Claude Gordon Brass Camp 1991 - Dr. Larry Miller on Diaphragm Fallacy and Dissection

The photo above comes from Masashi Sugiyama, who is an excellent protege of Claude Gordon with a successful studio and brass camp in Japan.

gentlemen over here that's no there's no fat on him I'm very proud of all those
with the staff and Larry's been with us now for about 12 years and when he first
came to camp he doubted everything because he'd been a product of all the things that
we've been talking about and teaching and had to change his armature he had the
worst armature I ever saw clear over here and under on it change it and boy we just
really hear Larry play it's marvelous what he's done in 12 years he's become really a
virtuoso and I love to see that and I'm very proud of and let's have a nice hand for Dr. Miller.
Thanks, Claude. I guess I don't need to use anything but this one that's on my lapel.
I guess this is off? No? And I have to carry this around? Lapel isn't working?
Wait a minute, is it working now? Well what we're going to discuss today is one of the biggest
misnomers in brass playing. For that matter one of the biggest misnomers in any kind of wind
instrument playing or even vocal music and that's the idea of the function of the diaphragm.
I've been told that the best lecturers tell you what they're going to tell you then they
tell you what they want to tell you then they repeat it so I'm going to tell you what I want
you to come away with before I start and that is I want you to understand what the function
of the diaphragm is in producing wind power. I want you to know enough about the anatomy of
your body so that you'll know how that diaphragm really works and what to look out for when you
read or are instructed about certain kinds of things to do with the diaphragm in order to gain
support for your brass playing. Basically as Claude said my experience with the diaphragm came
largely as a physician where I saw at surgery the diaphragm to be a very thin parchment like
membrane and having been a trumpet player since I was eight I had been taught and had read all
about development of the diaphragm and it just didn't make sense to me that this thin layer of
tissue could possibly be a muscle that we could develop and when I first came to Claude and we
started talking about some of these things he he was very clear that he didn't believe in this
diaphragmatic terminology and it's really not that people don't understand about development
of wind power it's that they don't understand how the physiology of the body works or they
wouldn't be calling it diaphragmatic breathing. This terminology is even gotten into medical
literature and you'll hear them talking about the diaphragmatic breathing and that really is an
entire misnomer and we're trying to get rid of that in the medical profession as well but it
came from the music people we think. The important thing to know is that the real instrument in brass
playing is you it's not the instrument that you play it's the body that you use to make the noise
because these lips set up the vibration they set up the frequency for sound production and the horn
merely amplifies it and the way we use that horn affects how it's amplified but we are the
instrument that's why it's so important for a trumpet player to be in good physical condition
because it's really an athletic endeavor. When I first started to really get serious about the
trumpet again after I finished my medical school and residency training I looked for the best
teacher I could find having had studied with a lot of other teachers over the years some here
while I was actually going to La Sierra I played right here in this band room for four years and
used to travel into Los Angeles to take from some of the fellows from the LA Philharmonic not knowing
that Claude Gordon was teaching right down the way would have saved me a lot of trouble but when
I finally did finish looking for the very best trumpet teacher I could find I did I found Claude
and we became fast friends and began really thinking about the function of the body in making the
trumpet play because if we're going to make the real instrument our bodies play we have to understand
how it works and so we began to look critically at the way all good players play and you've heard
Claude say over and over that there is a right way and there's a wrong way it may be that it's
a little different for somebody but for your anatomy and physiology it's the right way and
what this camp is really all about is helping you find the right way to use your body to make that
sound and there are some things that all great players have in common and we we've paid attention
to them very closely and what I talked Claude into doing was allowing us to use some of his
professional players in a study and to apply scientific research methods to see if we could
we could show what the diaphragm really did and we interviewed a lot of good players we we interviewed
Maynard Ferguson and Severinsen and and Kataravik and Manny Klein and Smetvik from Empire Brass and
a lot of different people were were contacted prior to getting into this study because we wanted to
get their ideas on it and see if they all kind of agreed about this misnomer of the diaphragm and
to a to a man they all felt like nobody understood why all the books you pick up Charles Collin you
pick up any of the the method books and they talk about development of the diaphragm and they try to
learn ways to develop that muscle that they think is so important so we really decided we saw that
most all these players were doing exactly as Claude had been taught by Herbert Clark and has as he
was teaching all of us and that was really what we call the Claude Gordon chest up accordion squeeze
and the reason I've used that little bit of a ditty to help you remember is I want you to if
