Monday, December 31, 2012

Asymmetry of brain sides: size, structure, neurochemistry

The Master and his Emissary

In chapter 2, "What do the two hemispheres 'do'?", McGilchrist writes about physical differences between the two hemispheres.


  • The right hemisphere is "longer, wider, and generally larger, as well as heavier, than the left", something true, apparently, "of social mammals in general." 
  • The right hemisphere is wider everywhere, but for one place; the left is wider in the posterior parieto-occipital region.
  • This right-side-bigger-than-left asymmetry is consistent from childhood to adulthood.

"As well as differing in the size and shape of a number of defined brain areas (Galaburda 1995), the hemispheres differ in the number of neurons (Galaburda, Aboitiz, Rosen 1986), neuronal size (the size of individual nerve cells) (Hayes & Lewis 1993), and the extent of dendritic branching (the number of connective processes put out by each nerve cell) within areas asymmetrically (Scheibel, Paul, Fried et al 1985). There is greater dendritic overlap in cortical columns in the right hemisphere, which has been posited as a mechanism for greater interconnectivity compared with the left (Seldon 1982). The ratio of grey to white matter also differs (Allen, Damasio, Grabowski et al 2003; Gur, Turetsky, Matsui et al 1999; Gur, Packer, Hungerbühler et al. 1980; Galaburda 1995). The finding that there is more white matter in the right hemisphere, facilitating transfer across regions, also reflects its attention to the global picture, where the left hemisphere prioritizes local communication, transfer of information between regions."- p. 33


  • Right hemisphere is more sensitive to testosterone (Lewis & Diamond 1995)
  • Right hemisphere is more sensitive to pharmacological agents (Glick, Carlson, Drew et al 1987)
  • Left hemisphere relies mainly on dopamine; right hemisphere relies mainly on noradrenaline  (Glick, Ross & Hough 1982; Tucker & Williamson 1984; Wagner, Burns, Dannals et al. 1983; Fride and Weinstock 1988)

No wonder this book is taking me so long to read/digest. Every page is crammed with fascinating side tracks. The most pertinent one on this page, in my opinion, for PT and other movement therapies, is the difference in neurochemistry in Tucker and Williamson 1984 (abstract): 
Reviews the literature on the neurotransmitter substrates controlling motor readiness, showing that these substrates produce qualitative changes in the flow of information in the brain: Dopaminergic activation increases informational redundancy, whereas noradrenergic arousal facilitates orienting to novelty. Evidence that these neurotransmitter pathways are lateralized in the human brain is consistent with the left hemisphere's specialization for complex motor operations and the right hemisphere's integration of bilateral perceptual input. Principles of attentional control are suggested by the operational characteristics of neural control systems. The affective features of the activation and arousal systems are integral to their adaptive roles and may suggest how specific emotional processes dynamically regulate cognitive function. 
(See #12 below.)

1. Galaburda 1995

2. Galaburda, A. M.; Aboitiz, F.; Rosen, G. D.; Sherman, G. F.; Histological asymmetry in the primary visual cortex of the rat: Implications for mechanisms of cerebral asymmetry. Cortex: A Journal Devoted to the Study of the Nervous System and Behavior, Vol 22(1), Mar 1986, 151-160.

3. Tamara L. Hayes, MS; David A. Lewis, MD; Hemispheric Differences in Layer III Pyramidal Neurons of the Anterior Language Area. Arch Neurol. 1993; 50(5):501-505

4. Scheibel AB, Paul LA, Fried I, Forsythe AB, Tomiyasu U, Wechsler A, Kao A, Slotnick J;
Dendritic organization of the anterior speech area. Experimental Neurology. Volume 87, Issue 1, January 1985, Pages 109–117

5. Seldon HL; Structure of human auditory cortex. III. Statistical analysis of dendritic trees. Brain Research Volume 249, Issue 2, 14 October 1982, Pages 211–221
6. Allen JS, Damasio H, Grabowski TJ, Bruss J, Zhang W;  Sexual dimorphism and asymmetries in the gray–white composition of the human cerebrum. NeuroImage Volume 18, Issue 4, April 2003, 880–894

7. Gur RC, Turetsky BI, Matsui M, Yan M, Bilker W, Hughett P, Gur RE;
Sex Differences in Brain Gray and White Matter in Healthy Young Adults: Correlations with Cognitive Performance. The Journal of Neuroscience, 15 May 1999, 19(10): 4065-4072

8. RC Gur, IK Packer, JP Hungerbuhler, M. Reivich, WD Obrist, WS Amernek, HA Sackeim; Differences in the distribution of gray and white matter in human cerebral hemispheres. Science, 207 (1980), pp. 1226–1228.

9. Lewis & Diamond 1995

10. Glick, S. D., Carlson, J. N., Drew, K. L., & Shapiro, R. M. (1987). Functional and neurochemical asymmetry in the corpus striatum. Duality and Unity in the Brain. New York: Macmillan, 3-16.

11. Glick SD, Ross DA, Hough LB; Lateral asymmetry of neurotransmitters in human brain. Brain Research. Volume 234, Issue 1, 18 February 1982, Pages 53–63

12. Tucker DM; Williamson PA; Asymmetric neural control systems in human self-regulation. Psychological Review, Vol 91(2), Apr 1984, 185-215

13. Wagner HN, Burns HD, Dannals RF, Wong DF, Langstrom B, Duelfer T, Frost JJ, Ravert HT, Links JM, Rosenbloom SB, Lukas SE, Kramer AV, Kuhar MJ; Imaging Dopamine Receptors in the Human Brain by Positron Tomography. Science, New Series, Vol. 221, No. 4617 (Sep. 23, 1983), pp. 1264-1266

14. Fride E, Weinstock M; Prenatal stress increase anxiety related behavior and alters cerebral lateralization of dopamine activity. Life Sciences Volume 42, Issue 10, 1988, Pages 1059–1065

Saturday, December 22, 2012

Mind: the brain's experience of itself

The Master and his Emissary

What the book is not about: 

""... the brain is not just a tool for grappling with the world. It's what brings the world about. 
"The mind-brain question is not the subject of this book, and it is not one I have the skill or the space to address at any length. The argument of the book does not depend on holding one view or another. But it is nonetheless legitimate to ask where the author of a book like this stands on it. Hence this very brief diversion.  
"One could call the mind the brain's experience of itself.* " McGilchrist p 19
*"Mind and brain are aspects of the same entity, but completely distinct types of phenomena. The difference is similar to what I take Sartre to mean by his distinction between our inward experience of the body (pour soi) and the fact of the body as a 'thing' (en soi)." (notes p 464)

[Or, perhaps, the distinction between pain and nociception?]
McGilchrist continues:

