Thursday, January 05, 2017

Remembering Gayle

She passed away just a few days ago. I've been awash the past few days remembering so many times we were together. The very first time I met her in PT school, that astonishing empathy that radiated, palpably. Her tinkly laugh. Her graciousness. All the singing of course. She invited me over for her 21st birthday, and I remember drinking chrysanthemum tea with a little flower floating in it. So exotic. I remember the way she held her long Benson and Hedges cigarette. So elegant. She had been to university in Montreal and had a degree in English lit, which I admired - she seemed so wise. The way she never walked past a flower patch without pulling one toward her, and inhaling deeply, with a smile. So blithe. Her beautiful handwriting. The way her voice sounded like music. The bits and dabs of Chinese she had picked up from her even more exotic boyfriend. The way she rocked that huge tattered second-hand fur coat that first bitterly cold winter in Saskatoon. Practicality before style.


She helped me get through PT school. We studied together. All those wiring diagrams made no sense to me, but she understood them, being so much older and wiser, and I managed to squeak through electrotherapy exams.


We had many adventures together.


1. I interned in Winnipeg right after her. She had an apartment there that I moved straight into. Judy (another classmate) moved in there too. Gayle and I overlapped by a few days. I remember marvelling at how effortlessly she inhabited her body, watching her do cartwheels in a big park there, by the Red River. She loved her physicality, her kinesthesis, just being in a body, feeling it. She seemed full of joy back in those days, doing tricks like that. I, on the other hand, liked my body best when it sat still because then I could think straight.


2. She moved to Ottawa with Lordson, her boyfriend. I visited her in 1972 and we went camping together in Quebec. On the way to the Laurentian hills, we stopped in a little town to buy milk, and she asked, Avez-vous lait? I was impressed. We did about 3 days of canoeing and tenting. It was September and getting cold. It was windy and choppy. I had no experience canoeing. We had no life jackets, if you can imagine, not even warm clothing, so we wore garbage bags under jean jackets. I was terrified but she loved every second. I remember thinking, woman, you are brave, and I am so not. The first night, we camped on shore of some island covered in raw old forest. I found the stillness and silence disconcerting. Forest primeval, Gayle called it, as she drank it all in, checking out all the different bits of moss bursting from trunk and twig. We found a flat spot to put up the tent. Sometime during the night a loud thudding woke us up. I was, as usual, terrified. In my mind it was either a bear or an ax murderer. She turned on the flashlight to peer out, see what was out there, and the whole tent glowed orange, which I thought made us even more a target. Turned out it was just a rabbit. We laughed hysterically. Both the trip and my canoeing improved after that.


3. She parted ways with Lordson and travelled in Europe, working here and there to support the trip. Back in those days, PTs could work wherever we wanted, it seemed. I was supposed to meet her in Greece, but in the end, I didn't go. I ended up back in university instead.


4. She came back from Europe, and moved in with me in Regina, worked at Wascana. I think it was less than a year. She moved to Prince George BC. Her fantasy was to build a log cabin and live in it, in the woods. I continued to work, live, and attend art school in Regina.


5. I visited her in Prince George, Thanksgiving long weekend in 1975. She didn't have a cabin built yet. She was working at the hospital, making lots of friends, enjoying the rugged countryside. It was a lovely sunny weekend. We were outside a lot.


6. Somewhere in there I visited her in Calgary where she was attending her cousin's wedding, to which she invited me along. I remember the bride cried. I remember thinking, that will never be me. Barry, her brother, was there. We had a good singalong after, outside on somebody's lawn.


7. In the summer of 1976 (I think it was) I got a scholarship to attend Banff School of Fine Art for a 6-week painting intensive. It wasn't super far from Prince George, so we thought it would be a good chance to meet up. She phoned to let me know she had arrived, and we planned to meet for dinner that evening. She said she wanted to go hiking on Tunnel Mountain, check out the trails. I told her to be careful of bears. She laughed. I was always paranoid about bears, she was never paranoid about anything. She never called, and I panicked. About 10pm that night I called the police, anybody I could think of. I said, I think my friend might be in trouble, because she hasn't called. The police said, oh, she probably went to the Calgary Stampede. I said, no... that's not her thing, besides she's utterly reliable and she would have let me know. She went hiking, Tunnel Mountain I think she said, and she might still be out there, and I'm worried. They weren't worried. They said, well, let's wait until tomorrow and meanwhile she'll likely show up. I worried all night, and the next morning got a call - she had been admitted to the Banff hospital. I raced over, and found her in emergency, where I watched her transfer herself from one stretcher to another. I was a sobbing mess, she was calm. She had climbed some godawful rock face with no lines or picks or any of that stuff that you should have if you go rock climbing. She got up OK, about thirty feet she said, but on the way down, slipped and fell backward off the rock face, got dinged pretty hard in the process. She passed in and out of consciousness, tried to light a fire but it got away, crawled around trying to put out the fire (succeeded I guess, because Banff didn't burn down that night), and passed out on a trail. The next morning some army cadets out for a drill found her and radioed in that they had found a "casualty." I remember her take fleeting but distinct note of that word. She was rescued by helicopter on one of those dangling stretchers. That must have been quite the ride. She was about to be transferred to Foothills.
It turned out her injuries were pretty bad. She needed spinal fusion at four levels, and a fusion of her left foot because the talus had shattered. The other heel was broken, but it healed OK. She was on a Striker frame for a couple months. I came to Calgary from Banff to see her on the weekends. We went crutch-walking outside. It was a lovely sunny summer.