you forget everything else about this lecture to remember that it really is a chest up accordion
squeeze that we're wanting to develop and we want to become a groove kind of habit just like if you
were a javelin thrower and you were going to groove the motion to throw that javelin you do
it over and over again until you did it the most efficient and correct way and pretty soon it would
be in your neuron pathways so much that it was not a conscious effort but a almost reflex effort so
we want you to not have to be thinking about these things when you make music but if you start out by
consciously saying to yourself I'm going to take a big breath and I'm going to do the Claude Gordon
chest up accordion squeeze that's all you have to remember about developing wind power and developing
the strength of the musculature required to move the air there's a lot of more there are a lot of
other technical things that we could talk about and pretty much what Claude was talking about when
we first met was theory he had by common sense and his good intellect discerned that the diaphragm
really was an enigma he didn't know what the diaphragm was like he'd never seen it but he
realized that it wasn't the diaphragm that was giving us him the power to play nor was it the
diaphragm that gave the great players that he knew that power so we decided to try and confirm his
theory and put it to the test with some scientific testing to confirm that it really worked the body
is an unusual mechanism in that it there's a great deal of fudge factor built into it you can do a
lot of things wrong and still have a fair degree of success in trouble playing it's very much that
way but you can eat wrong for most of your life and your arteries will narrow but nothing will
really happen until they get to be about 70 or 80 percent narrowed and then you'll begin to have
symptoms you can do all sorts of things the body will do all it can to bring you back to a position
that works we call that homeostasis the scientific term that means that the body tries its very best
to protect itself and to maintain function and with trumpet players we find that they do all
sorts of things to compensate for not breathing right and some of the things the theories that
have been developed have been developed around wrong concepts of breathing so what we wanted to
do was see exactly what happened when the trumpet was played correctly with a Claude
Gordon chest up accordion squeeze method if you think of nothing beyond that you will set into
motion the neuromuscular process that is correct you get so you take a big breath before you even
do anything else and that chest goes up and it's held up you'll make music but if you don't do that
you won't make very much music or you'll be limited tremendously by your your improper technique
let me just look at the anatomy a little bit the people in the biology department have been
tying down to bring over this skeleton really the area that this will come that far
well yeah why don't you lift that i have to hold on to this sucker i guess
okay basically you heard Claude talk about the the gas tank which is the bony thorax of the
human anatomy and it's made up of the ribs which are solid bones connected to the sternum the ribs
are connected in the front by cartilage which is a soft material and a lot of trumpet players call
me and they have chest pain oftentimes it's related to the cartilage being stretched or
irritated from playing extremely hard important other bony structures of thorax that relate to
trouble playing are the clavicles that are the the breastbones up here and they are hooked to
muscles that attach to the neck and head so that when we talk about the anatomy of playing those
would be very important in the back
oh i wish i didn't have to hang on to this thing
good idea okay let's turn this around if you can without dropping the whole thing
if we look at the back
the ribs guys pretty flexible
shut up the back of the skeleton is made up of the vertebrae which are partially in the neck
and in the mid back and then this is called the thoracic vertebrae and the lower back the
lumbar vertebrae and the ribs are attached clear down here to the 12th thoracic lumbar are
12th thoracic vertebrae and so all of this creates a solid structure that allows us to
increase or decrease pressures within it based on what we do and there's only a few things that
can happen to change the size of this rigid structure and that happens because of the muscles
and this little fella here shows you pretty much the muscles that are involved
with the chest wall
there are a large group of pectoralis muscles across the front which you
see hypertrophy and weight lifters and what have you then underneath the pectoralis muscles there
are smaller muscles that attach to the ribs then between the ribs you actually have what we call
intercostal muscles there are little vertical fibers in between each rib that allow us to
squeeze and expand these ribs and it's these muscles that we're training and and are are
bringing into play over all of that the uh the back muscles
the uh i'm not going to go into the detailed anatomy of this but to suffice it to say that
there are several layers of muscle that overlay the skeleton and the trapezius the
latissimus dorsi and then these long ribbons of muscle down the back which if you play enough
you're going to realize that this is where you get sore is right in here where a lot of this
squeezing goes on these are the muscles that make it possible to change pressures around this
skeletal system and these are the muscles that we want you to become
world-class athletes at using and the good trumpet players have developed that ability
most all good trumpet players have great athletic abilities they've developed a
