CRPS, or Complex Regional Pain Syndrome (Type 1), is a change in the nervous system that's usually triggered by a very painful episode. The bad kinds affect the brain, nerves, muscles, skin, metabolism, circulation, and fight-or-flight response. Lucky me; that's what I've got. ... But life is still inherently good (or I don't know when to quit; either way) and, good or not, life still goes on.

Monday, March 28, 2011

Out of the foggy night: Overmedication and abandonment issues

I was overmedicated on mixed psychoactives (in plain English, my doctors had me on too many pills for CRPS) and, at the beginning of February, I ditched most of them. The following weeks were pretty hideous in an interesting way, as my brain's natural chemistry struggled with the messy extrication and departure of the pharmaceuticals.

It feels like washing my dirty laundry to say this, but I suspect I'm being too finicky: LOTS of people get overmedicated by well-meaning medicos who don't talk to each other.

The pills I stopped were SSRIs and SNRIs. (I can't remember which was which.) The upside to this class of medication is that it specifically relieves nerve pain, in addition to helping lift depression. (I wrote an article, buried in my archives, about the tiny handful of neurotransmitters, and how each one has many jobs. Serotonin, for instance, helps digest protein in the gut; dopamine mediates decisions. I'll dig it out and post it on the Biowizardry blog.)

When you have CRPS and you're overmedicated on neurotransmitter Reuptake Inhibitors (of whatever flavor), your brain is in the toilet and there's no way to tell which mental blurch is due to drugs and which one is CRPS. I couldn't always tell how well I was thinking, though I kept trying anyway. Perceiving how I felt underneath it all was like trying to determine the shape of a bomb while it's still in the box. I was usually clear about what I remembered and what I wasn't sure about... but just try getting anyone to believe you when they already know that your brain is not firing on all four cylinders.

There's a lot of grey area in the grey matter, when you're overmedicated and have CRPS.

I'm not sure how much more crap there is to clear out, but I know I'm a lot clearer about what's going on right now. I look back on the past two years with some dismay, as I try to rebuild the relationships I dented, and (most painfully) try to understand why those who should have known better had simply abandoned me to that foggy night.

[photo credit]

But anyway.

I am remarkably clear, now, about what I remember and what is nothing but a sudden hole in my mind. I'm clear about whether I can think right now or not. I'm able to feel the brain crank up and crank down, so I can communicate to others, "I can do this!" or "Gotta stop now!" And, for the first time in years, I can get something done on some sort of schedule. Not a consistent or reliable schedule, not to any sort of clock, but just to know that I CAN do something is quite a step. I'll take it and be thankful!

I still have CRPS. My medication is still problematic. I still have sudden, random, Swiss-cheese-like holes in my memory and cognition. BUT -- and it's a big but! -- there is no grey area in my grey matter any more. I know if I know, and I know if I don't know.

And that's information I intend to use.

Sunday, March 20, 2011

A gift that keeps on giving

My 37th birthday happened at a fraught time (no, really?) but I planned ahead: 4 friends and I, tiny Brazilian restaurant, pitcher of mojitos.

No crowds. No fuss. No presents, please.

That was important. I was preparing to move but didn't know where yet.

So Joyce and Graham, the techies, got me an early iPod Mini. Laura, an artist, got me an extraordinary shawl. Vince, a true gentleman, did exactly as I had asked and felt terrible about it.

My 37th year had been full of character-building surprises. I had decided not to reprise turning 36 because the subsequent year had been so rotten, but I wasn't happy about getting older. Even before the drinks were poured, I was bitching about my age.

Joyce and Graham, who were just peeking over the shelf of 30, said, "There there, it's good to be seasoned, age brings wisdom," and so on.

Laura, a couple months older than I and the most sensible artist I've ever met, said, "Yeah. It sucks."

Vince, who was barely old enough to rent a car in his own name (although he was bright enough to write the certification tests for Borland C++), with a self-deprecating shrug and a charming little pinkness, said, "I don't know, you always seem to me like you have a mental age of 17."