"Such a formulation is immediately problematic, since the brain is involved in constituting the world in which, alone, there can be such a thing as experience - it helps to ground experience, for which mind is already needed. But let's accept such a phrase at face value. Brain then necessarily gives structure to mind. That would not, however, equate mind and brain. It is sometimes assumed so, because of the tendency when using a phrase such as 'the brain's experience of itself' to focus on the word 'brain', which we think we understand, rather than on the troublesome word 'experience', which we don't.
"All attempts at explanation depend, whether explicitly or implicitly, on drawing parallels between the thing to be explained and some other thing that we believe we already understand better. But the fundamental problem in explaining the experience of consciousness is that there is nothing else remotely like it to compare it with: it is itself the ground of all experience. There is nothing else which has the 'inwardness' that consciousness has. Phenomenologically, and ontologically, it is unique. As I will try to show, the analytic process cannot deal with uniqueness: there is an irresistible temptation for it to move from the uniqueness of something to its assumed non-existence, since the reality of the unique would have to be captured by idioms that apply to nothing else (Scruton 1997 p 367).
"Is consciousness a product of the brain? The only certainty here is that anyone who thinks they can answer this question with certainty has to be wrong. We have only our conceptions of consciousness and of the brain to go on; and the one thing we do know for certain is that everything we know of the brain is a product of consciousness. That is, scientifically speaking, far more certain than that consciousness itself is a product of the brain. It may or may not; but what is an undeniable fact is the idea that there is a universe of things, in which there is one thing called the brain, and another thing called the mind, together with the scientific principles that would allow the one to emerge from the other - these are all ideas, products of consciousness, and therefore only as good as the particular models used by that consciousness to understand the world. We do not know if the mind depends on matter, because everything we know about matter is itself a mental creation. In that sense, Descartes was right: the one undeniable fact is our consciousness. He was wrong, however, most would agree, to think of mind and body as two separate substances (two 'whats')." This was, I believe, a typical product of a certain way of thinking which I suggest is characteristic of the brain's left hemisphere, a concern with the 'whatness' of things. Where it was so obviously a matter of two 'hownesses' in the same thing, two different modes of being (as the right hemisphere would see it), he could formulate this only as two 'whatnesses', two different things. Equally it is a misplaced concern with the whatness of things that leads to the apparently anti-Cartesian, materialist, idea that the mind and body are the same thing. We are not sure, and could never be sure, if mind or even body, is a thing at all. Mind has the characteristics of a process more than of a thing; a becoming, a way of being, more than an entity. Every individual mind is a process of interaction with whatever it is that exists apart from ourselves according to its own private history. 
"The type of monism represented by the scientific materialism most often espoused by neuroscientists is not radically different  from the Cartesian dualism to which it is often thought to be opposed. Its solution to the problem has been simply to 'explain away' one part of duality, by claiming to reduce one to the other. Instead of two whatnesses, there is just one: matter. But Descartes was honest enough to acknowledge that there is a real problem here, one he wrestled with, as is clear from the passage in Meditation VI where he writes:  "... I am not merely present in my body as a sailor is present in a ship, but ..... am very closely joined and, as it were, intermingled with it, so that I form with it a single entity" (Descartes, 1984-91b, 'Meditation VI' p 56).  
Phenomenologically speaking, there is here both a unity, a 'single entity', and the most profound disparity; and any account that fails to do full justice to both the unity and the disparity cannot be taken seriously. There may be just one whatness here, but it has more than one howness, and that matters. Though (according to the left hemisphere) a thing, a quantity, a whatness, can be reduced to another - that is to say, accounted for in terms of its constituents - one way of being, a quality, a howness, cannot be reduced to another."
 I love the wave/water analogy: from the notes, p.465, analogy of mind to brain - wave to water: 
"Does the water cause the wave? No. Is it the movement of the water, then that causes the wave? No, not that either. The movement of the water just is the wave... the changing brain states are the mind, once the brain experiences them. And that is where the analogy ends, because there is no inwardness to a wave."

I think what he's saying here is that the mind (and maybe also the brain, body) are more verbs than nouns. Or better yet, just a single moving "thing" ---> interrelating-ed-ness of other also interrelating and ever-changing verbs.

That awful problem with language rears its head, yet again. As soon as that came into existence, language, as soon as humans developed symbolic thought, words that stood in as proxies for actual blobs of existing, i.e. nouns, and conceptualizations of things, also nouns, we started losing our bearings. We started being capable of lies to ourselves and to each other. We started losing our full consciousness, our relating-ed-ness to all that was around us and within us. Oblivious to most of it, most of the time, ordinary people wander about like zombies, lost in categorical thinking, the nouns of life and the behaviour they promote - un-thinking and un-feeling posing in roles -  inhabiting social space, reassuring each other, pretending to be sure of ourselves, acting like we know what's going on in our minds, letting the roles interact with one another instead of being authentic people who merely inhabit the roles, understanding the difference, and interacting with each others' authenticity.  

This is Dec 22, 2012. If there was ever a day for diving deep and just gazing at the mess, in the bright but mercifully short light of a clear glittery white winter day, the shortest day of the whole year, in the darkest season of the year, this is the day. I blame the left hemisphere. It makes up stuff all the time then pretends it's true. Then it hides in a bunker behind all the stuff it makes up and shoots at everything that moves. 

Yes, I know. It's a bleak outlook. Welcome to the inside of my particular brain. I've learned how to cope with and navigate the hall of jagged broken mirrors that is my particular take on life. Sorry, but this is how I see it. This is how my right hemisphere sees things; my left hemisphere has agreed to write it down. It finally agrees, after a lot of whining, balking, disagreeing and side-tracking. It will write whatever it's asked to write, in whatever form the right hemisphere would prefer. I'm fairly certain a lot of it won't be pretty. 

If there was ever a tradition of older single women living quiet lives as atheist nuns, so relieved, jubilant even, gleeful, as if we pulled a fast trick on the world, to have never reproduced, to have enjoyed our physicality but never let nature have its reproductive way with us: and, when forced to interact with the rest of the world, interacting from a place of as much integrity as is possible to find in the midst of external and internal chaos, hoping for nothing but less pain in the world, and peaceful departure from it when this particular way of being self-organized as a human anti-gravity suit is over: if there was such a tradition - and there isn't, other than in this privileged place and time, having been born here by sheer luck instead of in some horrid corner of the world where female physicality/capacity to reproduce is completely controlled and exploited...  I would be its triumphant poster girl. 

We have so not got a clue as human primates. We are so screwed as a species. I hate to think about what we've done to ourselves and the planet, and to each other, most of the time. The only thing one can do, to keep oneself steadied and sane, is refrain from participation in most of it, as much as possible. And I feel like the profession I joined is pretty screwed too, in many ways, but at least it's off to one side, kind of obscure, not really in any strategic target zone. I want it to get back to its roots, some day, if it can. Stop all its silly reliance on categorical thinking and get back to the verbs of being and doing unto others as we would like to be and have things done onto ourselves - get back to the verbs of interbeing, interacting and interrelating. Head away from nociception toward yesiception.

See the following video (about a half hour) for a great discussion by Robert Sapolsky on the dangers of categorical thinking. Very few thinkers are as nimble: he understands human foibles. He points out when using categorical thinking as a mere tool is useful, and warns of the dangers inherent adopting a klutzy categorical approach to life. 

Biology and Human Behavior 

Friday, December 21, 2012

Two brain halves, disappearing bridge

Still reading aloud to myself from Iain McGilchrist's book, The Master and his Emissary. I've made it all the way to p. 22. Yup, this is a good thing. This really slows me down, makes me think and feel, soaks info into the neurons way better than reading/skimming effortlessly/silently. Similar to walking through countryside on foot as opposed to driving through it. Makes the book feel alive, not mere "seen-ery."

