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This Is MS Forums-viewtopic-Inclined Bed Therapy | Multiple Sclerosis Research, News, and Support Community
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Questions asked and answered about Inclined Bed Therapy
Feel free to ask a question and I will endevour to provide an answer
Andrew K Fletcher
"Frequently Asked Questions On I.B.T"
- Frequently Asked Questions On I.B.T | Inclined Bed Therapy (IBT) Discussion Forum (view on Google Sidewiki)
Thursday, April 15, 2010
Question regarding this dye that is used in the veins. Do you know if the molecular density or the chemicals and fluid used is identical to the blood density? Is it administered with saline solution?
I ask because it is entirely possible that the introduction of said fluids can affect the flow of blood in relation to posture should the density be either significantly higher or significantly lower than the blood in the veins where it is introduced.
I never did get any comments regarding this simple experiment showing how dissolved substances can change the pressures inside soft walled tubes?
One could presume that too much salt is added at the top of this experiment, designed to show how a downward flow assisted by gravity has a direct influence on the return flow pressures and causes the wall on the return flow (representing the venous return) to be clearly drawn in.
Before dismissing this out of hand, let us remember we are not dealing with tubes anywhere near as tough as this silicon tubing with it's 1mm wall. In fact the silicon tube more closely resembles the comparatively robust structures of the arteries.
With this taken into account, the veins in the body would require a comparatively minuscule amount of salt to induce the same narrowing shown on the video, when we alter our posture and make use of gravity acting on density changes in the blood from respiration.
Is it a coincidence that reflux is observed during exhalation?
Do we have any evidence that altering posture alters the shape of veins, not only temporarily but permanently providing we adhere to avoiding the horizontal posture?
The term Chronic cerebrospinal venous insufficiency or CCSVI has been borrowed as you well know from Chronic venous insufficiency in the legs. Varicose veins provide visual evidence of said conditions, both internally and externally.
You say you are a simple plumber of the arteries and veins and I understand your modesty with this respect and your reasoning for this statement.
Physics affords us the simple video model, which incidentally works also in a closed loop suspended vertically. ( I will do another video to show this)
People have argued that this vertically suspended tube experiment is too simple and therefore the shown forces cannot apply to the "simple plumbing" in the body?
I question their logic. One cannot have a different set of forces applying to the body's plumbing, it is after all a network of vertically suspended tubes.
Another argues we have a pump attached to our circulation. But the question as to why this impressive pressure and velocity in the outward flowing arteries is dampened down in the venous return. I.E. The veins do not normally inflate along with the arteries yet Starling's law of the heart using the familiar vessel connected to the heart to show a greater returned flow (venous return flow) uses the same simple tubular principles with a huge difference. We do not need to raise the vessel in the body to alter the return flow. The body does not have such a luxury, yet is capable of performing the same improved venous return flow by altering the arterial density with every breath exhaled.
Providing we are correctly aligned with our posture either on an angle or vertical, we can make use of these subtle positive arterial pressure changes and improvements in blood flow, not only in the predominantly downward flowing main arteries.
Here we have introduced not only an improved density flow in the arteries but we have made use of the molecular drag that affects every single fluid molecule in the body by causing an additional momentum (improved circulation) in the veins, without Starling's experiment. Alter the density and we inevitably alter the circulation and this inevitably alters the shape of the veins.
What evidence do we have to show that veins can learn to become normal veins given sufficient relief time from the direct pressure changes applied to them where no gravity assistance is applied to the said density changes from exhaling (Horizontal bedrest) ?
As it happens we have some very good examples right here in this forum, provided by Alun as photographic evidence showing how avoiding sleeping flat over many months has assisted his veins to return to more normal looking veins without the need for surgical intervention.
Thursday, April 08, 2010
A 67 years young lady with multiple sclerosis took part in a simple study to determine what would happen to her symptoms if she avoided sleeping flat for 1 year by raising the head of her bed to provide a five degree angle, sloping down from head to toe. This is known as Inclined Bed Therapy or IBT.
Her progress reports from Thisisms forum here: http://www.thisisms.com/
If it were just one person's experience it could be considered a coincidence
2-3 people with ms reporting these improvements may even be shrugged off as a placebo.
But 17 years of feedback, 2 previous pilot studies and now these reports from the final study, not only confirming those previous results but proving beyond any shadow of doubt that all circulation, including the circulation in the nervous system requires the constant pull of gravity from head to toe to not only maintain it and help prevent damage but to assist the body to repair the damage that occurs in multiple sclerosis and many other medical conditions.
