to come. There are a lot of people like us that take good care of themselves but, for whatever reason, opt out of basic health screens. To date, this initiative has provided over 120 free comprehensive physicals and nearly 1000 individual free screens of various types. At least 5 people with serious risk factors have gotten the information they needed to prevent tragedy for themselves and follow up accordingly.

While at first I thought that these screenings would be the ‘impact’ of Chris’ story, I have seen instead that Chris is the impact of his own story. (And yes, I do see the lesson for me of thinking that I had to rally some big community effort to make sure what happened to us carried forward). If you have ever met Chris, you have been impacted. He is his own impact and he brings the most amazing things out of the people and situations around him.

Our daughter and I were talking before bedtime the other night and she asked me, “Why does baba talk to everyone? Everyone. He has these liiiiittle conversations with everyone he meets?!” And, it really is true. He makes friends with everyone, the butcher, the baker, the cashier, the crossing guard, the people walking their dogs, the bus drivers, the life guards, the garbage man, etc., etc. This wasn’t how he used to be before he died and came back.

He sees the worthiness in these could-be mundane interactions. He sees value in little moments and small conversations. Things like taking out the garbage don’t seem the same. (When we moved to our new neighborhood, he helped the garbage man load up all of our boxes and things and he was shocked. The garbage man told Chris that in all his years in his job, nobody ever had tried to help him load the garbage truck. And … while all this was happening, I’m inside watching with the kids and our oldest says, ‘Oh, he’s just out there making friends with the garbage man.” That kind of sums it up.)

I was so ‘proud’ of him that summer when I realized that he wasn’t wearing a t-shirt to cover his scars at the pool with the kids. Apparently, people just walk up to him – at least one each day – and ask what on earth happened. “You look so young and healthy, what happened to you.” And then they share something profound or something they’ve never shared with anyone else with him. He brings something out of people now that is so amazing and so sincere.

We all have that in us, right? Why does it take a handsome man with horrible scars to bring kindness out of strangers and genuine interaction in our community?

I have had the blessing to walk on this journey with Chris for nearly twenty years now. He started as a busy, overworked, charismatic realtor. Then something fell out. We realize now that from 2010 until 2015 he was living in heart failure. His frequent ‘migraines’ were likely something more and they have scarred his precious brain taking away from him a lot of the executive kinds of functioning that were a foundation for his overworked, charismatic personality before. Now things are different. Multiple anoxic injuries to his brain have taken away some things with organizing, planning, memory, etc. But in the aftermath, he has been opened up and sparked by a joy and a knowing. My Chris is a walking veil between this earthly existence and a tangible, true knowing that something profoundly peaceful and beautiful is part of who we are and awaits us when it is time.

This life is so special. It is so fragile. Even if the life isn’t lost forever, the experience of it can be forever changed in a moment.

He has what he calls his ‘evil meter’ where he can just know when people have bad intent or are acting of ill heart. His “heart blew up” (as he always phrases it) and now he has this discernment of the hearts of others that is amazing to witness.

Since most people do not survive what happened to him, there isn’t a lot of information to let us know what the future holds. But we have learned – that isn’t the point.

I love that Eleanor Roosevelt quote: “Yesterday is history. Tomorrow is a mystery. Today is a gift, that is why we call it the present.”

Death, nearly.

10.07.2019 | Melinda Bekos

“I long to be where they are,” my husband says. Not in a depressed or suicidal way at all, just a deep yearning. Reverence. (Spoken by a man that I have never heard use the phrase, “long for …” in our near 2 decades together). It’s a response I have become used to getting from him when he hears that somebody died.

He died in 2015, and he got the rare opportunity to come back.

A longer story of what happened that evening can be found here. And, as a soundtrack to your reading, a link to the version of the Gayatri Mantra that I was listening to at work all that day, unknowing of what was happening (somehow cramming myself full of spiritual fortitude for what was about to take place).

Since then, there have been many times when he’s struck by the same sincere solemn tone. I have been right there next to him enough to feel like I have some image of what it must have all looked like. We have all seen it here on earth. Those undeniable moments when Mother Nature forces pause. The sun penetrates the sky and clouds sending rays of clarity, light, radiance and magnificence over the scene in front of us. If we have been lucky enough, maybe we have found ourselves in one of the sparkling beams of sunlight and felt transcendent in that moment. For my husband, it’s too much to take in sometimes, I think.

I suppose that once you have crossed that veil, been in the presence of the Holy One and then been pulled into the tangible, 3D world again, it becomes easier to move back and forth freely. If I ever wondered if we could step between realities, I have seen for myself all the proof I will ever need. This ‘life’ we live out in this particular ‘body’ is not as concrete as we have been led to experience and believe. Clearly, we do not need our body to exist. And, we can come and go and come back again.

People often ask what his religious background was. Was he a spiritual man before he died? I’d have to answer – no. He was raised devout Greek Orthodox. Our life is a bit like ‘My Big Fat Greek Wedding.’ He had a very religious backdrop to his upbringing but he was not a spiritual man.

Now? Now, he knows that something much bigger than him will decide when his time is up. He knows he must have been sent back here for a purpose. He knows that he will die again someday and tells us often that we can’t be sad for him when that happens. “I know where I am going.”

When my husband woke up after his life-saving surgery, the last thing he remembered me telling him was, “Hold the best image of our 3 kids in your mind.” Then the nurse saying, “This is going to hurt.” They intubated him, bagged him and we waited. We both rode in the ambulance. I was in the front with driver frantically making phone calls and trying to reach people. He was in the back, losing pulses, dying. He thinks this is when his soul first left his body. This was when his near-death experience began.

When words started to come to it all, he began with recounts of ‘riding a beam of light’ and what he saw during his surgery. He was inclined with his feet higher than his head. There was lots of blood. Surgical gloves. Conversation. Sounds. It all made sense, but there was a very real question if he actually ‘saw’ it, dreamed it, imagined it, or experienced it all from a reality we don’t typically move in.

“I was upside down with my arms up but looking down and seeing s#*t. It was bizarre. I remember asking one of the doctors, ‘Did I see you in there? I think I remember you.”