A quote:

You might think that as brains evolve to become larger, the interhemispheric connections would increase in tandem. But not at all. They actually decrease relative to brain size (Jänke and Steinmetz 2003 p 210-11). The bigger the brain, the less interconnected it is. Rather than taking the opportunity to increase connectedness, evolution appears to be moving in the opposite direction. (...) it turns out that the greater the brain asymmetry, too, the smaller the corpus callosum, suggesting that the evolution both of brain size and of hemispheric asymmetry went hand in hand with a reduction in interhemispheric connectivity (Hopkins and Marino 2003). And, in the ultimate case of the modern human brain, its twin hemispheres have been characterized as two autonomous systems (Friedman & Polson 1981 p. 18-19).

So, yay. Just ducky. As if it wasn't hard enough for the neotenous ape to become adult and wait 20 years for its brain to myelinate all the way throughout the cognitive-evaluative frontal lobes to gain executive function, we have two almost autonomous brains in there, in a way, taking two decades to ripen. Plus, they have to learn to get along with each other with fewer direct pathways available, are forced to externalize themselves so they can hear, see, feel each other, plus they prefer distinct modes of operation. Oh joy. No wonder being a human antigravity suit is not for sissies. Two whole brains to manage. 

Just yesterday, I found this: Patients Reflect on Life with a Common Brain Malformation, by Daisy Yuhas: 

"At least 1 in 4000 infants is born without a corpus callosum... “It’s a hidden disability,” says University of California Institute of Technology psychologist Lynn Paul. Many born without this structure go undiagnosed for years—only neuroimaging can confirm the agenesis, or failed development, of this brain area. Instead people are diagnosed with disorders such as autism, depression, or ADHD."
 (Depression, eh? Hmmn...)

Wednesday, December 19, 2012

"Sensory neurons are the brain's portal to the external world"

This delicate tracing is not exquisite embroidery on some long-dead emperor's silk sleeve - it is a picture of the branched axon of a single sensory neuron; each little loop embraces the root of a hair follicle on a mouse's back. 

Read Nerve endings reveal hidden diversity in the skin, open access. 

Also read Morphologic diversity of cutaneous sensory afferents revealed by genetically directed sparse labeling open access. 

A news take on this: Why our backs can't read braille: Scientists map sensory nerves in mouse skin

Tuesday, December 18, 2012

The malleableness of "things"

A quote:

"Things change according to the stance we adopt towards them, the type of attention we pay to them, the disposition we hold in relation to them. This is important because the most fundamental difference between the hemispheres lies in the type of attention they give to the world. But it's also important because of the widespread assumption in some quarters that there are two alternatives: either things exist 'out there' and are unaltered by the machinery we use to dig them up, or to tear them apart (naïve realism, scientific materialism); or they are subjective phenomena which we create out of our own minds, and therefore we are free to treat them in any way we wish, since they are after all, our own creations (naïve idealism, post-modernism). These positions are not by any means as far apart as they look, and a certain lack of respect is evident in both. In fact, I believe there is something that exists apart from ourselves, but that we play a vital role in bringing it into being (Tanner 1999 p. 6). A central theme of this book is the importance of our disposition towards the world and one another, as being fundamental in grounding what it is that we come to have a relationship with, rather than the other way around. The kind of attention we pay actually alters the world: we are, literally, partners in creation. This means we have a grave responsibility, a word that captures the reciprocal nature of the dialogue we have with whatever it is that exists apart from ourselves. I will look at what philosophy in our time has had to say about these issues. Ultimately I believe that many of the disputes about the nature of the human world can be illuminated by an understanding that there are two fundamentally different 'versions' delivered to us by the two hemispheres, both of which can have a ring of authenticity about them, and both of which are hugely valuable; but that they stand in opposition to one another, and need to be kept apart from one another - hence the bihemispheric structure of the brain." - Iain McGilchrist, The Master and his Emissary, p.4 of  INTRODUCTION.

Last night I started reading this book again. I obtained it several months ago, had started it, had skipped forward, had read chunks, had even post-noted a few pages, dog-eared others, tried some underlining, but somehow had not been able to get into it, even though it came highly recommended by people I trust who have great taste and had found themselves enriched through reading it. 

The problem was with me, not the book, I decided. How could I engage with this book? Had I forgotten how to focus? Had I forgotten how to let a writer creep into my brain, how to be a good hostess to their thought; entertain, converse with, pay attention through my own engaged response to meanings derived from words, written by them, asynchronously, on a page? Had I spent so much time racing around online over the years, that my brain had developed ADHD? 
It was definitely I who was flat - not the book. 

No great surprise, in that I've been chronically depressed for years, diagnosed by myself, socially quite phobic, unless there was a perfectly reasonable point in being around other people; recovering slowly in the sunny wide receding horizons and white glittery winters of the elevated Saskatchewan prairies (1893 feet, 577 m altitude), a plateau sloped slightly east, after decades of life at damp coastal doom and gloom sea level in Vancouver, crowded between giant walls of rock in the east and north, US in the immediate south, and cold dark wet ocean west. Living like a bug inside a jug. A jug lidded by thick grey cloud most of the time.

I would find myself asking myself, as if I were an acting student, "Where's my motivation?" The answer: gone away, apparently. Maybe forever. Would life ever fluff itself back up? Be enjoyable? Before it finally guttered itself completely out?

Well, I think last night saw a breakthrough, kind of: 

Out of the blue, perhaps to make myself focus better, I started reading in this book, aloud. To myself.  

I have never done that before, ever. It must have changed the input into my brain. I could feel stuff start happening in there, again, after such a long time of not feeling much in there at all. Some part of my brain I remembered dimly from long ago, an underground spring, bubbled up. I could feel it start up. It liked being read aloud to
I (or something in the larger "me"..) liked the sound of my own voice reading aloud!

Imagine that. 

For so long I've treated my critter brain as if it were non-verbal and kinesthetic, only, that I probably, likely, had forgotten it was actually a human brain too, and could understand language, tone, inflection, all that.

It's been a very long time since my brain and I've enjoyed singing. It's been a very long time since my brain and I've really listened to, and enjoyed listening to, music. My brain used to like doing that, but stopped. Long time passing. It's been a long time since it and I've liked to listen to other people talking. 

I read to it for about an hour, aloud, at one point started the book over again from the beginning, kind of excited, because it felt like the right thing to do at the time, 1:00am, not able to sleep for whatever reason... my brain liked being spoken to. By me. 

So, this is me, starting a new relationship with parts of my own brain, parts of my own cognitive-evaluative capacity that are still connected to bits that still feel actual motivation. This will be a new relationship forged, possibly between my own 2 hemispheres - the verbal language side will hang out with and read, aloud!, to the non-verbal side, which nonetheless can understand fully everything that's said/read, can reflect on things, can respond in nuanced ways, can inform by sharing those thick and quite lush sensations with the speaking part of me. 

Maybe, just maybe, it isn't just that "the most fundamental difference between the hemispheres lies in the type of attention they give to the world" - it might also be in the sort of attention and respect they can give to each other, inside a single individual. 

Maybe, together, they'll figure out how to write better, more productively.

Here is a very good animated video of the author discussing the book, from 2011. 

RSA Animate - The Divided Brain

Tuesday, December 11, 2012

Deeper (more brain-based) model for posture

After I posted earlier today, some better stuff (at least, more interesting to me) came along. I found a link to a blogpost on posture:

How to increase testosterone and decrease cortisol through body language. 

Now this really makes sense, to me anyway, as a deep model for posture, or at least a rational rationale for posturing.
(No, I don't think I was being redundant in that last sentence. There are so many non-rational rationales for posture out there, floating around like doo-doo in a sewage pond.)