8. She went back to PG. She sent a picture of herself, astride a big log, peeling it, crutches parked alongside. We wrote lots of letters back and forth. I remember her asking specifically if I thought there was really such a thing as a death wish. I remember having no idea at all about such a thing.


9. Sometime in the early 80's, (maybe it was 1982) she visited in the month of May - she wanted me to go to CPA Congress with her, in Winnipeg. I had moved into a rented house and wanted to plant a garden. We spent a whole day putting in the garden, then raced to Winnipeg, in my '72 Chevy Nova, me driving 5 hours straight with a seat that wouldn't pull forward, so, leaning the whole way. I had the worst backache from that. We stayed in a YWCA hostel. She worked on my back for about an hour. I remember crazy interoceptive experiences, maybe from all the opioids my brain manufactured in response to her excellent intuitive handling. I think I passed out. The next day I was fine, pain gone. Congress was boring. We drove back to Regina and she went home to PG. 10. I remember her altered gait from the injuries. She moved with a distinct limp that she couldn't hide. I remember falling behind her as we crossed Burrard Street bridge in Vancouver, going fast, watching her as she strode, turning that limp into propulsion. I think it was around that time she took up Tai Chi in a big way.

11. She gave up on the log cabin idea, I guess, and moved to Vancouver. She invited me to visit her there and I can't remember now whose idea it was, probably hers, that we do a road trip to California. She had a beat-up truck to take us there. It seemed like a fine idea, even though I was paranoid about traveling in the US. I thought everyone was out to shoot each other there. She laughed. She had already scoped out the US and had found it utterly wonderful. We took our trip. We stopped on Orcas Island and she introduced me to what she was really into just then, in a big way, therapeutic touch. It was her gateway into years of spiritual investigation, a lot of which I ended up not being nearly as fascinated by as she was. Whatever. Anyway, we drove to San Francisco, visited some art galleries, saw a Flamenco dance production, drove back, camped along the way. On that trip I remember her driving, telling me about her mom dying of bowel cancer when she was 13, and her dad dying in a car crash a year or two later, and suddenly bursting into tears. It was the first time I had ever seen her cry. Ever. She retained perfect control of the truck even as she sobbed out loud for a few minutes.


12. I moved to Kamloops in 1983. I was determined to learn manual therapy, BC seemed to be the place to be in those days, and I got a sweet job in Kamloops running a private practice for a manual PT who taught me everything she knew inside a two-week space before she left town to go study vet. med. That lasted about 18 months. Meanwhile, Gayle had found a man (Frank), and they planned a wedding, and I was a bridesmaid. That happened the summer of 1984, a lovely outdoor wedding at Jericho Beach. Her brother, his wife, their two children, and her aunt, went with them on the honeymoon.


13. On the way home from the honeymoon, everyone died in a car crash except for the two children, who had been asleep in the back seat. She was no sooner a bride than she had to go back to Sask to pick up these children, aged 10 and 6 at the time, the youngest with two fractured femurs. On the way back to BC they stopped in Kamloops and we had Thanksgiving dinner together. Even though there didn't seem to be a whole lot to be thankful for at that moment. She cried frequently after that. I remember Frank asking me that evening, out of earshot, if I thought Gayle was going to be OK. I remember telling him I was sure she would be, that she was the strongest person I knew.


14. A bit more time went by. Gayle was now 37 and wanted to get busy building a new family. I moved to North Vancouver in 1985, lived in her basement for a year, ran her practice for her while she was on mat leave. She was horribly disappointed with her experience because they made her have a C-section. The next time she had a baby, in 1987, it was a V-bac at home. She had been determined to have a natural birth in spite of restricted mobility in her lower trunk. Alas, the baby sustained a head injury during birth. I think that was pretty stressful. She cried even more after that.


15. Over the next few decades we were less in each others' lives, because of very different personal interests, but remained in touch and saw each other several times a year. We attended lots of educational workshops together, the last one 2005 in Nanaimo. She continued to grieve. She had developed chronic pain, especially in the leg and foot that had been fused. I treated her once in awhile. I continued to marvel at how strong she was in spite of everything that had happened to her and her family.