His extraordinary medical team was very receptive and understanding, caring intently to listen to his experiences and memories. Then the very clear words were spoken. All of the things he ‘saw’ in surgery did happen. His memories were spot on. But, his eyes had been taped shut during the entire processes. He did not see it with his human eyes.

During the late-night hours as the full October moon passed across the big windows and my husband lay in surgery one floor beneath me, I had a very clear moment, sitting in a conference room nursing our 5 month old. I felt him standing behind me clear and obvious as an ice cube down the back of my shirt. In my head, I started yelling at him. “What are you doing here? Go back downstairs into your body where you are in surgery. Please. If I can feel you here, you are not where I need you to be. Please, please go back into your body.” I thought for sure that I had lost him.

When I’d seen him last, he was blue, lifeless, swollen and being pulled out of the back of an ambulance. The man that I drove to the hospital that evening was hard to be married to and parent with. He was judgmental. He was closed off. He wasn’t particularly happy. The man that woke up the next morning was grateful, confused and open. He quite literally had been born again. He had been resurrected. Nothing could ever be the same. And it hasn’t been.

When you start looking into the near-death experiences that are on record, they all seem more similar than different. The generality of what one experiences is hugely similar despite religious/cultural backdrop. They all reflect the basic nature of what Chris encountered as well.

“I was riding on a beam of light. I felt like I was either being pulled by a light wave or riding a light wave. It was very bizarre. I didn’t have extremities and I couldn’t move around but what I could see was experiences. Friends. Family. Life. Just flowing on this light wave. This was all in that 3-6 o’clock orientation around me if you were looking at a clock. Down and to my right. I was being pulled or it was going … I saw a movie of my life. Aunts. Uncles. My grandparents. I saw everyone on this light wave with me. All on this light wave. This is so vivid. Just like I am talking to you. Just like we are sitting here minus my arms, my legs. Being on that light wave and not feeling anything. It was wide. Like an exhale. Like a muffle.”

Interesting, were some of who and what he recalled. Old friends and girlfriends I’d never heard about before. Memories with his cousins and siblings growing up. It struck me how lovely and amazing it is that all of that experience, all those people who he loved and who loved him came forth in a way that wasn’t the clear obvious. People had left an imprint on his soul that he didn’t regularly call up in his everyday life. A reminder that we never know the importance we play in somebody’s life. Perhaps we can’t know during this earthly life the souls that have shifted and directed our course. Maybe it isn’t until we have the awesome retrospect of death that we can clearly see who impacted us the most.

“The light got brighter and brighter until it just was everything. It was so wonderful. So peaceful, like the deepest sense of coming home I’ve ever known. It all felt so familiar, so comfortable. I loved it there. I knew that it was where I came from and where I belonged. I stood in front of 3 orbs of light. There was communication but not in words or phonics that make sense here. Then, I started to feel myself being pulled backward. Almost like somebody was grabbing on the back of my shirt and pulling me back, away from this light. It felt slow. Sad. It got darker, the light further away from me.

Then I woke up. I hurt so bad, my chest was killing me. I was strapped to a bed. Tubes in my throat and neck. I couldn’t move. Trudy (the ICU nurse) was over by the sink. She asked me if I was OK and I gave her a thumbs up. She asked me if I could move my toes. I did. She came and put her hand on my shoulder and told me that I should rest. I was going to be alright, she said. I just closed my eyes. What the f*@!k just happened”

And he woke up. Swearing relentlessly. Full of gratitude. Entirely different frame of reference.

Whenever I find a way to share his experience with somebody that may benefit from hearing about it, I can see the peace and comfort that it gives. This is why he has agreed to share it openly. It is one of his new gifts to give. Even better, when I get to watch people receive the story from him… This unassuming package of a handsome middle-aged dad, meeting people at the grocery, at the pool, in the neighborhood. Somehow he invites near-strangers to share their deepest secrets, experiences and fears with him.

There is something very reassuring to people about this man that died and came back. I think it comforts people to hear where their loved one may have gone or hear where they are headed. And, to hear that this lovely man with a wife and children who adore him quietly awaits the time when he is called back. It gives a different perspective. Death doesn’t seem like anything bad at all when you talk to him about it. It’s a homecoming. It isn’t ours to control, ward off or fear. It just is. And it is good. And it has a timing that isn’t ours to know, control or be afraid of.

“Enjoy the time we have now. It is very important. It is about so much more than this. If everybody would experience what I experienced there would not be bad people on this planet. People need to know there is more to it than here.”

Organization

23.11.2019 | Melinda Bekos

Basically, we are made up of stardust. And, there is no reason to think that we are any less fractal than the bigger whole that we belong to. We can talk about carbon, hydrogen, nitrogen and so on. We can talk about energy. We can talk about religion. Regardless of the preferred language, we are talking about high-level organization and the amazing ability for life to occur and renew itself. We are amazing human creatures.

Early medical education in the west sought to dissect it and name it all. We gave function(s) to part(s) and labeled up the human body like a sophisticated machine. It makes historical sense that we took this approach. Timing overlapped with the coming of the industrial era. This was the culture of the time. That does not mean it was right.

Time rolls on. Collective consciousness shifts. We all know that we are not the sum of our tissues and cells. We are not machines. You can’t just refill fluids and swap out parts.

None the less, medical education treads on and the books have been written. Falsely perpetuated ‘knowledge’ has passively been handed down generation after generation. Health care tales have become embedded in our media, culture and care. We are the most unhealthy American cohort of all time.

I used to be passionate about teaching in the cadaver labs at colleges and universities. I thought that this would be a place that we could surely impress the ‘whole’ of a person while still following the language of anatomy and dissecting out pieces and parts. But I decided pretty quickly that teaching future healthcare providers would not and could not be an effective way of impacting the story. The establishment of healthcare doesn’t allow providers to practice in that way, so even if they have been trained to see whole people, it isn’t compatible with the way they have to practice in our healthcare system. People are the ones that need to understand what makes them whole. And so here we are.

It doesn’t make it any less fantastic to describe our physicality in terms of structures and systems. We know the universe is made of stars, planets, solar systems, etc. It doesn’t make it any less incredible to call things something so we can talk about it. For our bodies, this is the discipline of anatomy.