Anyway, from the video embedded in the link: 

1. "Practice for two minutes at a time" (that's about the length of time it takes to feel someone's body change over during certain manual treatment techniques - coincidence? I think not. It could be that is about how long it takes for perceptible changes in circulating hormones to manifest physically, if the research discussed in the link has any merit whatsoever..) 
2. Repeat as necessary. Face your fear, fake it until you make it, two minutes at a time. For as many years as necessary. 

For whatever reason, awareness of this post arose with awareness of this other post, A Radical Shift to Better Pain Relief. Excerpt:

"When it comes to pain relief, create the brain you want and the rest will follow."

Much food for nonverbal (i.e., postural) thought at the Center for NonVerbal Studies website, one of the earliest places I ever visited after joining the internet, more than a decade ago. See the entry for posture:
1. A vertically looming stance in which the body "enlarges" through extension of the limbs.  
2. A primeval "pushup" intended to lift the quadrupedal body higher off the ground.

A day in the life

It's 11am on a Tuesday morning. I don't have anybody booked for treatment today. This is a situation that I hope will start to change very soon. I've spent the last 3.5 years of my life wallowing about, living frugally but comfortably on the proceeds of my Vancouver condo sale, waiting for my latest depressive state to resolve, motivation and energy to return.

I haven't been entirely a lazy bum the whole time. I have exercised more regularly than ever before in my life. I've looked after the social media communication for the Canadian PT PainScienceDivision.
I've taught, studied, presented, travelled, written. I just haven't been making any kind of living. But I did get organized to do so, have a sweet place all set up. Now I'm working on filling it with enthusiastic patients who have honed in on the fact that they don't have to be in pain, necessarily.

Anyway, all that aside, this post is going to contain bits and pieces of what I look at everyday online. I'm a hunter and a pecker. I stalk Google reader. I subscribe to multiple news feeds and blogs. Day after day, I open Google reader to see what awaits. Usually there are 500 or so headlines and full text to scroll by. It's a bit slower on the weekends. [So I design materials for my practice instead.]

Anyway, I'm sitting here, coffee cup in hand, able to check my practice for phone calls every hour or so to ensure I don't miss any. Google reader is open, and in front of me are 448 posts to scan, select out juicy bits from, to post on Facebook, Twitter, and SomaSimple - to contribute to the thinking PT community and hopefully stimulate my own brain into feeling better about life in general and about my chosen path through it in particular.

There are patterns. The same themes crop up over and over. This is today's sampling:

1. Why are there so few women in the X Y Z field?
2. How fish turned into land animals - fins to legs
3. Targeted molecular or gene or novel drug therapy for this and that, with dizzingly complicated and dyslexia-inducing names comprised of strings of letters, numbers and sometimes Greek letters.
4. Nerve cells made out of stem cells from blood, cells in urine, skin, bone, whatever. Remarkable, actually.
5. Studies on what captures attention best.
6. Tracking evolution through gene studies.
7. What occurs at the interface of salmonella bacteria (or whatever) and our gut wall. How they breach defenses.
8. Epigenetics, or how genes are just a launch pad for all sorts of random environmental influence, including cancers, homosexuality, you name it.
9. Countries where you are killed for being an atheist [or female, or male, or gay, or by societal whim of any kind].
10. Overeating and binge eating.
11. Better medical needles, maybe, by studying porcupine quills.
12. Superbugs, hospital dangers.
13. Perception. Threat makes things loom larger.
14. Dozens and dozens and dozens of papers with names like "Epidermal Expression of Neuropilin 1 Protects Murine keratinocytes from UVB-induced apoptosis", and "PRC2/EED-EZH2 Complex Is Up-Regulated in Breast Cancer Lymph Node Metastasis Compared to Primary Tumor and Correlates with Tumor Proliferation In Situ"
15. Profiles of up and coming researchers at some university or other. 
16. Announcement of a new psychiatric pavilion somewhere. Fanfare.
17. Effect of physical fitness on Everything.
18. How basketball teamwork teaches people about networking and communication. [Yeah, I know.. file under Duh]
19. Time of year stuff - New Year's, resolutions, gift-giving, blahblah
20. China
21. Same sex marriage
22. Hm. CRPS-UK seems to have developed a heavily Buddhist flavour lately. [There is plenty of mindfulness training around that has no religious overtones or undertones.. I wonder why this blog, which I like quite a lot, actually, doesn't favour that instead? Oh well, we move along..]
23. Eating salt and drinking sugar seem to go together
24. Underwater noise and health of marine wildlife
25. New kinds of solar cells
26. Soybean diesases
27. Hurricane aftermath
28. Death of a revered Brit astronomer
29. Examining gorilla poop. 
30. Enticing toys to attach to bicycles [file, then disregard, under seasonal content/gift stuff]
31. Laser beam applications
32. More wonders of oxytocin
33. Lucid dreaming and creative consciousness  40 minutes, might be good to watch a bit later.. nah, on second thought, too many capitalizations and references to "spirituality" - don't want my brain shaped by fluff into more fluff. 
34. American politics, military, religion, blahblah 
35. Digital management of whatever
37. Autism
38. Premature children in later life, increased risk for this and that
39. Biploar disorder
40. Macro and microcephaly (we humans are so concerned about our head size and contents therein)
41. Black holes
42. Immunotherapy for this or that type of cancer
43. Women outlive men [men are still trying to figure out why]
44. Quest for new antibiotics
45. PTSD
46. Recession, fiscal cliff, blahblah
47. MDs try to adapt to social media, learn to doctor by Skype in remote areas
48. Flu season, go get shots
49. Effects of serotonin
50. Diabetes, obesity in children
51. Bedbugs are undaunted by ultrasonic frequency devices
52. Link between watching TV and obesity. [File under Duh]
53. Hot flashes
54. ALS
56. Coral still in trouble.
57. Ketamine
Same guy who posted the Buddhist video earlier.
59. Eczema
60. Postpartum stress and stressors on the mom
61. Apps and devices for this and that
62. Don't feel lonely or you may become demented
63. Diesel fumes and childhood brain tumours
64. Kate, pregnancy, blahblah
65. Illustrated history of this and that - mostly pop culture
66. Toxoplasma [pretty sure I have this, NYD]
67. Compatibility or non-, of science and religion [theme more pronounced at this time of year I think]
68. Isagenix Study Is Not Convincing, from ScienceBasedMedicine
69. Concussion
70. "Pain doubted if medical basis is missing", [You can say that again]
71. Rocks on Mercury, or Mars, or wherever
72. Using drones to track poachers
73. Is the internet rotting? 

Now it's 1pm: while I sorted through that batch another 85 came into the feed, which I scanned also. 
Anyway, I may have missed some themes and topics due to glazed eyes, but those were the endlessly recycled news items, with a few good, or at least less boring, highlights. 

I need to get a new life I think. 

Friday, November 23, 2012

Back surgery: should I or shouldn't I?

If you've been wondering about this, check this out:

In his just-released book, Back in Control: A Spine Surgeon’s Roadmap Out of Chronic Painorthopaedic surgeon David Hanscom argues against back surgery for back pain. 

Here is his website, Back in Control: Taking charge of your chronic pain treatment. He says, 

"Don’t live in pain: Pain is a perception – nothing more, nothing less. Understanding pain allows you to gain control of your care. Freedom from pain is not possible – with the right tools it is probable."

