Is Bare Better?...

This morning, for some strange reason, I woke up thinking about shoes. I wandered into my closet, curious about the number I had accumulated over the years and was astonished to find thirty-two pairs. How the heck did so many shoes get into my closet?!

Americans love their shoes, as do most societies where fashion trumps practicality. Do we really need so many shoes? Women are the worst culprits. It’s a luxury to have a vast selection to choose from and fashion forbids us from pairing the wrong shoes with our outfits. Think of the anarchy that would ensue should we pick strappy sandals over pumps. Oh, the humanity!!

But shoes didn’t start out as tools of fashion. The shoe evolved out of sheer necessity.

Try to imagine venturing cross-country with nothing between your feet and the torturous ground on which you tread. Rocky outcrops, razor-like switch grass, not to mention the temperature extremes of blazing deserts and icy tundra, would be pure hell. I’m guessing our clever ancestors took to shodding their feet soon after they discovered the benefits of clothing. If you can protect your torso by wrapping it in hides, why not your feet? They were no dummies, our ancestors…

One of the oldest shoes was found a few years ago, tucked inside an Armenian cave. Dated to over fifty-five hundred years ago, this leather moccasin was made from cowhide and laced with a leather cord. It had the good fortune of being buried beneath a dense layer of sheep dung, thus the exceptional preservation, but footwear goes back much further in human history.

One of the earliest forms of shoes appears to be the sandal, which is not surprising, considering its basic design. Ten-thousand-year-old sandals have been recovered from Fort Rock Cave in central Oregon, proving again what excellent preservation caves afford.

Curious sidenote: Do we find these ancient shoes in caves because people happened to be living there, or were caves the precursors to today’s walk-in closets? Something to think about.

But back to the Fort Rock sandals. They ranged in size from adult to child and showed the wear and tear of countless miles, some still sporting the mud from prehistoric landscapes. Some even held the imprint of its owner’s foot: faint impressions of a hunter who traipsed through the Oregon woods in search of game.

And speaking of feet, some of our evidence for shoes comes directly from studying the feet of our ancestors. Scientists have noted changes in the bones of our feet that may have occurred secondary to adopting footwear, possibly going back forty thousand years. Even today, shoes are reshaping our feet. Unfortunately, many of these changes are detrimental. In fact, for all the protection shoes can afford, many of the styles we sport come with repercussions.

Some evolutionists believe shoes have actually made our feet less healthy. The excellent support afforded by cushioned soles may feel luxurious, but can actually lead to weakened arches and flat feet. Thick soles also cause diminished sensation between foot and ground, which means lack of communication between foot and brain, putting you at risk for missteps and stumbles. And don’t even get me started on high heels. Yes, those stilettos may look sexy, but they’re doing your body no favors. Stress fractures, bunions, and hammertoes are just the beginning of chronic problems associated with high heels, not to mention back strain and deformation of your calf muscles, which actually become shortened with excessive wear.

While high heels present problems, so do their counterparts, the flats. Ballet flats, which are all the rage, provide little to no shock absorption; a real problem especially for those flat-footed individuals. They can also cause tendonitis and heel pain and provide scant protection against bottle tops and broken glass. But one of the biggest culprits is the flip-flop. Here in my home state of Florida, flip-flops are as prevalent as retirees (and frequently found in unison). The flip-flop is the next best thing to being barefooted, which is great for those sunbaked beaches, but provides little protection in the real world. Most are too thin and they leave the foot exposed to environmental hazards - such as that friend who chooses the stilettos -  and, let’s face it, they fall short of attractive.

So the next time you reach for a pair of shoes, choose wisely. Select your shoes as you would select a mate: something that’s well made, practical but stylish, and most important, the perfect fit.

  

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A Brainy New Year!

Now that 2014 has drawn to a close and we look ahead to the coming year, it is time to partake in that tried and true tradition of all wishful thinkers, the New Year’s Resolution. Let me guess: you’re intent on losing those extra pounds (even though you probably started accumulating them back in 2010); you’re going to dig out those musty workout clothes and force yourself to the gym (if you could only remember how to get there); and you swear to give up at least one of your vices, whether it be cigarettes, junk food, or as in my case, gin.

