Thursday, May 27, 2010

Brazil, Brazil Brazil

This post is a repository for all the Brazil posts:
1. Fresh spring, fresh start
2. Brazil - Prelude
3. First leg - Rio
4. Leaving Rio for Fortaleza
5. Fabulous Fortaleza
6. The Congress
7. Conversations
8. Conversations, continued
9. Leaving for home

Leaving for home

Eventually the dream adventure in Brazil ended and I prepared for home. I had to fly 4 hours south to Sao Paulo to catch an Air Canada flight north for 9 hours to Canada. In Fortaleza I was already almost halfway to Canada, so having to fly south again, land, wait, catch a new plane to fly north again kinda sucked, but oh well... It's the way flights are organized..

I had to sleep sitting up because I had a seatmate this time. I don't recommend it. I experienced the joys of dependent ankle swelling for the first time in my life. Some knee pain was also involved, but fortunately, nothing more serious, like hemorrhoids or deep vein thrombosis.

In the Toronto airport I was selected for random search. The searcher was quite sensitive, I thought - she asked, did I have any body pain? I guess the last thing the searcher would want to do would be to aggravate any existing physical pain with clumsily-conducted body contact. I told her no, I didn't have any pain. Other than mildly annoying, mildly invasive, by default a public experience, and there not being any free toaster to win or even a free coffee voucher to reward me for my cooperation, it was OK I guess. The searcher joked with me a bit, said I could pretend it was a free massage.

My checked bag was lost, but arrived by bus a day later.

Back home, I've been digesting what happened, staying in contact with people I met in Brazil, keeping up a Facebook page and this blog. The next presentation adventure will be in July, at CPA Congress in St. John's. I'll have Angela to help out with that one. So, this closes the series of posts about Brazil. I have a few more pictures to add:

One of Rio's harbours, from SugarLoaf Mountain.

Another shot of the amazing pastry shop's interior- you can see a bit of the mezzanine floor above.

The end of a visit to a beautiful country with beautiful people. Muito obrigado.

Wednesday, May 26, 2010

Conversations, continued

The second conversation, shorter and over only one meal and a couple bus rides, was with Paul Hodges, who did actually attend my second presentation, the one on dermoneuromodulation as a new filter through which to look at manual therapy in the context of the neuromatrix model of pain. I had already presented on the neuromatrix topic earlier, before he arrived.

He's also all about motor control.

He had questions which he took the opportunity to ask following the presentation, and I tried my best to first hear, then understand, then answer. He wanted to know, had I read any of the literature on motor control? If I had, how did I feel about manual therapy in the context of motor control? Something like that.

I replied, I had read some of the literature on motor control, but that because this was a conference on manual therapy, and because manual therapy was what I did, and because I considered motor control issues as mostly self-resolving secondary to pain relief, and because I prepared for a manual therapy congress, I had not covered motor control literature in any thorough way. I stated that motor control was important but unless someone took off the skin, treated muscles, then put the skin back on, I would consider skin input a neurological confound to issues of manual handling in motor control, a cart in front of the horse sort of situation.

As for the second question, if it turned out that motor control (training voluntary efferent output) could trump manual (sensory afferent) input in issues of pain resolution, then manual therapy clearly wouldn't be needed anymore.

This was in front of 1700 people, and both questions and answers had to go through translation.

We continued the conversation later, as I did want to be sure I had understood him correctly. I had. It was as though we talked past each other. I really could not see why, at a manual therapy Congress or anywhere else actually, it seemed so important to negate human contact or any learning somebody's neuromatrix might gain through deliberate skin contact. He couldn't see why I couldn't see why motor control was so vital to understanding the nervous system. Or something.

I said that it was too bad he had missed the first presentation, on neuromatrix model of pain, because this one had been built on that one. He said, I already know the neuromatrix model.