Then he provides psychosocial tools. 

What on earth would motivate a person whose livelihood is surgery, to advocate for non-surgical approaches to back pain? It sounds like he has likely seen through the mirage he and most of the rest of the medical profession continue to believe and have deliberately or inadvertently helped perpetuate - the societal illusion that pain can somehow be "cut out" of the body. 

This is the opening paragraph from a book review found here
"What kind of a surgeon tries to talk you out of surgery? An enlightened one? Seattle-based Dr. David Hanscom has been performing intricate spinal procedures for over 20 years. He has also suffered from severe burnout, debilitating back pain and anxiety disorders. After much investigation and personal soul-searching, he now shares his revelations in a must-read book, Back in Control: A Spine Surgeon’s Roadmap Out of Chronic Pain (Vertus Press, 2012), for all those contemplating, getting ready to embark on or frustrated with surgery of all kinds."
Included is a short video embed of Hascom, explaining what he went through and how he succeeded. 

Thank you for this book Dr. Hascom. Thank you!

The book: Back in Control: A Spine Surgeon’s Roadmap Out of Chronic Pain

Tips: Back in Control: Taking charge of your chronic pain

Saturday, November 03, 2012


The whole time I've been traveling lately, disliking a lot of it,  feeling frayed at the edges by it, I've been carrying around and trying to read a book, The Hour Between Dog and Wolf, by John Coates. Great book, by the way..

The second-last chapter is, Toughness: Can we control our stress response? Here is a synopsis.

1. Repeated stresses that do not have physical expression involved, but have lots of cortisol, harm the body ->  hypertension, type II diabetes, heart disease, immune disorders, depression:
" the fire brigade, the stress response may save our house from an emergency only to destroy it with water damage."
2. Can cortisol be turned off? Hard to do. E.g., open field experiment with rodents. Putting a rodent in an open field produces a predictable stress response (freezing, immobility, defecation, elevated stress hormone).  Repeated exposure habituates the animal - it's behaviour normalizes, however, the stress hormone levels remain high. Its adrenal glands still respond to "danger" even though the animal acts less stressed or afraid. Likewise, human physiology and behaviour can show similar discrepancy.

3. Stress is largely a physiological preparation for physical action. Physiology can be "trained". Greater mental and physical stamina can be attained. We can "toughen" against fatigue, anxiety, and psychiatric disorder associated with stress response.

4. Physical toughness might include things like strength, posture, coordination, and endurance. Mental toughness might include a particular attitude to novel events, seeing them as a challenge, opportunity for gain. An untoughened individual might see novel events as dreadful, potentially harmful. Each attitude has distinct physiology. What does resilience consist of? One must consider catabolic hormones, anabolic hormones, amines, and the vagus nerve.

5. Catabolic hormones (e.g., cortisol) break down energy stores (e.g., muscle)  for immediate use. "By breaking down muscles and converting them into immediately useable forms of energy, cortisol in effect stripmines our body for nutrients.. our body begins to disintegrate under its caustic influence." Cortisol has to be turned off ASAP, after a couple days, or at most, a couple weeks, or the damage is hard to reverse. It provides us with metabolic support in a crisis but it's a big price to pay, long term, so its production and release should occur only sporadically and be followed by a recovery period.

6. Anabolic hormones include testosterone and growth hormone. They rebuild the body, convert amino acids to muscle, calcium to bone, insulin removes glucose from blood and puts it in the liver, insulin-like growth factor (IGF) rejuvenates body and brain cells. Healthy people have a high ratio of anabolic hormones to catabolic ones; this is called the growth index. A high growth index = "thriving". It depends on rest, not growing old (which involves decline in testosterone and growth hormone). It can be linked to blood pressure, body-mass index, hip to waist ratio, cholesterol levels, blood glucose levels, noradrenaline and cortisol levels measured from urine. This is a reliable predictor of future health.

7. Amines are substances produced by cells in the brain. Included are dopamine, noradrenaline and adrenaline, several others including serotonin. They reach targets rapidly, focus our attention, release glucose and promote fight/flight response same as does cortisol, but they switch off faster than cortisol. "..a toughened individual is one who enjoys a powerful and immediate amine reaction when challenged, so he or she does not need to draw on the longer-acting and more potent cortisol response." In such a person, amine levels are lower at rest. They turn on quickly with stress and turn off fast. Stress is handled without emotional distress. "The research into toughness has suggested that our brain silently compares the demands being made on us against the resources we can draw on (taking into account our training and skill). If our resources are sufficient we view the event as a challenge and relish it; if not, we see it as a threat and shrink from it." Amine producing cells can be overworked though. They need rest to replenish themselves. Depletion of dopamine leads to lack of motivation, depression, anhedonia. Depletion of noradrenaline cells leads to lack of arousal and enthusiasm, and to learned helplessness.
Amine cells can be trained to increase their production! "..toughened people endure a sustained challenge without depleting the amines in their brain or succumbing to learned helplessness. [they have] all the cognitive and metabolic effects of  the amines while suppressing the damage done by chronic exposure to cortisol. Such a profile is found, for example, in elite athletes."

8. The vagus nerve calms everything down, conserves energy, and together with anabolic hormones helps repair. Good vagal "tone" found in toughened individuals acts as a brake; efficient cardiac output is coupled with low blood pressure in peripheral arteries. Good tone is associated with good heart rate variability. Those with poor vagal "tone" tend to over react to mild stressors, with a much shorter distance to go before fight/flight responses engage. Their heart rate variability is low. High heart rate variability is associated with high ratio of anabolic to catabolic hormones.

9. The biggest assist we have to become toughened, more resilient physiologically, build up our amines, is exercise. "Exercise expands the productive capacity of our amine-producing cells, helping to inoculate us against anxiety, stress, depression, and learned helplessness. It also floods our brains with what are called growth factors, and these keep existing neurons young and new neurons growing - some scientists call these growth factors "brain fertilizer" - so our brains are strengthened against stress and aging. A well-designed regime of physical exercise can be a boot camp for the brain." Also helpful: exposure to cold weather, cold water, thermal demand. Thermoregulation was an advance of mammals, then humans who evolved hairless bodies that can sweat. Thermoregulation may be coupled somehow with emotional arousal. (E.g., blushing, hot flashes.. ) Developing cold tolerance, or tolerance to thermal stress, may also increase emotional stability. Eliminating thermal stress might atrophy a large, fundamental part of our physiology.

10. Becoming more interoceptively aware (mindfulness training) will help us recognize fatigue sooner, and change activities, to protect amines. "Fatigue should be understood as a signal our body and brain use to inform us that the expected return from our current activity has dropped below its metabolic cost. The brain quietly searches for the optimal allocation of attentional and metabolic resources, and fatigue is one way it communicates its results.. the cure for fatigue...  is not a rest, it is a fresh task." Also, having locus of control over one's activity (e.g., in the workplace) reduces fatigue. Novelty is rejuvenating. At other times the brain favours familiarity and more vagus nerve action.

Bottom line: learn to exercise regularly. Make exercise your friend. Stave off your brain's dismayed perception of its own entropy. 


1. Sapolsky R; Why Zebras Don't Get Ulcers. Holt Paperbacks; Third Edition edition (Aug 26 2004) [link is to an online pdf] Also, 3 min video on your tube.

