Do No Harm

I just finished reading "Do No Harm,  Stories of Life, Death and Neurosurgery " by Henry Marsh. Autobiographical and enthralling. I read it in 2 days which used to be trivial but if you know me now, that's a testament to how good the book is.

As well as having very interesting subject matter, being candid, crotchety and compassionate in equal measure, it's well written, to add to the book's appeal.

If you're at all interested in the brain, neurosurgery or death, I don't think I can recommend this enough. Happily, I got this from my local library, and I expect you can too.

Several times he talks about "catastrophic strokes" and "wrecking" people in surgery, and I couldn't help but face the reality that I am profoundly disabled now, and quite likely to stay that way. It doesn't change my perspective, but it is quite stark.

Twists and Turns

I just finished Matthew Mitcham's autobiography, Twists and Turns. He's the Australian diver who won the gold medal at the Beijing Olympics with the highest scoring dive in Olympic history, which remains one of the most astounding pieces of physical activity I have ever seen. He was also the only out gay man at that Olympics, which is a delight: he's so bubbly and personable, yet still an amazing athlete (you hit the water at about 60kph from the 10m platform). A great role model.

The book is well enough written, it carries his voice strongly and articulately, which more than makes up for the naif style. Where it shines, though, is in its bruising honesty. This is a young man who was best in the world at what he did, a physically difficult discipline requiring hours of training every day, and who was nevertheless dogged by low self-esteem, depression and addiction.

As someone who is coming to terms with my own depression and self-esteem problems, now exacerbated by having had a stroke, Twists and Turns was as clear a message as you can get that the causes of depression are independent of the feelings of depression, and that unless you treat depression, you are screwed.

It's a great read for a number of reasons (including the big line spacing which made it easier for me), and I would recommend it to anyone interested in elite athleticism, Olympians, depression, addiction or the benefits of living an honest life.

Anatomy of Movement

Recently arrived from Amazon, Anatomy of Movement, by Blandine Calais-Germain, and its companion volume of exercises. They're great books, lavishly illustrated, and both volumes are serving me well, in conjunction with all the other exercise I'm doing.

That the exercises are helpful is no surprise: they're well explained and well illustrated (with drawings and photos--terrible hair), cover stretching and strengthening, and have accurate correlations between exercise and specific muscles. There are plenty of muscles affected by the stroke that are not obvious in their failure, although the effect is pretty evident (I fall over), and the volume of "Exercises" helps target them where free weights, Pilates or yoga cannot.

Slightly surprising, though, is that gaining a better understanding of my own anatomy from the first volume has been useful by itself. I have mentioned in the past that every action involving my right side has a conscious component: I can't simply raise my leg, I must think about it. It turns out that knowing what the principal muscles involved and not involved are is useful, and seems to be helping my brain recover.

I'm pretty sure that the deep muscles of my spine are affected, for example, but my brain has not had to work on them for 40 years or more. Knowing what they are, and having tools to exercise them will help with getting them more brain time, which, I hope, means less falling over.

A Small Victory

Another small victory, completely unrelated to boring stroke recovery:

I went, after the gym while waiting for the infrequent Saturday bus, to a book fair being held lethargically in the Digby Memorial Church Hall (coincidentally where I've started practicing Tai Chi). There was a Blake's 7annual I considered picking up, but it was a bit steep at £7 (about $11-12), especially for little more than a joke gift (sorry Joe).

My eyes wandered over the selection of children's books, all at 50p apiece, and what should I see but the Earthsea trilogy in the same editions that I read to death thirty years ago, or more. All in perfect (by comparison) condition. Sure the covers are whitewashed and the artist didn't read the books, but the interiors of the paperbacks include the fabulous original woodcut chapter illustrations. I would have paid rather more than the £1.50 I did, but mostly out of sentimentality. A victory!

The Brain That Changes Itself

At +Ralph Mazza's suggestion I recently read The Brain That Changes Itself, which sings a paean to the wonders of modern neuroscience, and in particular neural plasticity, which would seem to offer, say, someone who had a stroke, cause for optimism.

To get the bad out of the way, I didn't like at all the chapters that were thin on science, or relied to much on the author's experience as a psychoanalyst. The conclusions may be accurate, but the chapter on Internet porn came across to me like the author banging a well-worn sensationalist drum of titillation and puritanical propriety. Also, I haven't waded through the annotations, which seem to take up half the eBook, since reading is a bit slower at the moment, and I couldn't be bothered at the time. I still have them to read at my leisure, though.

Other than that, I thought it was an excellent book whose implications matched my personal experience very well. For example, the first chapter described a woman who--due to a poorly prescribed antibiotic and an almost total loss of vestibular function--had had the sensation of falling for five years, even suffering the same sensation when she had already fallen over. Miserable. The chapter describes how she was successfully treated using principles of neural plasticity.

Using the ideas in the first chapter (but lacking expensive equipment) I derived a way to experiment upon myself, potentially improving my own poor balance; it could do little harm. It worked. My balance improved noticeably. Score one for the principles the author was describing.

As I read more, it became clearer that everything I knew about neurology from high school (my A-level Biology 20-odd years ago) was wrong, or at best an inaccurate approximation. The implication for me is evident: recovery is not only possible, but attainable; it takes time and hard work, it will often be boring. My relative youth and the quite small amount of lost brain matter are an advantage. I suspect that never learning to drive will also help.

Yesterday, I was asked to speak as the "expert patient" or graduate of the ASPIRE program I mentioned in an earlier post and I found that I was unable to be as coddling as some medics seem to be. Sure it's horrible having a stroke, and sure it's tough, and for sure sometimes there's so much damage that recovery is going to take decades at best, if it's possible at all, but given all that we have a conscious choice to make, and we should be damn sure we make that choice consciously: Do I want to sit in an armchair and fester for the rest of my life, or do I want to get better? If the answer is "get better" then we do the hard work. 

The book lays out some of the principles and, I think, gives a pretty coherent and sensible view of how our neural matter really works, why localization made sense at the time, and most importantly for me, some ideas about how best to use those principles to effect a faster recovery. As an example, I now go to the gym quite a bit, and I was already concentrating on form over apparent brute strength, but understanding more about plasticity has meant that I pay more attention to my right leg while cycling, for example.

Another example that cuts to the heart of the recovery vs rehab dilemma, is that it matters when my left hand compensates for my right hand. Early on, I was compensating enormously and didn't know it, which partly accounts for my wildly over-optimistic expectations of how long it would take to recover. Now, I work hard to notice when my left hand has quietly assumed an automatic task that my right hand should be doing, and force myself to use my right. Even though it's often much slower. When I pay attention to forcing my right hand to do the things it used to, it improves. Any other improvement is as good as accidental.

If you've read the book and have thoughts or questions or whatever about chapters in it, let's talk about it! (Except the internet one. Can't be bothered. Not relevant to me.)

(Originally posted on Google+ with some commentary.)