He said that on one of my slides he had seen a reference to Gandevia, who had stated in one of his papers that cutaneous Ruffinis were important for position sense. He said that the range of Gandevia's papers were all about all position receptors in all tissue, not just skin, that muscle spindles were important to the brain... I did a submission gesture about that, saying that I could easily be wrong, that in fact I was usually wrong, that I could have got it wrong even after having read the paper through slowly, twice.. but that I'd been excited to have seen cutaneous Ruffinis mentioned at all. He seemed not to get that a manual therapy perspective should include, at least in my humble, omega human primate opinion, consideration of physical contact, mechanoreception between the sk-interfaces of living humans with threat-detecting neuromatrices. He seemed not to get that from such a perspective, rare as to be practically non-existent other than mine and maybe a handful of other people, any news of any kind about cutaneous receptors being the slightest bit important for anything movement- or position-related was exciting news. It's not my fault that cutaneous mechanoreceptors that fire continuously with lateral stretch of skin, that are found most densely in relaxed skin lines favored by plastic surgeons because incisions along these lines heal better, receptors which Gandevia finally decided to take a close look at, have been pretty much ignored until now. Instead people have been stimulating them without realizing it, and thinking that they are stimulating the fascia or muscle receptors way far within, way deep to skin, way deep to the half inch thick layer of cutis and subcutis that even slender people have encasing them all round, weighing the same as the skelton. Not my fault. This layer and its sensors has never been considered in manual therapy.

That was, and is, my point.

I said I thought biomechanics (joint movements) were usually taught like religion. He said, maybe in Canada, but that in Australia people were taught to palpate layers of the body. I said that was good to hear. I asked him, even if we could treat people without touching them, why would we want to?

I think he agreed we should continue touching people. I can't remember exactly.

However, the impasse between mesodermal and ectodermal concerns and perspectives cropped up over and over and over. We just never got anywhere. He didn't get me, or what I'm on about, or if he did, he discounted it as irrelevant (maybe it's the fallacy of Quantity of evidence substituting for actual Usefulness of evidence in the clinic, for understanding and being able to explain something complex like the nervous system and its care and feeding).

I get him, and what he's about, at least I think I do, and to me it has nothing to do with better understanding and better application of manual therapy for persisting pain in an intact but malfunctioning neuromatrix, or making manual therapy congruent with up-to-date pain models and neuroscience. I don't discount his work - I'm sure it will be important in the long run, but I don't think it's going to help me treat people who hurt, or to understand the nervous system better. And I am definitely not interested in joining any Church of the Transversus Abdominis or any other muscle that he's into - he seems to readily attract large groupie troops who immediately try to build treatment models around whatever his muscle du jour happens to be. I think he recognizes this is a bit of a problem, but not one he allows himself to be concerned with, particularly.

Should our focus be on puppet strings or on puppeteer?

There seems to be no real common ground available with him. Too bad, because he seems like a really nice person, and he IS pretty clear about what motor control training has shown itself helpful for and not helpful for. If only desperate PT people grasping for something, anything that might help their patients, would actually listen to him, and not constantly seize "motor control" as a singular tent pole with which to hold up a whole profession, I'd be a more contented PT human primate social groomer.

He actually does state that too much "stability" (translation: trunk muscles that are too contracted) is just as "bad" as not enough "stability" (based on what I think is an erroneous assumption, of course, or else propagating one unnecessarily, that muscles are bad guys somehow, display defects, not nervous system defenses, that somehow gaining "control" of misbehaving mesoderm will either help pain or else prevent it happening.. a wild goose chase (IMO) that PT has been on ever since its inception).

Too much emphasis on physical, not enough on therapy.

Too much emphasis on the puppet strings and not enough deliberate investigation of or perspective on how to access all the levels, conscious and nonconscious, of the puppeteer, i.e., the entire nervous system including influence of afferent systems and glial considerations.

Too little regard for pain as a neuro-biological phenomenon heavily influenced by cognition; viewing it as a mere abstraction, or distraction, like a fruit fly in the visual field, all importance placed on trying to prove/disprove a profession's mesodermal output control theory. No sitting down and trying to really really understand the nervous system situation first, what a kluge it is, a community of ancient bits and new bits wired together, what it's actually up against in life, where it came from, why it exists, what its role really is, how it operates, apparently ignoring mountains of pain science. Major confusion in the ranks over what our job is/should be, because of all the glare and parade noise from what the profession's over-confident leaders think it should be about. Major ongoing 'Cartesian divide' conceptual behaviour, begun long ago and still continually perpetuated, whether knowingly or unknowingly, by my profession.

