The Brain’s Way of Healing, by Norman Doidge, M.D.

• Category: Non-fiction
• Rating: 3 out of 5
• Tags: Brain, Medicine, Neuroscience, Neuroplasticity
• How I learned about it: Recommended by a friend.

This book is a follow-up to Norman Doidge’s previous book, The Brain That Changes Itself.  The new book’s subtitle, too long to include in the title of this blog post, is “Remarkable Discoveries and Recoveries from the Frontiers of Neuroplasticity.”  The stories are indeed remarkable.

A doctor with chronic pain was able to cure himself using a concentrated visualization effort.  Areas of his brain had been taken over by pain perception, causing chronic pain that persisted long after the initial trauma.  He was able to re-train those brain areas so they were no longer being over-used for pain perception.

In the chapter titled “A Man Walks Off His Parkinsonian Symptoms,” a man trained himself to walk in a coordinated way by consciously controlling every motion, overriding the damaged automatic way of walking he used to use.  In a similar way he was also able to control his tremors while holding a glass.  He was so successful that in a casual encounter, you wouldn’t know he had Parkinson’s.  This wasn’t a fluke; he was able to teach other Parkinson’s patients to improve their symptoms, too.

Other treatment methods that take advantage of neuroplasticity may be challenging to accept.  Low level laser light has been shown to help heal wounds, torn tendons, osteoarthritis, herniated discs, nerve damage, traumatic brain injury, stroke and depression.  The Feldenkaris Method uses focussed awareness of movement to program the brain for better movement of the body.  Electrical stimulation of the tongue improves the symptoms of MS, stroke and Parkinson’s.  Specific patterns of sound can be used to treat dyslexia, autism and other brain disorders.  These techniques, while not yet part of mainstream medicine, have plausible explanations, based on neuroscience, for how they trigger beneficial changes in the brain.

The biggest stretch, though, may be Doidge’s claims for the benefits of what sounds like the laying on of hands.  Piezoelectric changes to the electrical conductivity of bone by applying gentle hand pressure is supposed to promote healing, and the hand is said to be a source of electrical fields which can be applied to help heal wounds.  All of the treatment methods described in the book deserve further study – if proven to be valid, they could improve the lives of many people whose conditions have conventionally been viewed as untreatable.

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Being Mortal: Medicine and What Matters in the End, by Atul Gawande

This is a difficult topic to think about, but living in denial is no solution. Atul Gawande reveals some harsh truths about aging.  By age 60, the average person in an industrialized country will have lost a third of their teeth, and by age 85, 40% have no teeth left.  By age 60, the lens of the eye has yellowed to the point that only a third as much light gets through compared to someone in their 20’s.  When you are in your 70’s, your brain will have shrunk so much that there is nearly an inch of room between the brain and skull.  By age 85, working memory and judgement will have been reduced to the point that 40% have dementia.  This gradual process of wearing out will continue until you die, or, like half of Americans, you spend a year or more disabled and in a nursing home.

A geriatrician can help extend your independence and quality of life.  Their expertise can reduce the need for home help by 40% and disability by 25%, so it’s too bad that their numbers are falling as the number of elderly rises.  It’s even more sad because nursing homes are not designed for what the residents want.  They evolved as long-term care facilities to reduce pressure on hospitals.  They impose institutional controls and schedules, more supervision and  regulation than we like, in order to provide health and safety at reasonable cost.  They are safe, but empty of anything the residents care about.  They cater more to the children of the residents, who ask themselves if this is an acceptable place to park Mom or Dad.  What the residents want is privacy and some control over their lives.  A door that locks, a thermostat, a little kitchen for snacks, the freedom to wake, eat, sleep and poop on their own schedule.  Pets.  Sex.  The freedom to make poor choices, like the occasional drink.  They want to choose the risks they are willing to take, even at the cost of an earlier death.  What they really need is “help in sustaining the connections and pleasures that matter.”

Modern medicine is great at fixing things along the way.  We’re willing to endure a certain amount of suffering now for a good chance at a better life later.  But what if your problem is not fixable, or the chance of success is low?  Patients should understand how much time a treatment is likely to give them, and what their quality of life will be like afterward.  The median survival time or five-year survival rate is not enough information on which to base a decision.  What is the shape of the distribution?  Is it skewed?  Is there a fat, long tail?  Call me a geek, but I’d like to see the curve.  How harsh is the treatment, how difficult to endure?  If not carefully guided in their decisions, patient may choose a path that greatly increases their suffering for little gain.

So palliative and hospice care may be a better choice.  For many, the priorities are to avoid suffering and strengthen relationships, to be mentally aware in their last days, while minimizing the burden on loved ones.  Hospice care is not focused on prolonging life, but on maximizing quality of life now according to these priorities.  Ironically, hospice care can extend life by a few weeks compared to medical treatment, while providing a better quality of life.

There are tough questions to answer.  Do you want to be resuscitated if your heart stops?  Do you want aggressive treatments such as mechanical ventilation and intubation?  Do you want antibiotics?  Do you want tube or intravaneous feeding if you can’t eat on your own?  You need to understand your situation and the possible outcomes, and know the trade-offs you are willing to make.