neuro muscular pathway that allows them to control these chest muscles in the most efficient way
without thinking and they they do this while making music you know music is really a neuro
muscular kind of development and that's basically what allows us to play correctly if we develop
those muscles what i'd like to do is outline for you a little bit of what we did with the study
uh dave in our application today referred to a study that was done where they fluoroscoped
the tongue to find out what the tongue was doing with with trumpet playing and found that for each
note each frequency produced there was a different position of the tongue we thought we'd like to
apply those same sorts of principles to a study of the diaphragm and so we set about to uh to
examine six uh trumpet players who've been playing for years and among them we examined claude
and we did i approached it much like some of the experiments we've done with athletes at the
university in chico that i work with and we first had them line up in front of a grid that measured
changes in their muscular position with their activity and we filmed this so that we sat down
then later and and frame by frame measured the changes in chest diameter and where the changes
came and then we did the same thing uh in front of a fluoroscope it was a little bit difficult
because we had to do this in the hospital and i wanted it to be realistic so i wanted them to
play the trumpet and to getting get the hospital to allow us to to play double high c's in the
radiology department was a little bit tricky i had to threaten to take my business to the newest
hospital or the nearest hospital uh and before they finally let us do it in fact in this day
of malpractice i'm sure we wouldn't be allowed to do it anymore because if there was some radiation
exposure not much but enough to the hospital wouldn't want to take that kind of uh of risk
so basically we uh we don't have the fluoroscopy they would not allow us to film the fluoroscopy
but we do have uh the preliminary uh study that shows you exactly what we did in this
breathing study it will also show you the development of some of the muscles
on some of these players why don't we can we darken the room and see if we can put on the slides
i know how much darker it's going to get
okay this is just some more uh introduction to the musculature we've gone through this but
quickly that's the first layer of the muscles on the back there you can see there are thousands
of little muscles in there and boy when one of them knots up you have a masseuse go over your
back and i've gotten to the place where when i play a job that i'm really tired i go have a massage
and they'll find every one of those little muscle spasms and if they stay spasms they become little
cystic nodules they actually calcify and you can have chronic little hard spots in the muscles of
your back if you don't get them massaged out so everybody ought to have a have their partner
learn to give good massage but you can see these hundreds of little muscles on the first layer
let's go to the next slide we don't have an automatic control
let's see who put these together was it
dave getting ready for the concert tonight he's not worried
okay this is the next layer up we'll just go through it but i just want you to get the idea
there are ribbons of muscle that run up and down from the bottom of your spine to the top right
under your head okay here's the final outside layer of the back just keep going
yeah just keep going through these
too much anatomy for trumpet players
not that you couldn't understand it of course keep going
so
okay this is the diaphragm now if we can uh i don't get wound up in this thing here
so
what we're looking at is a thin sheet of tissue that actually separates the abdomen
from the lungs and the chest cavity and let me see if i can get this apart enough this is the liver
here and right over here is the stomach and the small intestine large intestine and the diaphragm
sits right here it hooks clear over here comes up over the liver up over the stomach and hooks
back down here so it sits in a rather domed position but it is this thin parchment thing that i
kept seeing at surgery that i i couldn't believe people really thought was so important it actually
has holes one for the esophagus and one from the aorta the big aorta that pumps blood to the whole
heart to the whole body comes down through the diaphragm so this sheet of muscle separates the
abdominal contents from the lungs not muscle excuse me sheet of just uh fascia okay let's do the next
that was from one of our trumpet player donors
yeah passed away during this study this is a close-up i wanted you to get the idea of what
this is like you'll see little tiny strands of muscle in there these are just single fibers
they're not thick bulky muscle like we were seeing over here or what we saw in the other slides
these are just tiny little fibers that allow the diaphragm to tense but you can see how in the world
would anybody hypertrophy this or develop it like a bicep by lifting weight how would you
possibly do this it's thin and it's transparent
this is uh the same diaphragm with a light behind it so you can see how thin it is here are the two
holes for the esophagus and the aorta and the light actually shines clear through this this
parchment-like diaphragm okay
this is the diaphragm in the anatomic position as you see it here where it divides the lungs
from the abdomen it sits domed like this and this is what it sits like here this is the actual
a diaphragm from a human cadaver that has been stuffed and in the position so it sits
in a kind of a domed position at rest
okay this is some medical illustration that i had done just to show you what happened in our study
okay this is at rest this is at inhalation this is at exhalation and this is really bearing down