16. Eventually I couldn't stand the dreary wet-coast weather anymore, and moved back to Sask in 2009. The last time I saw Gayle was 2010 at our class reunion at Waskesiu. My very last memory of her is seeing her crying. Publicly or privately, no difference. She would brighten up for brief periods, but it was as though crying was the only thing could keep her going.

I absolutely loved Gayle, who didn't seem to mind being the big sister I never had. I learned so much from her. I am kind of a mess, missing her big time at the moment, as our whole class is, I imagine. I really hope she's in a happier state. Life was not nearly as kind to her as she was to it, and to others.




In black text frames, Deb (the first one in the class to die) and Gayle. Both died from cancer. 



White Owl Flies Into and Out of the Field

by Mary Oliver
"Coming down out of the freezing sky 
with its depths of light, 
like an angel, or a Buddha with wings, 
it was beautiful, and accurate, 
striking the snow and whatever was there 
with a force that left the imprint of the tips of its wings — five feet apart — 
and the grabbing thrust of its feet, 
and the indentation of what had been running 
through the white valleys of the snow — 
and then it rose, gracefully, 
and flew back to the frozen marshes 
to lurk there, like a little lighthouse, 
in the blue shadows — 
so I thought: maybe death isn't darkness, after all, 
but so much light wrapping itself around us —


as soft as feathers —
 
that we are instantly weary of looking, and looking, 
and shut our eyes, not without amazement, 
and let ourselves be carried, 
as through the translucence of mica, 
to the river that is without the least dapple or shadow, 
that is nothing but light — scalding, aortal light — 
in which we are washed and washed 
out of our bones."

Added January 14:
Today is the memorial for Gayle. Here is a link to a lovely tribute from the North Shore Special Olympics organization.

It is with great sorrow that SOBC - North Shore says goodbye to beloved coach, manager, volunteer and athlete council coordinator, Gayle Robinson. Gayle passed away yesterday after a long battle with cancer and leaves (husband/coach) Frank and (daughter/athlete) Kara Williams for us to care for as well as many others. If anyone is interested in supporting the family (i.e. prepared meals), pleasecontact Kelly Klein at LocalCoordinator@sobcnorthshore.ca. Kelly can also be contacted on her home (604) 904-1020 or cellular (604) 992-1020.

A LIMB HAS FALLEN
A limb has fallen from the family tree,
I keep hearing a voice that says "Grieve not for me."
Remember the best times, the laughter, the song,
The good life lived while I was strong.
Continue my heritage, I'm counting on you,
Keep smiling and surely the sun will shine through.
My mind is at ease, my soul is at rest,
Remembering all, now I truly was blessed.
Continue traditions, no matter how small,
Go on with your life, don't just stare at the wall.
I miss you all dearly, so keep up your chin,
Until the day comes we're together again.
~ Author Unknown

Gayle Winnifred Robinson
Jan 18 1948 – Jan 3 2017

It is with heavy hearts that we announce the passing of our beloved Gayle: Wife, Mother, Sister, Aunt and Friend to all. After a lifetime of caring so deeply for others, Gayle passed away peacefully at midday on Tuesday, January 3, a bright cold winter’s day, at the North Shore Hospice surrounded by family and friends.
Born and raised in the small farming community of Lone Rock, Saskatchewan, Gayle grew up with strong family values, a sense for community and a deep love for nature.
A graduate of the University of Saskatchewan (BA; Diploma of Physiotherapy) and the University of Alberta (BSC Physical Therapy), Gayle was resolute in her commitment to health and healing. In her work as a Physiotherapist, she continually sought innovative approaches to enhance her patients’ well-being.
Gayle lived on the North Shore for the past 32 years, raising a family with her husband Frank, gardening, and welcoming friends for singalongs which she accompanied on piano or guitar.
When daughter Kara became a Special Olympics athlete, Gayle stepped into volunteer coaching, team managing, driving to games, and doing whatever was needed. She was deeply moved to receive a special award by North Shore Special Olympics in June 2016, for initiating the Athlete’s Council.
With her great interest in the arts, Gayle fostered her son Jesse’s creativity. She was an ardent supporter as he developed into a talented professional painter/illustrator.
More than being merely ‘survived by’, Gayle is clearly celebrated by her loving husband Frank Williams and their children Kara and Jesse (Jen); her brother Morris; her niece Colleen, and nephew Christopher (Rochelle) and baby Ruth.
Countless friends, colleagues and patients have benefitted from her soul’s warmth and healing hands.
The family wishes to thank Dr Paul Sugar and the nurses at Lion’s Gate Hospital and North Shore Hospice for their caring.
A Celebration of Life for Gayle will be held at the North Shore Unitarian Church at 370 Mathers Ave, West Vancouver, BC on Saturday, January 14, 2017 at 11:00 AM. All are welcome.
In lieu of flowers, kindly consider a donation in Gayle’s name to the Paul Sugar Foundation, Inspire Health or North Shore Special Olympics.