Everyone will have their own line in the sand, like the guy who said he’d be fine living with disability as long as he could still watch football on TV and eat chocolate ice cream.  Knowing this made the decisions easier for his family.

 

The Poisoner’s Handbook: Murder and the Birth of Forensic Medicine in Jazz Age New York, by Deborah Blum

I like the slick presentation of forensic science in the television series CSI, and I like the portrayal of Victorian forensics in Murdoch Mysteries (although it took me a while to get used to Yannick Bisson as Detective Murdoch – there’s something weird about those dark eyes).  So I was interested when I heard about Deborah Blum’s book about the birth of forensic medicine.

I assured my wife that she had nothing to worry about, then picked up The Poisoner’s Handbook and began to learn how to be a poisoner.  First, what’s your poison?  Chloroform?  Wood Alcohol?  Cyanide?  How about that old classic, Arsenic?  There’s a chapter on each one of these, and more, like Radium and Carbon Monoxide.  Sadly for would-be poisoner’s, these are now detectable in the human body by skilled medical examiners.

It was not always so.  Arsenic could be detected by around 1830, but nicotine was only isolated in a dead body in 1860.    Even by 1900, toxicology was still a “primitive field of research”.  I don’t know what things were like in Toronto in Murdoch’s time, around 1900, but in New York in the early 1900’s the elected position of coroner was a joke, plagued by corruption, laziness, drunkenness and incompetence.  There was no requirement that the coroner be medically qualified.  They issued fake death certificates and covered up murders and suicides.  After the problems were exposed in a scathing report, Governor Charles S. Whitman insisted that a qualified medical examiner be hired immediately.

Dr. Charles Norris became chief medical examiner of New York City.  He and his staff, notably toxicologist Alexander Gettler, turned the department into a respected, professional institution, developing new techniques and contributing definitively to police investigations.  It was an uphill battle, as the mayor never supported or funded the department, forcing Norris to spend his own money to equip it, and it took time to earn the respect of the courts after the poor job that had been done in the past.  It took exacting standards, long hours, hard work, careful experiments, and an insistence on better procedures to make the change.  Murder dramas today always have the coroner examining the body at the crime scene and performing an autopsy as soon as possible afterwards, but Norris had to convince the police force that this was necessary.

Blum does a great job of weaving together the development of forensic science with the history of New York, including stories of poisonings that prompted the creation of new forensic methods.  The true crime stories are darkly entertaining, like crime thrillers, but without the tidy conclusions of fiction.  The chemistry and physiology of poisoning are described in gleeful detail.  The descriptions of prohibition times are evocative, highlighting the absurdity of laws that led to the poisoning deaths of thousands as they drank anything – wood alcohol, stuff with plasticizers or other poisons.  The government deliberately poisoned alcohol to make it undrinkable.  Bootleggers would try to remove the additive, but people still died from the residual poisons in the drink.  Norris’ office warned about these problems repeatedly, but without much effect.  There are other stories, like the girls who died from radium poisoning after painting luminous watch dials.  But the real story is about the dedication of Norris and Gettler and how they turned their discipline into a respected profession.

Hallucinations, by Oliver Sacks

Oliver Sacks returns with another entry in his fascinating series about weird neurological phenomena and disorders.  This one is about hallucinations.  Interestingly, hallucinations are not restricted to the visual; they can occur with the other senses, too, so one can experience sounds and smells that aren’t really there, and experience false flavours and tactile sensations.  Sacks takes care to point out that usually, having hallucinations does not mean you are losing your mind; instead, hallucinations are most often the result of other medical conditions like migraine, epilepsy, blindness or delirium; induced by drugs; or associated with falling asleep.  He then explores each of these areas, as well as hallucinations of the various senses.

When I read one of his earlier books, “Migraine”, he described the mental state and auras associated with migraines so clearly I worried that just reading it would induce a migraine headache; fortunately, it did not.  Equally vivid and compelling descriptions are to be found in “Hallucinations”.

Fatal Flaws, by Jay Ingram

I just finished reading “Fatal Flaws”, by Jay Ingram.  I quite liked it.  Having first read one of Ingram’s earlier books, “The Barmaid’s Brain”, I found his writing to have matured considerably in the intervening 14 years.  To be fair, “The Barmaid’s Brain” is a more or less random collection of stories, and I don’t think Ingram himself would claim it was meant to have the depth and thoroughness of a book like “Fatal Flaws”.

Ingram has tenaciously tracked the convoluted story of prion diseases from their first hints in the form of Kuru in New Guinea, through to Mad Cow disease, Creutzfeldt-Jakob disease in humans, and Chronic Wasting disease in deer, elk and caribou, and finishes up with possible links to Alzheimer’s, Parkinson’s, and ALS diseases.  He deserves credit for his clear explanation of a complicated subject.  But it’s not just technical.  He also introduces us to the interesting characters involved in prion research, showing how the process of scientific discovery can be messy, how researcher’s motives can colour their interpretations, how results are sometimes suppressed or distorted for political and economic reasons, and that conclusions can be tentative, leaving us unsatisfied and wishing for more definitive answers.

Clearly the prion story is just beginning.  I look forward to future progress in our understanding of these weird little misfolded proteins.