I can only hope that one day my profession will take off the damn blinkers that have grown to the sides of its head before the whole parade ends up forced off an intellectual buffalo jump by the knowledge base accumulating all around it. Meanwhile, in the back end of the herd, I'm just a dead woman walking. I might not even be a buffalo anymore. Maybe I never was a buffalo to begin with. Maybe I just got mixed up in the buffalo herd.

A short rest from Brazil...

Well, not really. In fact I think this blogpost series from Greg Laden is actually pertinent to the topic, and highlights some of the issues inherent in the first "Conversation" posted earlier today. I would submit that we could substitute "PT" in for "civilization," and "human primate social grooming (HPSG)" in for "primitive cultures," and it would all make sense.

Primitive Cultures are Simple, Civilization is Complex (A falsehood) I

Primitive Cultures are Simple, while Civilization is Complex: Part 2

Primitive Cultures are Simple, while Civilization is Complex: Part 3


Perhaps because of the ease of defaulting into speaking English in a foreign country, I had an unprecedented opportunity to have a couple of extended conversations with two people in PT who work very hard at the delivery system of PT and developing the science which backs it. PT definitely needs these kinds of people or it would cease to exist as a profession, probably.

Both of the conversations were mostly about trying to find common ground and not finding much, really, in my opinion. I had a bit of trouble, actually, figuring out why they were at a manual therapy congress in the first place, as they clearly were not interested in manual therapy. I think they imagine themselves and the profession to have moved beyond it, some how, or if it hasn't, that it should. I got the impression that they find the entirety of manual therapy a bit unseemly somehow, a bit disreputable. They certainly have a right to think that, and I'd have to agree with them that the entire field of endeavor has become progressively botched, both in practice and in concept, more and more as time has gone by.

My position is that there is something about it worth saving. My presentations were all about what and why and perhaps how. Neither of these two people saw both presentations and one of them saw neither, so I can't blame them for not getting what they were about. I guess my status within the profession as being on the lowest-possible rung of the ladder, or maybe even under one of the feet of the ladder being pressed down into the earth, may have been duly noted and registered by them, before, during and after.

It is almost certain that had we not been in Brazil, with the peculiar circumstances of
a) none of us being fluent in Portuguese
b) having been put together by amazingly socially facilitative and forgiving hosts (forgiving because we rudely nattered away in English almost the whole time)
c) having a built-in time limit, end point, and a bit of time to kill in between, over meals...

.... none of these conversations could have transpired. I mean, I would never have gained direct access to prominent individuals or what they think or their apparent attitudes; I would have had to fight my way through a whole PT food chain of handlers/admirers/devotees, would not have bothered. In Brazil I could pick their brains on artificially equal footing, for a brief window of time. This is simply a reflection of the nature of the world, and how PT has evolved, or rather, been culturally selected for, nothing to do with either of these individuals, personally.

So, what on earth is she talking about, one might wonder, reading this...

I'll tackle the conversation with Sarah Mottram first, as I met her first. It transpired over about 4 days and as many meals. She is the one who saw neither of my presentations. My impression after seeing both of hers and our conversations, is that:
a) she wants to see the profession advance (as we all do)
b) she focuses on PT as a delivery system
c) she wouldn't mind if manual therapy stayed completely invisible, unknowable, even unexplored from a neuroscientific perspective.

She said she herself sees manual therapists, from the osteopathic branch of the human primate social grooming troop, whenever she happens to have a pain problem, but seems to think somehow, that this has nothing to do with PT, or any inherent deficiency therein, or that it suggests inherent contradiction. She thinks "motor control" is what PT is supposed to be about, and nice, pain-relieving, contactful interaction as something outside of it. I don't agree. If we are PTs who deal with nervous systems, then I do not think it's appropriate for us to chop them up into culturally convenient and professionally designated categories. A nervous system is fundamentally a biological phenomenon, not a cultural one. Categorization of nervous systems into broad baskets of "we'll deal with this and you deal with that" was a mistake from the start: now pain science/modern neuroscience has come along, like a big mirror, to show us what a colossal mistake it really was.