I thought of this song, by the Seekers, one of the many folk groups that walked the earth, being minstrels, getting the baby boom out there and into life. It used to be on the radio all the time. It pretty much covers the feelings I had for Gayle when I first met her and as we went through a lot of life together through our twenties and thirties.

Saturday, December 10, 2016

Out of gear

Just coasting these days.
One-third of the way through December. Sudden onslaught of winter - a foot of snow and minus 25C weather. A big change to adapt to after the creepy warm November we had, with rain and daytime temperatures that reached plus 20C..
........

Anyway.. it's a slow time of year, not much happening at work last week. The book has been out for a week and a bit. I have amused myself by looking up the stats on book sales. Definitely not a runaway best seller, but it seems to be steadily moving out into the world. I am pleased with the progress so far, a couple hundred ebooks and dozens of regular books. A guy who attended my class, Jaire, posted a picture of himself holding his new DNM book. So did another guy, William. A woman who blogs at My Cuppa Joe, Joletta Belton, wrote a lovely blogpost about her experience attending a DNM course taught by Rey Allen recently.

What pleases me even more is a sense of the ideas it contains taking root out there in the world, with or without the book. Not many of the ideas in it are original, but I like to think that juxtaposing them to each other my own way has maybe helped give them more pizzazz.

All this is great. The feeling is one of completion, contemplation, enjoyment. Maybe it's similar to that feeling women my age (who reproduced) have when they watch their baby grandchildren or great grandchildren doing adorable things.

Sunday, November 27, 2016

Sacral outflow is entirely sympathetic



The book, Dermo Neuro Modulating, is out on Amazon as ebook only just now.. seems to be selling well based on feedback from twitter and facebook, but really I have no idea of stats, or of when the hard copies will be available, and won't until the coming week when I can converse with the company that helped me self-publish.

For the time being, if anyone interested in taking a look or picking up an e-copy, here is a book link to Amazon.
.........



Time for a nerdy, nerdy interlude. 

In the past week it came to light that researchers got right down to the molecular level and found out that autonomic sacral outflow is entirely sympathetic, that there is no such thing as a parasympathetic cord supplying neurons to pelvic viscera or reproductive or sexual response function. This is huge news. Before I express any thoughts on that, here is Peggy Mason on the topic: 




Here is a blogpost she wrote on this topic! It examines a few of the implications from a science perspective, including the history of the concept and why textbooks will have to be updated.

Peggy Mason works at U. Chicago. I first encountered her brilliance at the IASP congress in Montreal in 2010. She discussed brainstem nuclei involved in micturition. I think that's her specific research area. But she does much much more besides. She teaches an online course for free, through Coursera, Understanding the Brain: The Neurobiology of Everyday Life. I signed up for it a few years ago but it was in May and I underestimated the daunting time factor. I had to run around teaching, myself, so had to drop out. But the amount I managed to assimilate was great, and I recommend it. She's a very engaging teacher.

She has also written a book, Medical Neurobiology. What I love about it is the non-hierarchical format - every single topic and even every little sidebar is connected to bits in other chapters, all the way through. Which means you have to turn a lot of pages frequently in a rather heavy book, but your brain is going to take in the information from lots of sides and angles and directions.

About the sacral outflow thing, clearly this is a big shift in the dogma surrounding neuroscience. I love that she's so excited about it! I know a lot of people whose world if rocked or their worldview pulled out from under them makes them anxious and upset. What does she say? She's excited, and says Whee!!!!

Anyway, here is what the new, more updated picture of sacral outflow looks like, from the Espinosa-Medina et al paper:




.........

OK, so what is the big deal? For manual therapists?
Well, the implications are kind of big, in my opinion.
First of all, there are still plenty of us roaming around imagining that there is some sort of magical elicitation of parasympathetic activity directly stemming from hands-on work. So much so that there is even a kind of guru-based modality empire out there called craniosacral therapy. That set of ideas needs to go. 

Second of all, and more importantly I think, we need to understand that when we do hands-on we are playing with the brain, and that EVERYthing we touch or do is going to excite, for better or worse, the sympathetic nervous system. The sympathetic nervous system has dual control of the entire body wall, and blood flow to each and every bit of it, including to that forest of highly sensitive neural tree comprised of 72 kilometers of passive noodle-y tubing throughout our body. THAT is what it is most protective of, and that extends to the surface of the body, everywhere. Really. Everywhere.
Think about it.
Think about how everything that was ever thought about how sex works (i.e., an orchestrated interchange of sympathetic and parasympathetic outflow), is wrong in light of this new information.
If this is how sex really works, then it must also be how any kind of manual therapy works, also. Because if there is no parasympathetic outflow to genitalia there certainly is none running out anywhere else in the body wall, either.
Which supports the idea that context is everything, and that descending modulation from brainstem nuclei is where it is truly at, for blocking ascending nociception, and (given everything else is level) for pain relief.