2. Chrousos G; Stress and disorders of the stress system. Nat Rev Endocrinol. 2009 Jul;5(7):374-81.

3. LeDoux J; The Emotional Brain: The Mysterious Underpinnings of Emotional Life. New York Touchstone 1996

4. Amini T, Lannon F, Lewis R; A General Theory of Love. New York Vintage 2001

5. Hennessey J, Levine S; Stress, arousal, and the pituitary-adrenal system: a psychoendocrine hypothesis.  Progress in psychobiology …, 1979 - New York: Academic Press

6. Jim Blascovich, Joe Tomaka; The BiopsychosocialModel of ArousalRegulation. Advances in Experimental Social Psychology Volume 28, 1996, Pages 1–51

7. Blascovich J, Mendes WB; Challenge and Threat Appraisals: The Role of Affective Cues. Ch 3 in Feeling and Thinking: The Role of Affect in Social Cognition, edited by Forgas JP,  Cambridge University Press; 1 edition (Jun 4 2001)

1. Rod K. Dishman, Hans-Rudolf Berthoud, Frank W. Booth, Carl W. Cotman, V. Reggie Edgerton, Monika R. Fleshner, Simon C. Gandevia, Fernando Gomez-Pinilla, Benjamin N. Greenwood, Charles H. Hillman, Arthur F. Kramer, Barry E. Levin, Timothy H. Moran, Amelia A. Russo-Neustadt, John D. Salamone, Jacqueline D. van Hoomissen, Charles E. Wade, David A. York, Michael J. Zigmond; Neurobiology of Exercise. Obesity Volume 14, Issue 3, pages 345–356, March 2006 (Full access)

2. David R. Vago and David A. Silbersweig; Self-awareness, self-regulation, and self-transcendence (S-ART): a framework for understanding the neurobiological mechanisms of mindfulness. Front. Hum. Neurosci. 6:296. 25 October 2012 (Full access)

Friday, November 02, 2012

The Brainy Brainstem

Ginger Campbell has just released her 90th Brain Science Podcast, "Review of "Self Comes to Mind" by Antonio Damasio." It's a very good review of the book; all the way though she highlights certain pages. She sticks mostly to the neurobiological aspects as opposed to the philosophical. Damasio's thesis is that the brainstem contains all the initiators of sense of self, emotions and feelings. 

Just by coincidence, yesterday I found this video (and transcript), at Big Think blog: What is consciousness

Also by coincidence, today, I ran across this news item in google reader - Heartbreak for parents as boy born without a brain dies after three-year 'miracle life
Excerpt:"Nickolas Coke suffered from a rare condition known as anencephaly, meaning he was born with only a brain stem."
Well, there are different severities of this condition, and sometimes brainstems aren't present either. The condition itself is a neural tube defect, in which sometimes only some bits of spinal cord don't close or are missing. When it's part or all of the brain missing, then it's called anencephaly. It sounds like this little guy, having had a brainstem, and a head that had closed over it, was able to live for a time at least, and interact some with his parents.

Further reading:

Antonio Damasio, Self Comes to Mind: Constructing the Conscious BrainPantheon; 1 edition (November 9, 2010)

Tuesday, October 30, 2012

Air travel stories

October 29/12
Today I made it back home, safe and sound, from the final teaching adventure in Vancouver on the weekend, the last one for 2012. Whew. Traveling stresses me out. 

Poor me
This post is pure self-pity, so if you'd rather skip it, I understand. I am going to go on and on, probably, just to get it out of my system so I can move on.
Every trip is the Worst One Ever, usually, but I think my luck is starting to change. This last one wasn't nearly as stressful as the one just before, to England and back in five days flat, with two full days of teaching in between. More about that later.

I like meeting new people who are interested enough in my particular pet passion to invite me to come by and teach it, and I've become accustomed to teaching, sort of, even though I am definitely not a natural - introverted plus having a quiet speaking voice isn't a great combination. I have no natural inclination or any teacher training, so I had to reinvent the wheel, then try to make it round enough that it could roll. But at least I don't dread it so much anymore. 

Getting there, and getting home, is still pretty dreadful, though. Usually. One day I hope I can blog about how I've grown accustomed to travel, and how it used to bother me some, but now it's old hat. So far, that just isn't true.

What I hate about traveling
It's kind of a toss-up which I hate more, the airport or the airplane. If I were to take a piece of paper with the words "Things I Hate About Traveling" across the top, then put a line down the middle, with "Airport" at the top of one column, and "Airplane" at the top of the other, both columns would probably fill up about the same.

Just getting to the airport
For starters, I used to live a 30 minute drive through traffic, or else a $25 cab ride, to/from the airport. Now I live a 1-hour, 15-minute drive away, in a different city, which forces me, pretty much, to either drive my own car and park it for 4 or 5 days, at $11/day, or take the bus between cities and have to stay overnight with hotel costs, plus cab to and from airport to bus station, which costs way more.. so I usually drive. 

It's about 115 km, a fast highway, 2-way/single lane; many, many huge trucks connected to the booming oil field activity barrel along in caravans. They either pull out and pass timid car drivers doing the speed limit, or else are passed by aggressive 4x4 drivers taking chances with equally aggressive 4x4 oncoming traffic. The speed limit is 100km/hr, but usual traffic speed is about 120. 

Prairie highways are deceptive. You think they are nice and straight, but it's not so. They take odd bends and curves for no good reason, obscuring one's ability to see oncoming traffic, especially in snowstorms or rainstorms. Number #39 has this one place where it looks like the surveyor must have become inordinately fond of one particular pond; instead of building the highway straight through it, the same way all the other ponds in the way were crushed, he decided to build around it; people driving cars have the illusion that the highway is straight, because you can see headlights off in the distance, but if you don't know the highway very well, or are going too fast, you could miss the curve, that arbitrary sideways bulge in the road that exists for no apparent reason other than a whim on the part of the surveyor; you could hydroplane straight off, fly for a short while and land smack in the pond.

Anyway, long story short, I don't much enjoy the drive. There is nothing quite like having to get up at 3:30 AM to get ready and leave the house by 4AM to drive for a good hour to reach the airport in enough time to catch a 6AM flight, and realize that nature has given you an unexpected, sideways prairie downpour to have to drive through, surrounded by huge trucks connected to the oil wells splashing your windshield every 3 or 4 minutes into opacity, slowing you down to about 70km/hour. Your cortisol levels peak jaggedly, you speed as hard as you can, you get to the airport desk with only one minute to spare before they were going to close boarding altogether. In other words, you are very late, but they let you on the plane anyway, 5 seconds before they would have had to lock the door and take off without you. That happened in May, on the way to teach in Quebec. Oh yay, please diminish, cortisol levels. 

Or, after being stressed out and sleep-deprived and jet-lagged for five days straight, you land in your home airport at about midnight, and still have to drive home; you clear immigration, pay your parking in the machine inside the airport, forget to take your parking stub out of the pay machine, but remember to take your receipt, get to the car, can't find the stub, hunt everywhere for it wondering to yourself oh-what-fresh-hell-is-this, still can't find it, suspect that you must have lost it somewhere between the terminal and the car, are too tired to go all the way back to see if you can find it on the ground in the dark, decide to take your chances and beg the parking guy to let you out, show him the receipt, but he only will accept the stub, and you feel like bursting into tears because you are so tired and you so do not need any more delay (but you are over 60 years old and so not a teenager anymore that you can't/don't go there).  You sit there, car running. You ask, "What do you suggest?"
He shrugs, and calls his colleagues in the terminal. They take a look in the machine, and voila, find your stub still in there, right where you had forgot to take it out in the first place. "So," he says, "next time bring your stub," and all you can do is say, OK, I will, sorry, and he lifts the barrier and lets you through. 

