Respectful Insolence

What a wonderful gift for Christmas

This one’s too good for me to ignore even on vacation. It’s the perfect gift for the skeptical.

Remember the Friday Dose of Woo in which I had a little fun with the whole concept of trepanning (drilling a hole in your head to “improve blood flow”)? Well guess what?

The trepanation guy (Randall W. Haws) has shown up right here in the comments of that post. And he thinks that I (and those of you who chimed in) are truly, truly misguided, not to mention hypocrites. He’s also pointing out how he is “free” and we’re all still “imprisoned.”

I can’t think of a better blog Christmas present. Well, OK, winning the 2006 Weblog Award for Best Medical/Health Issues Blog was better, but this is getting close. It’s certainly worth a mention even while on vacation on Christmas Eve!

Comments

  1. #1 wrg
    December 24, 2006

    I took a look and thought about responding to those comments, but it’s such a masterpiece of magical thinking that my crude hand could only sully it. He knows what he knows to be true because he knows it to be true! What a shame that we are too medicated and infiltrated to understand that with our unevolved minds.

  2. #2 notmercury
    December 24, 2006

    Oh Holey Knight

  3. #3 T. Bruce McNeely
    December 24, 2006

    You need this gift like a hole in the head.

    Had to be said…

  4. #4 familydoc
    December 25, 2006

    I need to include more holistic medicine in my practice………..

  5. #5 James Bowery
    December 31, 2006

    You say that brain metabolism drives blood flow, not the other way around, so how do you explain the double blind studies showing ginkgo, a vasodilator, significantly improves short term memory within the first hour of administration (the time during which perfusion would be increased by ginko)?

    If you’re going to go after cranks, you shouldn’t be one.

  6. #6 Randall W. Haws
    January 1, 2007

    Geez… you guys can’t take your own medicine can you? Thought you would like a nice sarcastic chime in from the guy who actually had a hole drilled in his head… As you have obviously interpreted.

    And James, you are on track with temporary increases of blood volume (including simultaneous decrease of CSF) in the brain via many methods such as Yoga, LSD, Herbs, etc. But what I have achieved is now a lifetime of elevated brain metabolism (back to what was originally intended before we began walking upright) via increased blood volume in my brain.

    Hence, my so called longing for that ‘feeling’ of calm, warmness and maximum fulfillment (or a ‘high) has been satisfied in one 15 minute procedure… whereas others often ruin their brain, body, emotions and energy with continual addictive tendencies to reaching this ‘so called high’ with only temporary and quite destructive methods and substances (synthetic and pseudo natural) that only end up needing greater consumption and frequency of use. Does not seem to hard to choose the method that is right here does it?

    Also, this is brain blood volume we are talking about here, not blood flow… and not brain metabolism driving it. Slow down and read the report below on what ‘science’ has already recently proven by repeatable observation.

    SUBJECT FOR DISCUSSION
    Investigation of possible negative and positive influences of skull trepanation on the functioning of systems of intracranial hemodynamics and liquorodynamics

    The Principal Investigator:
    Prof. Yu. E. MOSKALENKO. D. Sci. Head of the Brain Circulatory Laboratory, I. Sechenov Institute of evolutionary physiology and biochemistry Russian Academy of Sciences, Sankt-Petersburg.

    SUBTANTIATION?

    In the majority of neurosurgical operations trephine openings are made and the hermeticity of the skull cannot always be promptly recovered. As the specific reasons to close the trephine opening are not always obvious, there are numerous patients with permanent skull openings without any signs of discomfort. However, skull hermeticity has long been regarded to be one of the main conditions of the normal functioning of the cerebral circulation system, which is now proving to be incorrect.

    Therefore it is of great interest to elucidate to what extent the partial absence of a minimum 14mm diameter piece of skull bone can influence the mechanism responsible for the circulatory-metabolic support of brain activity and cause the occult patient’s indisposition. In other words, it has yet to be understood to what extent the postoperative trephine hole could influence the functioning and interrelationships between the systems of intracranial hemodynamics and liquorodynamics, that is the basis of the mechanism of cerebral circulation and its compensatory and adaptive capabilities.

    Until the present time the problem of the significance of the skull trephine hole has not been given due attention. For a long period the problem had been addressed only by a few investigations (Klosovsky, 1951; Moskalenko, 1967; ITAG, Inc. 2000-2006) and then the changes of intracranial hemodynamics were experimentally analyzed only in relation to a rather small number of volunteers electively having skull trephination.