...........................

1. I. Espinosa-Medina, O. Saha, F. Boismoreau, Z. Chettouh, F. Rossi, W. D. Richardson, J.-F. Brunet; The sacral autonomic outflow is sympathetic. Science  18 Nov 2016:
Vol. 354, Issue 6314, pp. 893-897

2. Adameyko I, Neural circuitry gets rewired. Science 18 Nov  2016 • Vol. 354 Issue 6314, pp. 833-4
 

Friday, November 25, 2016

The year's not over quite yet.



But it's drawing to a close.

A lot has happened, most of it in the last few months.

1. I finally finished the book. 

It will be available in the coming week I'm told.
Here is a picture of the cover, back to front.



Whew, glad that's done.

2. I moved my clinic. 

Total unplanned surprise. In September I got a call from another physio in town who told me she was opening a new clinic in a renovated school, and would I like to join her?

The deal was,
a) I got to keep my own name and business and patient list and files
b) I got to have lower rent per month, secure for the next five years
c) I got to have a room with a window and could add a sign to it



d) I had to break my lease in the old dilapidated building where my practice was formerly housed

VERY fair terms.
So I did move - I took a big hit because there was still over a year left in said lease, but opportunities like this do NOT come easily in this town. There is almost no new construction apart from residential. So I jumped at the chance.

And I feel like I dodged a bullet, because the same day I moved out, October 3, a giant rainstorm happened, the roof leaked, and water poured down from beside one of the light fixtures in the building.

Lucky me, out of there.
Whew again.

3. The weird election that just happened down south 

It has to have been one of the most bizarre elections humans have ever held since we've been human and since elections became a thing.
I used to think the following, ever since the Free Trade Deal with the US and Mexico, NAFTA:
That Canada and Mexico were like nurses, walking a large demented patient named Uncle Sam up and down the hallway helping him to not fall, and that he was abusive, striking out at both of us even as we tried to support him and look out for his needs.
Now that demented patient has been elected president of the US. He's now going to represent the US in the entire world. Unless some equally bizarre miracle happens..
Nothing he ever said or did in the election run up convinced me that he would do anything but lurch about and break things and hurt people and be thoroughly abusive.

Gad, I'm going to miss Obama.
Whew that I don't live directly in the US.
Quaking because I live very close to the border.




Sunday, October 30, 2016

Dream drama

Bizarre dream this morning, made me wake up at about 5:30 am. Like all dreams, absurd in retrospect.
Still, one of those dreams that is stark, memorable. The kind that twist you a bit, emotionally. Clearly a message from one part of my brain to some other part.

The dream

I'm a teacher in a classroom in an institution. The reason I know this is because it's a home room with those university type desks and a front wall covered in green board, and outside a long hallway with other doors to other classrooms. Apparently I've taught in there forever. (Absurd.)

I arrive to class to see that two other people are in there teaching. Not only have they taken over and are teaching my class, they are teaching them biomechanics. They are not teachers that I know well, but I'm willing to let them complete the exercise.

They have a human skeleton, or rather a vertebral model, about twice human size, a real one I guess, lying on its side curled up on a table. One of them has a percussive implement of some sort. She is thumping each of the vertebrae in turn. Each thump results in a unique movement of the parts of the column.

This is supposed to mean something profound, I guess, because she looks around at each student as if to say, Truth. Case closed.
They all seem quite dazzled by this demo.

I ask, where does this biomechanical demo and tool come from? And she looks at her teaching partner, then says, Scandinavia. (Which might be absurd, but I'm not sure.)

Oh, I say.

She is a large woman, broad shoulders, about 40-ish. Looks like a lifter. Cropped blond hair. Glasses with dark frames.
Anyway, she leaves out a back door, and I turn my attention to the other one, whose looks I can't recall clearly.

I ask, from a pain standpoint, what does this biomechanical movement model have to do with treatment?
He can't answer.
He stares at me for a moment, dumbfounded, as though I'm the incomprehensible one, not him; then, still mute, with an irritated look on his face he strides out the front door and SLAMS it shut behind him.

I and everyone else still in the room startle. Such a passive aggressive thing to do. I hope that lesson is not lost on anyone.

I have my classroom back, and all the people that are supposed to be in it. I try to gauge how mesmerized they have been by the demo, start a conversation with them by asking questions about what relevance they think this has for a real patient with pain. One thing I want to drag out of them is, do they think this movement (which was presented as the only true movement) is true for every individual? Alive? With nervous systems? all sorts of tissue layers burying their vertebral column?
I don't remember how this part goes. It goes on for quite a while.

At the end of the dream, I'm taking the skeleton home in my car with it still dripping a little after having given it a careful shower. (Absurd.)






