The physiological magic of real rapport

A couple days ago I got a call from the hospital in Regina with an appointment time for an MRI, at 7:30 AM. Today. Saturday. 
I was told, do not wear any metal and if you take calcium, stop until after the MRI is done. 
Long story short, I just got home.
Six hours of my life, including driving time, that I'll never get back. 

OK, longer story is this:

Regina is about an hour's drive away. So I filled the gas tank last night, got up at 5:15 AM, left home about 6AM, got to the hospital. It has changed so much since I worked there in the 1970's. It's humongous. I saw that the apartment block I used to live in out front was replaced by a very imposing medical building of some kind. There are no trees anymore. 
I drove all around, found paid parking, selected 3 hours, because who knows how long things are going to take these days.
I went in, wandered around looking for the MRI department, finally found it. Got processed. 

The MRI turned out to be just for the leg, not my entire physicality, so that was good... my head stayed outside the noisy tube.  I was given earplugs, and earphones. They said, you can listen to music if you like. What kind would you like? 
Oscar Peterson, I replied. 

What happened just before then, though, pulled the rug out from under my emotional containment system. 

They had to put in an IV. Something about taking scans, then injecting a contrast dye, then taking more scans. No biggie, I've been having tests that involve IVs, a bone scan, a CT scan. There were never any issues. 
This time, there were problems with collapsing veins. Three nurses poked me 7 or 8 times, including in my foot, and got nowhere. Finally they called the ER for someone there to come up and try. 

The nurse from the ER tried a few more times, and finally succeeded on the third try. Found a vein that didn't collapse.
But the backstory is how she was as a rapport-building human primate social groomer. She could see I was getting a bit decompensated about it all. She spent time, patting my arms, pulling the skin this way and that. When she applied the tourniquet, she slowed herself down so she didn't overshoot and make it unnecessarily tight. My arms were already sore from all the tourniquet-ing, and she seemed to understand that. She asked questions. The favourite question they all had was, Are you on blood thinners? I thought maybe I should devise a sign to stick on my forehead, "I am not on blood thinners," to save people having to constantly ask. But she seemed to want more. And as she patted my arm kindly, she extracted from me that this was all new, this whole being a patient business, and that I was tired of it already, and wanted MAiD.
Now, right here is where she showed me that she felt me, got me, supported my locus of control. So much that I got emotional, just from the relief of being seen and feeling heard. 
Yes, she said, if you start now, get in their sights, they can help you when the right time comes. 

She was so kind. 
Then she finally found something she was confident would take an IV needle, and just like that, she was in, taped things down securely, and I was all set for the scan. 
Was it her being patient and interactive? Was it my system finally letting go and letting her in? 
I don't know. All I know is I could feel her, feeling me, where I had not been able to feel the other three who tried to find a cooperative vein. 

Thanks for your opinion, AI.

I mentioned my hesitations about taking cancer drugs, Ribociclib (for which I will have to sacrifice grapefruit juice, which I love), Zoledronic acid (which sucks off excess calcification caused by cancer but can cause osteoporosis, so be careful), and Anastrozole, which could bring on all the thermoregulatory upheaval of menopause for a second round. 

I still have those hesitations, but before making any hasty decision about to take or not to take,  I needed some actual timelines, ballpark though they might be. 
So I asked google with its built-in AI to help. I asked, what is the life expectancy of a 75 year-old female with breast cancer with mets who is taking (the three drugs mentioned above), versus her life expectancy without them? 
The answer was,
with, around 5 years,
without, about 6 months.
Something like that. 

Imagine a pilot flying in fog whose instrument panel isn't functioning and info is scant, and a plane to land.
So, do you want a short runway you're coming up on fast and can't see easily? ... or do you want a runway that goes on for another 5 years? 
Even if the pilot is tired of flying, they will probably take the longer option, with less stress in the moment. More time to adapt to the inevitable.
A longer bardo between, 1. being diagnosed, and, 2. experiencing the end of existence that the diagnosis points to. 

About locus of control, I can always deploy mine if something goes sideways and I really don't want to live with some side effect or inconvenience. 

 

Locus of Control, big time

I mentioned to a couple physios I know about writing a memoir maybe, titled "Locus of Control: The Most Important Illusion." They approved. 

It is all I've got anymore.
Really, I understand that nature is everything and that I rest in it and always have, and that Indigenous people are totally right about how there is no division between nature and us, that nature is sacred, that every rock, tree, pond, mountain, animal and human is part of nature and therefore sacred, that "sacred" is interchangeable with anything that physically exists that nature made all by itself. 

I remember feeling a weird sense of relief when I first heard that during a retreat on one of those BC gulf islands, from Leonard George, son of Dan George the actor. He taught a workshop on native spirituality. "Prior to contact, Turtle Island [the name they give North America] was governed by spirituality," and for the next three days explained what it was all about. If a rock was sacred, I could be too. The white (agri)culture I had grown up in had taught me I was not. Not unless I followed a bunch of rules and held beliefs that I just could not ever stomach, even as a child.   

I have read widely and agree that a sense of self is an illusion, a mirage, a verb more than a noun. More a firing pattern of brain neurons more than an actual "thing." If it is anywhere, I think it would be mostly a left hemisphere illusion. The left hemisphere is the side of the brain that makes stuff up and wants to pretend it's true. It's the side that operates the right hand and right visual field. It's the side that can talk. 

OK, so given that self is an illusion, and given that a sense of self includes a sense of agency, we spend most of our early adult life finding it, honing it, growing it, learning the necessary boundaries, personal and social, and in my case therapeutic, that will keep us out of trouble and moving along to the end of a lifespan.
I did not learn the term "locus of control" until maybe a few decades ago. It became a well-known term, maybe well-worn also, by a decade or so ago, as it moved beyond psychotherapy circles and into other circles, like the one I chose to inhabit, a pain science circle comprised mostly of (mostly) manual therapists of various stripes. 
My own personal locus of control felt seen and included there. 

In other news, I got a call today from a person to let me know that the oncologist wants me to have a bone density scan a few weeks from now. I will go get it. I have traffic-in-big-city driving agency again now that my cataracts are history. My locus of control feels soooooo much better these days, with its vision restored. 

