Thursday, November 26, 2009

The "verbiness" of terms for describing pain

From a discussion thread on Somasimple, the difference between kinds of pain:
"I tend to think in terms of "persisting" and "resolving". - Sebastian Asselbergs PT

"Aha. I'm starting to get it. Conceiving of pain as a condition like alcoholism where the diagnosis of it being a "problem" can only come from the person experiencing it makes sense.

This is helpful to me. Assisting a patient towards resolution will be more effective if I have an appreciation of how their pain may be working for them. Only when they admit that the pain's not working, and become willing to change whatever behaviors are contributing to its persistence can they start towards resolution. This sounds like the movement from a pre-contemplative to contemplative stage of behavioral change.

Cognitive behavioral therapy principles come in to play here because patients may think their pain is working, but they are often mistaken. They don't see the whole picture, or are not reasoning effectively...because of the pain. Obviously, pain clouds jugdment(sic) and reasoning abilities. It also robs one of options- and the ability to imagine other possibilities.

I like the "verbiness" of "persisting" and "resolving." Conceptually, this supports a more interactional as opposed to operational mode of providing therapy.

I don't want to be a hero for my patients." - John Ware PT

Perfect. Pain as verb, not noun. Pain as a natural process (i.e., something that moves along) for which adverbs might be helpful, not as some static something requiring scads of ever more clashing and diametrically opposed, mutually exclusive adjectives, like "normal" and "abnormal."

Thank you John.

1. a word that modifies something other than a noun
2. the word class that qualifies verbs or clauses

Adverbial: a word or group of words function as an adverb

Thursday, November 19, 2009

Wednesday, November 18, 2009

Canadian Pain Physio Directory

I'm pleased to announce the launch of the Canadian Pain Physio Directory, an initiative of the Pain Science Division of the Canadian Physiotherapy Association. A permanent link has been added to this blog, at the top.

Sunday, November 15, 2009

Light, let there be.

I need to rave on a bit about how much I am enjoying the light levels here in Saskatchewan. My own particular very bossy suprachiasmatic nucleus loves being "home" again. Let me try to explain. This first picture is my view of the sky, looking west, about 5:15 PM. We don't change the clock in Sask. That's just point 1.

Where I live is situated 1850 feet above sea level. It's like living at the top of a very very large hill. When the sun comes up, or goes down, the light changes ever so gradually. There is nothing abrupt about this process the way it is at sea level. The sky takes a good half hour or longer to brighten or dim, both before and after the sun has come or gone. I think this gradated dimming/brightening, the slowness of it, the gentleness of it, the non-abruptness of it, is crucial - at least to me. I think it might be why the big fake sun-lamp stopped working for me. My particular suprachiasmatic nucleus took all this for granted the first 33 years of its existence. Then for the next 26 years or so, it had to put up with sudden light changes. They really are more abrupt when there are mountains and sea level blocking light as my brain had become accustomed to it, a brain used to a sky that faded or brightened slowly, so slowly, from very dark to very, very bright. And big. Huge. Dome. Sky. Sky that actually dips down on all sides below the horizon line, letting the sun smoothly illuminate it even when it isn't directly visible. How cool is that? This second picture was take at around 6 PM! There is still enough light in the sky to take a picture without any fancy equipment, just a handheld camera. Not much, but just enough.

Halfway through November, and no SAD. Not one bit of it. Just greater and greater decompression noted each passing week.

More about flu

I wrote a bit about this just yesterday. A number of years ago, while researching what life was like in the early part of the last century, trying to feel the context of the birth of physiotherapy as a profession in the world, I read all about the flu pandemic of 1918, and I must confess, it scared the bejeebers out of me. I don't scare easily - it's just that this thing killed such a huge percentage of the population of the day, and there was no stopping it then like there is now. Like most everything in nature that moves, it came in waves.

There were no flu shots available way back then. It was AFTER, and likely BECAUSE of the 1918 pandemic, which scared the bejeebers out of the entire world, that Centers for Disease Control developed, and vaccines were developed, to try to keep something like this from ever slowing us human primates in our various troops, down, ever again.

I want to grab Bill Maher (and others like him) (gently) and shake him, ask him to wake up, and go to, look at, read the following links. Try to understand the deal here. Ask him to set an example of the right sort.

1. Images

2. Wikipedia link
"The 1918 flu pandemic (commonly referred to as the Spanish Flu) was an influenza pandemic that spread to nearly every part of the world. It was caused by an unusually virulent and deadly influenza A virus strain of subtype H1N1."
(H1N1 - did you see that?)