I remembered being 17 -- happy, busy, fit, secure in my slice of the world, delighted with most things and amused by the rest, my adult mind just blooming, and absolutely no idea how cute I was.

Once I could reef in my grin enough to use my mouth for speaking, I said, "You just gave me the best present of all."

Sadly, he didn't exactly believe me.

The iPod Mini was superseded, then stolen. The beautiful shawl disappeared, along with everything else, when the US Mail failed to deliver what I mailed in my move.

But every year, when yet another birthday looms, I remember Vince twitching his shoulders and saying sweetly, "I don't know..."

And, really, the count of years doesn't seem quite so bad.

Wednesday, March 16, 2011

Radiation and sudomotor silliness

My hands and feet have been getting very swollen. My hands puff up on the phone or computer especially; with a bit of training, I bet I could learn to feel just how many rads are coming off of which hotspot, just by the icky feeling and instant puffiness. (Puffiness is driven by a neuro-vaso-muscular response called the "sudomotor response." Also drives sweating.)

I left the computer off & unplugged for 24 hours. Left the phone at home while I was out today. Hands: hardly puffy at all, until now -- they're inflating as I touchscreen this entry. Mood: ooooh, grouchygrouchygrouchy. And such a headache...!

Think I'd better back off on the radiation. I do not need that kind of physical or mental alteration. I do need the tech, but I can manage it better.

I knew my hands inflated near my devices, but the confirmation that they don't inflate normally was a relief.

Saturday, March 12, 2011

Because things change anyway

As I rebuilt my posture this morning per usual, I remembered a conversation I had in my 30's with my Shaolin teacher. I was sorting out knee issues, and after a week of working on something I hadn't thought much about in several decades, I said in a 'pity me' voice, "I'm relearning how to walk."

He shrugged, too distracted by the picayune-ness to notice the self-pity: "I'm always relearning how to walk."

That was one of those moments that made me go away and think all the way up the thought, all the way down the thought, and all the way across it, too. (A good Sifu/sensei can do this to you, sometimes in even fewer words than that. Ted Mancuso in Santa Cruz; look him up.)

So here's today's update from the Department of the Blitheringly Obvious, which does a brisk trade because we are so good at not connecting the dots ... Or I am, anyway:

1. Time moves.
2. We go with it.
3. Things change.
4. Our bodies alter, and take us with 'em.
5. We are always relearning, whether we know it or not.


I might as well pay a bit of attention and relearn better, instead of slipping off into relearning unconsciously and making things worse.

My posture is definitely improving. Core strength is damn good. Pants fit and my low back is MUCH better.

I haven't worried much about my knees in ages. ... Hunh.

New sib

Check out the sister site:

Bio Wizardry: Cauterizing the Bleeding Edge

I've already had one comment that told me I'm doing exactly what I intended -- "I'm always searching for info., but rarely understand what I'm reading. So thanks!"

I turn handsprings inside.

Bio geeks and patients, slide on over. Feel free to tell me what you want to know, or what articles you need to understand. If I can bear it, and if I can do it, I'd be delighted.

Monday, March 7, 2011

Dopamine, poverty, and pain: the lighter side

Executive decisions are made in the forebrain. The information that goes into them cones from the sensory cortex (nearby) and the hypothalamus (back in the dark heart of the brain.) The execution of those decisions happens in the pituitary, among other places. In short, there's a lot of nerve-impulse mileage laid down between the moment you feel the itch in your armpit, check your surroundings for privacy, scratch away, and give a happy little sigh of relief. Lots of neurotransmission there.

Dopamine is the neurotransmitter of executive decisions. It's a daughter chemical of adrenaline, and your adrenal glands share blood supply with your kidneys; interestingly, Chinese medicine views the need to make too many decisions as being hard on the kidneys. Makes perfect sense to me. But that's a red herring.