in exhalation also so this is at rest it's domed like this and as you take a breath in
it flattens out the diaphragm this is a front view this is a side view the muscles the little
tiny strands that are there tense a little bit and then when you start to blow it still stays
flat nothing changes here between the inhalation and the exhalation this is what we saw on
fluoroscopy we actually saw this happening i had a board certified radiologist and a sports medicine
physician and a pulmonary specialist all observed this with me and what we saw was that when
the trumpets were blown the diaphragm did not move until it reached a critical pressure around
the diaphragm and then it popped up and pushed just held itself it didn't move up or down it
just held itself in a pop position from having been flattened and popped up and stayed up
no matter how much pressure was applied it didn't move so what happened was it responded to a change
in pressure around it these muscles in this position here and in the back squeezed
to change the pressures around the abdomen around the chest and the diaphragm then popped up but it
just stayed up transferring these changes and pressures it did not move up and down as each
note was played one of the things that we did was something that Claude has now incorporated into
his lectures in fact he's getting so good at giving his lecture he's almost gives mine
i have to not feed him any more information or i won't have a lecture anymore but i'm glad his
hearing aids are off the tape's on that'll tell him anyway one of the things we we said to the
trumpet players was move your diaphragm and they all took a big breath and nothing changed in the
diaphragm and they they all blew out and nothing changed we asked them to do it voluntarily without
moving their chest wall and there was no way the diaphragm was going to move except when the chest
wall moved and the pressures around it changed let's go ahead and take a look at the next slide
and we'll run through these fairly quickly this is just that the study was done up at feather river
hospital in the the offices there larry susa this is a young tom brazine right there keep going you'll
see more of him literally and this is how we recruited this is dave bendekai who you'll see
later this he was also a much younger man yeah go ahead
we uh we involved an exercise physiologist harold meyer who's uh also happens to be a trumpet player
he was willing to work with me for nothing which made it easier for us but we uh we did
maximal stress testing which we're just completing here with claude we did
complete pulmonary pulmonary function testing including helium washouts and we did we went
through about uh thirty five thousand dollars worth of lab work with these guys not only did
we find out a lot about diaphragm and its function but we found out a lot about pulmonary functions
and and trumpet players that's a whole nother study in itself a lot of people that play trumpet are
told they have emphysema but it's because of the way they breathe and not because they have emphysema
okay here's the grid and uh these are not tom's nipples this is
is
this is tom before he got married
anyway we put these markers on so that we could measure changes and and movement of the abdomen
and the chest and before this grid with and we had cameras positioned so that we could
go over it with a uh uh caliper and then and figure out exactly where the changes came all right go ahead
unbeknownst to claude i wanted to know a lot more than just the breathing i wanted to see what
happened to their armatures i wanted to see what happened when they they played what we did was we
had them play uh are starting at the double pedal c uh and move up to a double high c
and what you're seeing here is the changes in musculature as they come up so this should be
probably a second pedal c or the first pedal c he's already played the second pedal c
you can see how high up on the upper lip this armature is too he's beginning to tighten down
and if you'll notice there's there beginning to be some changes in the neck that's one of the first
things i really noticed when i started looking at these studies with that the neck was very
important you look at trumpet players who are well developed and they all will have real stout necks
and the next few slides will show us and the video that we have shows it even more
okay here we begin to see these these long muscles here called the sternocleidomastoid
connected to the clavicles right here beginning to pull up and hold that against the pressure
that's being created okay
okay
okay at all times you'll notice he's doing that clod gordon accordion squeeze as he gets
into the higher register look what's happening in the neck muscles it's doing everything it can to
keep that chest up okay
okay back just to reminding ourselves this is the diaphragm at rest we take a breath in it tenses
up and begin to exhale and it doesn't move much we exhale a little bit harder and it flattens out
a little bit and then pops back up if we blow hard enough and get enough kind of toothpaste
tube squeeze to push that air out
it's been estimated by putting little gauges in the airway that when people sneeze they create
a airflow of about 500 miles an hour so if you could develop yourself so you could bring as much
muscle to bear as you do when you sneeze and put it through a horn it would work pretty good this
is larry suza doing the same sort of thing i put these in just to show you there is as many
positions of the way the horn is held i brought a book that's called altissimo trumpet playing just
to see how crazy some things get and this author is saying you have to hold the horn one way and
do a specific thing to make it work all of these guys did something different with the way the horn