Post-diagnosis bardo

I needed a word for that slice of time between diagnosis and death, a waiting room kind of word,  a word that can be explicit, a word, preferably in French, that lies between "c'est la vie" (pre-diagnosis) and "c'est la mort" (when the diagnosis takes effect).  

A diagnosis is when an official bone-pointer (like an oncologist) points the bone at you, psychosocially.  

Couldn't find a French word for this psychosocial waiting room. 

I remembered the word "bardo" from Tibetan Buddhism, all the stages that people supposedly go through before rebirth, if you believe in that kind of thing.
(Which I don't. Please spare me having to come back for any reason. I've been preparing my whole life to have no unfinished business with existence.) 

Anyway, the word "bardo" surfaced in my brain as I pictured myself sitting in an existential waiting room. Apparently, it can "be interpreted as any transitional experience, any state that lies between two other states." So says Wikipedia.
That is convenient. Hopefully it's not cultural appropriation to use this word. Hopefully Tibet is cool with this interpretation. 

If the two states at each end of existence are both non-existence, then existence itself is a bardo. Right? Maybe nonexistence is the usual state of affairs. I know I won't really mind going back to stardust, the way I was before I was born.  

I do not want mess, or fuss, or memorial, or funeral, or "celebration of life," that way too exuberant term for something so natural and final. I want nothing. Just a way out that doesn't hurt and that I can sort of manage. Loss of dignity is my greatest... I won't call it "fear," I would call it, that possibility about which I feel most aversive. 

When I was at the appointment with the oncologist last week, I brought up the topic of MAiD, and he seemed to recoil. Too soon maybe? I pointed out that I felt reassured by the thought. He wasn't listening. He was doing was felt to me like a schtick about how I could live "for years" with the meds he wanted to prescribe me.  At the moment I am staving off the urge to inform myself about them,  Ribociclib, Zoledronic acid, Anastrozole. 

So far I've just glanced over the handouts, mere toe-dipping. With Ribociclib I would have to give up drinking grapefruit juice, which I love. 
Zoledronic acid has osteoporosis as a side effect. I do not want or need the worry that my bones, spinal bones, any bones, could collapse while I'm still alive. 
Anastrozole is for breast cancer that is making the body make estrogen outside the ovaries. As in, post-menopausal production of estrogen, which at age 75 is me for sure.  The handout says it's well tolerated, serious side effects are rare, but at the appointment he said I could end up going through menopause a second time, and honestly, once through that particular bardo is enough for me. 
I got through it in the late 1980s, early 90s, but only with a solid intense round of Jungian therapy with a therapist who never flinched. Why? Because I couldn't stop crying and it was embarrassing and it went on for months. I did not medicalize menopause at the time. I never took hormone replacement or supplements or anything. I squirted myself with cool water to cool down hot flashes. I simply waited in the bardo of it, with a therapist who wanted to know all about my dreams, until things changed by themselves and I had a postmenopausal life I could enjoy again. 

I think I'll find out time lines. I mean, what's the timeline for the post-diagnosis bardo with the meds? What is the timeline without them? Because right now I still feel just fine. 

I really do not have any pressing reason to continue existing. I have no descendants. I've done my best and worst in these 75 years. I'm not beholden to anyone for anything much. I'm not anti-social, I would describe myself more as a-social in this town. I have no pressing financial worries or obligations. I'm retired with no lofty projects to complete. I've been enjoying the life of a hermit, actually, since covid came along and pandemic restrictions knocked me off my stride in 2020. 

Furthermore I do not want or need psychosocial, psycho-spheric pressure of any kind on me. I have been building my own autonomy, my own sovereignty, all my life, and it's my life, dammit, cancer or no cancer. I think I have every right to be comfortable and not inconvenienced in whatever might be left of it.  

Time for catch-up

I see I haven't blogged since Feb 2025. 
What is that? Sixteen or 17 months ago? 

Let's see:
I still am moving about.
I am still volitionally using my human anti-gravity suit to do that with, and it still feels quite good, healthy, not hurting anywhere.  
This is still my blog. 

A lot has happened since Feb 2025, most of it in just the past 6 months. 
I think I stopped feeling motivated to write here as my cataracts got worse. It seemed like just too much work to look at words. 
Long story short, I sort of vegetated when that happened. I could still see videos if I sat close enough to my monitor, and games on my iPad, so I did that, and time passed. 
Then things started getting busier at the beginning of November '25 when my mother, at age 101, started to decline, fairly rapidly, and died in Feb this year. I was called upon to be involved for this or that task, or phone call to ask for a hospital bed for her at the senior lodge where she was put on a more medically sensitive level of care, or permission for this or that med. 
I did not see well, but enough to still be able to drive, as long as it was daytime and only locally, a few blocks on well-memorized routes in a quiet little prairie city. 
Anyway, I didn't find a lump until a week or so into Feb, then she died, then we three siblings congregated to deal with her death and all its attendant paperwork and appointments for this and that, and cleaning out her room at the lodge. 
I got an appointment in early March and a referral to a mammogram clinic in a large city about an hour away. Meanwhile I couldn't get in for an eye appointment until April. So I had to lean on my brother and a cousin for rides, first for a mammogram, then a biopsy, then an appointment with a surgeon.
Along the way I finally was referred for cataract surgery, first one eye and then the other two weeks later, but that did not happen until June. The good news is, I can see like I'm 5 years old again, perfectly. It's amazing Star Trek stuff, cataract surgery these days. 
The not so good news is that the surgery was canceled because this invasive ductal cell cancer had found a lymph gland it could hijack and demand passage through and get it or else just slip through unnoticed. So while I was distracted by all the family commotion, it had crept around and found lots of little places  everywhere to grow itself. 
These days around here, women with breast cancer are vetted for if surgery will do them any good or not. The cancer agency wants people in my cohort, maybe demographic cohort, to have a CT scan or bone scan or both, first. These are to detect any metastasis. 
In my case, surgery won't make a dint. Neither will chemo or radiotherapy. Incurable. 
It's in lungs liver spine and (bizarrely) right tibia. 
There are some SlowDownTheInevitable pills I can take. I suppose I'll probably take them. 
I have yet to look them up to see what they are all about. 
Before they can be prescribed the oncologist told me he wanted an ECG, an x-ray of the tibia, and to get a dental exam, so he could monitor dosage or whatever. Something about wanting to avoid osteoporosis. 
I did those three things. I saw him on Monday, the 6th of July, and by Wednesday the 8th, they were done. I presume they have the results by now.
I expect a call from his office or else the pharmacy soon. 