Tuesday, October 25, 2016

New rumblings in defining and philosophizing pain

Very low rumblings, like thunder far away, but who knows? They could turn into something, right?

1. This just in: Updating the definition of pain. (Full text, at least for a little while..) 



Current def:
>>> An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.

Proposed def:
>>> Pain is a distressing experience associated with actual or potential tissue damage with sensory, emotional, cognitive, and social components.

Yes, I think I like the proposed def more.


It seems the world has moved past the general systems theory upon which the BPS model was constructed, into something much more integrated, less objectified, more phenomenological, (more post modern?), so therefore a better model is required.

Gee, and here I thought BPS was soooooooo much better than the odious biomedical/biomechanical/postural-structural models that so many are still working with, when it comes to pain experiences.


How interesting that these two rumblings both arrive in my facebook feed on the same morning and amplify each other.

REFERENCES

1. Williams, Amanda C. de C.; Craig, Kenneth D.; Updating the definition of painPain:
November 2016 - Volume 157 - Issue 11 - p 2420–2423

2. Dave Nicholls; Is the Biopsychosocial Model all it’s cracked up to be? Critical Physiotherapy Network 25th Oct 2016

Wednesday, September 28, 2016

Nicole, hair artist

I love my hair dresser, Nicole.
I've only been to her twice; the first time was a year ago, the second time was today, and I put in a whole year of waiting for her; a year ago I had a single haircut from her that satisfied all my hair neuroticism, then she went away, had a baby, has just finished her maternity leave and is now back to work, and I was in there today, back in her care.
During the year she was away I got haircuts from other people, but none of them felt right, not the way my hair felt after that one time she cut it, a year ago; I knew I had found my one and only. I mean, anyone can cut off hair - not that big a deal. But it takes an artist to be able to feel through it and decide on the basis of how it feels, how to thin out the hair where it grows in too thick and feels too bulky, and where to leave it alone because it's the right thickness, and how to leave it thicker over flat spots on the skull (like where one was left lying too long as an infant) so the head looks symmetric and round even if it isn't, and so that when I run my own hands through my hair I'm not painfully aware of how my now aging hair is a lot thinner in some places and by comparison way too thick in others.
The difference between all the other hair dressers in town and Nicole is like the difference between some random kid practicing a cartwheel on the lawn, and someone from Cirque Du Solieil performing in LUZIA.
Nicole is definitely a keeper. She might have another baby some day and I'll have to make do with other hair cutters, but really, she is the only one I will ever feel bonded to.

Friday, September 23, 2016

When autumn leaves start to fall

I'm in a particularly ambivalent stirred-up disquiet mood today. I blame the change of season, partly..
One of those (thankfully rare) windy rainy autumn days out there..
The one and only patient I had booked today cancelled with only a half hour notice. Grrr.

In other news, I am so restless or anxious or something today that I had a hard time focusing on editing. Yup, last edit before my beast of a book gets published. A very nice PT I know wrote a gracious foreword for it, which reinvigorated me for most of the edit this past week.

But today is Friday already, for some reason.

And I've got other things on my mind, alas. I will move my office soon and I still have one travel/teaching gig to deal with this coming month.

Hopefully THIS move will be the last, ever, until I die.

Opportunities like this do not come along every day.

A couple weeks ago I got a phone call from a PT I met years ago while doing a short stint at the local work rehab facility in town. She's a lovely person, young, early thirties, three children, wants to open a new clinic in town. She invited me to join her there, rent a room (WAY cheaper than the outrageous rent I'm paying right now, and which rises each and every year.. in a building that, shall we gently say, has seen better days) for about half what I pay now per month, for the next 5 years. Her new clinic is in a brand new strip mall close to the hospital which used to be a separate catholic school, but has now been repurposed. (Seriously, there just are not enough catholic children anymore to warrant a completely separate school for them.. I guess.)

Anyway, it's lovely, fresh, lots of light, clean, large.
We checked for any conflicts of interest, having two practices in one location, but it seems there is no problem with our licensing body about that.
My soon-to-be PT roomie/landlady who will be subletting to me recently went out and got certified to be a yoga teacher. So the place will be a yoga/physiotherapy center. Which is OK by me, because I asked her if it would mean I would have to put up with any talk about chakras and she said no. :)

So anyway, I have the phone company coming in a week to move my phone number to the new place (yeah I know... old fashioned landline, but gad I hate cell phones and smart phones..); I have atrociously overpriced movers coming the first workday of October, mostly to move my atrociously overpriced hi-lo electric treatment table over, plus odds and ends. My brain is already leaping ahead, planning how to pack and what to pack and what to toss. I will toss the desk, as there will be no room for it in my new room, and my new roomie will let me share her charting area where my file cabinet will sit anyway.