moved and that's the way claude teaches is you find the natural homeostatic mechanism that works
for you using the basic principles of the claude gordon chest up accordion squeeze okay
just keep going right through these
all right
neck muscles are starting to fight to keep the the the chest lifted up beginning to get some
squeeze larry gets a lot of squeeze by leaning back go ahead just keep going through them
okay
this is where we first noticed that larry brought that mouse piece
way over to the right when he got into the higher register starts over here and he kind of twists
the lip
okay i think you'll see that all these guys have in common that armature is high on that upper lip
okay same thing just to remind you
the diaphragm doesn't do anything except pop up and stay based on the pressure changes okay
is that it
this larry doing some more of the same stuff
okay lots of neck stuff going on and lots of back muscle and when you actually measure out the
changes in the musculature we it's this toothpaste tube that's happening squeeze that's happening
again a reminder the diaphragm pops at the end of the of the play we found for trumpet players that
appears to be g on the staff if you play an arpeggio from from c in the staff to high c
that in front of the fluoroscope for all the trumpet players that we did that with
the diaphragm just popped at that critical note at g on the staff and then was maintained at that
for anything they did higher double high c's the diaphragm stayed exactly where it was
which g the second line of g on the staff on the just on the top of the staff okay is that it
oh here's claude i put claude in here just to show you the tremendous neck development claude
was quite a bit heavier at that time but the musculature underneath is amazingly developed
amazingly developed okay claude played a triple c three times in this study for us
as well as a fourth pedal at c i was impressed i thought this is the guy i want to study with
okay
okay
lots of neck development just bull necks you look at these
players like carl and some of them that really are developed and you'll see that
you recognize this guy
actually i think you're better looking now
okay that looks like a pedal c down there for him his armature is boy right dead in the middle and
high on the upper lip just way up i was lucky enough to begin studying with claude before he
was no longer able to really play and boy i'll tell you what a beautiful sound he mentioned this
morning the character of the of the person shines through the horn claude always has
when i heard him this sweet big loving sound i can't it the more i know him the more i know
the sound describes him he has a natural kind of a fast vibrato that comes in there even when he's
not working on it
i think this is one of the triple c's we're going to show the video
with him doing the double c at the age of 72 i think something like that
okay why don't you just keep running through the and when we get to the end of that we'll go to the
the video yeah that isn't a satisfied man i don't know what is
that was after the girls left
okay again i just want you to remember the claude gordon chest up accordion squeeze
allows the diaphragm to function correctly it allows you to make the changes that create air
flow the diaphragm only supports it doesn't add by strengthening it to the wind power at all
the things that you're strengthening are the muscles around the rib cage that allow us to
create pressures to squeeze that tube of toothpaste and get that accordion squeeze
that's basically what we want you to come away with from this lecture
let's do the video okay let's see oh yeah i don't know i think it's a diaphragm
yeah had trouble with patient donors but we finally got enough for this lecture
this is the yeah i just want to go remind you again is this very impressive
i mean when you read about pushing the broom into your tummy to strengthen your diaphragm
do you really think that this is going to add much to your wind power i don't think so
whenever you're faced with that and you will be by people who really are well-meaning but they
don't have the right nomenclature just kind of smile and understand what they mean
but know that you understand a little bit more than they do don't be fooled by the nomenclature
and it's better not to do battle with them because they don't understand unless they've
had the background for it you're going to alienate them so just kind of go hey i know what he means
when he's talking about the diaphragm he's talking about strengthening the muscles around the chest
the abdomen that are are part of the clod gordon chest up accordion squeeze okay
now i have on video what we've part of what we filmed we don't have the sound they weren't able
to to change the sound to video so we'll see what what this shows you mainly what i want you to see
is the anatomy of the musculature involved in blowing and we'll see real well particularly on
tom in his premarital days the anatomy is real good in fact that's tom that's in the
that's what she says the the brass playing is no harder than deep breathing that's tom in that
picture
oh yeah you know i thought that maybe music was going to be less political than medicine and having
never really done a whole lot with the the hierarchy of trumpet playing claude and i did some clinics
and we went back to the new york brass conference for for one of them and all the east coast players
there have this thing about the east and the west and and they had their doctor who was a
cardiologist had not really done any cardiac surgery but he was convinced that the diaphragm
did do a lot of things so here we are there's about 5 000 people we've just given our lecture
and everybody's mobbing claude and this guy is after me to to disprove what we've talked about
and the guy got so heated that's the reason i even said this to you about just don't try and