When I asked her why motor control didn't work for her own personal pain issues, she replied that motor control was more about preventing pain problems than it was about solving them after they had arisen. Well, that's nice (if true), but it won't help those who already have pain then.. will it?

I honestly couldn't figure out what she was doing at a manual therapy conference, other than she possessed credentials as a manipulative therapist, had been involved in a manipulative therapy organization at some point, which I guess has provided her a lifelong passport. But manual therapy or understanding it or redefining it is clearly not where her heart rests.

She acted as if she was interested in my stuff... but I think this was mostly just to be polite. I do not think she is anyone particularly interested in pain science or in examining or thinking about what happens at a skin or nervous system level between two neuromatrices therapeutically in contact with one another, one of which has constructed a pain experience which needs replacing by a new, non-pain experience. To become interested in such a modest question would take her too far off her current trajectory, probably.

Tuesday, May 25, 2010

The Congress

The congress venue was a 40 minute bumpy scary minivan ride away. I didn't mention that the minivans were often without working seatbelts. No matter - apparently I escaped unscathed. I'm back home and all in one piece.

Here is a little map of where the venue, the Centro de Convençöes do Ceará, was located. It was pretty gigantic, with a large PT fair on the main level, the congress above on a mezzanine floor. There were large coolers of filtered water everywhere, and a stand for free coffee, so I was happy. The coffee was served in teesny tiny cups, but this was balanced by the fact that it had a lot of punch. Lunch was a large buffet service, included for free.

I did my first scheduled presentation Thursday, May 13. Here is a picture of me presenting. The woman to my right is Laura, the translator, who had lived in Toronto for a few years and spoke excellent English. She was staying at the same hotel and made herself available to go over the presentations with me beforehand.

I still can hardly believe that's me, wearing a skirt for the first time in about 20 years no less. There were about 1700 people in the room. Behind me were 5 large screens, stretched out in a line, so that everyone could see everything from wherever they were sitting.

I met many of the other presenters, listened to their presentations as best I could, not being fluent in anything but English (which was a surprise to many since I'm from a supposedly bilingual country, and finally, at this late stage of life an embarrassment to me that I never found French something my brain could wrap itself around as easily as it did Spanish).

A lot of the presentations seemed to be mostly 40 minute long advertisements for various schools of osteopathic mesodermalist thought. The Upledger institute was there, being promoted by somebody from Panama .. pictures of dolphins and babies, shots of its white-and-fluffy-haired founder. I thought about, but refrained from asking about, the therapy tragedy in the Netherlands - I had my own presentation to get through.

I was unprepared, actually, for what felt a bit like rock star treatment after I was done. Scores of beautiful young Brazilian PT students, both female and male, came up directly after and wanted their friends to take a picture of them with me, in ones, twos, small groups. It's quite the custom. The camera and I have never been close friends, more like distant acquaintances. So no picture of me ever makes me look good. Whatever. I complied.

Here is a picture of me (wearing my comfortable flat shoes, with foot scabs from a different pair of sandals that had chewed my feet up pretty good the day prior) looking very short, the little fashion schlub from Canada, beside the other women in their 4-6 inch platforms and heels and guapo men; Helder, the organizer, in his guapo suit. Sarah Mottram is second from left. Fourth from left is Marlene, who was Sarah's helper throughout, Palmiro beside her. I met the other two but don't have a working memory of who they are.

Fabulous Fortaleza

A Congress minivan picked us up at the airport and hurried us to the Ponta Mar Hotel. In the lobby a nice woman wearing a Congress badge and high heels who spoke quite good English, named Bea, made it clear that she was the go-to person for any requests or needs. She stayed on duty the entire weekend (in those high heels) arranging buses and rides to and from the venue and the airport.

I could hardly wait to get a shot when I saw the ocean out the window. I've decided I like the ghostly camera in the sky, my reflection in the window.

The food bar was bountiful... I thought the Rio hotel had a good spread, but it paled by comparison to two huge groaning buffet tables as seen on the left, every morning and every evening, filled with platters of sliced treats, twelve kinds of tropical fruit, plenty of hot choices in giant servers, full coffee pots. I started to like hot rice pudding for breakfast, and salmon casserole. No coffee bar, but the regular cafe con laite was just fine.