The key is, without dopamine, the decision can't get from the frontal lobe to the action parts of the brain. Dopamine levels can be knocked back by pain, drugs (including the prescribed ones), depression, poor diet, and -- of course -- overuse.

People who have crippling pain have to make exponentially more decisions than those who don't. Every action is measured against an internal set of standards that don't exist for normos: how much pain will lifting that cost me? That car door -- which way should I turn my hand to minimize damage when I pull it? How many function-dollars do I have left in my body's account -- enough to do laundry _and_ shower? Or should I do just one? If so, which one is more necessary?

Poor people have a similar ceaseless train of calculations running in their heads, but with different parameters. Can I get a little meat this week? What are my produce options, since there's no good market in this area? Which neighborhood's market has the best prices? Have I got the bus fare? Will I get into trouble over there? How do I blend in? Can I call in a favor to get some Tylenol too? These headaches are killing me.

As a poor person with pain, I figure I make easily 20 times as many decisions -- on a slow day -- as a normal person my age. When I was still overmedicated, I used to feel like a loser for not making 100% perfect decisions 100% of the time; in fact, I occasionally just goofed. And the trouble with living within such narrow parameters of function and finance is, the occasional goof can put you behindhand for a very long time.

It's easy to sneer at those who make weird decisions like paying for a flat-screen TV instead of a semester of junior college. But try wringing out your dopamine every single blessed day, week after month after year, and see how well you do. These people don't have decision-making disorders, so much as decision-making overload.

If you're poor or in pain, take some credit for getting through the day. Cut yourself a little slack. Take a moment to rest and relax. See, it's easier already.

Being hypercritical just uses up your dopamine faster. Why? Because criticism is the result of long strings of decisions. It's very dopamine-expensive. (Ever wonder why hypercritical people don't seem very happy? Now you know.)

Take a moment to be happy, to notice what's good. Those moments rebuild your store of decision-making, anti-depressant dopamine. Each natural, happy little sigh is a shot of the stuff.

Sniff that flower one more time. Scratch where it itches (preferably in private.) Feel the sun warming your head. Laugh with your friends. There's a reason why it feels so good. It really does make you stronger. It freely gives back what life makes you use. And it's not too hard to find a reason to be happy.

Sunday, March 6, 2011

Mind, brain, spirit, and the im/pertinence of death

I referred to this material in an earlier post, where I described the online conversation that started it. My first thought was to turn it into a coherent essay. On reflection, I realized that digesting what my co-conversationalists said was not necessarily going to improve the content, as they're very eloquent and have distinctive voices. So I chose to let them speak for themselves.

Note to non-academics and other civilized beings: I find that, with academics as with working engineers, it's more important to be clear than to be sweet. Caveat emptor.

This thread is from James Croft's blog on "State of Formation," an excellent venue for lively conversations. It started with Jim F., as I secretly suspect a lot of the most interesting arguments do:

Jim F. says:
[...] Injuries to the brain from accidents or from disease like tumors or strokes can lead to radical changes in personality and/or character. In Lamont’s opinion, there are no real good reasons for believing that consciousness is something that can exist without the body. Therefore, when the body dies, so does the mind.

Isabel says:
February 28, 2011 at 2:30 am
Jim, I’ve mulled that relationship a lot. (Lifelong interest in neurology, now with neurologic disorder.) My studies and experience leave me certain that it’s a seductive mutuality, but not an absolute connection. It’s certainly not a simple one.

While mental states are associated with neuroendocrine activity, the subjective experience is inevitable _only_ to the extent that it’s unaware — or, of course, volitional.

This seriously disturbs the structure of the idea that "mental state doesn’t exist without physical state." And that doesn’t even go near the eternal chicken/egg question — whether the chemical shift or the feeling it’s supposed to transmit comes first.

Go on to look at more organized ways of managing one’s mentation & neuroendocrine flow, like meditation or yoga or "inward" martial arts, and the question of connection and control becomes not just loose, but flaccid.

