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Integral Anatomy Artwork
Season 2 - Episode 6

Visceral Movements

30 min - Talk
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In this video, Gil looks at different types of adhesions, discusses their possible causes, and the effects they have on the viscera.

This video was filmed and produced by Gil Hedley. It includes videos and photos of dissections of cadavers (embalmed human donors). You can visit his website for more information about his workshops.

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Jan 19, 2021
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So, here we're going in a differential movement by a fluid's true gliding. Okay, this is the hockey puck on ice with the water. This is the glass slip with the drop of oil on the glass slide. True gliding. Okay, we're in the chest, we've made our windows in the chest wall of an unfixed body, and it's gliding along.

Look at the way the lung glides on the rib cage. It glides. That's true gliding. That's a fluid interface, it's adhering to it, but you can't just... And look at this.

This is a differential movement. You see that? Yeah. Okay, keep open between the ribs there, and you'll see a differential movement between the lobes of the lungs. Why?

Because as the lung inflates, it's just a spirotic movement of the lung. It twists on itself, and so it has to glide on itself. Simultaneous to gliding along the rib cage, it glides on itself at the lobular interfaces. Isn't that cool? Yeah.

These are beautiful half-lungs. I mean, they were. Look at the displacement of the liver. Every inflation of the lung moves the liver. The liver then displaces the other viscera, right?

And you have a general, repeated 20,000 times a day excursion of all your viscera based on your breath cycle. It's quite a magnificent dance going on. Wonderfully, in this same room, we had two forms, both unfixed, on one table, this healthy gliding lung, and on the other table, they had lung cancer from smoking. So we inflated those lungs, too, and saw them to have emphysema. Okay, that's the bubbles.

Emphysema means blown up. It's a Greek word. You can read it in the New Testament. Jesus walked into the upper room after the resurrection and found the disciples hiding in fear, and he addressed them, he said, peace be with you, and then he says, and he enthused them. He blew them up.

He blew on them. He said, restate the Holy Spirit, these are blown up. The parent kind of the lung is gone. There's no recoil. You can't expel the air when you have emphysema.

So it's kind of like this. My lungs are filled, and I breathe on top of that. That's emphysema. It's not that you can't get the oxygen, and you've got to work for it, and you can't get the carbon dioxide out. You can't get the carbon dioxide that goes up, C-O-D.

Anyway, watch these lungs breathe, quite different than the other ones. It's like a knuckleball. Look. We don't have differential movement between the lobes of the lungs because they're fuzzed over. Right?

The disease process has resulted in inflammation, which has resulted in adhesion, sticking of surfaces that once collided are now bound to one another, they're fuzzed over. Blows up like a knuckleball now, right? There's no spin. No more spin. No more glide.

Cigarette? I won't even tell you not to smoke. Okay, and I'm the last guy to tell you what to do. My uncle, he was a very nice schizophrenic, his only pleasure in life was smoking. I'm the last person to tell him not to smoke.

So this is raised lung, so you can see that the visceral core is adhering to the parietal core. It's like a bandit adhesion, and what I notice, again, like I say in a fuzz speech, I can see time in the fuzz. I was referencing visceral adhesions, where it's kind of cool. You could see like, oh, there's something about going, it generated a general stillness, and then you start getting trabeculae growing in there that represent like follow-on adhesions. Right?

It's progressive. Stillness begets stillness, movement begets movement. This is what I was basing that insight on, and you can see time lapse things, right? And then you can start, and if you do, you can see snapshots and recognize that something is in a stage of a cycle. You see, oh, you never see the sky.

I was going to say, you see the planes going over, right, and they leave a little white cloud behind them, and if you stare at it for a while, often you'll see little pendules drop off of them, and then you see kind of spreading, you may see ten of them in a row, and all spread together in this big smear of a cirrus cloud that's not a cloud born of the Earth's things, but born of the airplanes, right? And after a while, if you get used to looking at the sky in such a place, then you're like, oh, it's like a four-hour-old airplane cloud, that's not a regular cloud, right? It's the same thing here. I'm looking at an ex-many-year-old adhesion followed with other adhesions. Here's Flo's chest.

This was amazing. So, okay, I've torn the pleura, I'm dissecting a chest wall, the lung has dropped down, and I've created a space where there was only a potential space, right? It's the lung that normally be adhering to the chest wall by the fluid, but the system is operating now, so the lung has collapsed and dropped down. And the pleura, don't touch each other, there are two of them, right, and so that creates a channel at the chest wall. I can poke my finger in between the pleura on the right and the pleura on the left and create a channel in between.