When I was teaching, I would always belabor this lecture that I’m presenting to you here. Not because it was complicated but because its implication and metaphor got overlooked and underpondered. This basic hierarchy proposes all the parts that have to come together to make a system and that multiple interconnected and interdependent systems are necessary to make a whole. The metaphor is big. In it, I see more than just something to remember for the quiz. Chapter 1 is important. Genesis.

Atoms form molecules. Molecules are structural building blocks that eventually become the structural support, organelles and membranes of our cells.

When multiple cells come together a tissue is formed. Our complex body is made up of only four basic tissue types: 1) nervous tissue, 2) muscular tissue, 3) epithelial tissue and 4) connective tissue.

When these four tissues integrate an organ is formed and when multiple organs support each other functionally, there is an organ system. The human organism is formed of eleven organ systems, they are the 1) integumentary system (skin), 2) skeletal system, 3) muscular system, 4) nervous system, 5) respiratory system, 6) digestive system, 7) urinary system, 8) reproductive system, 9) circulatory system, 10) endocrine system and 11) fascial system. (Note though that depending upon how one subdivides the organ systems there can be nine to twelve.)

When the organ systems function together, an organism is formed. A human body.

Like the cosmos, the more you look into the smallest parts, the more hidden worlds open up. Even if this hierarchy is an incomplete story, it repeats itself and repeats itself all throughout the natural world. Interconnectedness. Interdependence. We are part of something unknowably big.

Awesome.

“There are no basic ‘building blocks.’ Quantum physics paints a strange yet enticing view of a world that, as Heisenberg characterized it, ‘appears as a complicated tissue of events, in which connections of different kinds alternate or overlap or combine and thereby determine the texture of the whole. These unseen connections between what were previously thought to be separate entities are the fundamental ingredient of all creation.”

-Margaret Wheatley, Leadership and the New Science

Fascia – The ‘Newest’ System of the Body

31.03.2020 | Melinda Bekos

“… A loose chaotic network operating separately but with a global, unified goal” said Robert Schleip. He was actually talking about the research community when he made the statement, but the metaphor to the fascial system itself was lost on no one. In an era of medicine producing sicker and sicker people being treated conventionally in more and more specialized clinical silos, the fascial system coming to center stage is a hopeful metaphor for more unified, collaborative, integrous, interdependent times ahead. Fascia is the system of resiliency, integrity and exchange. It is a timely time for us to be discovering the importance of fascia.

FASCIA AND CONNECTIVE TISSUES

The terms are not synonymous. ‘Connective tissues’ and ‘fascia’ are not one-in-the-same. The body is formed from just four primary tissues types. Connective tissues are 1 of the 4 tissue types that form the body. Fascia is one of the 9 organ systems. It isn’t just semantics.

To be categorized as a connective tissue, three conditions must be met.

· First, there must be cells present.

· Second, there must be a fibrous component.

· Third, there must be ground substance, or a matrix.

A good visual analogy can be found when thinking of reinforced concrete. Rocks go in; we can think of these rocks as the cells which in reality are actually secreting the ground substance and forming the fibers. Metal support rods are inserted; we can think of these as the collagen, elastin or reticular fibers representing the fibrous component. And finally the cement, or the ground substance. When the ground substance is still fluid while kept in motion, we have a tissue something more like blood. As the ground substance becomes increasingly firm the analogy progresses to one of proper connective tissues, cartilage and finally bone.

 

 

Notice, none of the structures listed in the table are ‘fascia.’ Fascia is NOT a connective tissue. Fascia is a system of the body formed, in large part, from fibrous connective tissues. It can be separated from, and in some cases categorically include, other specifically organized structures. Fascia varies in thickness, density, and the amount of fat, collagen fibers, elastic fibers and tissue fluid it contains. It could be thought of as a three-dimensional, web-like structure that contains, organizes and supports all of the parts of the human body. A ‘snag’ in one part of the web necessarily impacts the entire structure. It has amazing properties. Fascia surrounds every structure in the body allowing for the perfect adaptive balance of tensile strength, connective integrity with gentle suspensory support and ample movement for optimal functioning. It is a full-body system.

In the introduction to the book that accompanied the 2007 First International Fascia Research Congress in Boston, T. Findley and R. Schleip offer this definition: “Fascia is the soft tissue component of the connective tissue system that permeates the human body forming a whole-body, continuous, three-dimensional matrix of structural support. It interpenetrates and surrounds all organs, muscles, bones and nerve fibers, creating a unique environment for body systems functioning.” Findley and Schleip extended this to include all fibrous connective tissues, such as ligaments, tendons, retinacula, joint capsules, aponeuroses, organ and vessel sheaths, the meninges of the central nervous system, the periostea and all the endomysial and intermuscular fibers of the myofasciae. And so, quite appropriately, from the first International Congress on Fascia a first formal definition for fascia was born.

It was only in 2015 that the American Association of Clinical Anatomists declared fascia an official system of the body. This came only after the elegant Delphi study conducted by Dr. Carla Stecco. While her work turned to ‘weekend workshop,’ ‘modality certification’ holistic healthcare apparatus upside down, it made perfect sense in the grounding of the field of gross anatomy. Textbooks are being rewritten.

CELLULAR MECHANICS OF FASCIA

Cellular biologists were among the first international researchers in the fascia research community. There are many cellular mechanism that will surely prove interesting in the decades of inquiry ahead. Collagen fibers are the primary fiber type found in fascia. Collagen is formed by the intermingling of three hollow tubes which together form a triple helix. Each tube is filled with an ultrafiltrate fluid which is very high in photons or light particles. Cerebrospinal fluid shares this similar quality. Collagen molecules are hydrophillic and attracting water molecules to them with tensional precision. These qualities allow fascia to act with great fluidity. Fluidity is fundamental to fascial function. It allows for ease of movement as well as provides a medium for effective paracrine intercellular communication. Fascia has the special electrical properties of being both piezoelectric and a semiconductor.

While this is a lot for the research community to take in, it is clear that exciting new knowledge is ahead. The fascial system is going to be a teacher further bridging the divide between native healing traditions, energy medicine and the unseen elements that connect and spark the human body.