and convert somebody to thinking this way unless they have a lot of time and can see the maybe even
see the lecture this guy got so livid i thought he was going to hit me and i'm looking around for
claude for some protection and he's over there laughing with these other people and and jenny
was jenny with us that trip i don't think jenny was somebody i think jenny was something she
actually pulled me away from this guy he was so mad he was tied to this idea that the diaphragm
was important and he wasn't about ready to give it up and it's something that people it's kind of
like a fetish you know we latch on to things that we know and we're we're not happy to let loose
even though the evidence points in a different way and a lot of people feel that way about the
diaphragm this guy was ready to he was ready to fight over it okay ready okay i don't know how
much you can see but this gives you a dynamic for what we've been talking about all these things are
rigid examples okay here's a diaphragm again um just to remind you that it's this thin sheet
of parchment with a few muscle strands in it well you know what did you rewind that no i didn't touch
it okay okay here we are here's uh tom rosine look at the look at the muscles in the back
the abdomen the chest is held up
look at the back they spread just like a a cobra snake almost these muscles are held rigid the
whole time and he squeezes now i had him do it without his horn so i could watch these little
markers tom had the the largest vital capacity and he had the most chest excursion of of any
of the players that's what happens for every two centimeters that you can increase
the rib cage size if you pull this out two centimeters you gain 300 ccs of air that's a lot
of air so that's why you want to lift that up and hold it up
this is clod
tremendous muscular development
very susa
you can see some abdominal squeezing we don't like to talk about that because that confuses you but
yes it does contribute to all that support all the muscles around the whole body and
see the muscle muscles in the back are really contributing to this whole thing
is it any wonder your back aches after a long job
this is without the horn chest comes up stays up
the chest isn't let down until the tune's over
dave bendakite
these guys are all taking it up to a double c i wish that the sound was on here
so
again the back muscles are unbelievable
so
what people get confused about is they feel that tightening down here and they think uh-oh
that must be what's happening that must be my diaphragm they're really talking about
muscles of the abdomen it has nothing to do with the diaphragm at all i see them in the hospital
put a weight on their bellies and tell them to push out their belly trying to strengthen these
muscles they think there's something about the diaphragm involved with that but there really isn't
this is clod on the treadmill i guess this is pretty much the end of this day we're just running
through this is when we first noticed there was a little abnormality in claude's heart
well these things are getting yellow
okay
why don't we all stand up and let's do the clod gordon chest up according squeeze and
you know this is what you're learning with the breathing techniques
the uh if you want to figure out where you've gone wrong when i start losing my range or
something goes wrong often most often it goes back that i haven't kept my breathing exercises
up or i'm not running enough to keep my muscles in shape for the respiration we're going to do so
let's let's all take a big breath in and do the clod gordon chest up according squeeze
yeah really this is evans after the concert
hey thanks for the donation
okay
oh what is juice my favorite that's just anybody before dinner
how do you stand in front of him because he's tall oh uh that's okay
where's my nurse
kill
like i don't know i don't know if they got enough
the diaphragm yeah what is your choice dark me please
anybody like body parts
oh
that's the heart we'll have to figure out the anatomy as we go here
okay yeah go ahead my hands are a little bit bloody right now okay these are the lungs
the heart lies right in between them like it does on the human and this is diaphragm
that they've got here i got that on the floor that's the diaphragm there yeah this okay here we go
okay trachea you recognize the voice box air goes down
you bet really i don't know cpr
okay this is the esophagus or the trachea and you can recognize the larynx where the
voice box lies the air comes down through here comes into the lungs these are the lungs here
and three lobes on the right and two on the left and in between lies the heart
yeah this pig did not smoke this is the all famous diaphragm can you imagine see this attaches to the
chest wall like we showed you and there are muscles that attach it to the chest wall
but i've seen this at surgery so many times i just could not get impressed
with the fact that this could be a muscle that we could hypertrophy or make into something that
would particularly help our trouble plane or that doesn't look much different than the peritoneum
does it doesn't it looks just very much like peritoneum in fact it's you can see it's it's
pretty much transparent look you can see the yeah see how thin the thing is just really thin
and the whole thing this is not just a little tiny bit of it the whole thing is that way
maybe i can spread the diamond
it sure is nice to have the biology department here i can't tell you how neat it is to have
their help because i didn't have to deal with this as i usually sterilize instruments too
okay you can you can see through that yeah you hold it up again
i thought it was more rigid than that nope it's real fleshy see you can talk all you want and if