And then that's normal anatomy, that there would be fuzzy yellow stuff between the mediastinal structures and the chest wall, it's predictable anatomy. Now, I'm tearing the pleura on this mediastinal aspect because I'm just making the dissection keep going, right, and I want to do the whole thing, but I get over here and I'm like, huh? I already tore the pleura, what's going on over here? I push, push, shove, shove, I've got to look out my scalpel, I'm going to get through it with my hand. I've got to get a knife and I've got to cut this lung off the chest wall.

That's kind of weird, huh? I mean, it's a gliding surface, right? And I need a knife to get them apart? What's the deal there? And look at the force that I have to use with my hand to pry that lung off of the chest wall.

This particular lung is in here and over 100% of the surface. How about that's weird? Since when do you have to pry the lung off the chest wall? It should just be flopped down like that other side, right? Because it's a gliding surface.

Look, I cut the chest wall, look up in a couple of there, glue. It's gummed up, it's fuzzed over, right? The entire apex of the lung is stuck to the couple of the thoracic space. And I had to pry everything apart. I go on the papay as a point of contrast, the lung on the other side, and you can see it's three edges, right?

That's the normal presentation of a lung being dissected. And this little banded adhesion was maybe a place of a problem, given the fact that the other lung was completely adhered. But it does represent the same kind of adhesion you saw in Ray's chest wall. I pop it and now the whole thing is three, and that was that. But over here I go back and I have to pry the visceral floor from the made of style floor because they're glued together completely.

How is that lung going to move? A little different, right? It's going to glide, it's going to glide at all. No more gliding surfaces. But I'm going to glide with glue.

I've got to glue the lung. I had to pry the whole thing off. I had to pry it off with a diaphragm. And of course he's gotten curious and all in all like, how's that? What's the deal with that?

Like a completely progressive adhesion that overtakes the entire organ. My best friend from high school, one who I was playing on a universal machine with, he owns a lot like this. Now we're on up and we just got to stow on this. But he's a critical care pulmonologist. I called him up, I said, hey, Rich, I have this case in the lab where the lung is adherent to over 100% of the skin.

Got any insights on that? I'm curious about that. He said, well, we have a procedure. I was like, whoa, tell me that. So the procedure is when you have a patient whose lung keeps collapsing repeatedly, you can inject talcum powder in between the visceral and parietal pleura, reinflate the lung, it will be completely inflamed, and the pleura will stick to the pleura.

And it won't collapse anymore. But here, because inflammation leads to, and dehydration, the talc, leads to stickiness. So that was intended, or this could be an instance of that. There are other ways that this could happen, it turns out. But I thought this was most likely that.

And you can see, again, when the braces implant loses 10% of your breath, the client 30% might sacrifice that. So maybe she was like, hey, this really hurts, and I can't stand it anymore. So this is a therapy that's offered, and then the person makes a choice. Yes, do this to me. I know that my lung won't be stuck forever, but at least it won't collapse.

It can collapse. Lungs and little old ladies really hurts. It hurts the young people, too. I had a fellow sitting in the chair right about there two talks ago, and he said that was happening to me, too. This is a young man, like a yoga dude, right?

And it must have been a yoga dude. It must have been a yoga dude, because he had a really cool beard. So he, to me, had some. He was really sweet, but he had this problem of repeatedly collapsing lung, and they offered him the therapy of the taup injection. And he refused it, because he looked into that and learned that it was carcinogenic, and he didn't really want to endure that.

So maybe if you're young, you don't want to do that. Maybe if you're very old, it's, you know, 60, 100,000 or the other, and you get cancer in 20 years, and you're 80, chances are, right? So he rejected that, but he asked them instead to abrade the surface. Smart thing. Abrade the surface, the interior surface of the lung.

So they scratched it all up and made it loose, and then they inflated it as long as it stuck to that, and it doesn't collapse anymore. So he has an adherent lung, but he's not at risk of cancer because of it. Smart thing. So I had another lady, and of course several times, who had this problem also, a young person with repeated collapse when she had a period of her lungs collapsed. It was like a syndrome.

