Saturday, June 28, 2008

Divorcing the car

Over a lifetime I've had a changing relationship to car ownership. When I was a teen I desperately wanted to learn how to drive, as I'm sure all teens still do. But it was the early 60's, the Canadian prairies, and I was a girl in a farm family which had yet to become egalitarian in how it treated its son (my brother) and me (the oldest but a mere female). My mother did not acquire a driver's license until well into her thirties.

A memory snippet from around the age of ten: I remember her practicing with the family car (a powder-blue 2-door '53 Ford Meteor), steering it carefully around the yard with her glasses (cat's eye shape, framed in reddish brown across the top, little sparkles in the corners) perched on her nose, looking very focused, very aware of her responsibility for the control of hundreds of horse power. She thought there was no need for me to learn to drive or get a license. My brother however was encouraged to get a license and a car as soon as possible. Not fair.

At the age of twenty five, long after graduating from physiotherapy school and feeling very definitely like an adult, I took driving lessons. At age 28 I bought my first beater, a green '74 Chevy Nova. My anger at my mother's mean sexism finally could abate. I felt like I had the world by its tail. Wheels at last. Driving victory was mine.

I loved driving. Took long trips. Explored. A couple Toyotas after that, a Ford hatchback, and this last car (which I will say goodbye to tomorrow), an Olds, the one and only car I've ever had that had air conditioning. All have been second hand.

It is thirty years later and the honeymoon is long over. I'm fed up with owning a car. My car sat idle, mostly, for the past year, as I learned and practiced how to be carless again. This decision to finally let go was not taken in haste - I remember vividly how much I used to love being a car owner/operator, how much I once associated it with independence - but... the thrill is definitely gone.

I'm tired of getting the car fixed, putting in gas, washing it, checking the tires.. all the stuff one does with a car. Actively loving and caring for it. I'm tired of paying for insurance on a big hunk of metal that just mostly sits there. And I'm really annoyed that the battery died because of letting it sit and not burning up gas. Thanks a bunch. Here I was being good to the planet and the battery dies from not being used. Time to kiss car ownership goodbye.

I'm looking forward to joining a car co-op - I'll be able to drive when and if I need to, but I won't have any responsibility for upkeep. I'll save a small fortune in insurance. Nothing will be in my parking spot but empty space. Decluttered.

With the money I get for the car I will be able to afford a new laptop, something I'll really get a lot more use from. The deal happens tomorrow, for cash. By Sunday evening I'll be carless and will feel much less encumbered by life.

Monday Jun 30:
Well, I'm still a car owner today... "the best laid schemes 'o mice and (wo)men gang aft agley" and all that. The car was inspected by the prospective new owner this morning (instead of yesterday) and he likes it. But he wants to bring cash (fine by me), and can't until Saturday July 5. Our new time is 8AM Saturday morning. I'm still very much looking forward to being a carless person.

Wednesday, June 25, 2008

New blog - Eric Matheson PT: Feel Better, Move Well

The PT blogosphere is growing all the time. Eric Matheson has just launched a new blog called Live Better, Move well (and a new website, Matheson Physiotherapy. If you live in Nanaimo and need some help, Eric is your guy.)

Eric's latest blogpost is entitled Itch, and I must confess I read his post on SomaSimple and got the idea for my own blogpost, Itchy and Scratchy from it.

I like the line he drew out:
"This understanding of sensation points to an entire new array of potential treatments - based not on drugs or surgery but, instead, on the careful manipulation of our perceptions."

So true - for pain also.

Eric, I like your post better than mine.

Monday, June 23, 2008

Itchy and Scratchy

The New York Times has a great article by Atul Gawande about itch, and how sensors can go wrong. It's not the same as persistent pain, but it sounds awfully similar in behavior. Here is a link to The Itch. Here is a link to an audio interview about it.

Here is Jonah Lehrer's blogpost about it in his Frontal Cortex blog.

Here is a link to Atul Gawande's website.

Sunday, June 15, 2008

Alberta woman with chiropractic stroke sues bigtime

A class action lawsuit has been filed against chiropractic in Alberta. A woman was turned into a quadriplegic by a chiropractor.

