Acupuncture and Stroke

Why I Pay To Have Over 50 Needles Shoved in Me Every Week

It works.

I go to the gym, go to the pool, and go to acupuncture, all things I have to pay for, and all things that involve varying degrees of discomfort, because they are all working, demonstrably, to hasten my recovery from brain damage.

To get why they are having a positive effect, I think it helps to understand what's going on with me. When I had the strokes, bits of my brain died. The bits that died mostly controlled motor function: the movement of muscles. In some cases, like the left side of  my face, although sensation remained, I lost all the brain matter that was sent signals to move the muscles. In other cases I lost sensation and control, like in part of my right butt; it felt like I was sitting on something in my back pocket, but in fact I was just sitting on my ass, and couldn't feel it (I can now, no need to kick me). In most cases, I lost some of the brain matter controlling some of the muscle, with the result of making almost every part of my right side below the neck weaker and less coordinated. The secondary problem, in some cases, is that of atrophy: it's been a long time since some muscles saw use. My right hand is visibly thinner than my left, and there are muscles in my face that can only be felt on the right side.

At this point, some seventeen months after the strokes, to recover, I have to get other parts of my brain to do the jobs that the dead bits used to do. This is a process that is similar to a baby learning to use its body, a process that takes many years, and is eventually optimized in adolescence, which is why teenagers can be great klutzes, but suddenly graceful by their late teens. I'm hoping it doesn't take me as long as a decade, but it might.

Using the brain's plasticity to get live bits to do the work of dead can only happen when there is stimulus in the brain in the live bits. That's why function now improves slowly, and improvement only happens in muscles whose controlling brain parts were adjacent to living brain tissue. Their signals were reaching still-living brain matter, but it has to learn not to ignore the signals as irrelevant, and take responsibility for new muscle.

Gym work both requires muscles to work, and the brain to control them, more often than not in the stabilisation; that's why I do mostly dumbbell work. In the pool, I'm requiring muscular control and coordination, and also parenthetically working on my endurance which is pretty low. The benefits are clearly noticeable: despite being tired after swimming, I walk better. So, what does acupuncture do?

Here's what an acupuncture session is like, if you've never had one. You take off varying amounts of clothing, sometimes  lie face up, sometimes face down, and the acupuncturist puts a bunch of needles in you. Then you rest for a while, often falling asleep. Finally the acupuncturist removes all the needles and you're done. Yes, some of the needles hurt some of the time, but usually for no more than a second or two. Also, I've had a lumbar puncture (a.k.a. spinal tap), and these are nothing in comparison.

Often, you're booked in for an hour's session, and the acupuncturist will come and wake you up so they can get the needles out and get you dressed before their next client. I've been going to a great place called Olo Acupuncture in New York, that practices community acupuncture: the treatment happens in a communal space with a bunch of table and chairs to lie in. Apart from the price, the best thing for me is that they let you rest (or snooze) for as long as the treatment takes. On a recent trip, when one of the needles was damn sore, I slept for over two hours, and it's not like I'm running a sleep deficit.

There's a lot about traditional Chinese medicine that is alien to my skeptical self, and as a result I find it useful to think of much of the approach as having a very good, but rather peculiar, working metaphor. Frankly, I don't care if a practitioner is balancing my chi, clearing wind from my trembling limb, or just poking me with needles: it works. I feel better afterwards, more even, more symmetrical.

What about the placebo effect? Perhaps it's just me thinking that acupuncture is going to work, and so it does. For many of the benefits I perceive that could be the case, and the mind is certainly significant in changing the brain, but not all. The left side of my face has gradually been moving thanks to acupuncture. I have no doubt about it. Before I had needles in my face and left orbit, my left side did not visibly move. It does now.

What I think is going on is that the needles are stimulating the atrophied muscles, or nerves into those muscles, and my brain is recognising that stimulation as requiring response. Perhaps it's as simple as the needle being fine enough to be an irritant without causing damage. Perhaps it's something else: acupuncture anesthesia seems to work on a different principle. No matter, I can't stimulate those muscles any other way; believe me, I've tried.

In the end, what matters to me, is that acupuncture is helping me to recover, and to recover faster from the brain damage caused by stroke. It works.

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.

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.)