It was like 24 people on Earth who had the syndrome, and this poor lady had the syndrome. Great suffering, you can imagine. And she was offered the taup injection. She didn't want to do it as a young, young person and didn't want her lungs stuck. And so she's worked with food and all kinds of stuff to try and change her hormone system to make her lung stuff cause.

Which one's success, by the way? Good for her. These are Flo's lungs being inflated now. They were outstandingly beautiful. You have to blow them up after they've been stuck all that time.

And look at how they pinked up. They actually pinked up. And they're so beautiful to me, the way that they lift her heart. You see how the inflation of the lung actually lifts the heart? See?

What is the heart? If not the organ that infiltrates every cell of your body, what is the shape of the heart if not the shape of your body? And the lungs being only the wings of your heart. And they beat with every inhalation and exhalation and lift you up. Beautiful.

Again, with every inflation of the lung, the liver will be displaced in a particular excursion path. Based on its ligamentous relationships. So see, the liver will move you more dramatically if the chest wall were in place, right? But it's not. And so we still see some movement in the liver in response to the inflation of the lung, the movement of the heart center there.

But the liver has a coronary ligament here. And it's in relationship to the diaphragm of the right amount of triangular ligaments. And that creates an axis, an axis of movement for the liver based on its coronary and right amount of triangular ligaments. So it turns like this. But then with each inflation it's displaced footward, right?

And it follows the path of this ligament, the falsiform and the round ligament, towards the navel. So the liver is rotating on its axis, dropping down and rolling towards your belly button basically. With every breath, inhale, and then with exhale, right, it rolls laterally, same axis, but backwards and rises up and tucks back under the ribcage. That's the normal excursion pattern of the liver. It flows the liver at a beautiful gliding surface there, according to which it would have moved as I'm describing.

This liver would not move, as I was describing, right? Because if you have an anchor point on the lower margin of the liver, now when the lungs inflate, the liver is trying to roll forward but it's caught up on a hitch. So it's not going to roll forward. It's going to maybe be displaced like a knuckleball straight down and maybe it's going to tip right or it's going to tip left based on where along the margin of the liver we find the adhesion. Now skilled visceral therapists could palpate for the normal excursion and variations on the excursion of the normal liver and also palpate these kind of distorted movements.

That is the same as palpating that scar on the leg. Now you've spotted the thing. You've seen the axis point around which the thing is turning, which isn't the predicted one, and then you can play with that and see if you can invite vectors of movement through that space that will maybe melt that adhesion over time because, again, 20,000 times a day you have lots of opportunities once you've introduced a movement for that movement to increase in its range until the body will dissolve something that it doesn't need anymore. So it can't necessarily retreat from our wounds. And again, that represents a healing event in its own way.

You see, these agglomerative processes that are happening in our bodies, this is a treasure. We can look at it and say, oh my gosh, this bad thing is happening to me. I go to sleep and eight hours later I'm more stuck than I was when I laid down. I sat in a chair for four hours and I feel more stiff than I did when I started. But this is actually, you have like a lawyer on retainer in your body.

In other words, the process that affects the wound closure and the healing and this is times of difficulty, that process is always present to you. And in order to keep it in check or in balance, to keep from healing you so much that you're turned into a block of wood, you've got to keep moving. But we don't want to consider it a bad asset. It's an asset. Do you understand that?

It's a healing principle in our body that's always with us and in order to not let it get the best of us, we keep going. Flo's liver was actually adherent but all along the margin of the liver where her greater omentum was stuck to it and she had very many abdominal surgeries. I'll show them to you in a minute. First of all, look at Ray's belly. This is day five, folks.

You do object to advertising of fresh tissue dissection because you take it out of the fridge, it didn't crush anyone. So I like to say fixed or unfixed. It describes the state of the embalming. It also describes its movement potential. The unfixed body actually moves too much.

You see, you can take grandma's arms and toss them over her head. She might not have been able to do that. No, no, no. No, not past here. It hurts. But she ain't complaining afterwards, right?

All the muscles have gone flaccid. There's no emotional resistance. You can break through adhesions that she doesn't even feel. So the unfixed body is hypermobile. The fixed body is not mobile.

The truth is somewhere in between. He had no adhesions into this hearing. They were quite beautiful. So I was moving them about and showing you the gliding properties of the intestines. As I gather the loops of the mesotary, you can see the loops of the intestines themselves just gliding, slipping, sliding along each other with their spheres, fluid coating.

