Blood Pooling Is NOT Caused by "Loose Veins"

So, if you're pooling blood, what would have to be true? We would have to say that maybe your venous system is just not working. Like all of the tension in the veins just relaxes and the blood can't get back up to the heart. So, that could be a thing.

When Veins Really Are the Problem

How would you notice that? You'd have blown-out veins, varicosities, all the pooling, everything would just drop into the legs — and they're usually quite painful. And that's its own thing, right?

But a more subtle gradient of that would be that they're just kind of hypo-functioning, and that can happen as well. But also, that's going to be driven in a large way by the arterial outputs.

Your Brain Has a Map of Your Body

So if you have a picture of your body in your mind — in your brain there's a map of every part of your body. It's in your primary sensory cortex. We call it the homunculus. It sits kind of right on top of your head and then hooks down in the middle, like an M shape going around. The one on the left side of your head feels the right side of your body, and vice versa.

So any point that you touch on your skin, anything that's a sensation in your muscles, anything that's a sensation in your joints — all of that stuff is like a little dot, and those dots are all communicating with your brain.

The Same Map That Controls Your Muscles Controls Your Blood Vessels

The same map of your brain that controls the output of, say, your leg is also going to control the blood vessels that serve it. So if you've got a muscle that doesn't work accurately, the probability that the vessel that controls it doesn't work accurately is high — because they're correlated in your brain. They come from the same area in the brain.

Let's say, for example, you don't have good feeling in your leg below the knee on one side. And then you also have movement troubles there — you're weak, you're uncoordinated. Like, you go to tap your foot on the floor and it's just rhythmic — it's hard to catch a beat. And the sensation is bad. Then what we'd look at underneath that is the same map.

And it doesn't have to be your whole leg. It can just be little patches of areas. It's not like it's dead — there may be a couple variables to consider.

Three Ways Blood Flow Control Goes Wrong

When we look at movement disorders, these are three of the criteria we're always looking at:

• Latency: The response time to get blood there may be slow.
• Accuracy: Maybe you need blood in that leg but you get it to the thigh, right? It isn't accurate to the specific area you're trying to get it to.
• Amplitude: Kind of like the volume. Is it enough?

So when we have pooling — whether it's in your gut or your legs or your arms or wherever — we're trying to understand: is it because peripherally we're seeing a change in the accuracy or the latency or the amplitude of the blood supply, and then that causes a slower return back to the heart?

It's Not Always Peripheral

Or are we seeing that neck down, everything runs great, but we're just blocking arterial systems going into the head? Right? That's going to change outputs as well.

Or are we seeing that the baroreceptors are getting it wrong — assuming we have more blood in our head than we do, or less blood in our head than we do? Or the autoregulation — the ability of the brain to manage that pressure — is decayed, so that when you lay down you get a ton of pressure in and when you stand up you get a ton of pressure out. Like the tide rolling in and out.

Recalibrating the Map

So all of those are ways we'd want to think about recalibrating the nervous system — and that's kind of a cliche way of saying we have to improve the functionality of the map. We go back to central sensory, central motor, peripheral motor, peripheral sensory. We want to look at how those are working.

If the output is bad — arteries aren't working great, or you're not getting blood in your head — then we back it out and try to figure out: maybe my brain just is not processing. Am I looking for movement disorders there? And then how does that relate to the information that's coming in? Do I have a peripheral neuropathy that's the main problem?

Sometimes, especially in post-infectious patients, the peripheral nerves just don't work. We have to figure that out. But a lot of times, it's processing in the brain where the maps aren't accurate. And if the map's not accurate, when you go to navigate off the map, the navigation's poor. We get a bad output.

Your Brain Is Built to Get Better at This

That's what's cool about the brain. We don't give it enough credit — the whole thing is designed to just always get better at processing the things you're doing. The more time you spend doing anything, the better you get at understanding how to do it more efficiently. People can get good at weird stuff. You see Guinness World Record stuff and you're like, "How did you spend that much time?" But people can get good at juggling chainsaws, spinning plates, playing basketball, writing code — whatever you spend a lot of time on, your brain learns how to do more efficiently.

Where we run into trouble is if something has created a problem — an injury, an illness — and you're trying to do a thing that's way above the dose level of what you're capable of. Your brain's having a hard time being able to make that leap.

So we want to break it down into segments that are easier to achieve — those segmental capacities — and build it back up again. That seems really simple, but it's just how learning works. If you were going to learn calculus, you'd start out with addition and subtraction, then multiplication and long division, then algebra and geometry, and you'd work your way up, right? You don't just start trying to do calculus.

Kind of a similar concept. If you're injured and the brain is stuck and it's not able to get through there, then we've got to break down the resources into simpler chunks so that we can build it back up again.

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