THE FIVE PRINCIPLES OF FASCIA

Fascia needs to be dealt with within the parameters of its natural laws / response characteristics. One cannot treat fascia like muscles or bones and expect to get a lasting change in the fascial system. You wouldn’t think you could treat your respiratory system like your digestive system. The dynamics of fascia and the fascial system are unique unto itself and are now starting to be recognized as such.

Fascia isn’t a technique you might think about trying. It is a system of your body every bit as important as any of the others and as crucial to the whole. Providers from any background and people for their own self-care benefit, can and should work to engage incorporate fascia in many diverse ways.

These unifying principles were the outcome of a content analysis ending in 2009 and presented at the International Research Congress in Amsterdam that year.

1. The Exchange Principle:

The fascial matrix gives home to the cells of our immune system. It is the medium through which waste and nutrients are exchanged between cells and their blood supply. It is where tension is handed off and redirected. The ‘tangibles’ of this principle include fascial propertyies of: mechanotransduction, semiconduction, piezoelectricity, crystallinity, hydration, continuity and coherence.

2. The Scaffolding Principle (aka Tensegrity):

Our bodies are geometrically efficient. They have tensional integrity. Fascia acts as the ‘guide wires’ that the rest of our structures organize around. Throughout the body 45- and 90- angles are visible in the meshwork of fascial sheaths. Diagonal relationships abound. A fascinatingly, not-yet-understood, pattern of 78-degree angles is also found at fiber cross-striations. Structural integrity in the fascia makes it possible for other systems to function properly and most efficiently.

3 The Container Principle:

Fascia organizes our muscles and organs into separated, but interwoven, compartments and cavities. Just beneath the skin and the fatty layer is a fascial ‘wetsuit’ that forms the outermost container of the entire body. Deep to this there are fascial sheaths that identify individual muscle compartments (i.e., anterior thigh) or separate out large structures (i.e., carotid sheath). Within each of these compartments each individual structure (muscle, vessel, etc.) has its own fascial sheath. Within each individually sheathed muscle every 100 or so muscle fibers are contained in their own fascial sheath called a fascicle. At the cellular level, each muscle fiber has its own fascial sheath. Each of these containers within a container are interwoven by the fibers of the fascial matrix. A ‘snag’ anywhere in the matrix impacts the entire ‘container’ (your body).

4. The Hugging Principle (aka Creep):

The fascial matrix ‘hugs’ its areas of weakness, injury, pain or misuse. Think of the posture of a person following open heart surgery. Picture what your skin does as a wound is healing. Think of how a person holds their arm when it is broken. What do we do when we have abdominal pain? The fascial matrix will try to lend support to areas that are perceived as in danger by our nervous system or immune system. Studies have shown that mechanical stress will cause fibroblasts (cells that make collagen) into myofibroblasts (cells that make smooth muscle). Unfortunately, this ‘hugging’ can yield layering of compensatory patterns which will eventually become too difficult for our musculoskeletal system to efficiently support.

5. The Unwinding Principle:

The collagen fibers that predominate throughout the matrix, at a molecular level, are a triple helix filled with fluid. At its core it is nonlinear. Fascia will not respond to linear stretching. Instead it has a very unique, slow, sustained, meandering quality to the release characteristics observed clinically. Some of this may be explained by the sol-to-gel transformational ability of the collagen molecule.

TAKE-AWAYS FASCIAL FACTS …

Fascia, together with our muscular and skeletal systems, gives us our posture, defines the quality of our movement, holds our tension patterns and provides a structural casing for nerves, arteries and veins, all skeletal muscles and nearly all organs of the body.
Other than the muscles that act on the vertebral column, few muscles cross more than one joint. When we feel a sensation that does cross multiple joints, there is a good likelihood that that sensation is fascial or nervous.

In the embryo, fascia develops before muscle. Future muscle cells migrate into the fascial sheaths and then develop into the muscles that we can identify by name. This means that the muscles are to a great extent at the whim of the fascial casing that encloses them. Releasing the muscle will have little long-term benefit if the fascia is not coaxed into better functioning as well.
Fascia has a strictly afferent (sensory) relationship with the nervous system. We cannot tell our fascia what to do. It is not under efferent (motor) control of the nervous system like muscles. Instead, our fascia is constantly telling our nervous system what is going on in the fascial environment.

Fascia has natural response characteristics to activities such as rocking/shaking/bouncing, traction/compression, floating, direction-of-ease unwinding and diagonal reinforcement. Holistic therapies such as Rolfing, Trager, myofascial massage, Yin Yoga, Body Rolling and in general many physiotherapies make use of some or all of these fascial response characteristics in their therapeutic approaches.
When people have thoughtful practitioners attempting to increase strength and/or flexibility and they cannot make gains. If the fascial ‘container’ is malpatterned, then the muscle does not have the functional ‘room’ to hypertrophy or lengthen.

IN SUMMARY

In another generation or two, this won’t be confusing. It will likely seem silly that it ever was. Kids will learn in health class that they have a fascial system. Branches of physical medicine like physical therapy and osteopathy will likely be the training grounds for skilled fascial therapists. Just as we have pulmonologists and yoga teachers both talking about breathing, we will have a spectrum of providers working with fascia.

It is in large part on the shoulders of an industrial age that western medical education grew. We weren’t in a paradigm looking to celebrate the connectedness and interdependence of it all. We wanted to name and understand pieces and parts to make it easier to live in these machines called bodies. Many false truths have been handed down. We are ready for a new era.

Fix-the-machine medicine is literally the lifesaver in crisis and trauma. But it doesn’t serve us as well in the decades between. As we live longer, we need to do more to help our bodies adapt to the wear and tear of the lives we’ve lived. Fascia holds the patterns, stories and acquired inefficiencies to a fault.

Reestablishment of relationship. Bringing parts back into the whole. Connection. I’d like to think that’s the metaphor this ‘newest’ system of the body brings.

Dr. Melinda Cooksey Bekos

melinda@IntegrateColumbus.org

614-563-0997

Community…

02.04.2020 | Melinda Bekos

I couldn’t say when it started seeming important to me to feel ‘in community,’ but as time rolls it feels more pressing. It has all become so very muddy and broken. We are all, whether we care, know or will admit it, in need of community. Human beings are supposed to live in community. And if you believe in spiritual Oneness, then we already are one-in-the-same, whether we are acting like it or not.