Here are the thoughts at the top of my mind. 
I am 75 years old.
I'm done with my former work life and have decluttered my mind a lot around physio, both physio as a profession and myself as one of its global representatives, a farm kid from Sask. who was a boomer and for whom possibilities and opportunities opened up almost magically at just the right times, including a physio school that opened in my province just three years before I applied. 
I feel lucky in life. 
Nowadays I also feel lucky in that I don't have to pay medical expenses, and the system is stepping up to look after me. 

My personal beliefs about existence is that it's a something, like a slice of meat, sandwiched between bun halves of very thick non-existence. I really don't have any issue with going back to the way I was before I was born.
It's all in the hands of nature.
And really, it always has been, all along. 

So, what am I going to do here? In this blog? 
Good question, I do not know. 
Write stuff I guess. 

Psycho-technologies in physiotherapy

Lately, I've been conversing with a kinesiologist about constructed ways of thinking about treatment. 
He came up with a system for assessing biomechanics of people who are unhappy with their bodies, how they are moving. It's all based on the supposed architecture of the human body. Five ways fascia holds us up and together. The neurology side of it focuses on only the output side of the nervous system and the only afferent aspect of interest is proprioceptive feedback from structure. It very much reinforces the whole 'body as machine with moving parts' perspective. 
I know that perspective. I learned it in physiotherapy school once upon a time. I was hoping I'd never have to encounter it again. 
Anyway, I was crustiferous. Slightly grouchy. I was a 74-year-old retired person with a get-off-my-lawn attitude because good grief, I guess that's what I have turned into.
Unless I ponder deeper on things. 

I did, am still doing, a lot of reflecting. 
I remember my life and how being a physio was how I got through it. 
But I was never completely comfortable in it either. 
I always wished it had had more to teach me.  
I remember at a physio congress in 1982 in Winnipeg, finding a bit of anger inside to help push me, speaking up at some meeting about how the profession had taught me all about the body but nothing about people and how to interact with them. 
Nothing came of that, of course. 

Later when I was preparing myself for private practice, to calm my nerves about it, who I would be interacting with, responsible to, 1992, I managed to get myself enrolled in a Peter Levine, "Somatic Experiencing" training workshop series. It wasn't easy, being around a lot of high-emotional-octane-sensitive people, mostly psychotherapists, but I really really liked what I learned. 

The thing I found most ethical about SE was that even though I was just a "physical" therapist, I could address the emotional containment issues people were being beset with and overwhelmed by without ever having to know the actual verbal content of them or interact with any of it, which was a big relief to me. Because I did not want to be a psychologist.

To me, it was a relief to know I did not have to be.

I did not have to be a neurosurgeon, just a skilled paramedic.

I loved the play involved. The SIBAM of it all. How predictable Peter Levine had made the outcomes. How to help people focus away from their "story" onto a new story about what they were experiencing in their body, where, and what that would look like if they could see it, colour, size, shape, texture, what it would feel like if they could touch it, temperature, dry or damp or slippery, all the details. It was fascinating! How they could just sit with it, contain it, hold it with their hands (usually in the torso somewhere). If they started to wander into story again, asking them what was going on with the shape, size, colour, etc. of their body experience. They would recognize the change in their emotional "pain" as change occurred.

We learned to sit still and shut up and just watch. (Levine said, be a cat, kill time by licking your paw. My translation: You're working with nature here and nature needs time and for you to shut up while it does its own thing.) You do your job by persuading the person to focus on sensation, and that is the only key interventional bit.

If people drifted off they would need to be gently brought back by asking them to describe their sensations, "And what are you experiencing in your body?"

He called it "titrating." He said, you want the nervous system to integrate but not all at once because that just reinforces the trauma story. He made the analogy with sodium hydroxide and hydrochloric acid (I think), two horribly caustic compounds. If you just dump them into each other, they explode or something. But if you slowly drip them into each other, titrate them, they turn into salt and water, two compounds essential for life. (I can't confirm because I am not a chemist, but it sounded good.)

And invariably the horrible sensations would turn into golden lights and lovely stuff like that and people would feel so much relief.

That was when I learned that nervous systems can do their own heavy lifting and I could be free of feeling responsible and anxious about "fixing" things in other people. After that training, I was able to figure out how to be a way kinder manual therapist.

SIBAM = sensation, image, behaviour, affect, meaning.

It's such a lovely way to be with people. I wish the physio schools taught this kind of thing along with all the (mostly irrelevant) anatomy.

Ancient physio wisdom

It takes me a while for things to sink in.
I've never been much of an exerciser, but I am determined to not "go gently into that good night," words that  Dylan Thomas immortalized.
And I'll be 74 in a few days, get aches and pains like everyone else on this planet does at this age. Exercise is the preventive medicine. I believe that, after spending a lot of time learning about nerves and interoception.  

So I finally landed on something I did not hate doing, which I call "weight-walking," which involves holding weights overhead as high up as I can while walking around inside my condo. A usual trip is 48 steps. 

I started off with 10-lb weights,  just one or two trips a day. 
Then, yesterday I changed it up. I did a walk with 5-lb weights. So easy. But it woke up the pathways. 
A few hours later, another with 8-lb weights. Still easy, and, and, ooh, pathways opened a bit wider. 
Another later on, the usual 10-lb weights. Less easy but totally doable because more familiar.

Then, a tiny miracle, I felt enough dopamine in me that a few hours later I did a 4th (a 4th walk! Unheard of!) with (ta-dah, drum roll...) fifteen-pound weights! For the first time! 