The more I think about awareness, and the more I learn about neurophysiology and endocrine behavior, and the further I go on the personal inquiry into how to navigate this neurologic disruption, the less I’m persuadable that the mind depends on the brain. That concept totally fails in the face of this experience — the clinching argument for me, obviously — but it also fails to describe those experiences that are _not_ as unaware, uncontrolled, and are experienced as irreflectively as those of animals. We are richer beings.

When my neurochemistry is whacked, I’ve gotten pretty good at finding other ways to hold my mind in a bearable state. That would be impossible if the brain were the only determinant of mental state. And I know I’m not so special that this capacity MUST be rare if I have it.

I’ve never found a good explanation for that part of the mind that can participate with and respond to neurochemistry, without being pwned by it (in hacker parlance.) It sure is an interesting inquiry, though I don’t need an answer. I just need to continually improve my command of it, since so far this condition is incurable. (We shall see.)

I’m glad you raised the mind/brain issue. More philosophers should study neuroendocrinology — and meditation.

Jim F. says:
March 1, 2011 at 7:21 am
Responding to Isabel. I have always found Hume to be pretty persuasive on this subject, even though he was without the benefit of modern neuroscience. In his essay, “The Immortality of the Soul”, he wrote:

"[...]— Sleep, a very small effect on the body, is attended with a temporary extinction, at least a great confusion in the soul. — The weakness of the body and that of the mind in infancy are exactly proportioned, their vigour in manhood, their sympathetic disorder in sickness; their common gradual decay in old age. The step further seems unavoidable; their common dissolution in death."

//Isabel comments: Hume must have had curious nightmares. My own dreams tend to be rich and narrative; not as rich as waking life but often more encouraging.
// Hume's understanding of mental development is clearly in step with his own time, which is to say, very uninformed: the brain of an infant is in the most quickly-developing, rationally evolving period of the person's entire lifetime. Never again are we as aware, as able to learn, and as able to prune away useless thoughts as we are in infancy. The tiny fledgling bodies we have are needy indeed, but again, the capacity to recover from proportional insults to the body and brain is better than it ever will be again. Still, the brain function far exceeds the body's function in infancy. Not proportional at all.
// The mutual disorder of the body and mind in sickness is rarely proportional, and as I have worked with sick and injured people for most of my life, I am the authority there. Sorry, Hume. Normally-healthy men are vile patients, making their tenders miserable while refusing to mend themselves; old women typically manage their way through pain and physical disruption that would have most of us on our knees in howling agony -- unless it kills them. And of course, the rest of us fall in between these extremes, depending more on our personalities and cultures than on a proportional response to the illness or injury.
// Senility in old age is not a given, either: some people's bodies rot long before their minds do, and with others, their minds go fast while their bodies soldier mercilessly on for decades. Any true proportionality between a fading body and fading mind is so rare that, in my clinical experience, it's the exception and not the rule. (It would be fun to find a study on that, if only to discover the name of a doctor who has the nerve to tell us what degree of disintegration is "proportional.")
// Thus, while Hume's prose is wonderfully telling, his conclusions are not.

"[...] Every thing is in common betwixt soul and body. The organs of the one are all of them the organs of the other. The existence therefore of the one must be dependant on that of the other. — The souls of animals are allowed to be mortal; and these bear so near a resemblance to the souls of men, that the analogy from one to the other forms a very strong argument. Their bodies are not more resembling; yet no one rejects the argument drawn from comparative anatomy. The Metempsychosis is therefore the only system of this kind that philosophy can harken to.

// Hume is always delicious to read, but he is ignorant of the better-developed spiritual traditions which characterize the spiritual body as overlapping and interacting with the physical, but not being either a clone or tied into lockstep with it. These (both Asian and European) traditions therefore fundamentally differ from his base assumption about the twin-image nature of the body-mind relationship.

Concerning meditation, Rick Heller has been writing on the neurological basis of meditation in The New Humanism. He is himelf a practioner and teacher of meditation and also a convinced naturalist and physicalist.