There's a vacuum packed in there, folks. There's no space, right? We have still continuity in the viscera, but the viscera are different, right? So we have this embryo folding and balling up and then folding in on itself, right? And as these movements take place, right, and then the viscera turn and form, and they kind of blossom, right?

They have a common wound. It's the same plant, right? But there are pearl elongations that then kind of rub against each other. In this case, it's fascia, fluid fascia instead of fascia, fascia, fascia, like you have in the musculoskeletal system. Here you got fascia, fascia, fascia.

Here you have fascia, fluid fascia. But they're continuous still, and that fluid in between them is alive, and it's you, okay? It's not some dead stuff. The fascia is alive. The fluid is alive.

You're alive. Isn't this awesome? I hear this strange distinction being made sometimes, like, well, the fascia is inert and dead. I'm like, what are you talking about? My fascia isn't dead.

You're not being dead by my fascia. I don't feel it. Here's Flo's ascending colon covered in the fluid. We're not talking about gallons of fluid in here, folks. We're talking about a serous membrane, the coating of the organ with a mesophilia layer that kind of oozes grace, but then becomes an adhesion point, like the drop of oil between the glass foot and the glass slide, allowing these organs to be continuous and moving differential, gliding on each other.

Here are Flo's small intestines. I'm running the bowel. That means I'm kind of tracing through the pathway of the intestine just to observe them. What's she got going on there? Anything?

You know, this is what all surgeons do, this is an abdominal surgery. You kind of run the bowel, and I do it in the dissections too, and I find stuff when I do it, like here, okay? These loops of the intestine are stuck to each other. That's strange. Why are they stuck to each other?

I dig a little further. Turns out the leads of the mesentery are stuck to each other because a tumor has grown in between them and stuck them together. Tumors can stick things. Growth. And the adhesions are alive, okay?

They have vasculature. They have innervation, and they grow. So you can see right down below. Look, is it filming fascia? It's like fishing roo filming fascia, right?

We have cotton candy and membrane connecting loops of the intestine that would normally be gliding surfaces. Can you see how confusing dissection is? When you see tissues like that here, and they represent, right, what has gone wild, and the very same tissue is what's permitting movement in the musculoskeletal system. Here I found another adhesion. This time it was stiches.

Stiches and staples. Leads of the mesentery, they were stitched and stapled together. Why would that be? I kind of guessed that surgeons were there before me because they had already taken a tumor out, probably. I don't get the people's medical records.

I just guess based on the footprints I see in the body. So flow had quite a few, right, different types of adhesions, whether in a thorax or an adenine, demonstrating all the different ways that things can stick to each other inside of a gut. As a demonstration, right, of agglomeration as a sequelae of inflammation, do we become inflamed also in our musculoskeletal tissues? Yes. Do we become agglomerated in our musculoskeletal tissues?

I'm not going to say, well, I don't think so. But we're not going to be able to say that definitively as what was going on in a given body during dissection. You have to do that with the histology. You have to do that with biochemistry. I can't see that in growth dissection.

All I see is fuzz where fuzz belongs. I can't tell you it's too much fuzz or not enough fuzz. I've got to look at function for that. I've got to know whether you used to be, I'll put the macaroni on the third shelf, and then I can put it on the first shelf. And when I see that limitation, then I can add to my series of questions about it, is there agglomeration there?

It doesn't have to be that, but it can be that. Just another thing in your toolkit. Oh, bunny. Have you ever had a bunny get hit by a car, walk up on your front lawn, and die? I have.

What kind of a bunny? Isn't that sweet? When you walk up on my front lawn, probably one of them, I've got a brick courtyard in my backyard. Yeah, I don't know what kind of a brick. Ah, excuse me.

So, the bunny. Okay, the story of the bunny. The bunny did walk up on my front lawn, died, and being a homeschool dad, I was like, Sarah, cut a cookie sheet, and the camera, it's a lesson. So if you're about to cut your cookie sheet, you're in the camera and die sick of the bunny. And I showed, too.

I guess I talked about bunnies there earlier, right? And I want to show you by point of comparison. You saw inside Flo's belly? There was one, yellow, right? Pretty yellow.

That was completely normal. Hopefully your bellies look like that on the inside. Not so stuck, maybe, but yellow, fatty, mesentery, mesocolin, transverse mesocolin, fatty appendages along your column. This is all normal, healthy tissue. Flo, we call her Flo, because she had a very flowing, superficial fashion.