I have relationships with my weights. 
First of all, they are my own private weights, not left over from my clinic. I've had them at home for a decade at least, have played with them various ways. Never very seriously.
The 5-lb weights have a blue non-slip coating which feels pleasant to my hands.
The 8-lb weights are a nice bright orange colour.
The 10-lb ones are black.
They all feel soothing smooth room-temperature to my hands. 
But the 15-lb weights are naked steel and bumpy and my hands never really liked them. So macho. What was I thinking when I bought those? Truth is, they were the only ones available at the time and I was in an optimistic mood that someday it wouldn't matter that they felt so unattractive to my hands in the brain space where I have spent most of my life, focused on what I feel through those hands, haptic cognition I call it, or the one for my eyes, eyes that have an unwaveringly friendly relationship with every colour on earth, probably a carry-over from art school days where I learned to draw and paint and see space as a shape, a deliberately awakened visual cognition.
But I do not want to digress too much. 
Those ugly weights had sat there inert for years.

This post is about a new (for me) kinesthetic cognition, neither visual or haptic. 
It's about graded exposure and how I finally after all this time can see how graded exposure is a sneaky way of making friends with the parts of one's own brain that hate exercise, and weights unless they feel comfy through glabrous palmar skin and look attractive to the eyeballs.
Not by being operative (power-over), which a lot of physio is, but by being interactive with those parts, encouraging them instead of overwhelming them. And in the end they become willing to do things all by themselves. And come on, that's the entire point of anything we do in rehab, isn't it? 

For me, it was a sense of triumph I had never really experienced for myself, or truly integrated, from exercise. I can see now how people can easily become addicted to it.
I mean, in spite of the noceboic aspect of these 15-lb weights, grey steel, bumpy, heavy, etc., and the nociceptive aspect, the heavy bumpy cold steel-ness of them against my palms, in spite of all that, I succeeded in carrying them overhead without too much trembling (my arms wondered at first, WTF is she doing to us? But only at first, because as soon as I was aware of trembles happening I also felt a surge of steadiness arise all by itself; I did not have to use any willpower, my critter brain just took over all by itself and enough strength ensued automatically. It was so pleasant to feel my physicality function well all by itself and require no push from the "me" space where I usually reside.  
I guess you could call that kinesthetic cognition. Deliberately induced kinesthetic cognition. Never too late! :)
Had I been able to experience this sense of power arriving in my body so effortlessly much earlier in life I might have been more attracted to the wealth of knowledge that exists about motor output side of the nervous system my profession is so heavily invested in, rather than the sensory input side of the nervous system, mostly ignored by my profession, but important for mental health of individuals, I would argue, based on just this one little experience, significant to absolutely nobody but myself. 

Anyway, yay physiotherapy, it taught me something way back in first year as mere protocol that I finally figured out the meaning of, all these decades later. So, thank you, former profession of mine. Thank you very much. Now I know, have experienced, have cognized how it actually works, in my own human anti-gravity suit.  



 

 

Our sovereign real estate

 By that, I mean our body. Our physicality. The only thing we are born with and will die with. 

OK.
It's been a few years since I last posted here. I've been enjoying retirement and not thinking much about treating people anymore, since I don't anymore, or teaching anymore, since others do that now under a DNM banner, which I left trademark (and responsibility) -free. 
I still look after my almost 2-decade old Facebook group though, which still pops up some interesting stuff from time to time.  
What prompts this post is a reflection I had there in response to someone who posted a question about "extended mind," by which he meant, using one's mental faculties to travel through the body of someone on the treatment table. So I wrote a fairly lengthy reply to him, and for whatever reason (maybe he was embarrassed) he deleted his post (and my reply along with it in the subthread), which is irritating, but hey, Facebook, right? 

I wanted to find out if he thought mental meanderings through somebody else's body while treating them was appropriate.  If it was a "good" thing to do, philosophically speaking, to penetrate even just mentally their sovereign real estate, their physical body. 
For sure, a lot of instructors in manual therapy give students all sorts of conceptual hallucinations to ponder as they treat. I remember a class in cranial treatment in which I was instructed to learn to feel the "energy" from my hands flow down through the spine of the lab partner all the way to the end and then back up. I'm pretty sure people teaching these approaches mean no harm, and generally, no harm is done. I'm sure they want people to slow down, so they give them all sorts of anatomical minutia to ponder in hopes they won't be abrupt with their handling.  In another class, however, I was the person on the table and we were learning a move that involved sliding the skin over the sternum down toward the feet. It was framed as a fascia release maneuver. My lab partner was a very nice young man who diligently applied his whole attention to learning the specific conceptual hallucination. I was just lying there, zoning out while he worked on me. But I started to feel like he was falling asleep maybe, or losing track of me, because I realized he was using way too much downward pressure and it was uncomfortable. I asked him to stop, and he did. Maybe it was my imagination connecting this to heart palpitations I felt from time to time for a few years after, and luckily they resolved by themselves, but it made me think that if we lose track of what we are doing with our handling, we could hurt people. Especially if we are large, strong, have big hands, and our focus is on our fantasy, our conceptual hallucination, and not on the person we are treating.
These examples are from my own experience going to classes in the early 1990's, always trying to improve. 
After that I decided most of these approaches were delusional perceptual fantasy. Yes, interesting to learn all about the insides of people, but if that's what you're supposed to think about when treating people, it's a huge distraction. It ends up being operative, and therefore, irrelevant in our line of work as human primate social groomers. I put all notions about fascia, muscles, joints and viscera into the "delete" bin when I pondered treatment ethics. I called them "mesodermal," and denounced them. Later on I called them "operative" and denounced them even more.  

So, back to the reply I made on Facebook. 
I said I thought such mental notions were a distraction, and that as soon as I realized that, I had reshaped my treatment so that it disincluded ideas like that, "extending" the "mind" into someone else's body.
That I had stripped off any thoughts about anything deeper than the skin surface itself, and cutaneous nerves, because I was unable to disinclude those, as they are attached from below the surface directly into skin. (And conveniently as it turned out, there was a whole reality-based mechanism I could adopt instead, neurodynamics.)
That the whole trick was to be interactive with the person, and have neurodynamics to back up one's approach, so, interactive with the nervous system as well. To put the person in charge of their own comfort. To check in with them frequently. To give them explicit permission to choose their preference of handling and tell them I would shift my hands to something most comfortable with their guidance. That they were in there with their own nervous system and could feel it way better than I ever would be able to, so I wanted them to stay aware of how my handling was making them feel.
I pointed out, in my reply, that in reality every person on the table is an unknowable entity full of mystery, and every treatment encounter is like a walk across a narrow footbridge through fog over a chasm of unknown depth. I even posted this picture, which has been my treatment inspiration ever since I first saw it and used it in my teaching many times. And then the guy on Facebook deleted the entire thing. Dang. C'est la vie I guess.  