More of these cases are coming to light all the time. Rather than writhing in shame the way a profession should if lives are ruined at constant spaced intervals by its own "rock star" type of human primate social grooming, chiropractic shrugs and moves on, lets the individual chiropractor take the hit and acts like it's not the profession's fault.

This is an unconscionable attitude to take. I've always thought so and I always will.

In this case, (as I understand it) the woman and her husband are hoping to take the profession itself, and the provincial government which subsidizes it to court instead.

Nobody "needs" this kind of high-neck manipulative intervention on a regular basis to maintain their "health." Never let ANYONE tell you otherwise, no matter how charming they seem. It's a lie. It's a crock. Don't let anyone twist your neck for any reason. It's dangerous.

Watch the video, Kinsinger Report on Chiropractic.

Here is more information:
1. Chirotalk thread on the topic (Chirotalk is a board run by sane ex-chiropractors which means it's anti-chiropractic)
2. Old blog post, How I really feel about chiro
3. Please sign this petition against neck manipulation. Seriously, folks, this is a malevolent and thoroughly unnecessary human behavior that should be extinguished completely. Analysis of all the hidden symbolic dominance-submission ritual content it contains can wait until after it's been de-legalized.
4. Paralyzed woman sues chiropractic for half billion
5. Alberta woman launches massive chiropractic lawsuit
6. Sandy Nette's website
7. Action for Victims of Chiropractic (UK)
8. Video (short) Is a Headache Worth Dying For?
9. Chiropractic Lawsuit, blogpost by Steven Novella at Neurologica Blog
10. Adverse effects of spinal manipulation: a systematic review (JRSM 2007)
11. A Deadly Twist (story of another survivor of chiropractic stroke)
12. Chiropractic and Stroke (blogpost by Harriet Hall, MD and skeptic)
13. Another survivor, Graham Maynard's site
14. Stroke after chiropractic (CNN)(short video of a news clip)
15. Fact sheet on the class action (7-page pdf)
16. Doctor Who? Deception by chiropractors, by David Colquhoun
17. Chiropractors resort to legal intimidation, by David Colquhoun

Here are videos from the Nette couple's website,

1. Sandy Nette's Story (about 8 minutes. Sandy speaks through a message board)
2. David Nette's Story: Part 1 (about 10 minutes. David talks about what happened at the hospital initially.)
3. David Nette's story: Part II (about 10 minutes. David talks about how he adjusted to the new situation he found himself in with his wife.)
4. David Nette's story: Part III (about 9 minutes. David talks of their shared resolve to prevent this ever happening to any other person, by launching the class action lawsuit.)

These videos are very revealing, very, very real and raw. They are a must-see.

June 20/08:

Since I put this blogpost up I've received a couple comments from one or two readers, both named "anonymous." I did not allow their comments to appear. They are glaringly pro-neck-manipulation, and I think the pro-neck-manipulators have already had far too much leeway in the realm of swaying public opinion to give them any sort of platform, however buried, obscure and humble this blog may be.

It's because of:
1. chiro training in a rationalized (as opposed to rational), deliberately propagated, bizarre belief system, combined with
2. a cultivated and honed persuasive attitude,
3. which appears aimed at propagating reckless enactment of a type of human physical social grooming (high-neck-manipulation) which is irrelevant and unnecessary in the first place,
4. against all common sense AND scientific investigation,
5. for the sole purpose of making $,

... that this woman became tetraplegic.

I have too much respect for the human nervous system to ever condone manipulation of its high-neck housing; therefore, "anonymous," I consider my prevention of your promotion of it on my blog, a positive choice - an action (however tiny) against letting myself and this blog be a vector for further perpetuation of your particular memeplex. And I happen to think it's an accumulation of tiny actions that count in life.

July 6/08:
Back in with this blog thread from Science-Based Medicine on this case.

July 17/'08
Back in with another Science-Based Medicine blog thread which deconstructs a chiro article which suggests patient visits to chiros and patient visits to medicos result in the same numbers of strokes overall.