    Nowadays the interesting materials indicating close interdependence between intracranial hemodynamics and liquorodynamics were published ¬(Moskalenko et al, 1980; Rosenberg, 1994; Moskalenko et al., 2001, 2003). These materials indirectly indicate that skull trephination does make some measurable and significant changes in functioning of cerebral circulation system.

    To gain a reliable answer to the question about the role of skull trephination in mechanism of cerebral circulation it is necessary to carry out investigations for evaluation of the functional state and adaptive-compensatory possibilities of the systems of intracranial hemo- and liquorodynamics in the patients who have undergone an operation of skull trephination. Some questions, connected with detailed study of changes in local brain blood flow, local hydration of brain tissue and local oxygen availability closely related to trephination will be decided by chronic experiments with animals (rabbits) and eventually human subjects as approved through the Helsinki Agreement.

    METHODS?

    The investigation of the above-formulated problem was carried out on patients treated in a base of the Institute of Neurosurgery, using original methodical complex created in I. Sechenov Institute of evolutionary physiology and biochemistry, Russian Acad. Sci., and intended for evaluation of intracranial CSF mobility and peculiarities of interrelations of intracranial hemodynamics and liquorodynamics.

    The investigations consist of simultaneous registration of transcranial dopplerogram (TCDG) and rheoencephalogram (REG) and their following simultaneous processing by modern computer methods, as well as their routine analysis. The localization of REG electrodes (fronto-mastoidal or occipito-mastoidal) will depend on localization of the trephine hole, while the TCDG-probe will be focused on A. carotis interna or A. vertebralis, respectively.

    For evaluation of the peculiarities of functioning of the systems of intracranial hemo- and liquorodynamics the functional tests used was: hemodynamic tests (1 min. 7%CO2 inhalation, 30sec voluntary respiratory arrest) and liquorodynamic tests (Stookey and Valsalva maneuvers). It is to carry out two series of investigations for the comparison of the parameters registered before and after trepanation (on 1st, 2nd, 7th and 10th days), and the comparing of patients who have undergone trepanation with the control group of healthy persons. It will be necessary only to renew some blocks of instrumental complex.

    In chronic (long term) experiments with awaked animals with a special closable hole in the skull bone (modern modification of Dr. Klosovskii investigations), near which a number of fine wire electrodes have been implanted, changes in blood supply, hydration and oxygen metabolism just before opening, during opening and after closing of hole in skull bone, will be measured. In his experiments Klosovskii observed some movements within the skull which took place during opening of a hole in skull bone and which then disappeared when the hole was closed.

    He did not relate the movements to any physiological processes other than de-hermetization and an immediate re-equalization of cerebral blood flow and cerebral spinal fluid (brain water). The idea of these experiments is to record a number of physiological parameters, which show what is actually happening when opening a hole in the skull bone.

    For this purpose a 5mm diameter fistula was inserted into the trepanation hole in the skull bone. The fistula is then hermetically closed by a special cap, which is possible to remove and close again. During this opening and closing a number of physiological processes were recorded by wire electrodes that have been implanted into the brain tissue in advance.

    Such experiments make perfectly clear the measurable effect of de-hermetization of the skull by trepanation.

    The technology of such type of investigations were approved and have been used successfully used in the ongoing investigation.

    THE RESULTS OF THE INVESTIGATION?

    It is concluded that the materials which have been obtained reveal the character and degree of changes of parameters of intracranial hemodynamics and liquorodynamics, as well as the relationships between them, resulting from skull trephination.

    On the basis of these materials the results appear to solve the question – whether the hermetic skull recovering is of positive significance for mechanism of adequate brain blood supply and for the patient’s feeling, or it plays only protective and cosmetic role.

    It could not be excluded that under some anatomical-physiological skull peculiarities the trephination could play self-depending (independent) role for optimization of hemo- liquorodynamics. In this case one of the first aims is to determinate the indications for such operation and criteria for optimal localization and size of trephine hole.

    Further, the applying of manual-osteopathic techniques for optimization of interlinks between intracranial hemo- and liquorodynamics in the trepanned patients seems to be quite perspective and positive.

    There should be special attention to another significant indication that the vibro acoustic nature of the skull is changed after trephination.

    http://members.tripod.com/~quadrillo/VAT/e_jindrak-2.html

    http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16357902&query_hl=5&itool=pubmed_docsum

    May everyone have a prosperous new year… and when you get that next headache… think of me, the guy with a hole in his head, who has rid himself of headaches for the rest of his life. I’m certainly not thinking of you as you pop those gel caps or tablets to find some temporary relief.

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