And you drive... you nearly fall asleep and go off the highway about 20 times, but you hang in there and you make it to your own bed that night. But you decide, never again. If you ever ever have to go to Europe ever again, the night you come back you'll go straight to a hotel and go to bed and not try to drive home until the next day.  

But really, driving to and from the airport is the least awful part, usually. If courage is defined as being afraid and doing it anyway, I had nothing but courage 2 years ago when I travelled to Brazil and back via the Toronto airport. I have learned subsequently through word of mouth talking to other women my age who travel, that older females traveling alone are often targeted for body searches, because security goons at the Toronto airport think we would make perfect mules, so they decided in advance that we therefore must be mules, then "randomly" select us for public pat down. So, yay about that.. 

Plus, Air Canada likes to hold back checked luggage to later flights, which has inconvenienced me, twice in a row, which in turn taught me to never travel with any more luggage than I can take with me into the cabin. This has discouraged me from making any trips that are any longer than just a few days.

So, if you make your flight, you calmly scrunch yourself into the one square foot of real estate you are allotted, for the five or seven or nine hours there, and then back, with a tray table that sits way too close to the midriff, with just enough room for a small laptop computer to sit on top, and the danger that anytime, the huge dude sitting in the chair ahead of you might decide to catch a nap and throw his chair back the two inches it can recline. This isn't much, but it will either break the case on your computer into an accordion shape, or else will drive it like a very blunt machete into your midsection, and neither possibility is any fun. Please, cortisol level, will you go down already?  

In case you get complacent, there is always DependentAnkleSwelling (DAS) one develops when sitting for hours on a vibrating plane, dozing instead of staying awake and uptight all night, plus dehydration, plus meals (when they are served) that contain way more salt than you normally eat in a week, which add more water retention. 

Airline officials must think there is an inverse, not direct, ratio, between the obesity epidemic, on the one hand, and their job of gauging the size of seats, amount of leg room on planes they would need to provide to ensure travel comfort, on the other: At least it seems as though, when airlines hear news that the world's population is getting fatter and fatter, they interpret it as thinking they should cram even more seats into airplanes. 

I am a short person with short legs, but my knees are against the seat in front of me, usually. I do not know how long-legged people cope. I really do not. And I'm kind of roly-poly, but I don't weigh 300 lbs or anything - I do not know how large men fit in those seats. Or large-bottomed women. I fill the whole seat, in size ten pants. My elbows slide over into other peoples' space frequently, and I have to haul them back in and try to velcro them to my sides so as not to intrude into someone else's one square foot of real estate for that trip.

Still, all this kind of pales by comparison to the living nightmare that some of the world's largest airports have to offer: Toronto, I'm looking at you, and, Heathrow, you too.

I managed to navigate the huge airport at Sao Paulo by myself, and it was in a different language and everything. People there spoke enough English and were willing enough to help a bewildered foreigner that I found my next gate and connecting flight to Rio without much problem at all, inside about a half hour. Immigration was perfunctory, there were many uniforms all over the place whose sole job seemed to be to expedite traffic by moving the ribbon barriers to make movement between them intelligent and swift. If there weren't very many people in line, those ribbons were instantly moved into a perpendicular pathway to the desired counter, avoiding the arbitrary switchback manoeuvre. Brazilian airports (the three I was in) were still stressful, but they weren't frustrating.

So, I had to go to England, which was fine.. my carry-ons fit the cage in the Regina airport to the attendant's satisfaction, and she let me get on the plane to Toronto without any further ado.. there was a bit of a wait in Toronto, so I went to what I thought was my gate, and sat there for awhile, checking my computer, grabbing a bite.. My latent OCD niggled at me though, so I decided to check the gate, my boarding pass, just in case I missed something. I guess my brain knows me better than I do. Anyway, as it turned out, I had sat down at a gate that was the same number as my seat number (!Duh!), and the actual gate was nowhere to be found on my boarding pass. I now had 45 minutes to catch a plane and had NO IDEA what gate I was supposed to be at. 

So I started looking at those big hallway screens, asking people, found out I had to walk about a half mile back to E section, couldn't find E section, went all the way up D wing thinking maybe E was at the end of D, but it was a dead end, and the guy at the dead end said, go back - it's beside the info booth, I went all the way back, kept missing it because it was up an escalator with poor signage, tucked around a corner! I found it at last, went up, realized it was yet another half mile to get to the gate along another huge passage way past two more boarding pass checkers, at intervals, caught a little ride on a cart (although I could have run faster even dragging luggage). Anyway, I made it, caught the boarding line just as it was in process, and caught the plane with a good ten minutes to spare. Oh please, cortisol level, please go down, we still have so much ahead of us we have to get through.

The flight went OK, no sleep, 7 hours all night after being up all day, but we landed and bam, I was suddenly in England. It was 7:30 AM there and about 11 PM my time. Bed time. So, up for about 18 hours by now. I had 5 hours to kill in Heathrow. The crowd I was part of herded itself toward immigration. Immigration was in an enormous room about the size of a football field, divided into the usual two sides, one for locals and one for foreigners. I had walked and jogged, but still ended up at kind of the tail end of the crowd. Anyway, it was the usual RibbonedSwitchbackArrangement for controlling traffic flow. There were about thirty long lines moving past each other in opposite directions.. to an overhead camera it would have looked like slow-moving herringbone pattern. Each line was half the length of a football field. After about an hour, it was my turn.

Well, I got me a keener, as it turned out. Woman, thirty-something, maybe looking to work her way up, my first actual encounter with British bureaucracy. She took my card, looked at my passport, saw I was only there for 4 days, must have decided that was Strange, saw that the line was very dwindled and decided to take the bit in her teeth, and Do Her Job To Her Very Best. Long story short, I was held for "questioning", because she was pretty sure I should have had a work permit to show her, but I didn't. She made it clear she could make me turn around and go back to Canada right there if she wanted. She took all the contact info I had on me, left me sitting for a good 20 minutes while she phoned the people who had organized the workshop, said she hadn't been able to get hold of them, asked me tons of questions about what I was teaching and how much I was being paid and what it was all about and did I have the invitation with me? I said yes! it's on my computer - it was in an email - was there wifi available? I could show her, but she said, no, no wifi. I had already cracked like an egg, had told her Everything I could under the circumstances, had given her my complete cooperation.
She crisply informed me that had I been from Europe, or from anywhere in the UK, it wouldn't be a problem, but because I was Canadian, it was a huge problem. She pondered the situation. I thought maybe she was going to start asking me for a medical history or something, next. But she didn't. 

I didn't know what more I could do. I was completely at her mercy. I had no locus of control in this situation, and had to take whatever Fresh Hell might come my way. I think I stayed patient. I think I asked her if she had any suggestions on what to do next. 
Eventually, she decided to make a one-time exception. I was to never ever come back to England to teach without a work permit, ever again. OkyDoky then. 
Now the poor guys who organized the workshop are permanently emblazoned on some sort of Official Brit Bad Boy list, along with both their phone numbers.