Part of my soul deeply remembers ‘having my tribe.’ We all knew we depended on one another. Unashamed. Grateful. Plentiful. All for one and one for all. Not because it sounded good and had opportunistic value but because it was the only thing that had promise of working. That has stayed the same. It is the only thing that has promise of working. But we have hugely forgotten and tainted these basic sparks of reliance. Interdependence is universal truth, a birthright, a joy and a deep comfort. Sold to us as religion, charity, us v. them. We feel inadequate and don’t admit it when we can’t pull it all together and make it go on our own. We are told our psyches, neighborhoods and institutions need analysis, fixing, better leaders and more control.

We live in a culture where margarine has been sold and ingested for decades as a safe alternative to good old butter. Stranger danger. Play dates. Social media. Photoshop. Everywhere we exist, we can manufacture ourselves into a version we let the world see. Cookies that literally never lose their shelf life. All the confident selfies out there from ‘friends’ wanting validation. It’s a mess. We’re not being honest or transparent or kind. We are not ultimately moving ourselves forward. We live in a time where every wanted comfort can be met, and yet we live with more disease, anxiety and depression then ever before in humankind.

Another possibility has to be possible. Somebody having your back. Potential for strangers to become friends. Belonging. Engagement. Respect. Joy. Accountability. Cooperation. Reverence. Some ancient part of me clearly remembers. All of this. Hugely missing in our social circles, professional lives, neighborhoods, governments, politics and religions.

There are great groups and communities out there. But one doing their good thing while another does their good work in parallel does not create community. You doing you and me doing me, even if we are supporting each other in self evolution and betterment, will not cut it. If that’s the best we’ve got, each organization and individual is ultimately still in ‘it’ for themselves. With the right triggers in place, they fear/flee/fight in self-preservation mode. We see evidence of this every day.

So, while I don’t know when my longing for community exactly started, I do know when it became glaringly clear. I had spent 5 years co-creating the All Life Center, a cooperative nonprofit organization. We had an incredible community center, that over 180 individuals and businesses collectively sustained. With a revelation of ‘new’ intent for the property, it could-have-been/should-have-been that the community ran toward one another and continued on. But that wasn’t what happened. With a handful of exceptions, it became a scatter, every man for himself. Human nature at its worst. Hidden agendas. Fear mongering. Storytelling. The ‘community’ had 2 basic choices. Stay together or fall apart. It fell apart.

Tragically curious.

We hadn’t created community at all. My formal unpacking of what ‘community’ was and wasn’t began. Author Peter Block quickly gave me that key clarification above. It is worth restating. Me supporting you and you supporting me while we both theoretically strive to become our best person, professional, organization, neighborhood, healthcare system, city, (whatever …) is nice. But it is not community. It is still you being interested in you and opportunistically accepting me on your sideline and in your toolbox. It is me either doing the exact same or being taken advantage of and manipulated by you.

Not community. I had greatly mistaken the difference. Noted.

If it weren’t for my professional life, I might just throw in the towel there. Work with who and what I’ve got, count my losses and forget about it. But I seemingly can’t. I deeply know that I can’t hope to serve people on their physical/medical journey if I have no hope in the broader community they are healing within and returning to. Healthy people need healthy communities to stay well. Healthy communities need healthy people to sustain them and move them forward. I don’t believe you can have one without the other.

And so, I founded a new nonprofit in pursuit of cooperative community wellness.
While our outreach is geared specifically to help the public sort through integrative community-based health and wellness options, we know this must be done with a foundation, undercurrent and backdrop of community engagement and meaningful, felt impact. We started an ongoing and recurring book club around the Peter Block book, ‘Community,’ and host other events/groups/reasons to gather in central Ohio. Seeds of possibility are intentionally being planted and thrown to the wind …

If you’ve read this far, all of this sparks something in you too. That is the conversation we need to have more of. What gifts do you bring? What other organizations and groups we should be connecting with? Visit IntegrateColumbus.org to be part.

(and thanks for reading …)

SCOBY Symbolism

02.04.2020 | Melinda Bekos

When we moved last year, something struck me differently about our recycling. My family drinks a lot of Kombucha! It’s the painfully expensive, but healthy, drink of choice for my preschool/elementary tribe. The number of bottles were a travesty for Mother Earth and my bank account. Quick, easy choice – it was time to start making my own Kombucha again.

Last time I tried, I aborted mission early when I found myself pregnant and throwing up everywhere, for 39 weeks. The Symbiotic Culture of Bacteria and Yeast (SCOBY) sitting in the corner of my kitchen fermenting with some sweet tea was literally too much to look at. So, she sat. And sat. And sat. Some 16 months or so later, she was rescued from her glass vessel.

I’d, rather stupidly, started it all in a huge glass jug with a narrow top. Like placenta previa. Trapped. Two ladies I knew lovingly broke the jar to try to rescue something in there. They saved some of the long-overdue Kombucha for us all to taste (after straining out all the glass). It was the most delicious I’d ever had.

The 1st symbol in the SCOBY emerged: Sometimes your culture can block you from fulfilling your purpose. Choose your vessel and tend to it regularly. Things get funkier and worth savoring over time.

So these years later now, I have a really stable Kombucha operation going on in my kitchen. I now use honey and white tea, instead of the traditional black tea and cane sugar. I’ve learned this is actually its own different beverage called ‘Jun,’ a close cousin to Kombucha. I make a weekly batch for my family, friends, neighbors and people I work with.

My SCOBY makes a lot of babies. So, I put it out over Facebook, ‘who wants a SCOBY?’ … And the 2nd symbol in the SCOBY began expressing itself. I ended up getting to see a student from over a decade ago, she came to my home to get her SCOBY. I got to reconnect with an old colleague. I got to meet a few friends for coffee and lunch. I made a new friend. And I finally met somebody in person I’d only known virtually before.

This simple, slimy pancake of bacteria and yeast is a metaphor of symbiosis at its best and the kind of community culture I’d like to believe in.