// I'll have to look him up. Could be interesting.

There seem to me a lot of problems with the sort of psychophysical dualism that Isabel seems to be defending. If it is true then this would seem to violate some of the most basic laws oh physics. Maybe such basic laws like the laws of the conservation of energy and of momentum are not completely valid, but most natural scientists are going to requires lots of very strong evidence to be so persuaded. Dualists have yet to come up with a convincing account of how a nonphysical mind can interact with the physical body. Dualistic interactionism therefore seems to violate a general heuristic principle of science: the causal closure of the physical world. And at this point we can invoke Ockam’s Razor to argue that we really have no need to posit any sort of a mental substance that exists apart from the physical organism.

// The assumption that mind is necessarily physical because the brain is, is a false conclusion. This nonbrain attribute is generally considered to be energetic in nature. Energy interacts with matter all the time, or none of us could (for instance) access this web site, let alone think the thoughts we bring to it. Hence the law of conservation is easily observed.
// Given how the body parts transmute so nothing is wasted, it remains reasonable to suppose that the energetic component transmutes as well, without being lost. Unrecognizable, perhaps, as Paul indicates below — but not annihilated. That would indeed contravene a number of laws of physics.

Returning to Corliss Lamont, one of the other arguments that he made was that even in the Abrahamic religious traditions, there is the tacit assumption that a body is required for conscious existence. Hence, the doctrines concerning the resurrection of the dead that exist in all three of the major Abrahamic religions. Eastern religions likewise have their doctrines concerning reincarnation

// I've been content to agree with the theologists/spiritual philosophers who explain that this is a metaphor for the benefit of the many-headed, i.e., a handy lie; the inward self continues in a way that does have its own integrity, but re-inserting the energetic "self" into the physical body is not something that happens literally. It makes a useful concept for the bulk of the laity to work with, to reinforce the idea that they are going to be held responsible for what they do to themselves.
// (While I object to using religion as a form of terrorism, it _is_ an ancient form of crowd-control. In the times of short lifespans, societies were run by adolescents and post-adolescents; therefore, these kinds of down-to-earth metaphors could be very useful indeed.)
// Physical experience has no exact correlation in the nonphysical realm; therefore, certain kinds of understanding can only be reached by means of in-carn-ation -- allowing the spiritual/energetic/durable self to become embodied. This is one of the most basic theses in many traditions which consider both life and afterlife to be valid memes.
// It would be more accurate to speak, not of "conscious existence", but of incarnate life that's perceptible to itself. This leaves an obvious logical gap: What about perceiving non-incarnate "life", or un-embodied types of consciousness? That's a much more sophisticated question than, "is there continued existence after bodily death", and requires a degree of intellectual care on everyone's side.
// Why so much intellectual care? Partly because, to assume that spiritual life must be consistently observable only through a narrow spectrum of physical means, is to overlook one or two (or a million) basic realities of matter, energy, logic, and so on. And partly because, if spiritual theses can't be described in plain language, they probably need rethinking. Thus, both sides need to approach that question with consideration, care, and (ironically) good faith.

Paul J. G. says:
March 2, 2011 at 3:49 pm
So thought-provoking as always. You just can’t help yourself can you?

// obviously, I didn't even try to :)

Something cannot become nothing. What is it precisely that we want from an ‘afterlife’? What did the Star that went Supernova ‘want’? It probably wanted to keep being a Star. It could never have imagined its afterlife to be human cogitation, and Happy Meals, because it lacked the vision and imagination to see its new emergence as an afterlife. So maybe the Star thought it had no afterlife. I would disagree. Brian Swimme leads us down this road.

[...] What’s more, we don’t need to wait till some ‘final’ death (in the way we usually talk about death of a person as a person) to identify our many continuation bodies– the infinite ways that our life, energy, heat, thoughts, words, bodies, breath continue. Just because we are not sensitive enough to identify all of these continuation bodies, teaches Thich Nhat Hanh, does not mean they are not there. It just means that we fail to see. Hanh teaches this because the Buddha teaches that there is no annihilation.