Foreverspring's journey is quite remarkable and by no means an isolated case.
Tuesday, March 30, 2010
In a 1967 prospective study, Taylor and Weil tested the effectiveness of the Trendelenburg position in 6 hypotensive patients in clinical shock and 5 normotensive controls.3 In 9 of the 11 of patients, Trendelenburg positioning was ineffective, causing reductions in systolic, diastolic and mean arterial pressures. These authors noted that, in the head-down position, the viscera weigh down the diaphragm and compromise lung volumes. They also suggested that patients were at higher risk of cerebral edema, retinal detachment and brachial nerve paralysis.3
In 1994, Sing and colleagues4 assessed the impact of the Trendelenburg position on oxygen transport in 8 hypovolemic postoperative patients and found that it was associated with higher mean arterial blood pressure but not with improved cardiac output. Therefore, despite increases in blood pressure and left ventricle filling, there do not appear to be changes in tissue oxygenation during body tilting.4,5
In 1985, Bivins and coworkers6 studied the effect of the Trendelenburg position on blood distribution, finding that only 1.8% (99% confidence interval, -1.3% to 4.7%) of the total blood volume was displaced centrally when normovolemic patients were placed in the head-down position. They concluded that the autotransfusion effect produced by Trendelenburg positioning was small and unlikely to have an important clinical effect.6
Sibbald and cohorts investigated the effect of the Trendelenburg position on systemic and pulmonary hemodynamics in 76 critically ill patients (61 normotensive and 15 hypotensive) with acute cardiac illness or sepsis.7 In the normotensive group there was no change in pre-load or mean arterial pressure, but cardiac output increased slightly. In hypotensive patients there was no increase in preload or mean arterial pressure, but cardiac output decreased, suggesting that Trendelenburg positioning may be detrimental. These authors, like others, concluded that there were no demonstrable beneficial hemodynamic effects in hypotensive patients.1,3,7
1. Martin JT. The Trendelenburg position: a review of current slants about head down tilt. AANA J 1995;63:29-36.
2. Ostrow CL. Use of the Trendelenburg position by critical care nurses: Trendelenburg survey. Am J Crit Care 1997;6:172-6.
3. Taylor J, Weil MH. Failure of the Trendelenburg position to improve circulation during clinical shock. Surg Gynecol Obstet 1967;124:1005-10.
4. Sing RF, O'Hara D, Sawyer MA, Marino PL. Trendelenburg position and oxygen transport in hypovolemic adults. Ann Emerg Med 1994;23:564-7.
5. Terai C, Anada H, Matsushima S, Shimizu S, Okada Y. Effects of mild Trendelenburg on central hemodynamics and internal jugular vein velocity, cross-sectional area, and flow. Am J Emerg Med 1995;13:255-8.
6. Bivins HG, Knopp R, dos Santos PA. Blood volume distribution in the Trendelenburg position. Ann Emerg Med 1985;14:641-3.
7. Sibbald WJ, Paterson NA, Holliday RL, Baskerville J. The Trendelenburg position: hemodynamic effects in hypotensive and normotensive patients. Crit Care Med 1979;7:218-24.
Wednesday, March 24, 2010
Ventilatory changes of pulmonary capillary blood volume assessed by arterial densityJ. S. Lee and L. P. Lee
By use of an improved density measuring system, we found that the gravimetric density of arterial blood of dogs fluctuates at the same frequency as the spontaneous or mechanical ventilation. Similar density fluctuations were observed in the blood leaving isolated, perfused lobes of dogs that were ventilated cyclicly. Employing an analysis that balanced the erythrocyte and plasma flows through distensible capillaries containing blood with a tube hematocrit lower than the hematocrit in large blood vessels, we derived a relationship to estimate from the density fluctuation the change in pulmonary capillary blood volume (Vc). For mechanical ventilation, the maximum change in density over one ventilation cycle increased from 0.084 +/- 0.01 to 0.47 +/- 0.05 (SE) g/l as the frequency decreased from 29 to 6 cycles/min. These density changes were estimated to be the result of an 1-16% change in Vc. A larger tidal volume for the mechanical ventilation led to a larger density fluctuation. The maximum density change of spontaneous respiration of 6 cycles/min was one-sixth of the mechanical case, indicating a much smaller change in Vc during spontaneous respiration. When the airway flow resistance was increased for spontaneous respiration, larger density fluctuations were observed.