Symbiotic relationships, in the biological sense, are interactions between different organisms that live physically close to one another. In the sociological sense, it is organisms, people, or things existing together in a way that benefits them all. For our little yeasts and bacteria, it is apparently both.

When I was talking about wanting to start making Kombucha again last year, a lovely woman I work with offered me a start from her SCOBY. Isn’t that how it is all supposed to begin? With kindness. With simple offerings of exchange and communal goodwill. With simple things that offer the promise of nourishment, refreshment, joy and tradition.

Well, she overheated her SCOBY (my SCOBY’s mom) last winter. It died. I was able to give her a grandbaby SCOBY back to start over with. Isn’t that how it is supposed to be? Full completed circles. Abundance. Lineage. Friendship.

It just takes a little clean, honest attention. It requires making the space. Things need to be generally stable. Boundaries (like temperatures and cheesecloth) decide if the culture will ultimately survive, or not. If it’s healthy and doing its thing, it is all self-perpetuating and the good will just keep coming. You’ll have to start sharing your baby SCOBYs. You will have to share these precious little slimy gifts in order for them to survive.

They make the notion of a ‘healthy culture’ and ‘symbiosis’ look easy. If the environment isn’t right, growth won’t occur. Simple. When a sustainable colony is cultivated, it can go on generation after generation after generation. It can go on forever if you keep it clean, hold the space, share with others and just give it a little sweet tea every so often …

 

Enthusiasm (‘En-‘ + ‘Theos’)

02.04.2020 | Melinda Bekos

Breaking down the word … ’enthusiasm’ comes from the prefix en- (‘within you’) and Theos (‘God’). So, to be enthusiastic is to have the spark of God within you. To speak with enthusiasm means you are speaking divine words that light up from within you (and likely light you up). We can’t necessarily pick (or shake) the things that ignite light and action.

Enthusiasm for a cause is a divine gift. Let’s start there. But the question, “why does it matter?” is a very fair one. One worth revisiting as the years roll on for sure. I’ve been asked this a lot over the past year and I’ve had to really listen to my answers. I’ve sat with myself and played with a related question, “could I just let it go and drop it?” Could I just go to work, take care of folks one person at a time, and drop this vision for cooperative, integrative community-centered heath care? I have been a volunteer for the cause since the late 1990s. Maybe I have had and done enough?

Apparently, no. I can’t drop it.

I suppose it is the ‘fortunate’ that have this sense of purpose about something in their lives. So, to be able to ponder the notion of living on that purpose and how much of our life we want to give to that purpose is a consideration of privilege and a rich blessing. To feel so compelled, so passionate, so unwaveringly pulled to create and co-create is a very hallowed double-edged sword. These internal missions drive our use of time, our priorities, our finances, our relationships and our direction. It is necessary to sit with ‘it’ from time to time and be sure that we are still willing, enthusiastic stewards of the cause.

If it is your ‘Life’s Work’ then it will not be shake-able until it has fulfilled its potential. So here we are. Here I am.

__________________________________________________________

Almost every single person I see in my private practice has been struggling for far too long. If they are lucky enough to have found a good team of practitioners, it is solely up to them to keep that team in communication and their information sorted out. Amidst their suffering, they are forced to be their own ringleader. More often and sadly, people arrive with huge gaps in their support network. These people can’t get well with such holes in the foundation of their healthcare.

I see all ends of it. There are basic needs, like a primary care doctor and standard preventative strategies. There are more creative needs, like integrative teams of experts putting their heads together. We should be able to do better to serve the public and help people in need. I know many of us have ideas about what that could look, feel and operate like. And apparently, I have an undying enthusiasm for bringing it all to fruition.

Resources are finite. It is a truth no matter who you are or what you are dealing with. Energy. Time. Money. Emotional wherewithal. We ultimately only have so much reserve to cope, adapt and heal with. And, when somebody has been living with a chronic condition, those stores are already tapped. It is unrealistic and relatively unkind to expect that a general person would or should be able to navigate the healthcare landscape, much less when they are already low on resources across the board.

It shouldn’t be that hard to provide a simplified framework, create efficient paths for approach and bring together teams of providers. It just requires an infrastructure, community effort and community support. The notion of community has to be front and center in the healthcare/wellness care conversation. I can’t believe we can create healthy people in the absence of healthy (or at least authentically striving to be), engaged community.

One part of the framework is the ‘6-Domains of Integrative Medicine’ educational tool along with the personal support to implement it into a sustainable and thoughtful wellness strategy. Another part requires thoughtful virtual engagement of a broad, diverse and reputable community of wellness providers. And the final, perhaps most important part, is a relationship with the public that offers various, comfortable, engaging points of entry and contact.

This way, when a person is in need they know where to find resources immediately. They don’t waste months and years floundering trying to put together their own piecemeal team and educate themselves through Dr. Google. They don’t waste a ton of money, time and energy on disparate services, questionable providers and incomplete treatment plans. They know right away, ‘I have this great infrastructure in my community that brings me reputable integrative health and wellness resources I can trust and access easily.’

We all know and have felt the big, confusing abyss between inpatient care and outpatient wellness. We all know there is an infrastructure needed to fill this void. These can’t just be words that sound good and feel good to speak. There needs to be action. There needs to be engagement. There needs to be vulnerability and transparency. There needs to be evolution and impact.

Obviously, I’ve been sparked. Community-driven integrative healthcare delivery really matters to me. It matters a lot. It is clearly my ‘Life’s Work’ and I won’t be able to drop it until its potential, or my role in it, has been fulfilled. Enthusiasm. It is quite a thing …

(And of course – please consider supporting IntegrateColumbus by donating financially, volunteering, putting your voice in the conversation or just staying in the loop!)

Victimhood

02.04.2020 | Melinda Bekos

Angry victims. Empowered Victims. Defeated Victims. Passive Victims. We have too many victims in the world today. When my husband was in cardiac rehab last year, he sent me this text. A man on the treadmill next to him dropped some wisdom …

“There is a growing phenomenon of people posing as victims which is a consequence of a culture which portrays victimhood as a form of moral superiority.”