The New Year is a time for reflection. We look back over the past twelve months, at the changes in our lives (or lack thereof), and the swiftness with which each year passes, anticipating what lies ahead as the year unfolds before us. It can be a scary time.

Let’s face it, the older we get, the shorter our future becomes. The horizon, which seemed so far off as we cruised through adolescence, suddenly looms large before us as we find ourselves cresting the onrushing midlife wave. And with each passing December, with each approach of the New Year, we grow more aware of the “tick-tock” of Father Time.

I happen to love the New Year. To me, it signifies a fresh start, new beginnings, and the opportunity to set new goals. I know that spring is just around the corner, putting an end to the winter doldrums which, here in Florida, last for an excruciating week and a half). But all this anticipation got me thinking about that one crucial commodity for planning ahead: optimism.

Optimism is a vital mental tool, one that can not only make us feel better, but can actually improve our health. Some evolutionists believe a tendency toward optimism – what they term the “optimism bias” – is hard-wired into our brains and was integral to the dramatic cultural transformations that have taken place among humans over the past fifty thousand years. In that short span of time (geologically speaking), we have gone from artless, illiterate hunter-gatherers to beings that communicate on a global scale, create masterful works of art, and traverse the cosmos. And how could we have achieved any of this without a strong dose of optimism?

The optimism bias is universal among humans, but can vary depending on our individual wiring. Even though our brains are constructed as two mirrored halves (bilaterally symmetrical), many of our skills, such as language and handedness, are controlled by a designated half. This brainy asymmetry allows us to perform many tasks at once. And when it comes to optimism, it is the left hemisphere - or “left brain” in neuro slang - that takes the lead. 

This “lateralization” of optimistic behavior is expressed in the way we think, feel, behave, and even plan for future events. We’re all familiar with the “glass half-full-half-empty” analogy. Optimistic folks tend to focus on the positive, usually ignoring or minimizing anything that threatens to quash their rosy outlook. Pessimists (those "right brainers") do the opposite: their “half-empty” mentality tends to lead them down the gloomy paths of worry and doubt. These opposing life views have even been tested experimentally. Optimists will spend less time focusing on negative visual stimuli than their pessimistic counterparts, who not only spend more time focusing on the negative, but also tend to take greater cues from negative stimuli in their environment.

That’s not to say that pessimism should be eliminated. It serves a vital role in keeping our overly optimistic tendencies in check. Can you imagine the havoc that would ensue if we failed to anticipate setbacks, accidents, or illness? Unbridled optimism could result in financial hardship, traumatic injuries, or debilitating illness if we ignored the necessities of savings accounts, seatbelts, and preventive medicine. A little bit of pessimism goes a long way.

So as you enter the coming months and tackle your resolutions, strike a balance between your brainy halves. Approach the New Year with the utmost optimism, but temper it with a small dose of pessimism. Perhaps you will finally lose that weight, or become a model of fitness, or finally shake that vice. But if you don’t succeed, at least take comfort in the fact that you are making an effort. And remember, the key to optimism is that vital, life-sustaining force: hope.

Happy New Year!

Sir Isaac Newton, Trauma Junkie?

Lately, I’ve been dreaming about trauma. In my spare time, I’ve been doing ride-alongs with Aircare, the EMS helicopter based out of Orlando’s level 1 trauma center, just to get a taste of my former life as a paramedic. (Does it make me a bad person to wish for a critically injured patient?) You could say I've had trauma on the brain.

To me, trauma is the most exciting realm of emergency medicine. Traumatic injuries can result from a variety of scenarios, from crashes to falls to shootings and stabbings. But they all have one thing in common: physics. Let’s explore.

We’ll begin with a quick trip back in time… It’s the mid-1600s and a less-than-stellar student named Isaac Newton is attending Cambridge University in England. We’ve all heard the story: he’s reclining under an apple tree when suddenly, out of the blue, he is bonked on the head by an errant piece of fruit. The blow to his noggin results in his epiphany that gravity exists, that it can help explain the motion of planets, and that, if an object has enough mass, it can do serious damage to one’s head.