EDIT: I'm back in here to apologize to the person I thought had deleted his post. Turns out he didn't. Turns out it was a goof on either Fbook's part or my own. 

A Q&A about DNM with Maggie at Embodia

 Here is a link to a transcript I finally finished of the Q&A which took place Sept. 21/'23.

LINK

So, I transcribed it for anyone interested whose first language is not English and who might be interested. 

I had a lot of opportunity to observe myself talking about something that used to take up a lot more of my personal mental hard drive than it does now since having retired over three years ago, formally, but before that, operationally, because of Covid.  

Shockingly, I couldn't remember the former name of a condition now called CRPS. The former name came to me later, after the Q&A was over. Reflex sympathetic dystrophy. Here is the video with Jonathan Fass, and Brendan, the person Jonathan worked with and in which DNM was mentioned by name. 

It's shocking to me that it would not easily come to mind as it likely would have back in the day before I retired. C'est la vie I suppose. Getting older, different interests these days. 

Something else I botched up during the session was a memory I had about hyperpathia, a mechanism about it that Simon Beggs had proposed that I remembered from a pain class I took in 2010. It was in a recorded video that was part of the class, so no wonder I was pretty foggy on details. Later I remembered he talked at length about P2X4 receptors, and that it was an issue with an electron on that particular receptor (I think). Anyway, here is an open-access paper, with Simon Beggs as lead author, for pain nerds, that is all about P2X4 and neuropathic pain because of microglia in the spinal cord exacerbating the situation.  

P2X4R+ microglia drive neuropathic pain 

I hope this helps.  

............... 

 

Leonard's view of the future of rehab

Here is Leonard's website. https://hrfhome.com/

I have only just started to examine/ingest it. There is so much there, and like eating feels at my age (72) it's best done in small meals spaced out. 

Right on page 1, we see the project all laid out. Kind of breathtaking really. 

It'll take me quite a while to wade through each of these ideas and fully comprehend how they connect and how far back they go and who all the people were and what they showed about themselves and what they hid from history. 
It's a very big site. There is much to read and ponder through. It's sort of like wandering through a new world, worldview. 

But let's just start with the video and some highlights from it. (I made notes.)

Leonard's intro
(I love how he starts out, bright and bold:) 

 “Today we speak of embracing a new era of rehabilitation, or what we like to consider, the journey toward human rehabilitation.” 

(Psst: It's for everyone who deals with the entity known as a human. And who wants a better way to do so. Be you an analytic type or a humanist or both combined. You are human also, and you just may want to level up yourself.)

He points out that it's for any/all allied health professionals. That he's able and willing to mentor any professional from any profession:   

"The reality is this might come off a little bit more clearly to physical therapists, OTs, and speech therapists, but this was designed for professionals across all disciplines in medical allied health, mental health, behavioural health, fitness and wellness industries in mind."

He talks about "functional understanding" which we can get to later. There's a heap of stuff about that in the "whitepaper" (I don't know why public papers were ever designated as "white," but I do not want to get sidetracked here). The whitepaper is free to read by signing in on his website. 

"... the HRF is an open source project."

... Which means, he hopes it will travel by itself through interested parties out into the wider world. 

The situation we face/rehab faces

This is the situation we find ourselves in as professionals in a profession which looks like chaos, faced by people coming for treatment who are told all sorts of contradictory things by different people, left with no way to make sense of it except what they are told, feel left out of the process with their personal experience invalidated, with no way to make sense of any of it, their problem stuffed into some grouping or other that was designated by someone else a long time ago or maybe a week ago, and varies by profession. I would call it a tyranny of nouns and operations that were designed to manage all the nouns, but not the actual people themselves. Huge boundary problems resulting from science that framed us as professionals wrong from the start. But I digress.      

He talks about the biomedical model: 

"...what we have to embrace first off is that you know, we live in this biomedical model, and this model has a number of achievements but it certainly has a number of shortcomings especially when it comes to dealing with health. So where did it start? Well it was this focus on biology exclusively and its become again our dominant model for healthcare. It gained its prominence in the 1800s and has saved a lot of lives. I mean if we think about what it’s done for infection and disease, many more people are living today than in the past because of advancements in the biomedical model. But as we’ve learned, when it comes to health and well-being, it’s been falling short quite significantly. So these significant shortfalls include this excessive reliance on interventions that are targeting biology in isolation, separation of the psychological and social factors from the biological aspects; this idea that somehow they can be separated really is quite illogical and unscientific on so many levels. It really overlooks the true complexity of human health and well-being."

Enter the biopsychosocial model from Engels 1977. He explains the BPS model has certain shortcomings and drawbacks. And that he would like to improve it. Make advancement. He says taking a functional contextualist worldview and treating humans from its standpoint would work better. How? 

"It embraces human complexity. It comprehensively appreciates the history and context of the person and considers each person’s uniqueness and ability to change as a part of the bigger picture. What we really appreciate about this kind of functional contextualistic worldview is that it sees humans as having infinite potential to successfully make things work with whatever problem they face. We believe that’s a really helpful lens if we’re going to be dealing with complexity and we’re going to be dealing with problems that are human in nature. We propose that we need to transition from fixing machines to working with humans, which means we have to develop approaches that highlight human resilience and adaptability rather than treating them as machines that wear down and break down and have to be repaired and you know things can be permanent and unchangeable. In this process, we have to emphasize the dynamic, multi-level, multi-dimensional nature of human challenges as well as what that means for their potential for growth. We also need to acknowledge that people can learn and adapt even while they are in the middle of a health crisis or struggle. In doing so and in concentrating on supporting the individual where they are and working with their health issues, rather than merely trying, attempting to “fix” them, we truly believe we have the potential to make a much greater impact on human health and wellness as a whole."