How is it that some people go through the trenches and back and just simply never become a victim of it all? No matter what life throws, they aren’t victimized by it. They find courage, persevere and blaze ahead. And then there are others, apparently enduring victims of a past or daily victims of the present. Chronic victimhood worn as a badge, worn like a quiet secret, worn like an excuse and heart-string for the world. Some create false bravado to overcompensate their pain, others act like sages sanctified in their empowered victim status. How did we become a culture of so many victims?

Has the world really given us more to be victimized by? Or, have we just become more inclined to identify, embody and claim the title and role of ‘victim.’ Like the guy on the treadmill said, ‘a form of moral superiority.’ Anyone who experiences injury, loss or misfortune has been a momentary victim of events, circumstance or another person. But then there are those that choose to carry their victimhood as a steady undercurrent, a backdrop, a medal of something earned. It turns into an invisible ‘award’ allowing them to be treated and regarded differently, apparently forever, because of what they’ve endured.

But, trauma and loss are not enough to make somebody a victim. Anne Frank, Jackie Onassis, The Dalai Lama, John McCain (insert the names that come to you here …) Tremendous loss, grief, suffering and pain and not an ounce of victimhood.

A victim and a hero are very different things.

Psychologically, the underpinnings of victimhood are the feelings that:

  1. There was harm,
  2. I didn’t cause it,
  3. I couldn’t have prevented it,
  4. It was unjust, and
  5. I deserve empathy …

The desire for empathy – maybe that’s the element we have more of in our culture these days. Perhaps people are just craving empathy, sympathy, compassion and understanding.

The perpetual victim avoids responsibility and criticism, while receiving attention and kindness. While they might play the empowered victim, the humbled victim, the angry victim, the grieving victim, the healed victim… But, they are still so very wounded. Wounded teachers. Wounded prophets. Wounded healers. Their sense of worth all wrapped up in what happened to them with the hope that the world love them differently because of what they’ve been through. In the short term, it draws some people near. In the long term, the fallout can be seen trickling through their relationships and interactions like an acid. Unfortunate. Reactive. Eroding.

You want to love them, support them, see the strength and survivor in them. So, you overlook behaviors that are really pretty self-serving, narcissistic and manipulative. These people can come off as the heroine in the corner, having overcome so much with wisdom and heart now to face the world more bravely because of the sadness and misfortune they met in the past. The undercurrent there though is victimhood layered in coping. It’s sad. It’s misguided.

If victimhood becomes a permanent mentality, it becomes a tool of abusive power, grooming others, gaining special treatment and regard, soliciting sympathy and evoking compassion. It buys cooperation and opportunity and becomes something of a talent, drawing people and bringing out their altruistic motives. It also draws more victims into their company.

It becomes a pattern to blame for undesired situations and feelings. It becomes a pattern to deny personal responsibility for their own life, circumstances and emotions, even if it looks like they are taking it all by the reins. In this blueprint, there will always be more suffering, more casualties, more wounds, more loss.

A forever-victim, even if wrapped in the trappings of a Guru, is duped, tricked, scared of being a target and ultimately playing the fool. And, they end up duping others, making them a target and making them look the fool. For somebody who has overcome so much, it seems so sad to sabotage themselves and those around them again and again and again.

Victimhood, regardless of form, is an imbalance. It requests permanent special status. It asks others to support you differently. It becomes a distorted way to draw people toward you and attempt to claim power. And really, it fuels the whole victim story.

The opposite then would be balance, self-confidence, equanimity. A victor. A leader. A champion for themself and for others.

In the end it becomes a, perhaps totally denied, belief that their suffering is their only access to power. Their heart is not full of love because it is that way, it is full of love because they have been a victim of so much loss. Their spirit is not strong because it is that way, but because they have been a victim and had to fight. They don’t have to admit that they are angry, because they can instead act hurt. They don’t have to face life, because they are a victim of what life has given them.

Victimhood, denied or realized, inhibits us from recognizing and consciously wielding power we already possess.

Having suffered loss, a crime or betrayal at the hands of another, is a temporary condition. Everyone will experience wrongdoing, disloyalty, devastation or defeat at some point. But, it does not take on a special status for everyone. There is no moral, spiritual or metaphorical superiority to having lost in life. Life is loss. Life is suffering. Life is change. Coddling the angry victim just feeds their need for the anger. Putting the empowered victim on a pedestal just fortifies the mistaken coupling of their worth with their pain.

There needs to be a growing phenomenon of people posing as victors. No apologies. No cover stories. Value in vulnerability and in strength, not because it follows misfortune but simply because it exists in all of us.

Lymphatics & Circulation – The Applied Anatomy

02.04.2020 | Melinda Bekos

The functional anatomy and structural integrity of the lymphatic system is, unfortunately, a greatly under appreciated dynamic in the quality of our everyday lives. Frequently the importance of the lymphatic system is nested in conversation of the circulatory system as a whole or in immunity at a cellular level. There are key principles that guide a conversation of the lymphatic system.

  1. Maintenance: The lymphatics absorb excess fluid, proteins, electrolytes, toxins and foreign debris from the tissues. This cleanses the tissues and thereby maintains functional integrity of the connective tissues.
  2. Transport: The lymphatics transport substances between the tissue compartment and the blood. Through this function the lymphatics help to localize infections in the body.
  3. Defense: Immunocompetent cells are generated and distributed by the lymphatic system.

FUNCTIONAL INTEGRATION OF THE SYSTEMS

It is important to note that many authors combine the lymphatic system into the cardiovascular system; the systems are so intricately interwoven that it is certainly fair practice to treat the systems as a single larger system. When thinking of the circulatory system it is absolutely appropriate to view it as a huge circle that starts and ends at the heart.

The lymphatic system is profoundly unique in its unidirectional nature. All other systems in the body are circular from a functional standpoint. This is not the case with lymphatics. This microscopic, blind-ended vasculature begins in the tissue space (interstitial space) and then converges upon itself forming larger and larger vessels. These vessels will specialize into nodes throughout the body.