I couldn't stand being so close to the ocean without getting into it or on it. The same precautions held - no watch, no money if you go to the beach. It was less anxious for both Palmiro, charged with my care and feeding, and I, who am sort of anxious anyway, to go together. We went for a little walk/wade and had a beer in a beach pub. Later we went on a little harbour cruise on a pirate boat.

Monday, May 24, 2010

Leaving Rio for Fortaleza

With the workshop over, I had a chance to see old downtown Rio, visit an incredible pastry shop (see photo), and shop for a new shirt in Ipanama, fashionista that I am (not), with Adriana (Palmiro's girlfriend), a very nice woman with her own practice there.

I had been staying at the Vilamar Copacabana Hotel a number of days before I realized how close I was to Copacabana beach - only about three blocks. I didn't wander around by myself, thanks to Palmiro's warnings; when I did go out, it was usually with him or with other designated handlers, to some preplanned place for a specific task, so I had no clue the ocean was only meters away. On my last evening in Rio a small group of us went out to eat on the beach, and it finally sank in how close it was. We ate in a tent restaurant, right on the beach, the worst food I experienced in Rio (where the food was ordinarily fabulous) - dried out chicken and fries and watered down drinks, a too-loudly-miked-and-guitared singer singing Stairway to Heaven and other old songs, (annoyingly) in English.

The highlight of that last evening was insisting we walk down to the edge of the water, where my feet and the Atlantic ocean finally met and could greet each other. It was dark; a few lit-up ships sparkled in the distance, the air was still, the waves full and slow and warm. We couldn't linger though - the one slightly-built 20-something guy with us was nervous - possibly he had visions of his little flock of older foreign female responsibilities being total mugger bait, might have been overcome by the thought that he wouldn't be able to protect all of us all by himself. He soon wanted us to go back up to the street. So, an excellent moment, one of those rarest of moments that seems to hang suspended all by itself in eternity, one I wish could have lasted a lot longer, was over, and we walked back.

Next morning we were all up early to catch the plane to Fortaleza, 4 hours north, on the north coast of Brazil very near the equator. I had my first ever Congress presentation to make the next day, and stewed over my slides some more on the plane. I sat beside a nervous woman in the window seat who had never flown before and wanted the window cover down the whole time. Palmiro was on my other side. I was informed that Fortaleza was a dangerous city, that people had started noticing that plane loads of men came from everywhere just to buy sex with children, that authorities had begun to deal with the problem. When I asked how large the city was, I was told it was "just a small city," maybe 2 million. (Two million is huge in Canada. Double the entire population of the entire province of Sask. Oh well.) As it turns out, the size of Fortaleza is more like 3.5 million if you count in all the burbs.

What I was completely unprepared for and made me ecstatic was finding out the hotel faced the beach and that I had ended up in the ocean-facing side. I was able to look out every morning and say hello to this roiling turquoise marvel, right across the street from my 4th floor room.

Next, the congress.

Sunday, May 23, 2010

First leg - Rio

I had to get to Rio by flying to Sao Paulo on Air Canada and catching another local flight. The first flight was all night long (9 hours) and covered over 5000 km. I fussed over my slideshows some more and managed to curl up horizontally to sleep, as I had no seatmate. This nice part about flying north-south or south-north is that no jet lag is involved. It was the first time I'd ever been outside North and Central America. I'd never been south of the equator before. So many firsts.

Dinner (with wine) was served on the plane, and shortly thereafter, breakfast. The coolest part of the trip was that even the economy seats have a place to plug in one's computer so that one's battery stays juiced.

I was nervous landing in Sao Paulo. It seemed to take an hour just to fly over the city through smog cloud to get to the airport. It's 20 million people large, after all. I expected the Aeroporto Guarulhos to be enormous (it was), and I'd learned no Portuguese, hoping my rusty Spanish would suffice. How would I find my way around? I didn't have a lot of time between flights. Fortunately, customs there is a perfunctory matter, one's immigration card is merely glanced at, lines move fast, most of the people in uniform speak a bit of English, and there are many many people in uniform, standing around, changing the cloth bands between stands to facilitate new lines and faster movement. The signage is quite small and the distances huge. I did the default female thing and kept checking with new people as I walked along to make sure I was still going in the right direction. I reminded myself that I was English-speaking in a Brazil airport, not Polish-speaking in a Canadian airport.