OK, I made that last bit up. In fact, the whole story is fairly bogus. Yes, young Newton supposedly observed an apple fall to the ground (no mention of head injury), which may have triggered contemplation of the moon’s orbit. However, it took him years of study, informed by the works of Descartes, Galileo and Kepler, to develop what would become some of the most important and impactful discoveries of motion and light.

So what does any of this have to do with traumatic injury? A lot, it turns out.

It wasn’t so much Newton’s theories on light and gravity that would influence trauma medicine some four hundred years later (although anyone who has taken a tumble knows the inherent drawbacks of gravity). It was his later work on motion, which he handily summarized in three laws, that would elucidate the drama of trauma and its devastating effects on the body. Since you’re probably not interested in the mathematics behind Newton’s laws and the thought of explaining quantum mechanics is enough to send me screaming, we’ll simply explore the basics of the three axioms and how they relate to the treatment of trauma patients.

Law number one: A body in motion remains in motion unless acted upon by an outside force. Say you’re driving along one night when suddenly you veer off the road and strike a tree. In compliance with Newton’s first law, if you were travelling fifty miles per hour, so were your internal organs. Your car strikes the tree, your body, if unrestrained, then strikes the steering wheel, and your internal organs slam against the confines of your body (brain against skull, heart against ribs - you get the picture). Each impact has consequences for the body’s tissues. This is why seatbelts are so important. Seatbelts provide a mechanism for keeping you from impacting the inside of the vehicle when it is brought to a sudden stop. Yes, seatbelts can do their own damage at high speeds, but I’d take a seatbelt injury over a steering wheel to the chest any day.

Law two: The force on an object is equal to its mass times its acceleration. Think about our collision—car vs. tree. The heavier the vehicle (more mass), and the faster it is moving (acceleration), the greater the impact when it strikes an object; especially if that object is also massive (say, an oak tree). Which leads us to the third law.

Law three: To every action, there is an equal and opposite reaction. Once again, in our collision we were travelling fifty miles per hour, which means that the tree we struck will push back with the equivalent force of fifty miles per hour of speed. Thus the motto, “Speed kills.” How much better off we would have been had we been putting along at a snail’s pace. High speed impacts have devastating effects on the body. The breaking of bones, the shearing of vessels, and the subsequent bleeding that results from these injuries make trauma patients some of the most complex to manage, since any - and many! - body systems can be involved.

Thanks to Newton, we can make predictions as to the types of injuries that will result from traumatic events. Whether it’s an auto accident, a shooting, or a fall, if we know the speed of the vehicle, the caliber and velocity of the bullet, or the height of the fall, we can infer the potential damage inflicted upon the body. Thus, the “mechanism of injury” is one of the fundamentals of trauma assessment and it all originates with the genius of Newton.

Could Newton have imagined the impact his work would have on trauma medicine? Perhaps… The 17th century was a period of dramatic discoveries in science and medicine. The year 1628 saw the publication of Harvey’s An Anatomical Study of the Motion of the Heart and of the Blood in Animals, which detailed his groundbreaking work on the cardiovascular system (although he scores no points for brevity of title); Frenchman Jean-Baptiste Denis and others were tinkering with blood transfusions and slowly refining their techniques - dog to human simply didn’t work. And Leeuwenhoek would perfect the microscope, under which he would discover blood cells and microorganisms (along with the creepy-crawlers inhabiting his own dental plaque). In this climate, it would seem natural for Newton to appreciate the impact (no pun intended) of his laws on medicine.

And if he actually was hit on the head with an apple, surely he could envision the carnage, had that apple instead been a cannonball.

Thanks for reading and don't forget to share!

Here's an absolutely ridiculous video about mechanism of injury, in case you have some time to kill...

Thirteen Years...

The sun has lost its outline

As I wash the weary skies

The quarter moon ascends the slope

Where on its back it lies

Among the woods the cedar pines

Begin their sweet release

And buried in their needled brow

I’ve come to find my peace.