It will be expensive to move and I had to buy out the remainder of the current lease because the property-owners in this city are nothing if not money-grubbing, seems to me.. However, averaged over 5 years,  at half the rent I'm paying now and no increases for 5 years, I'll still come out ahead. Yay me. Plus, it looks like I'll be getting a treatment room with a window! And it's exactly the same size as the treatment are of the room I currently work in, so all the necessities are going to fit.

Saturday, August 13, 2016

Mental models in manual therapy


Our mental models, (ESPECIALLY in manual therapy) need continuous examination, updating, renovating, because if we stay caught up with basic science, especially pain science, we'll notice that it's all quite turbulent, philosophically problematic, scientifically problematic, and therefore, we have to be nimble, like a kayaker in white water, paddle on one side then the other to avoid tipping over and still make our way down the river. (Forgive the analogy, I recently watched the kayaking event at the Rio olympics.)

Our mental models are subject to cocktail party effect, or cognitive conspicuity. We need to be aware of that.

What is the biggest clue we are responding only to cognitive conspicuity?
When we realize we are paying more attention to some movie going on in our own head, and not to the patient or any discomfort they may be experiencing as we impose our lovely mental models on them.

We still need mental models, because that's the human part of our own brain, the most complex object in the known universe, mostly still unknown, possibly unknowable in the ultimate sense.
"Acquiring knowledge can be a very daunting task. If you think of the mind as a toolbox, we’re only as good as the tools at our disposal. A carpenter doesn’t show up to work with an empty toolbox. Not only do they want as many tools in their toolbox as possible, but they want to know how to use them. Having more tools and the knowledge of how to use them means they can tackle more problems. Try as we might, we cannot build a house with only a hammer. 
"If you’re a knowledge worker, you’re a carpenter. But your tools aren’t bought at a store and they don’t come in a red box that you carry around. Mental tools are the big ideas from multiple disciplines, and we store them in our mind. And if we have a lot of tools and the knowledge required to wield them properly, we can start to synthesize how the world works and make better decisions when confronted with problems."

What if the mental models our professions chose to teach us were based on tissue-based, structural, patho-anatomical sidetracks? What if they were modeled after or taught by people steeped in orthopaedic medicine and surgery? What if they are all completely beside the point when it comes to pain? Like the pain being experienced by your next day full of patients? That 50 year old woman who still has neck pain from a car accident when she was twenty? That 16 year old who loves snowboarding but developed knee pain 5 months ago, has been told he "has a miniscus," has been receiving brutal massage therapy that helps for about a week but then the pain returns?

How do tissue-based etc. mental models help people like that?
Are they not swamped by nocebo and subject to the revolving door of treatment?
Have they not probably concluded they are doomed to forever be a patient of one treatment person after another?

Do we (the practitioners) have any shot at all of developing mental models that actually help people recover, get off the merry-go-round, feel normal again, feel themselves in their bodies the way they used to?

I think first of all we have to decide to entertain the possibility that the old models are wrong. Dead wrong. And be brave enough to operate from that assumption. As a test. Of faith? Maybe. Of reality? Maybe.. OK, probably.

As the Farnam Street piece points out,

“...two main factors contribute to our inability to make good initial decisions. First, we don’t have the time to think. And second, we don’t have a firm understanding of how the world really works...”
“We don’t often realize that our first thoughts are usually not even our thoughts. They usually belong to someone else. We understand the sound-byte but we haven’t done the hard work of real thinking. After we reach a first conclusion, our minds often shut down. We don’t seek evidence that would contradict our conclusion. We don’t ask ourselves what the likely result of this solution would be — we don’t ask ourselves “And then what?” We don’t ask what other solutions might be even more optimal.”
“Mental Models allow us to make better decisions, scramble out of bad situations, and think critically. If you want to understand reality you must look at a problem in multiple dimensions — how could it be otherwise?”
“Getting to this level of understanding requires having a lot of tools and knowing how to use them. You knew there was a hitch right?... Luckily there is another path.”
“If you understand the world as it really is, not as you’d wish it to be, you will begin to make better decisions.”
The tools in this case are NOT more courses or treatment systems or actual physical tools, such as expensive equipment, needles or cups or machines that go ping, ding, ring or ting, electronics that zap or zing.
The tool we need in this case is "knowledge that changes slowly over time," but not so slow that it ends up dogmasphere type knowledge that lets the world go by and won't evolve.

Higher-order thinking is recommended in the piece, an awareness and acceptance of the fact that with each action, even a mental action, second and third-order effects ripple out into the world. Each of us in a node of information/knowledge transference. Things we might want to consider: What is the range of possible outcomes? What’s the probability I’m right? What’s the follow-on? How could I be wrong? As a philosophic massage therapist friend pointed out long ago, what about taking care of the future of the neuromatrix of each person who comes to see someone like us?
Understanding how the world itself works is hard enough.
"Understanding how the world works isn’t easy and it shouldn’t be. It’s hard work. If it were easy, everyone would do it. And it’s not for everyone. Sometimes, if your goal is to maximize utility, you should focus on getting very, very good in a narrow area and becoming an expert, accepting that you will make many mistakes outside of that domain. But for most, it’s extremely helpful to understand the forces at play outside of their narrow area of expertise.
Because when you think about it, how could reality be anything other than a synthesis of multiple factors? How could it possibly be otherwise?"
If a human brain is the most complex object in the known universe, a human neuromatrix is its most complex verb.