Lymph nodes can be found in most of the areas of the body where there are ‘pockets’ to provide safety and room for nodes to rest. These areas are referred to as nodal beds. Nodes, for instance, are found under the medial and lateral malleoli under the ankles (malleolar nodes), behind the knees (popliteal nodes), in the hip crease (inguinal nodes), in the connective tissues of the abdomen (mesenteric nodes), under the armpits (axillary nodes), deep to the muscles of the neck and under our jaw bone (cervical chain nodes). There are between 400 and 1000 nodes in the body; over half of the nodes are located in the abdomen. Lymphatics are pervasive throughout the entire body, with one exception. The central nervous system has no lymphatics.

As fluid passes from lymphatic capillaries to vessels to nodes and onto larger vessels into lymphatic trunks, the fluid moves closer to the heart and will eventually converge on the subclavian veins. At the junction of the subclavian vein and the internal jugular vein the lymphatic fluid is returned to the systemic circulation.

EMBRYOLOGY

The lymphatic system begins functioning around the 5th week of fetal life. Its developmental path closely mimics that of the circulatory system. It is most widely believed that lymphatics develop as outpocketings of the veins in the developing fetus. As such they follow the route of the veins traveling from the periphery toward the heart. The 2 central ‘sacs’ form during the 5th week and allow for the drainage of the head, neck and upper limb. During the 6th week, 4 additional reservoirs form to drain the lower limb and abdomen. When the mature lymphatic system has formed, there is one thoracic duct that drains the entire body, except for the right side of the head and neck, right upper limb right thoracic region. The right lymphatic duct is also part of the final anatomy of the lymphatic system and it serves to drain only this right upper quadrant region of the body.

THE FLOW

Blood is ejected from the left ventricle of the heart and travels via a system of arteries and arterioles to vast networks of microscopic capillaries. There are only 2 tissues in the body that do not have blood supply (cartilage and epithelia). The dense mesh of capillaries nutritionally supports all other tissues. Capillaries are the place of exchange. Cellular wastes are exchanged for nutrients in the arterial blood. Carbon dioxide is exchanged for oxygen.

The capillary is literally just one cell thick. Many substances can pass through the cell membrane, while others require transport proteins to carry them across specialized membrane ‘tunnels’ to the other side. The membrane is selectively permeable, meaning that the size and shape of its ‘tunnels’ will only allow certain molecules across.

Importantly the large red blood cells are retained inside the capillary. They are simply too big to cross over into the tissue space. Only a clear filtrate of the blood is permitted to pass into the tissue space. When this fluid was part of whole blood it would have been termed blood plasma. Now that this fluid has filtered out of the capillary and into the tissue space, it will be called tissue fluid, or interstitial fluid. In the space between all of the tissues in the body there is this fluid. It acts as part of the interface for the transfer of nutrients and wastes between cells.

Interstitial fluid can be considered the ‘clear phase’ of the circulatory system. ‘Clear’ refers to the relative color of the fluid itself. When erythrocytes, or red blood cells, are added to the fluid it takes on a dark red appearance that we usually think of as blood. When the red blood cells are sieved out of the fluid, a clear(ish) colored fluid is left behind. This fluid bathes the cells and acts as a medium for the exchange. This fluid will come to contain a relative sampling of the state of the tissue space. For example, if there were bacteria present the tissue fluid would contain indicators of a potential infection.

Each circulatory cycle, the tissue fluid is filtered out of the capillary, acts as a medium for exchange in the tissue space and then the tissue fluid re-enters the capillaries, becomes part of the blood plasma again and returns to the heart. Fluid returning in the veins will travel through a system of venules and veins before entering a vena cavae and returning to the heart and closing the loop of the circulatory system. In the systemic circulation:

heart > arteries > capillaries > veins > heart

But … not all of the tissue fluid returns to the circulation in this manner, some fluid will take a different route through the structures of the lymphatic system. About 10% to 20% of the tissue fluid is taken up from the tissue space not by the venous side of the capillary, but by a blind-ended lymphatic capillary. Once the tissue fluid enters the lymphatic capillary it is appropriately termed lymphatic fluid, or lymph. This ‘sampling’ of tissue fluid could be thought of similar to quality control in a factory setting. If a factory makes shoes they do not carefully inspect each shoe that comes off the line, rather they take a sample (maybe 10 to 20%) of the shoes and inspect them as representative of all the shoes. Our lymphatic system exists for this function, to act as ‘surveillance’ for the body. The proportion of tissue fluid that enters the lymphatics will take a different journey, through immunological checkpoints, called lymph nodes, before reentering the blood plasma of the veins.

capillaries > vessels > nodes > trunks > right lymphatic duct/thoracic duct > veins

Most of the body will drain ultimately its lymphatics through the thoracic duct. The upper right quadrant of the body has its own unique drainage pattern. We will see later that the right side of the thorax, right head/neck and right upper limb all have unique circulation compared with the left. Bilaterally, lymph is dumped from the main trunks into the subclavian veins that run under the clavicle [sub, under; clavian, clavicle). These veins join the superior vena cava and thereby return to the fluid as a component of whole blood to the heart.

THE LYMPH NODE

Lymph travels through the lymphatic vessels to nodes where a sort of ‘percolation’ takes place. Think of a coffeepot. It has a hole in the top to dump a good deal of fluid into. For our conversation here this is analogous to the lymph coming in the afferent ducts of the lymph node from the periphery. The coffeepot has a chamber wherein the fluid is slowed down and altered. This represents the node. Inside the node the fluid will be surveyed for potential situations that will require an immune response. Fluid leaves through a very small opening and continues in the same direction onto its next fate. The fluid may pass through multiple nodes before reentering the blood plasma at the subclavian veins. Lymph nodes function specifically to:

  • Filter and purify the lymph
  • Capture and destroy toxins
  • Concentrate lymph
  • Produce lymphocytes (which increases as flow through the node increases)

FUNCTIONAL INTEGRATION OF THE SYSTEMS

So, the circulatory cycle begins with a nutrient and oxygen rich phase that brings these elements to the tissues (the ‘red’ phase). At the smallest level of the single celled vessel, the capillary allows for exchange (the ‘clear phase’). Most of the waste and carbon dioxide is carried back to the heart through the venous system (the ‘blue’ phase). A small amount of tissue fluid (‘clear phase’) is carried into the lymphatic system where it acts as a biological sample for surveillance of the status and needs of the body before returning to the veins just before they enter the heart.