Sounds good to me, I'm in. 
He talks a bit about how what works better is to stick with a beginner mind, process-oriented, N=1 approach with every single person who comes into the clinic. And it makes sense because each human is a world unto their own self. And he says, importantly... 

"Processes of change are independent from the treatment methods themselves."  

This fits with everything I've read that says that it's not about having some magic method, it's about relating. He introduces the names of the pioneer psych researchers who have developed this new worldview and who have informed his vision so valuably. He says they looked at their own profession, found 600 different ways of going about their business,  and developed an overarching meta-framework with 6 dimensions, called the Extended Evolutionary MetaModel, or EEMM, to which he added (with their support and encouragement) 3 more dimensions to cover return to human physical wellbeing. I really like that two-thirds of this work was already in place already. 👍
He says, around minute 13, 

“What we have found is that by partaking in this journey along with the psychological pioneers, we already are able to speak across the psychological discipline and domain and our hope is by adhering early on to a kind of unified language for process-based thinking that we’re going to truly be able to embrace a transdisciplinary approach to care.”

How does this process approach work? Well, helping people get to psychological flexibility is the goal, really. Not just for the clients, but for the clinicians too. Network theory can provide a tool to navigate complex processes. It can be applied to rehab, can give a picture of interconnected processes within each individual. He has some numbers to share.

1. over 84% of our client base are high complexity cases which means they have at least three factors or comorbidities. They have a central senseitization inventory that is at least 30 points. Their history and their psychosocial and social determinants of health clearly indicate that they are stuggling and this is a more complex case. 

2. Over 25% of our patients utilize Medicaid. 

3. Over 40% of our auto and workman’s comp cases are in active litigation. 

"So, needless to say if you’re looking for a challenging environment to test something, we have that." 

He gives a little rundown of results so far from 250 clients. 

"With HRF, trans-diagnostic FX include: 

• Psychological flexibility improved 15%

• Mental health quality of life up by 5%

• Client satisfaction: 99% - clients feel validated and heard 97%,  and confident 92%."

He's going to be publishing his work with (by the sound of it) some new statistical tools the psych people are coming up with. 

He talks about the financial implications for clinics, always a hot topic, especially for big corporate clinics: 

"The national average rehab cancellation rate for low complexity : 12-25% 

Pain speciality >30%

No show rate ~10% 

For HRF: cancellation rate 7-15%, 1-2% no show rate."

 He talks about "transdiagnostic and social outcomes of learning psychological flexibility skills."

• "Clients come off opioids, reduce overall medicating, reduce imaging, cancel surgeries.

• Come off disability and start meaningful careers

• Parents teach these skills to their kids

• Spouses and caregivers learn the skills

• Teachers and professors add it to their curriculum

• Clients use the skills to go to substance abuse and eating disorder rehab"  

I gotta say, all this seems pretty impressive to me. And I had not dug into the white paper yet. So, there will be more to come. Before I forget, here is the improved https://dermoneuromodulation.com/ website where all my stuff has been given sanctuary by HRF. 😊

  

Back again

SOME BACKGROUND

So, I left off writing thoughts here a couple years ago.  I had accepted being newly retired, for real. Had landed that particular plane. Still had runway left. 

I had accepted that I was retired, and deliberately wasn't going to worry about physiotherapy anymore. I was going to edge away from it. Not put any more energy into trying to help it improve. I pivoted. 

I had committed to scouting around on youtube to find things that were interesting. Something I could deep dive into and luxuriate in learning, ponder from all angles, watch develop. 

I settled on Ukraine. It wasn't hard. I mean, there is a war happening there because Russia decided it had the right to believe its own BS and invade its neighbour after having signed treaties, twice, agreeing to borders established between the two countries way back in 1992 or whenever. So, it was as good a way for me to pass the time as any and was very attention-attracting, served to keep me interested in the world, the whirled world. Which is also a verb, not a noun.  

I committed myself to Timothy Synder's excellent Yale education series, The Making of Modern Ukraine. I watched every single class all last fall as soon as it was uploaded. Then I started all over again, and am up to Class 16 of 23. It's a full semester of history. Timothy Snyder is a great teacher, and I take copious notes, but that's not what this particular blog post is all about. 

No.

An email came along one day last month from the Weebly people who had offered free websites and from whom I had built two, one for my former physio practice and another for Dermoneuromodulating. I had let go of the practice site already and decided I would let go of the DNM site too because it was no longer going to be hosted by Weebly for free. They were going to start wanting to be paid. Why keep it? I was no longer teaching. I let people in the DNM Facebook group know that soon it would be gone, along with the very incomplete international directory I had been maintaining there for people who had taken the workshop and wanted a listing. I announced to the Facebook group members that they could grab whatever they wanted from it before it went dark. 

A few people salvaged it, and one guy in particular volunteered to maintain it all on his own site! I agreed, because he gave me a look at the content, all beautifully and functionally reformatted,  and offered to maintain and update the directory and everything, so how could I say no? And I turned over the url to him because he offered to pay for it, off into the distant future. It was like he was carefully lifting an albatross from my neck so I could retire even more! I asked him why he wanted to do me such a service and he said because it lined up well with his own vision for the profession, Dynamic Principles, and his Human Rehabilitation Framework. Here is his introductory video, Clinical Overview of the Human Rehabilitation Framework (HRF).

We talked. 
The more I learned about Leonard Van Gelder and his company the more it started to feel like home there! This is a screenshot of the principles he has, and I agree with them all. 

So, I'll be blogging more about this. It's all quite wonderful, and I feel very congruent with it all, and I'm not promoting Leonard just because he was kind enough to take responsibility off me by hosting accumulated DNM content, I'm promoting both him and his mission because it's like the freshest air I've ever had the privilege of breathing when it comes to physiotherapy. If the profession manages to change and save itself from becoming a dinosaur, it will be thanks to his vision, I'm pretty sure.  

Next post: Leonard's vision for evolving rehab science. 

Life is a verb, not a noun.

 I'm in the process of truly adapting to retirement, for real. 
After I returned from Saskatoon at the end of August, and the workshop card started filling up for the coming year, I started to recognize in myself a feeling of panic. 
It became abundantly clear that something or someone in me reallyreallyreally did not want to teach anymore. Felt horror at the very thought of teaching while the coronavirus is still around, with its sped-up evolution, its bursting forth of creative forms, each potentially more deadlier as a result of faster transmissibility.
No end of the tunnel in sight. 

