On January 18, 2009, the Anchorage Daily
News ran a Tim Mowry story from the Fairbanks Daily News Miner under
the headline “CPR saved dog, maybe its owner”. Mowry’s article
detailed how Barry Whitehill’s efforts to revive his dog made Barry
so ill that the Fairbanks doctors sent him to Seattle. After much
head scratching and batteries of tests, the experts at Harborview
diagnosed two problems, the more serious of which was that one of
Whitehill’s carotid arteries was not delivering any blood to his
brain.
While a complete carotid occlusion like Barry’s may be rare, less
severe cases are exceedingly common. These restrictions are usually
caused by whiplash and trauma. Between Alaska’s slippery surfaces;
our cautious, courteous drivers; and our penchant for motorized
recreation, it’s surprising that all of our brains aren’t running on
empty like Barry’s, or close to it.
What was different about Mr. Whitehill and the rest of us whose
brains lack adequate blood is the degree of arterial obstruction.
Most have only a partial obstruction so their blockages tend to go
undiscovered and untreated—unlike Whitehill, whose symptoms were so
serious and mysterious that some of the best neurologists became
involved.
Job number one in the body is to “keep the light on upstairs” by
delivering oxygenated, arterial blood to the brain. Only two sets of
arteries perform this critical task: the right and left carotids and
the right and left vertebrals. Of these, the carotids are more
important as they can service the entire brain while the vertebrals
typically serve only cerebellum, pons, and medulla.
Intelligent by design, the body has a little built-in redundancy.
For starters, when there is a problem on one side, the body can
back-flow blood into the affected area from the other side. That’s
what was keeping Barry alive and relatively asymptomatic prior to
the exertion of resuscitating his dog. The carotid design is
especially provident: right and left carotid journey solo from the
thorax up opposite sides of the neck. However, once inside the
brain, rather than branching separately, the carotids deliver their
precious cargo to the Circle Of Willis. This wonderful arterial
roundabout makes it possible to serve both hemispheres from one
carotid. It’s not ideal, but it works—at least, until we over-exert
ourselves by doing something like CPR.
Pons, cerebellum, and medulla lack an arterial roundabout analogous
to the Circle of Willis. But in a pinch, one vertebral artery can
supply both sides of these structures. Furthermore, the basilar
artery links the vertebral arteries and the Circle of Willis. This
intertie allows the vertebral arteries to help out when one of the
carotids is severely challenged. And it’s a two-way street, for the
basilar artery can back-flow carotid blood from the Circle of Willis
to pons, medulla, and cerebellum when one or both vertebral arteries
are challenged.
Most anatomists believe that cerebellum is the original equipment,
our first brain. As we evolved—at least some of us—and became more
complex, our brains did, too. As they did, the brain’s needs for
arterial blood outstripped the vertebral arteries’ capacity. Like
the typical Alaskan home on its odyssey from cabin to mansion, the
human brain received additional plumbing—the carotids—as its needs
grew.
Given the importance we place on thinking (largely the domain of the
cerebral cortex supplied by the carotids), one might assume that
what happens to the old equipment in the original structure isn’t
that important. Not true. Cerebellum, pons, and medulla orchestrate
basic life support and help decide when to pull the plug. From that
perspective, these three structures constitute the mother-board, our
hard-drive.
However, if the body has to choose between protecting the carotids
or the vertebrals, it usually favors the carotids. This preference
probably has more to do with the fact that the basilar artery can
back-flow blood into the cerebellum from the Circle of Willis than
any theoretical bias for the cerebral cortex over the “lower”
structures. (The entire CNS probably makes these kinds of
decisions.) We know of the preference because when both the carotids
and vertebrals are challenged (if we resolve the carotid issues
first), the vertebral problems disappear on their own about 85% of
the time.
Almost any symptom in the body could be a sign that the brain is not
getting enough arterial blood, but the most common are chronic
tension in the neck, shoulders and thorax; chronic headaches; vision
problems; hypertension; and dizziness. Any history of physical
trauma, including whiplash, birth trauma, falls, and maybe even
orthodontics or oral surgery raises the possibility. A weak cranial
rhythm or a shortage of cerebral spinal fluid (CSF) is another
possible clue. CSF doesn’t just fall out of heaven, it’s distilled
from arterial blood in the third and fourth ventricals. Therefore,
if there’s arterial insufficiency at the Circle of Willis,
inadequate CSF is virtually inevitable.
Fortunately, advanced manual therapy makes vascular insufficiency
easy to treat, even inside the cranium—at least in otherwise healthy
patients. Whether the problem is an adhesion outside the artery,
scar tissue in the arterial wall, or arterial plaque, in most cases
these can be resolved in a single session, regardless of cause or
length of residency. When the restriction does not relent readily,
buried emotions, beliefs or issues are often involved. Once these
are found and released, the blood surges through the artery like a
tide that’s been held back.
If any of the above symptoms or history sounds like you, please get
checked out by your local manual therapist. Your problem may not be
a ticking time bomb like Barry Whitesell’s, but running a quart low
isn’t doing your body any favors—and which part of your brain don’t
you need, anyway? May the Circle of Willis be unbroken—and well fed!
A CranioSacral Therapist in
Anchorage, Mike Macy specializes in addressing circulatory
and neurological challenges, regardless of cause. (907) 258-7261
mmacy@acsalaska.net