3. Modern strain similar news story

4. The 1918 Influenza Pandemic from Stanford, somewhat scholarly treatment of the issue

5. Mother of all Pandemics

Saturday, November 14, 2009

Conversation re: flu

So, this morning I arrived at the Wheatland bright and early to help peel spuds for a catered dinner later today. There were the two main caterers, Ruby and Helen, and Helen's husband John. John already had the potatoes in the sink, had quite a few peeled, so I donned an apron and joined him, with a peeler I brought with me from home, originally purchased at IKEA in Vancouver. It's a great peeler, sharper than most of the ones I've tested at the Wheatland.

Anyway, I asked Ruby how things were going for her. "I'm not going to get that flu shot," she announced, which made me think that she had been thinking about it that very moment. Which one? I asked. "H1N1" she replied. Oh. How come? I asked. "Because I don't think I need it. By the time we get the vaccine here, the flu will have come and gone anyway," she replied. "I'll get the seasonal flu shot though," she added. She continued ripping up several heads of iceberg lettuce for the large salad she was building in an enormous clear plastic rectangular tub, enough to feed 60.

"That's interesting," I remarked as I fished a gigantic potato, a good three pounds, up out of muddy sink water, a potato that still had half a farmer's field stuck to its side, which I set out to remove before trying to peel it. "I came to exactly the opposite strategy after thinking about the whole business. I'm willing to become part of 'herd immunity' for H1N1, because, well, while seasonal flu does kill people, it's usually the really weak and sick that die from it, whereas H1N1 is picking off healthy people, kids. I'm more interested in not being a breeding ground for something that kills healthy people than I am in not being a breeding ground for something that is mostly not dangerous for healthy people." I managed to chop up the three-pounder into about 6 large chunks, each of which I could peel more easily with my small hands and wicked sharp peeler from IKEA.

Ruby replied, "But those people who die from H1N1 must have a weak immune system."

"Actually... my understanding is that they don't, that the virus actually provokes their immune system into over-reacting, and it's their own immune system response that does them in."

Silence. Then, "How are those potatoes coming along?"

"Good. How many pots-full will we need?"

"We'll need about two and a half small pots full, but we'll cook them all in just the big pot. There are only 60 people coming to this. It's not like a regular supper with a hundred and 20 where we need the big pot full and two small pots as well."

"OK then, I think we'll have enough with these four big potatoes we have left to peel here."

Long pause.

Then Ruby said, "I don't know.. I think I'll just go with what the doctor said. He said he thought that by the time the vaccine got here, the flu would have already come and gone anyway.."

I waited an appropriate length of time, then said, "Well... I was thinking about that 1918 flu. I think it arrived in waves. I think it can go away for a bit then come back again... I wouldn't want to be someone who worked for the Center for Disease Control, tracking viruses and whatnot, trying to figure out how to advise as I tried to understand what was happening around the country.. That 1918 flu took out a huge chunk of the population. In those days there were only 2 billion people on the planet, and the flu took out 50 million, something like that.. that's a big percent of the population, and there were no shots for it, no Center for Disease Control, nothing. People died like flies in those days from all sorts of things, but for sure that flu made a big impression..... Do we have enough potatoes peeled now, do you think?"

"Yup. That should do it. Let's go have coffee."

Thursday, November 05, 2009

The Red Albatross

Finally, the red Persian rug is gone. I took one last picture of it today, lying in a semi-rolled up heap in the middle of my living room, just prior to the arrival of two men who carted it away, off to the Wheatland Center, where it will either live on the floor of the puzzle room, or else be raffled off as a fund-raiser, a more recent idea Helen, the administrator, hatched. Either way, I'm glad it's gone from my life where it had become a burden, and will have a new life with someone (or someones) else, who will give it a nice home and enjoy it. Plus, if the Wheatland makes a goodly sum of $ out of it, all the better.

Sure is nice to have it gone. A weight feels as though it has lifted. Bye-bye rug, hello more simplicity.

Tuesday, November 03, 2009


Mo at Neurophilosophy Twittered a link to a blog called Inside Higher Education: Career Advice, about writing a dissertation, by Peg Boyle Single. It seems she has a book out.

The column is also full of good advice about writing in general. Part 1, A Regular Writing Routine, is a layout of the mechanics. Write whenever you have a chance.
"Motivation in writing comes from prewriting, prewriting, prewriting. Motivation occurs when you have done the necessary planning steps so that when you sit down to write prose, you have had time to subconsciously play around with the ideas and you only have to retrieve and type down the ideas, not to think them up. Motivation occurs when you have a very detailed long outline, filled in with citeable notes, by your desk that guides your writing."