Well, once it was removed, she had a belly just like Mr. Boutley's. It was concave. She didn't have any fatty accumulation in her abdomen that was presenting, and yet we saw all that fatty tissue in her abdomen. That's normal human presentation. Don't be thinking, I shouldn't have any fat in my body, right?

No, we have fat. It's our function. It's our endocrine system. It's our lymphatic system. It's our metabolism.

It's our health. But bunnies have a very different emotional life. Here's the bunnies' mesentery. We don't see any fatty deposition there. Instead, we see the peritoneum, like soap bubbles, on the arcades of vasculature that constitute the mesenteric fabric running out to the loops of the intestines.

It's quite beautiful and quite a sharp contrast to our human form. And we see this same pattern repeated in the bunnies' uterus, actually. A little bunny was a momma bunny. She was going to have five baby bunnies. And they were really cute bunnies.

I was like midwife to a dead bunny. And pretty nice thighs, too. She got none of it. Okay, I was like, no, you can't have the bunny. That's my bunny.

So I gave her a cow bone. She's going to eat it. It's too big. I want the bunny. No.

Stupid dog. Her name is Luna. Flo's heart, unlike her abdominal, or her lumbar was not adhered. It was just fluid and beautiful heart as you could possibly find. And you can see, as I touch it, you can see the differential movement of the heart under the...

You can see through the membranes, right? If I grab it with my hands down, try and pull up. See how it's adhering? There's no space there. I have to cut it to make a space.

Now the air gets in. Right now, the fluids have de-adhered, right? That's like a long glass. Boom. There's air in there now.

It's infiltrated into the potential space. It's like sardines packing on out. I find that the deeper I go into the body, the more deeply I'm touched in the process. I consider it an extraordinary honor and responsibility to hold another human being's heart in one hand, even if that human being's passed on and left their shell behind. That shell itself was precious and moving.

You enter your relationship with that and feel your own heart move in response. And this heart in particular kind of shook me. It was so perfect and so fluid and such a beautiful representation of the place where the blood refreshes its movement. And I'm using the mechanical metaphor, right? I like to think about a movement model for the heart rather than a pump.

Maybe instead it's the place where the skin is refreshed on the blood. And maybe the most vital aspect of what the heart does is its refreshment of the blood's laminar vortex rather than pushing. It's not pushing. Your blood's sucked to the perfect angle, sucked back to the center, sucked to the periphery, sucked to the center. If it were pushing it, it'd have to be much bigger.

So it was quite precious to hold. And three, completely three, smoothness. Yes, sir. Got Bay's heart. He had had a triple bypass.

So we can see all these adhesions between the visceral pericardium and the paracardium. These are staples. So in the heart surgeries, the membranes are opened and sometimes just stapled back onto the surface of the heart without being closed. And these processes, again, if the heart is a pump, then you're replacing the pipes. You're not too much worried about these sorts of things, right?

But if the heart is the place where the blood spins and refreshes its motion and you've done something, it's going to generate a straitjacket on it in the next many years. It's a different, right? Again, the model that you bring to it is going to affect your behavior if you brought a movement model to the heart. You might do your surgery a little bit differently, right? You might work with the patient a little bit differently in a way that would minimize the straitjacketing effect of adhesion on that prepared pump.

All right. I love fair enough stuff. I feel very rewarded. This was a cool situation here because we had an unfixed heart like close, but it had just one adhesion. And I thought a lot about this as we play with it again and we play with the stuff when we find it and explore what's its range of motion.

That's the play, right? So what happens to the heart's movement if it's holding hands with the side of the space that it's in? It now has an axis of motion that wasn't normal to it when it was completely free to do its little dance, right? So now it's stuck here and it's going to change the dance. It's going to change the way that it spins the blood, isn't it?

It can't spin the blood exactly the same way or in its dynamic or variable way. If I look to the other side of it, after copying that adhesion, look down by the pulmonary veins. I'm checking, sure enough, there's cotton candy growing in there. That's what I mean by one still point leads to another. You get that one banded adhesion that leads to kind of cotton candy and the trabecular formations on the opposite side of that axis of motion that's been created.

So rules of thumb, folks. Melt them, don't pop them. By melt, I mean soften, introduce vectors of movement to invite range of motion rather than provoking and tearing because you think something doesn't belong there. Remember, compensations have their place, right? And if you just pop that adhesions, you're just going to get more adhesions, right?

So you're going to create information and it's going to repeat the cycle.


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