Calgary Herald article by John William Kinsinger MD, Jun 21/08: Cracking necks destroys lives

Last night CTV's news program, W-FIVE, examined Sandy Nette's lawsuit. The program provides a glimpse into her life - it looks like she is able to use her left hand a little bit now. The viewer is introduced to a few of the others (people who had strokes shortly after chiro manipulation, some of whom recovered and others who didn't) who also are part of the class action suit.
The clip from W-FIVE

SPARC : Stroke Prevention & Atherosclerosis Research Center
Strokes From Neck Injury

Blogpost on bilateral internal carotid artery dissection from chiropractic neck manipulation.

Paciaroni M, Bogousslavsky J; Cerebrovascular Complications of Neck Manipulation.
European Neurology 2009;61:112-118 DOI: 10.1159/000180314
(If that link doesn't work, go here and click on full text or pdf.)

Feb 10/09
Harriet Hall, Chiropractic’s Pathetic Response to Stroke Concerns

August 4/09
Beware the Spinal Trap Simon Singh
“We are more possible than you can powerfully imagine”
Ben Goldacre, Bad Science blog

Tuesday, June 10, 2008

Pain Science Division is not only official, but the news is now out

In reference to Canadian Physiotherapy Pain Science Division:

This morning I sat for a few minutes and read the "e-blast" from CPA, a report on our last National Congress, with this list of topics:
Tremendously Successful and Incredible Congress!
New CEO of CPA Officially Installed at Congress
New Pain Science Division Launched
Best and Brightest Recognized
Congress Receives Positive Media Coverage
Cost of Business Survey - Only 4 Weeks Left!
CPA Teleconference Program - Last 2 Sessions!
Obesity Survey - What Should Physical Therapists Do
Physiotherapy Foundation of Canada - New Board of Governors

The item I bolded above states:
New Pain Science Division Launched

It was a very successful Congress for those behind the three-year-old effort to have a Pain Sciences Division of CPA. The Board of Directors voted unanimously to approve the Division launch this past weekend. The purpose of the Pain Sciences Division is to disseminate current scientific information to Canadian physiotherapists, foster collaborative efforts between academic researchers and clinicians involved in pain management, and to promote physiotherapists as leaders in non-pharmacological pain management both nationally and internationally.

The first annual general meeting of the new Pain Science Division will be held in 2009. CPA members can join the new Division in the fall of 2008 when they renew membership.

Neil Pearson, a physiotherapist member from Penticton, BC, and a pain management specialist, is the new Chair of the Division. He says those who were behind the scenes did a lot of work to get it off the ground and are very excited now that it has been approved.

You may recall that a survey about creating a Pain Division was sent out to members in January, and there was overwhelming support for it.

For information on CPA Divisions, contact Tracy Blyth in the national office (email deleted)

The excitement was particularly sharp the day of the vote, two weeks ago. Although decreased in amplitude this excitement has not diminished in frequency or endurance. I feel it the way I can feel my own blood coursing around, a feeling that's right there whenever I care to tune into it.

That which sustains our humanantigravitysuits II

In reference to That which sustains our human antigravity suits:

This is hilarious. May the Farm be With You, a short video (under 10 minutes I think) with a loosely borrowed StarWars theme. Meet young Cuke and Obe Wan Canoli who fight the Forces of Darkness and rescue Princess Lettuce. You won't want to miss Ham Solo and ChewBrocoli.

Friday, June 06, 2008

That which sustains our human antigravity suits

In light of recent news reports about a global food shortage, I'd like to bring a series of you-tube videos here, highlighting the obnoxious corporate behavior of a certain company, Monsanto, that would do anything/is doing everything to take over anything/everything to do with global food supply, simply
a) to make itself money and power, and
b) because it can, and no one stops it.

(Behavior in this category is considered psychopathic when identified in ordinary mortals. See this film, The Corporation.)

Judge for yourself if any trails might lead to this company as a major contributor to this alleged food shortage.