you don't really see the live specimen it's very difficult to understand this only thing
that this can do is to respond to changes in pressure it can't squeeze it's not voluntarily
controlled it can only react to a change in pressure on the underside enough to squeeze it
as the air goes out that's all it's supposed to do all it does is keep you know if you just have
that if you just have the liver and the intestines sticking up underneath there
it would be an irregular surface so that the lungs wouldn't have a smooth surface to sit on so that's
what the diaphragm is kind of like a liner but yeah it is it's one of the body lines
i can't there's the heart boy here's they've they've gone into the left ventricle the main
pumping chamber let's see if we can these are the coronary arteries and in the pig they are
fat this is the aorta coming off the heart right there and this is what we bypass too when we did
clog the bypass you just pick these little things right out of here and you take a vein out of the
the leg and you put it in right here let me see if i can with the scalpel if it's
this pig had a bypass already it's going to have one when we're done
last time he'll have a heart problem the light's not very good here nurse the pig won't complain
yeah bring in the light
any questions anybody want to get a closer look did everybody see the diaphragm yeah
i have a question about the lecture he needs to see this thing
is this the first time you've done this what first thing you had a
i know we've done that before this is the first time i've seen this particular
pizza afterwards yeah it looks like roast beef here's the diaphragm
not very impressive boy now that could really exert hold still yeah isn't that hard to make
a double high oink with that yeah let me see if you go like that like you have to develop
you bust holes all over that's right anyway yeah they get hernias in the diaphragm they actually do
patients will get bulges where the diaphragm gets so thin that it actually balloons instead of
maintaining its its structure so that's well i'm still curious why do you get hiccups and why does
it jump on still well with hiccups you can change the pressures around the diaphragm very quickly
and so it's not so much the diaphragm itself as it is the muscles around it there is a little
bit of muscle that attaches it to the wall and that's that's all that this is that attaches it
to the wall boy when you stop thinking who designed that was pretty smart yeah amazing
he is but he's playing second
i was going to show you how the where the bypass is this is the heart here yeah the aorta coming
off the top of the heart and these are the coronary arteries that run down in these grooves
right here and i just poked a hole like we do at surgery right in there and we take a vein out of
your leg and hook it in up here and run it down to this hole here to bypass the occlusions that
occur that's what the amazing thing when i had that bypass surgery i was amazed i had four bypasses
and what i didn't realize after i went in of course i was out of it i didn't care you know
how come you didn't get up the doctor yeah the uh what's his name the uh anesthesiologist
and i'm laying on the table there's about five other tables out there
i'm laying on the table and he comes up he says how you feel okay and he says uh are you nervous
i said well not really i said maybe a little apprehensive but i'm not nervous
and uh he says well i'll give you a shot to calm you down and i was all set when they wheeled me
into surgery i was going to say um yeah come elizabeth it's the biggie you know
and he gives me that shot and so i never knew a thing until the lights came on again and uh so i
didn't get to pull my joke but i understand boy i've got scars oh and then uh stomach surgery
last year on top of it i got scars on that and i understand that they open up they they saw all
your saw right through this right through your ribs and they get this and they pull this open
then they bring your heart out and lay it on your chest and then they work all this was going on i
had no idea i couldn't complain or anything until later
about the plural i mean that must be quite elastic right the pura is the lining of the lungs and
there's a uh the pura that is adhesive right to the lung here and then there's a a lining of the
inside of the ribs that is the pura so that you get a pearl space between those two things and
that's what creates the energy pressure that's a whole physiology thing but is it can i see it
no because the pura is left in the skeleton this is called visceral pura here that lines this
portion of the line somebody tells you the diaphragm does the blowing are you going to bring it
yeah yeah i think we need to have another basic disposal of the diaphragm yeah oh we had a ritual
of it one year we had a bonfire outside if i could get one of you guys to
hold this up i'm going to cut it out before you do can i just take one more with the light from
behind okay i'm on my i'm on my macro lens and i don't you get on the other side i'm getting
a good one do you have a light to go i don't i don't need it i come on on my macro and
and i got a tripod so i bet larry can't possibly enjoy a barbecue anymore it's hard
real hard can i just get some light from the line rare steaks but
25 years of surgery has changed a little okay what's the reason they didn't allow the filming
of the fluoroscopy um because they were uh afraid of the medical legal ramifications that's funny
when you look at it we're not really very pretty are we ready not inside just wait one second here
i come okay here i go this goes on everything works okay what i want you to do is hold that
up like that and i'm going to dissect that out of my way here take take this off take this one
yeah that's part of the organs underneath i'll show you that's part of the little bit of muscle