My panic manifested somato-sensorially as a sinking feeling through the chest, one that felt heavy and simultaneously cold, and spikey, like an anchor. It was close to a feeling of dread.
I have surmounted many moments like that, though, never dropped down dead from them; but this was a bit different. It came over me more suddenly. I was less prepared. I was on automatic pilot but suddenly the plane I piloted was signalling that it was in trouble. Alarms were sounding, lights were flashing. 

In this case, I had no valid argument against quitting. The existence of the virus, my age, and the fact that I really do not need to continue making an income, all converged to argue for quitting. 

Long story short, my inner demands to NOT teach/travel anymore were discomforting enough that I canceled my plans for 4 workshops, all here in Canada. 
Which kind of sucked for everyone involved. 
And I regret having had to ever be a volitional agent of suckage of any sort or to any extent for anyone. 

.................................

It felt so final. 
And solemn. 
Like a sacrifice. 
The final decision hurt, and delivering it hurt. I felt like I imagine my dad must have felt, saddled with the the responsibility and no doubt, existential angst, that surrounded his "job" of killing chickens and steers and excess numbers of kittens and chicken-killing skunks and badgers, etc., on the farm I grew up on. I imagine it contributed to his dying on the rather young side of old age, at 77. 

But now, I must digress for awhile. 

...................................

Since I retired, I've been watching a lot of Iain McGilchrist videos, and planned to buy his new book.
The actual book. 

Which is 1500 pages long. 

The Matter with Things. 

But another part of me is inhaling the wisdom it contains, just by watching videos, and is arguing against buying the book. 
I'm already pretty convinced about what is in it, so I would just be exercising confirmation bias by owning a copy, and is that any reason for buying the book?
Another part of me argues, life is short and then we die, and I would enjoy reading all his words and ideas and arguments. I have the right to amuse myself, it says.  

Anyway, here is my take so far.
Life is a verb, not a noun.
Two verbs, actually. Because the brain has two sides, two hemispheres. Each one has its own personality, in effect. 
Sometimes these two come into some dissonance. 

The right hemisphere gets that life is a verb, not a noun. But it doesn't talk. 

The left one is very gabby. It loves words. It can talk.
It's like a four-year old though.
Lots of energy but no wisdom.
Lots of content but no container. 
Very pushy. 
Needs a lot of handling and carefully boundaried coaching to get it off all the squares it gets stuck on. 

Now, (bearing in mind that the verbal hemisphere is like the 4-year-old), every time a word is used, it is a "thing." The left hemisphere uses words to describe something that it considers to be a detachable aspect of the world, something specific. It turns the verb of the world and life and consciousness into a bunch of nouns, manipulates them, builds ideas from them, creates structures with them, conquers continents, pretends money is real, grabs as much of it as possible, turns competition into a fun game to be played on top of the bones of everything that is not itself.  Self-flattering, self-aggrandizing monuments to heroic events meant to make the nouns it has created in its own image, permanent. Anything that steals life itself. De-verbs it. Noun-izes it. Thinks it can stop entropy by slowing down life's very creativity, which doesn't work and only accelerates entropy instead.
Lovelessness. 
A perfect example of this is all the plastic the world is currently drowning under. 
The rubbish heaps that poor people all over the world scavenge for bits to reuse or recycle or sell.  Or eat. 
The community in India that lives on top of a below-ground fire that has burned for a century already, and occasionally breaks above ground to consume this house or that one. (These people can't move - there is nowhere else for them to go.)  (https://www.aljazeera.com/program/people-power/2017/1/5/india-the-burning-city)

His book is about where, when, and how all this went so very wrong.  All from a very highly educated white Brit male, whose cultural container is the same as that of some of the most virulent colonialism the world ever saw. 
He is trying to undo the worst of the worst, examine and point to the places where wrong choices were made ideationally. Go back to source, and provide a different perspective. Backed by (I don't know) something like 40,000 references. 

He places himself in the middle of it all, able to argue both sides of most dogma and convention.
Not sure how many non-white, non-male voices he has listened to though. 

..................................................

I like to think that my hemispheres communicate fairly successfully with each other. 
My left hemisphere listens to the feelings in my body that the right hemisphere generates to warn it of things. It responds. It does the job of interacting with the outside world.
It's like an inner marriage I guess. 

For years and years, decades really, my two hemispheres had their relationship worked out just fine. If their relationship was tested by circumstance, they usually worked out what to do in the background somehow, and allowed me to enjoy the illusion of being integrated. 

However these days I can more clearly see the outlines of each of them having their independent thoughts and feelings and motivations. 
They are connected by and through, my body. 

At the same time, I am far less bothered by this now than I might have been earlier in life.
Nowadays I view these two hemispheres of mine who have come so far together as an Amaryllis,  that tall, red, two-headed (or more) flower that blooms around this time of the year, whose Greek name means "to sparkle." 

 

A Saskatoon adventure

This whole past weekend I was in Saskatoon staying with a friend and her family in their home; I volunteered to be rapid-tested a couple times in the process to make sure no covid bugs were present in the posterior wall of my nasopharynx. 
I did my own swabbing, which although it did not hurt in the slightest, was exceedingly tickly. 
I do not think I could have tolerated anyone else doing that to me - so ticklish. 
It brought tears to my eyes as it was. 
I expect that one's sensory nervous system would easily adapt to repeated testing, however. 

The snot-drenched swab is put into the little test tube and five drops of reagent is added, left for a short period of time, then dabbed on the tester. The strip at the bottom turns pink, which disappears, and a line is left. Or if you are positive for coronavirus infection, two lines are left. 

The kit set up

                                           My negative test result.                  Two lines would indicate a positive test. 

...........

So, why was I in Saskatoon, invited into somebody else's personal covid-free bubble? 
This particular friend had proposed a reshoot of my entire online dermoneuromodulating class at Embodia with a professional film company. She found a space, handled all the logistics, food, everything, including looking after me, most spectacularly and efficiently. She made sure that all who attended the presentation/overview were double-vaxed and masked, including the camera people. 
There was a brief moment of concern when one of the attendees notified her that his girlfriend had tested positive (which is why I took a second test) but as it turned out he tested negative, so we carried on and completed the entire shoot over the 3-day period. 