Part I: Monsanto Patent for a Pig
Part II: Monsanto Patent for a Pig
Part III: Monsanto Patent for a Pig
Part IV: Monsanto Patent for a Pig
Part V: Monsanto Patent for a Pig

I grew up on a farm. As I watched this set of videos, my blood alternated between curdling and boiling. It's enough to turn a peaceful person into a political activist.

Thursday, June 05, 2008

Canadian Physiotherapy Pain Science Division

We made it!
The group a few of us started in Canada in 2005 is now officially a division.

I've blogged about our little group, the CPPSG, a few times before, specifically Nov 2006, about a year after we were denied divisionhood after our first application.

We decided to keep going anyway, representing the profession as mirrored in a new way, a brand new way to most of the members that comprise it. We kept plugging along, developing a public profile. Neil Pearson engineered a magnificent set of webcasts on pain. We produced a series of newsletters of pretty good calibre, free to the public and to members of the profession worldwide. Each of our (total of six) members remained fully engaged in life, practice, and keeping our little flame lit.

It paid off, because at the end of May, just a week ago, the decision to include our group as the Pain Science Division of CPA was unanimously approved by all the official leaders in the Canadian branch of the profession.

Now the REALLY hard work starts. Yours truly will take on getting a new website together, which will be a major learning curve. Already there are lots of knocks on the door re: a series of teleconferences for fall. We're going to have our hands full, and we'll be keeping skype very busy.

We are aiming to improve the general overall level of knowledge in the profession regarding pain and how to treat it, when to not try to treat it manually, how to understand it, what to tell patients about it. There has never been an official physiotherapy division in Canada that coalesced around a ubiquitous symptom before, or around delving into what pain means. Instead, physiotherapy divisions have usually coalesced around a type of treatment or a specific patient population or a segment of human anatomy. We are the first division to have taken on tackling the essence of why physiotherapy exists in the first place - to help people overcome their pain and suffering, and try to help us all get better at it as a profession at the same time; understanding pain much better, by studying, learning and teaching a deeper model, also as a profession.

Wish us well.

One little drawback is that we won't be able to produce public newsletters anymore, for awhile. We have to become inner-focused, membership-focused, to get our work done within the Canadian branch of the profession. But we still have a commitment to the public and to physiotherapists worldwide, so I envision a day coming when we will start to produce publically available newsletters again.

Sunday, June 01, 2008

"The pain is gone"

To me, an old-fashioned human primate social groomer who has always leaned harder toward the "therapist" side of treatment rather than the "physical", but who uses manual therapy as my main intervention, the advantage of deep science-based pain models like my favorite, the pain neuromatrix model, is that one can remain connected to one's patient (i.e., in good therapeutic contact) while explaining to them what their experience of pain, or in this case radical pain relief, might mean, regardless of how strange it may seem to me or may have seemed to them.

Here is a diagram, famous by now I'm sure, of Melzack's neuromatrix model. Click on it to make it bigger, so you can read the detail.

I often haul out this little diagram and sit down with a patient, because a lot of times, simple handling isn't quite enough - they need answers.

Case in point: last week I saw a young woman for the first time. She had been sent to me by her massage therapist (who I've known for years) who had worked with her for many months. Let's called the patient Rosie (not her real name).

Rosie had had a prior history of low back pain for ten years, for which she had gone to a chiropractor semi-regularly. She had worked as a fund raiser for some outfit, until about two years ago; while nursing a sprained ankle (and on crutches) she was in a car accident. Now she had back pain, sprained ankle, and neck and shoulder pain. She was unable to do her fundraising job anymore and had had to quit.

She had endured persistent neck and shoulder pain for two years in spite of seeing 36 of the finest manual therapists, both conventional and alternative, that Canada has to offer, in two different provinces, and having attended a modern pain clinic.

Then, to her surprise, during a meditation retreat in December last year, her pain vanished. All of it. Gone.

Emboldened, she began a vigorous yoga program, and inadvertently overstretched something. Bam. She had felt instant leg pain and a lot of weakness in the quads. This had persisted beyond the massage therapist's expertise, and was why she had been sent to see me.