Part 2 is What the Research Says. The first item recommended is to develop "deliberate practice."
"So what is deliberate practice? It is not inherently fun nor is it intrinsically rewarding. It is work. Deliberate practice is effortful practice with full concentration and includes a mechanism by which the results of the practice can be evaluated and improved upon in future sessions. Often a coach or master teacher oversees the deliberate practice, chooses individualized training tasks, and evaluates the results of the training. Experts more often engage in deliberate practice during the morning; research has supported that we have the greatest capacity for sustained, engaged and demanding cognitive activity during the morning. Research has also supported the many anecdotal accounts that four hours is the length of time that deliberate practice can be sustained."

It sounds like training for anything sounds. Start with twenty minutes a day and build up to 4 hours/day. Neuroplasticity will develop the brain. Pattern recognition is enhanced, etc.
"Novice writers tend to focus on the word or the sentence as the unit of creation or as the unit of analysis. Expert writers focus on the whole and on the paragraph as the smallest unit of creation or analysis."

Please, if you want to be a writer, read the entire posts carefully, especially if you have to write something academic. I can attest to how hard it is and how easily one can be chewed and spat out. My first and only (academic) paper so far was a disaster, swiftly rejected by the one and only journal I sent it to. I could not figure out what it was reviewers wanted - if it was a failure merely of style, or if I was simply inept at delivering written content, or if they hated the content itself. I'm still baffled. I could definitely have used this advice a year ago.

I can hardly wait for the next two columns in the 4-part series. Thank you Peg. Thank you Mo.

Monday, November 02, 2009

Selves and selves and selves

By happy fluke a friend, Jon Newman, posted a thread on SomaSimple about Sandeep Gautman's blog, The Mouse Trap, and links to several posts about the many selves we each carry around. I was delighted to learn that someone has bothered to study their existence, hypothesize their functions - I don't have to do it all by myself (haha, lame joke).

Listed below are the particular posts Jon found, and thought were compelling enough to bring onto a physical therapy board. They are compelling, because even when we are tootling along in a well-integrated, functioning state, working for a living providing services to health consumers, etc etc., we are dealing with psyches which might seem glued together on the outside but which might feel shattered to pieces on the inside. I've preferred to see this shatteredness as merely kaleidoscopic, interesting and even lovely, but I can appreciate that a sudden plunge into the depths of self/selves might feel shattering to people at first exposure to it. It was that way for me at first, too.

Anyway, for those interested:
1. Development of Infant Consciousness
2. Splitting of the self: "me" and "I"
3. Five kinds of self/self/knowledge

I had no idea there was a field called Philosophical Psychology, with its own journal, but there is. Someone named Ulric Neisser wrote a paper way back in 1988 and delineated Five kinds of Self-Knowledge. In his blog, Gautman has outlined them:

The ecological self is the self as perceived with respect to the physical environment: I am the person here in this place, engaged in this particular activity.
The interpersonal self, which appears from earliest infancy just as the ecological self does, is specified by species-specific signals of emotional rapport and communication: I am the person who is engaged, here, in this particular human interchange.
The extended self is based primarily on our personal memories and anticipations: I am the person who had certain specific experiences, who regularly engages in certain specific and familiar routines.
The private self appears when children first notice that some of their experiences are not directly shared with other people: I am, in principle, the only person who can feel this unique and particular pain.
The conceptual self or ’self-concept’ draws its meaning from the network of assumptions and theories in which it is embedded, just as all other concepts do. Some of those theories concern social roles (husband, professor, American), some postulate more or less hypothetical internal entities (the soul, the unconscious mind, mental energy, the brain, the liver), and some establish socially significant dimensions of difference (intelligence, attractiveness, wealth). There is a remarkable variety in what people believe about themselves, and not all of it is true.

No mention in there of the over-extended self.. which women end up becoming a lot of the time.. I think (with my private self) the over-extended self may house a bunch of the subselves which can cause trouble. Perhaps it depends on the sort of "specific and familiar routines" in which one engages. I think it's the one our "role" is housed within. Of all of them, it's the one that changed itself right under my nose, and seems like is busy plotting a coup with my conceptual self these days.

Also, no mention that I can find of how each of the discretely labelled selves experiences time passing. I have a hunch that a key to re-integrating them is to get them all back on the same clock again somehow.

As an aside, recently neuroscientists found brain cells that keep track of time with extreme precision in macaque monkeys. Everything gets a time stamp. See MIT news story, A Head of Time.

If the brain is an oscillator, predictor and simulator, I can see how easily one's sense of self/selves can develop a few timing problems and need "tune-ups" on occasion.