The camera guys were great, and their lighting and camera equipment impressive. The mic was clip-on, very tiny, and the battery box so small that it and the cord fit easily inside the front of my bra, totally invisible. They used to work for a TV station. It was evident that they were pro, the way they moved around completely silently and signaled to each other with just hand signals.   
On occasion, a train would go by out back, and they would stop me until it had passed out of earshot. But remarkably (and thankfully) that did not happen very often. 

...............

I have come to realize (with slowly growing horror) the extent to which my own profession (physio) is in the process of being taken over by the chakra belief system. A glimpse was gained when an individual I was chatting with used a chakra framework to discuss her neck issues.
A physio. A yoga physio. 
I don't care what people do with themselves or their own brains on their own time, or what they "believe," but I really do not think their belief systems should be imposed on my profession. I want my profession to be science-based. Maybe it never will be.  
I guess I must have been unaware until just this past weekend how deep chakra talk has permeated into the way (probably all yoga-physios) think and speak. Such a slippery slope from there into operator notions of "energy" and "healing." Exact same BS as the massage profession is up against. I have intense disturbing visions of physio becoming awash in crystals and all the other crap that goes with chakra BS.

I don't know how to deal with it.

I mean, I guess it's less (overtly) harmful than the way my profession was taken over by the bone-cracker mentality 40 years ago.

But it may be ultimately MORE harmful in that it uses the same mental shortcut pathways (exceedingly UNcritical thinking) PLUS, it comes all draped in gauzy "spiritual" flowing robes of metaphor, more insidious, less easily dismantled/disconfirmed by scientific investigation.

Sigh. 

Yet more weeds. 

I may need a new and better cognitive weed-whacker.  

Thoughts on authoritarianism

Every so often on Facebook you see frames pop up that can be added to one's profile picture. I saw one I liked and added it - programed to go bye-bye in a month. 

It made me think a lot about authoritarianism when somebody pressed me on science being authoritarian. I pushed back because I haven't seen evidence of science, or actual scientists, being authoritarian. Rather I've seen authoritarians trying to justify their authoritarianism by using science to try to justify themselves. 

If any group of humans understands that life is a verb, not a noun, it's actual scientists. 
They get that things, like viruses, like life itself, evolve. They try to keep up, they don't impose. They know they'll never be completely right about anything but they always strive to be less wrong about everything. 

The ones who impose, the ones who are authoritative, are those we elect to lead us. Hello? WE elect them to lead us! 

And from whom do they seek information on how best to lead during a pandemic? From effects of climate change? 

From science, we hope! 

That way we can all stay together and move as a large group in hopefully the right direction at the right times, stay nimble against threats to our human collective existence. It's a pretty good system, democracy is - it allows authority/authoritarianism to spread out and be dilute as possible among as large a group of individuals as possible while protecting the body politic from as much die-off as possible. Because you see, authoritarianism is always in there as a default brain thing - but how we organize ourselves in groups will either ameliorate or exacerbate it. 

.................

Speaking of authoritarianism, I also made this little picture: 

The pic at the back is of soldiers from the famous Star Wars movie, and the one at the front was taken just yesterday or the day before, of the new regime in Afghanistan. To me, there is a striking resemblance.  

Both were/are authoritarian. 

There is nothing on this earth more authoritarian than a collective of males banding together to save themselves from the verbs of life by trying to turn everything into nouns to be defended or vanquished. 

By them. 

They keep for themselves alone the right to be verbs and everything else becomes a noun to be manipulated.

Meanwhile they are "salvationed" from having to think for themselves because they take orders instead from whoever feeds them and gives them uniforms to wear. They can go back to being dependent babies in some ways. 

They crave certainty. 
Insecure people don't see existence as a human as being an active agent who has learned to surf on a moving body of water. Instead, they want solid ground. They want to turn everything into rocks that they can pick up and throw. They are vulnerable to wanting authoritarianism to dictate to them what to do with themselves. They want religion to tell them the answers to life's conundrums. They want to blame the world and everyone else in it for their own personal existential angst. Especially they blame females, because perhaps they just can't reconcile with the fact that they came out of one of those "others" and find the very thought rather horrifying.
...............

So many examples of this tendency in the human primate brain - well, for sure the male human primate brain, because males are very homosocial and they love to dress up all the same so that as a group they look more foreboding/less human.
Women perhaps not as much. We prefer to remain individuals I suspect. 

.............

A third thing I saw today that reminded me of authoritarianism was a post from Adam (Manual therapy sux!) Meakins, who I've spoken of before here and here. 

 

I enjoy this guy and his take on the world, even though it's so opposite my own, and even though he is so "authoritarian" with his stance or maybe adamant is a better word. 

(Right, adamant is a way better word! It contains his first name even!)

There is nobody on the planet probably, as wedded to the idea that tissues are the cause of back pain than Stu McGill. There is nobody on the planet probably, as prepared to openly confront and contradict him on this than Adam! 😄 

So, who's the authoritarian here? 
What is the background to all this? 
In my mind, I put Stu McGill and all of chiropractic and all of orthopaedic manual therapy and most of orthopaedic surgery all in the same boat: those who subscribe to it want nouns they can manipulate, not messy changey verbs that are like water that they cannot grasp.
They are transfixed by skeletons. They love bones. They sit there and puddle around with individual vertebrae in front of them on the desk, fitting them together, pondering for hours on how they move, what stops them moving, trying to design systems of thinking, algorithms for manipulating them, and assuming (this is the important bit) that somehow those bones not moving on each other is what pains people, not that pain might be something (in the nervous system!! Hello??) that stops them from moving. 
And from that, they built themselves quite the authoritarian world to inhabit. 
One that I examined for a time, quite casually, then, in the end, rejected as pseudo. 

In case you haven't figured it out yet, I am anti-authoritarian in most aspects of life. But not in a meaningless way. 

I got the shots and I wear a mask when out and about. 

I enjoy freedom but not free-dumb.