Eventually I got to the proper gate in the correct wing of the port and on the TAM plane for the 45 minute local flight to Rio. At the Rio airport, things were even more brisk and easy. Palmiro was there to pick me up, so I could finally relax.

First things first - it took a good 45 minutes to get from the airport to the hotel, through Rio traffic. Rio is another huge Brazilian city, about 12 million. It has a bit of a smog bank too, although Rio citizens choose to downplay it. So beautiful though. In the car I was given a lesson on the social stratification of Brazil, and how to stay safe, not be a target. Palmiro has been around some and has had a chance to observe how life is in North America, so he took great pains to inform me about how in Brazil you can be killed for your cheap ten-dollar watch. He wasn't trying to scare me, just protect and inform me. I listened.

That evening I was introduced to caipirinhas and the sort of steak I can't ever remember tasting in my life. Delicious. Then we went up SugarLoaf Mountain in the cable car, in the dark, to see the lights of Rio way down in the distance. The next day we saw it again, in daytime. The other main tourist spot is Corcovado, on top of which is a giant Jesus statue. Giant Rio Jesus is apparently suffering from acid rain, was covered in restoration scaffolding when I visited.
The mountain is so high and the smog was so dense that I couldn't get any pictures of the city - I could not even see the city.

On the way down I took a bunch of pictures of a very dilapidated but still beautiful and elegant hotel, which is slated to be restored in time for the Rio Olympics, I think.

On the weekend I taught a two-day workshop to 26 people, the largest class I have ever taught. Palmiro had translated my treatment manual in Portuguese himself, ahead of time. A translator had been arranged. It couldn't have been a better organized event and it couldn't have been filled with better, more attentive, gentle students with hands like butter and minds like sponges. By the end of the second day several had already left to make flights etc. Here is a picture of who was left. Palmiro is in the back row, second from left. The translator, Dan, is beside him third from the left.

I learned to do Brazilian cheek-contact air-kissing on this first leg of the journey. I was struck, actually, at how contactful the culture in this branch of my human primate social troop. Such a welcome somatosensory, epicritic input.

Saturday, May 22, 2010

Brazil - Prelude

Yesterday I started to write a bit about this adventure-of-a-lifetime undertaken earlier in May. Here's how it transpired.

Last year in either March or April, during the time I was completely buried in preparing to move, I got an email from a perfect stranger in Brazil, Palmiro Torrieri Junior, a PT who teaches Mulligan* in Brazil and elsewhere in South America. He invited me to consider travelling to Brazil to participate in a Manual Therapy Congress scheduled to take place over a year later in Fortaleza.

I do not get these kinds of requests. Ever. Except... apparently Palmiro had tried to invite me two years prior and I had replied, "I never travel." I do not recall this - a lot of email comes my way that just gets automatically deleted or else ignored: it may well have happened - my memory has been pretty faulty, and, if the story is true, Palmiro is remarkably persistent besides being a gentleman and a scholar.

I told him I'd think about it. I did think about it. I also checked him out to make sure he was for real. He was. I told him I had no credentials other than a diploma from 40 years ago and no presenting experience, just a lot of self-study, a set of convictions based on neuroscience and biology, and an online presence. He said, no problem. I talked it over with my set of online PT friends - they all thought I'd be crazy if I didn't go. So, in the end, about a week later, I agreed to go.

Me being me, immediate self-doubt set in. Who did I think I was, anyway? I didn't linger for long with the self-doubt because I was too busy getting myself uprooted and moved away. And besides I had an entire year to come up with something. I didn't have to go out to work until long after it would be over with. I had enough time to come up with something, surely.