yeah that evidently was adhered when they
sacrifice the pig to the child how similar is a pig to us pretty similar it's probably one of the
closest because i remember once you had a sheep up at the yeah i forget where it was but you had a
sheep which one would be closer pig probably now how is it similar just in size or
well the anatomy is fairly close on a lot of the things i'm not going to take all of that
scalpel is getting dull
well
yeah fetal pig is a common thing for biology students to do it it's amazing to me how similar
the anatomy is in all these animals i mean even though they're horizontal as compared to our
uprightness
easy to do this with scissors
or that is the bottom so yeah now we need to let me get another spot here
you can probably just let go of that one and come on over here
i think i'll wash my hands of creditor now
i'm gonna give me some more what do i say give me a nurse that can work in clothes
oh my goodness do that again yeah do that again dr feller he wants to get you on film
last year i wouldn't have had to use my glasses this has been the
first year i've had to use my glasses to operate that's because you're opening
your eyes for the first time when you operate
it's like i always tell them i'll give you the black pill
and let's swing it that way
there we go okay this is the diaphragm of famous do you like game plans every time before you go
do you like meetings and stuff oh i usually depends i've done so many of them i don't really
have to think about it much anymore what may depend on what you're doing yeah what's this here
that's a little bit of the muscular attachment to from the chest wall itself
that was removed when they did the pig so it's not part of the diaphragm at all is it no
you know about these diaphragmatic hernias somebody told me they don't repair those
surgeries that's right very seldom we do them in kids when the kids that are born with
oh i'm sorry i'm sorry i just want to often require emergency surgery because it compresses
the lungs but in adults no we don't it wouldn't it wouldn't hold doesn't need to be it doesn't
really oh there's no need that's another thing that shows you how important the function is
it really doesn't need to be done
do they usually occur just sort of at a weak spot in the diaphragm or not or not around the
opening for the esophagus and aorta usually it's on one side or the other part just not
not the whole thing let's put that down
can i go stick it on the skeleton or something
yeah
here
yeah these are the muscular attachments that you see
hold it on to the sides of the wall
that's the diaphragm
what's medical does the diaphragm certainly what's what's the medical purpose
divides the abdominal contents from the thoracic that's basically transfers pressure
why don't you really read your stomach because it must be sure that's involved with your stomach
is pushing it's changing the pressures around the diaphragm most of the time you don't use
those muscles you know unless you're you know voluntarily your abdomen goes with your chest as
you squeeze it it'll all squeeze in but you don't think of pooching out your stomach to get more
air in your stomach all you're doing is allowing the stomach muscles to relax so they can contract
so that's like why because when i took theater they always say don't breathe up like this
yeah like this your stomach well i don't agree with that that's that's where they get mixed up
with the diaphragmatic but i don't know if they're talking about i don't know if they're talking
about diaphragms at all but they say don't don't do their shoulders breathe out you don't want to
lift your shoulders up like this i think it's for support yeah there is support from the muscles of
the abdomen but not the diaphragm your muscles down here are real hard you know when you play
you can really feel that
okay now the question is how am i going to keep this in here let's see i think uh
you want a bark baked from an airplane well i have some of those if you want them well let's
see if i can wrap it in this will be all right if not that might be a good idea
yeah i saved it for diapers well if we ever have to go somewhere when i locked it up i thought
like throw a couple on my camera that's a new little tripod yeah i i like it especially because
of the macro because you got to hold it still yeah it's got the open line we just can't use a flat
yeah i want to put this
thank you yeah you bet there was that of all the lectures i've heard you this this is the best one
i think the slides helped too but i've never actually seen seen you dissect it like this and
you hold it up this is a much better one this time by far good i'm glad i was hoping that would be
how often do you ever travel because you never got to toronto do you i've never been to toronto
would you ever consider going to toronto sure sure because uh i have to plan ahead but we can do it
well i'd i'd look into something like that myself i think i would vince and vince isn't here but
i the two of us we might be able to get some students or or a class or something like that
i don't know see if clad will go up we'll go up together i pad wants to go so maybe maybe
clad will have to go now okay yeah thanks
if you get two centimeters i think i said 300 but i think in my notes it's 200 centimeters
200 ccs 200 ccs more for each okay that's why the more development you get you know you'll
you'll get these ribs so they almost come up horizontal and that's where you really get
oh let's see you also get some expansion this way your grid you've measured but i wanted to
know which way the two centimeters was ap dia or the answer okay so it sound like you're a medical
i'm a nurse oh yeah 200 centimeters say it again for each two centimeters of increase
in this anterior posterior dimension front to back you get 200 ccs more air