By now it was about 9:30 AM. I still had lots of time to find my way around Heathrow, or so I thought, and the organizers had even very kindly arranged an executive lounge pass where I might catch a nap if I wanted, which was tempting, but I had no idea where to find it, so I thought I would better use my time first finding the next gate, getting the domestic flight to Manchester's boarding pass, then I could relax and explore a bit, or else find the lounge and snooze for a little while, maybe.

However, all there was for me to explore was the next circle of Heathrow Hell. The e-ticket had on it which terminal to go to, to get the next boarding pass, so I defaulted to my usual strategy for finding my way, which is to ask successive people if I'm going in the right direction. Yes, I was going the right direction, it was right over there, just a short walk. 
The short walk was at least a kilometer, through all sorts of tunnels, some with moving sidewalks but mostly not, tunnels that were inclined up and declined down and contained bends and switchbacks.. anyway, I finally saw elevators, and went up. I came out on the ground level. It seemed quite small, and only had restaurants. I didn't see any airline counters. So I asked at a coffee shop how to find the airline counter I needed. The girl behind the counter said, airline counters are upstairs. So I went up to level two, stepped out.

The elevators in England are very careful to explain to you, in perfect English, when the doors are opening and closing. There must be a lot of blind people in England, who travel, because, while the talking elevators are nice, the signage is absolutely terrible. At least, in that terminal, the signage was terrible. 
In probably every other airport on the planet, when you walk into a terminal, there are huge logo signs all along the top of the walls, where you can easily scan for the one you want. You take a quick look, see where you want to head, then head over. Easy. Right? 
In this huge, vast terminal, there were big, generic yellow signs, row after row after row of them. The actual information was in black text. Sort of like price club, where no-name brands of food are in yellow plastic labelled in black helvetica. I had no idea where to start looking, and I was exhausted. It looked like it would take me at least an hour to drag my luggage around, looking at every sign to find the right sign. So, I defaulted to asking, as usual. A guy who looked quite together and organized, a middle-aged man, well-dressed, who seemed sane enough, walked by; so I asked him, excuse me, what direction should I head in order to find British Airways? And he replied, oh, BA isn't in here, hasn't been for years - you need to go to terminal 5. 
Oh... OK, where is that? 
And he said, go downstairs and take the tube, it's just a short walk. 
And I said, Oh, OK, thanks. And went down stairs. And the elevator told me when it was closing, and when it was opening. I looked for signs, found one that had an arrow on it pointing to where the train station would be, and off I went. 
The underground train was not far away, but the walk to get to the right place to get on it, was another kilometer or so, through a big underground passage, brightly lit, with a big arched ceiling, lots of coin-op machines in the center for this or that, and foot traffic on both sides. I found myself walking on the wrong side, against the traffic flow. Oh well, I was too tired to care. 
I found the right platform, waited eight minutes, got on the train, which was free, and reassured me in perfect English over and over that it was, indeed, going to terminal 5. It took about ten minutes to get there. 
So I got out, into the bottom of some huge fancy glass tower building, occupied completely by British Airways. I had to go up to the twelfth floor or something - memory is sort of hazy, but anyway, I remember feeling flooded with relief when I spotted a big British Airways logo sign only a quarter mile or so across the huge room, and hardly any people in the way. Long before I got to the ribboned pathways, a nice man in a uniform asked if he could help me, and I said, yes, was this the right place to be? I needed a boarding pass to go to Manchester. 
He said, I'm sorry but you'll have to get that in Terminal 2. (...WHAT??)
British Airways had just sold its domestic portion to another company, which was in Terminal 2, but there would still be a sign there that said British Airways, if I looked closely. 
I said, OMG, I just came from there. Now I have to go back? And he said, yes, afraid so. So I turned around to go back. Of course, I had not paid much attention to how I had got from the train up the elevator, got turned around, couldn't find the elevator I'd come up on, everything looked different, so I asked a flight attendant how to find the elevator to get to the train to find terminal 2. She said, come with me, I'll show you, I'm going there myself. So, yay.

The other thing I noticed about Heathrow is that there are not very many facilities of the "Ladies" kind there. Maybe about a fifth as many as anywhere else. Plus, they are old, and always up some stairs, up which you have to drag your luggage, and wait in a line. This was a bit disconcerting. But I dealt.

Anyway, at last I was back in Terminal 2 in the huge room with yellow signs. At least another hour was long gone, and I had put several kilometers on my inner pedometer, dragging my luggage. I felt pretty hopeless yet again as I gazed around, looking once again for a clue as to where to even start. Two guys walked nearby. They looked like they worked there, not nice, misleading passengers who would send me off on another wild goose chase. They had badges strung around their necks. I decided to ask. They were in some deep conversation about something and weren't all that thrilled to be interrupted by a lost Canadian, but one of them pointed in a specific direction, so I said thanks, and headed off.

This time, I made it. I got the boarding pass, and got pointed toward the gate. Good, there was only one gate, clearly marked. Except for, when I got to it, it wasn't a gate, but was yet another one of those endless tunnel things that changed direction and went up, then around a corner, then down for awhile, with no moving sidewalk, and felt just plain creepy. Another kilometer at least. Then another room full of ribboned pathways, with a counter at the far side. I was the only passenger in the place, and the guy behind the desk was as bored as bored could be, yawning and rubbing his eyes. But he sat there and watched me go back and forth and back and forth, through six widths of the room, until I had made my way through  the arbitrary maze. In Brazil, there would have been a guy who would have moved the ribbon aside. Clearly, in Britain, there is no such guy, and the guy behind the desk who does the retina scans doesn't consider moving ribbons as any part of his job..

But I still wasn't anywhere close to my gate. I walked for another kilometer at least - dragging that luggage, walking through progressively older parts of the airport, different flooring, different architecture, the usual shortage of bathrooms, and at last, I was at the gate. 
I had about twenty minutes to spare. I bought a coffee, and sat down, and opened my computer, but, because it's Heathrow, there is no free airport wifi. Of course.

Coming home was a bit easier.. I didn't have to navigate Heathrow again - I flew straight back from Manchester to Washington on a US carrier. But because it was a US carrier, and security is at least 12 times tighter than through any other city I've ever flown through, there were about 5 more retinal scans and as many showings of my passport and checking of my luggage and yes, I had to take my shoes off. So many more ribboned gates and large burly guys wearing navy blue suits and ear pieces. And I had to take tweezers and nail clippers out of my luggage. What a colossal pain. One of the guys who helped organize the class, and who had brought me to the airport on the train, and who had made sure I got to the right airline counter, offered to send them to me by post, which was above and beyond the call of duty and very kind of him; they arrived a couple weeks later, so no harm done. 
And the flight was OK, what I can remember of it. I guess I must have crashed. I do remember I played sudoku for awhile on the touch screen on the seat in front of me. That was kind of cool. In DC there was more immigration, but it was a whole lot faster and no one cared about the little old female Canadian. There was whole body scanning involved but no patting down at random. Eventually I got to Denver, then to Regina, and then had the parking attendant run-in, and the scary drive home.

This latest flight, to Vancouver and back, was fairly uneventful but for the blizzard I had to drive through on the way to the airport, and the Christmas carols or else bagpipe muzack that played, and here it was, not even Hallowe'en yet, plus the fact the plane was delayed by a good half hour in both directions because it needed to be de-iced. But no major problems, no cortisol inducing waking nightmares.

And yay - that's it for awhile. I can finally dig in and start building up this practice I'm supposed to be running.