I think there is no such thing as a final death– and that’s what is meant by afterlife: endless going on, eternal life. But, I agree with Charles Hartshorne who says, eternal life is not some eternal human career after death. To think that is an offense against the lavish exuberance of cosmic creativity. Human beings are not the end. Maybe we are merely embryos, or blastocysts, or zygotes of what is yet to come!

Isabel says:
March 2, 2011 at 9:52 pm
Well put, Paul. Yeah.

Further thoughts on stroke and brain injury ...

These are good examples of unprepared-for, unawarely-encountered changes in the brain state, and these are the kinds of conditions that most disrupt the mind. Without a chance to become aware of the interface between your mind and your brain, and without a chance to learn and practice the techniques that give you some conscious leverage over it, the damage that these injuries do to the mind – that energetic aspect of the self, the one that may or may not outlive your body – can be devastating indeed, because the injuries to the brain specifically disrupt your ability to understand and deal intelligently with that interface. The injuries that disrupt the personality are perhaps the most difficult to overcome, because access to your accustomed "self" is specifically disrupted.

Practical note: It's much easier to manage a well-hydrated brain. Drink more water.

Friday, March 4, 2011

Query: where have all the good studies gone?

I wonder why so much money gets thrown at the same basic studies over and over again. My personal hair-puller is the ones that call for subjects "with chronic CRPS, with only one affected limb." They must be testing the same dozen people over and over and over again. Wait, they can't, because if the subjects have chronic CRPS with only one limb affected, they're either about to get better or much worse.

It's all very well to keep re-proving a treatment until a level of acceptance is reached, but there are more effective and cheaper avenues -- and much richer ones -- that are passed by, in favor of flogging a handful of horses who are, at best, unconscious.

It has been too long since significant effort has gone into much more basic research: by and large, we're still working with the scientific equivalent of the horse collar, when it comes to pain management -- not the Ferrari. In fact, it's unclear to me why we're still fixated on management, when we need to think in terms of cure. Most chronic pain is needless.

If we knew more about the relevant neurochemistry and cellular metabolism, we'd be in a MUCH better position to figure out when NSAIDS, lido, shock, acupuncture, spinal cord stim, or ketamine comas will work, and when they'll just be another doorway into hell.

Can you imagine how much money -- and misery, and time -- it would save to have a short list of things to try, based not on each doctor's semi-religious leanings or equipment contracts, but based on each body's signal framework and chemical signature?

Dreaming is free. Studies require funding. Follow the money, and unfortunately the reasons behind all this brutal silliness become clear.

Tuesday, March 1, 2011

Expanding these horizons

As a gift of my old friend Jen, I've scraped the online acquaintanceship of a very lively group of secularists... And it says a lot that many will shoot down that collective noun; these are the intellectual equivalents of the clan of Asterix the Gaul, who will cheerfully scrap with each other when there's no one else around to scrap with, and woe betide anyone silly enough to try and conquer them.

I love it. Oink heaven. My memory still has Swiss-cheese holes in it, but my reasoning is not completely shot.

I was mulling a blog entry on "trying to remember there's a forest among the trees", given the way that we tend to get fixated on a tiny handful of things which, if we had 'em, would surely fix everything. Surely.

These thoughts have been rather derailed by an online conversation I got into about the mind/brain issue. It touches on neurology, history, philosophy and theology, with logic and info architecture as palette-cleansing interjections (or so my thoughts are trending.) Naturally, I'm knawing it like a rawhide bone, tail thumping.

In fairness, not everyone wants the erudite stuff; nor does everyone want the why-what-works pragmatism. Both are so closely linked for me (the blogger, here) that I've decided not to break out a different blog. I'll get better about tagging, and I'll use indicative titles.

Please come along and play. I hope this works out well.