I learned that after she had given up fundraising after the MVA, she had become involved in an experiential psych counselling training program, where they let her learn from a physical position of comfort, i.e., horizontal.

At visit #1 I had taken her history and provided some manual treatment, some very rudimentary pain education, and showed her a neural glide to do for the leg. She'd been happy for something to do - anything.

Yesterday at visit #2, I was ready with a neuromatrix diagram and was planning more in depth pain ed.

She arrived.
I asked how she was doing, and she said, "Fine, I'm all better."

(I was thinking,... huh? Did she go on another retreat?)

I asked how she had managed it this time, and she replied that the evening prior she had invited two shamans in to work on her, and they had, with burning herbs and drumming, and lots of touching. Before they left, they had pronounced her cured.

And sure enough, she felt that way. No pain.

She really did seem better, could walk better, move better, sit comfortably, breathe better.. Wow, I thought. "Good for you," I said.

"Well," she said, "I still feel some stuff..."
"..It looks like the stuff you might still feel doesn't bother you anymore - is that how it feels?" I asked.
"Yes," she replied, "I still feel some stuff but it doesn't bother me at all. I didn't need to come today, but it was too late to cancel my appointment."

We had an hour to spend, so I decided to stick with the plan; I asked her if she was interested in learning some things about pain. She said yes, so I invited her to go through the neuromatrix diagram with me. We sat down and I began explaining how the center circle with circular arrows represented the entire nervous system, how it was always processing even at night during sleep, how it was more of a verb, therefore, than it was a noun, how the diagram depicted the movement of this neuromatrix through time... how it had three main inputs on a spectrum that ranged from mental (cognitive evaluative) to physical (sensory-discriminative) to physiological (motivational-affective) and three main outputs, one of which just so happened to be pain, which could be influenced by any of the three inputs and which in turn influenced the three main inputs plus the other two outputs...

As we wandered through the diagram, I plugged in pieces of info she'd given me, she asked questions, we talked about treatment crucibles, safe containers and catalysts, symbolism and shamanism, meditation and movement forward. During her shamanic experience she had had a great deal of novel sensory-discriminative input, through all her senses, not just kinesthetically. I told her it sounded like it had been enough to get her neuromatrix off the square it had been stuck on. I pointed out, based on the prior meditation/pain relief experience, how much more her particular pain matrix seemed to respond to shift of cognitive input than it did to sensory-discriminative input. I mentioned that for most people, sensory-discriminative input of the physical kind was often sufficient, but that she'd burned through 37 manual practitioners of various kinds, including me, without much help, and she nodded..

She told me this was all making more sense to her now.. that she was someone who just didn't "get" things through only her body, the way most people can if some reasonable sensory-discriminative input of a novel sort is provided... Instead things had to make sense to her through her emotions/mind.

Apparently long ago some other PT had loaned her the book "Explain Pain", for a few months, and she had diligently made notes and some photocopies, but it had never quite sunk in or gelled. Now it was finally starting to make sense. She said, "I wish I could read that book again. It was really good, as I recall." I replied that she could buy her own copy if she wanted.

We discussed rehab, and I told her about some options, but that wherever she went, to stay in complete control, not let anyone rush her, and to use "graded exposure" and "pacing", concepts she already knew about.

I showed her two chapters from Pain: A Textbook for Therapists and she took copies. She said this would help her learn the neurobiology for when she herself would be a therapist, counselling pain patients. I mentioned she would be able to buy this book online as well - that buying these two books for herself would be much cheaper in the long run than seeing a bunch of expensive therapists for sensory-discriminative input that her particular brain seemed to not be wired to be able to easily accept. She agreed.

I worked with her leg for a little while, and unlike the first time, this time she remarked on feeling heat and movement in the thigh, and non-painful sensation connected to the leg in other parts of her body. I asked her if she could do an active straight leg raise after, and to her surprise, she could.

She left very pleased with all the progress she had made in one week, by her own efforts. I didn't need to see her again in my opinion; her downregulation was well and truly hooked back up. She's away to her next adventure, all in one piece again finally.

Way to go, Rosie. Way to go.