So, what's the solution? I'd say, don't only learn about paddles or kayaks. Learn to understand the river. Interact with the river. The river.
Interact how?
Well, telling patients all about your great paddle or kayak probably will make you feel like a hot therapist, but won't help them.
Remember rivers get along just fine without you. Unless a river comes in dammed up somehow, and your job is to undam it...
It's not about you, the paddle or the kayak.
It's about interacting with the river, clearing it so it can flow better (now and in the future), and not becoming drowned in the process.


Sunday, August 07, 2016

Waves of thought

A lovely Sunday morning in August.
Idly sitting, watching TV at a time of day I'm not accustomed to.
Watching swimming, Rio Olympics.
Also doing a jigsaw puzzle on an iPad, and sipping coffee. The jigsaw is about water. Lots of wavy turquoise colours.

My thoughts disengage and go inside, which is quite common for me.
Mostly they are forgettable.
This time, though, they hook up in a way that is more interesting, a way that leads to a realization.
Here are the thoughts.

Alberta, swimming
The time: mid-seventies.
I was about 25 or 26 years old, very involved in art school, had won a scholarship to paint intensively in Banff for 6 weeks. While there, I hang out with a small group. One of the group, a woman who lives in Calgary, has logged actual exhibitions. Another woman and I are just students with nothing much to show for ourselves except active learning about perception, and big gobs of enthusiasm.

Woman #1, the accomplished artist, loves to swim. We all go swimming every evening, at the Banff Springs Hotel.
It's a big pool. When I first start, I can make it only about one length, along one side, with frequent rests along the way. By the end of the summer, I can swim 4 lengths with no stops.

Homeward bound
On the way home from this excursion we are invited to this woman's place in Calgary.
She and her husband, also an accomplished artist, prepare simple tacos for a group of 5 or 6.
We are sitting, eating, enjoying: She suddenly develops a severe headache. Out of nowhere. So bad that she starts to cry. She stays put, though, doesn't seclude herself in a bedroom or anything. She is in a lot of pain, and everyone tries to figure out some way to help, but nothing comes to mind.
I sit there.
Even though I'm supposedly a trained professional.
I commiserate, but have no clue what I could possibly offer. I am completely outside my therapy world. I can "be" a therapist, but only when I am in that therapy bubble (which in those days was a hospital setting) do I feel the least bit competent.
Like everyone else, in this situation, I feel helpless.
The other woman in the swim group gets up, stands behind her, and rests her hands lightly on the hostess' shoulders. She attempts some amateur massage, which is better than nothing..
I don't think it helped the headache, but at least she tried to help; I did not.

Insight
What I conclude from having this drift up into my mind is that it had an influence on me. A big one, mostly unconscious. Mostly being embarrassed that I was supposedly a trained hands-on professional and I somehow lacked empathy to the point where I felt too inhibited to even try to help somebody who was having a bad time with pain.
Whereas my art student friend instinctively reached out and did her best.
Makes me realize my early PT training actually stopped me instead of helping me to help somebody else, with a pain problem, in a common social situation.
I buried this aspect of this memory until now, but to have it drift up in this new way makes me realize that at least some part of my brain tried to sort it any way it could, by helping to motivate my interest in pain and in what I now like to call, human primate social grooming, that instinctive reaching out to help by touching, feeling, massaging, making some kind of physical contact with any individual who feels crappy. This isn't the ONLY reason, of course, but it definitely helped; I do not doubt that now.
Now I feel competent enough to be fully capable to take a role in any situation, and in many cases, I have.
The woman on the plane sitting beside me who told me why she was wearing a brace on her hand. A fresh ulnar nerve compression syndrome from about 7 hours of unaccustomed mountain biking and leaning too long on one handlebar.  After about a half hour of working with her, she regained use of her hand and could touch her little finger and thumb together again.
The young Swiss guy sitting beside me on the plane home from Europe who had neck pain.
Many other examples that don't involve planes.
Like the wedding I attended in a back yard, where one of the other guests developed sudden horrible back pain, and the bride sought me out to see if I could lend any help; I and the guest retreat into the house to a bedroom, where I do my very best, and after a half hour at least she can walk a little easier.
Live and learn.
If I had enough lifespan left I would want all therapists to feel competent to help with pain problems or weakness problems stemming from nerve problems in any situation anywhere. Without being overly concerned with conventional North American social boundaries.