Palmiro was great - whenever I had a doubt or a hesitation about the trip he was right there in my inbox, with "No problem Diane, I will look after that." He had a translator. Everything was going to be paid. I would teach a 2-day class in Rio. He would organize the whole thing, find all the students. He would schedule my time so that I would have rest days between gigs. He would look after all the arrangements from the second I got off the plane until the second I got back on. He sent me a detailed itinerary of what we would be doing each day I was there. By email and later by Skype, I found his English to be really quite good (way better than my non-existent Portuguese), got to know him better and decided I would trust him.

Eventually the details at my end were all sorted and a visa, shots, new luggage, some tropic-appropriate clothing were obtained... I had learned to make slides, had put in many many 18-hour days reading and learning and sorting and thinking. I still wasn't satisfied with the presentations but they were as good as they were ever going to be and it was time to make the trip.

Next installment: Rio.
* Mulligan (named after its creator, in standard ortho guru style) - a weird ortho combo of biomechanics and skin stretching, which I do not happen to find unconscionable because its over-arching emphasis is all about not creating more pain for the patient

Friday, May 21, 2010

Fresh spring, fresh start

It helps that I just returned from Brazil, buoyed by an amazing, once-in-a-lifetime adventure of travel, presenting to a crowd of somewhere between 1500 to 2000 people, all-expenses-paid, with a hotel room looking out the south hemisphere's version of the Atlantic Ocean, right across the street. I never dreamed anything like this opportunity would come to me in a million years. Even when it did, I couldn't believe it had. Now that it's over, and I'm back, it feels like a fabulous dream. Except that I have pictures of the trip, and a little trophy for presenting, so I know it must have been real.

I provided two presentations, each 40 minutes, through a translator. The first one was on the Neuromatrix model of pain, an the other was on dermoneuromodulation, my own version of manual therapy and an argument in favor of good handling based on nervous system considerations as opposed to structuralist and other mesodermal considerations.

I had a chance to speak up close and personal with a few of the English-speaking (much much) higher rollers in the profession, Paul Hodges and Sarah Mottram, and engage them in a fierce conversation or two. Both of them are doing nice work, but work from a perspective that (too narrowly, in my opinion) targets only the voluntary efferent aspect of the multi-dimensional human nervous system and leaves out consideration of all its afferent aspects, handling only to "correct" somebody's posture, or to electrically "stimulate" some sort of observable and variable muscular response. Neither of these people have anything much to say about strategic deliberate handling of tissue or what the brain might think about that on all its multiple levels, so I suppose the conversations were mostly just flybys. They were entertaining though.. and these are sweet people - just not on any kind of resonant human primate social grooming level with me at all. In any way. Whatsoever. They believe (at least I gathered they do) that motor output is all there is or should be interesting in PT. The "movement specialist" thing. This to me indicates a seriously blinkered perspective which shrinks the interactive aspects of physiotherapy to "operator" stance only, and doesn't explicitly deal with somatosensory input or the kinds of (usually favorable, provided the nervous system isn't sick) changes, effects on pain perception, which can catalyze in a neuromatrix on multiple levels. Sarah commented that she thought my term "human primate social grooming" was "horrid." Alrighty then...

I have more blog posts to make about this fantastic adventure, and I will. I'll tell you all about Brazil from the vantage point of a human primate social groomer of exceedingly low rank in the greater human troop, who quite suddenly found herself being treated like a queen and knew not quite what to make of it all.

However, now I have to arrange to go back to Vancouver for 5 days, rent a car, dismantle what's left of my practice, deal with paperwork (never my fave), get rid of the "stuff" (treatment table, etc.), stow my patient files appropriately and legally with a PT in BC (already organized) until they have expired, visit the bookkeeper, pick up and file my income tax finally - I have til mid-June apparently.

This is all major organizing-cognitive hard drive stuff for me. I'm never very good at it, or at least I always feel completely incompetent at it, but I have to say I doubt I could have got any of it done the shape my cognitive hard drive was in a year ago or even half a year ago - it has been doing a lot better since moving back into sunshine. Now I can remember lists of items again, as long as they aren't very long. I can make plans again and execute them more seamlessly instead of just following my nose around and course-correcting by bumping into the walls of reality/social troop requirements. Things are looking up this year. Less stress, less depression, less pressure, less rain and fewer foggy grey days.