Archive for the 'illness and injury' Category

I had a migraine a few weeks ago. As migraines go it was a breeze, really. There was no piercing headache, just a vice-like tension that I would normally associate with the before- and, to some extent, the after-effects. It was not a muscular tension-headache nor alcohol-related.

I didn’t experience the normal visual aura, but I’m sure it was a migraine because it was preceded by a strange faintness accompanied by shifting vision. I felt funny for most of the following week, then had a severe headache last Friday. The previous day I’d worked out hard in the gym. So I took medical advice. They said it was probably a virus that had triggered the original migraine; it was not surprising for the symptoms to be there a week later. Take paracetamol, they said. You’ll be fine. And so it turned out.

365 Days - Day 208 - Migraine

I’ve had one or two really severe migraines, but I’ve been very lucky. Apart from the couple in my teenage years that would conform to the agonising archetype blighting many people’s lives, I’ve been a light sufferer, by any measure. For 10 years of adulthood I had none. Then just a handful with no pattern or recognizable trigger. And some of those were easily knocked on the head by the early ingestion of paracetamol.

Most recently, my first half-marathon triggered one. And after the London marathon in 2005, I succumbed. In both cases my training had been incomplete: I’d overstretched myself. That would constitute a huge stress: an obvious trigger. I’ve wondered too if the demand for calcium/magnesium following that excessive hammering on bones and joints might not have helped. Too much to know.

Because I’ve escaped lightly, my knowledge of the significant progress of migraine science has been almost (but not entirely) non-existent. I noticed only yesterday, for instance, that Oliver Sacks wrote a book called Migraine in 1970 (with a revised edition published in 1992).

But the subject hove back into my view for a couple of reasons recently. I learned, for instance, that migraine as a neurological condition has a close genetic alignment with epilepsy, and that migraine sufferers are more susceptible to background noise; there is a similar phenomenon (which I don’t fully understand) in relation to eyesight.

My late brother suffered from epilepsy. But, because his epilepsy was apparently brought under control by a similar progress of pharmaceutical research, the family had been largely able to forget the underlying seriousness of a condition which reportedly affects 60 million people worldwide; migraine, by contrast, may affect as many as 300 million. The general impression — certainly one that my brother held — was that the major risk to his health came from the long-term effect of such chronic drug dependency on his vital organs. But it seemed that we could feel blessed that it wasn’t a whole lot worse; going back a generation or two, some family members’ lives had been completely wrecked, and this had chronic knock-on consequences for their carers. These days there are still those whose condition does not respond to treatment.

So, when I was researching my earlier post on Didier Sornette and the housing market, I came across a presentation he delivered in Oxford in January. It revealed some of the wider applications of complexity theory beyond the geophysics where Sornette started. In collaboration with several others, Sornette has published a paper or two explaining how the study of data sets of the brain activity of epileptics (specifically those whose condition does not respond to drugs) showed patterns akin to seismic data of earthquake incidence. The hope is that this might lead to some better method of prediction for sufferers.

The maths is rather intimidating and I’ll try to paraphrase the following as I go along, and link to definitions. Fingers crossed:-

That the pdf [probability density function] of SZ [seizure] energies E follows a power law, and more importantly that its exponent is beta almost equal to 2/3 (as for EQ [earthquake]), has far-reaching, statistical-clinical implications: the mean and variance of E are mathematically infinite, which means in practice that the largest SZ in a given time series controls their values (3). As a consequence, variability is dominant and “typical” has no meaning. The energy pdf, and specifically its heavy tail, also suggests an explanation, at a mathematical-conceptual level, for the proclivity and capacity of the human brain to support status epilepticus, a potentially fatal condition characterized by prolonged/frequent SZ during which the brain does not return to its “normal” state, even when SZ activity abates.

Well, I think the key point is ‘variability is dominant and “typical” has no meaning’, which we liberal artists would tend to capture with the expression ‘to be in a constant state of flux’ although that does not quite cover the sense of unbounded potential for an extreme spike. The problem is that we like to convince ourselves that there is some “normal”, some stability. And, on the surface, so it may appear.

And then Sornette explains:-

In seismology, it has been recognized that the many small, undetected EQ provide a major if not dominant contribution to the triggering future of EQ of any size (7). Prolonged recordings of brain cortical electrical activity (ECoG), the equivalent of seismographs, from epileptic humans and animals contain frequent, low intensity, short bursts of abnormal activity unperceived by the patient and observers and interspersed with infrequent, but longer, more widespread, and more intense bursts (convulsions) (4). The SZ-EQ analogy, including the evidence presented here for an inherent capacity of SZ to trigger future SZ, suggest that a workable prediction scheme should use the triggering by, not only past perceived (clinical) SZ, but also the myriad of unperceived (subclinical) abnormal neuronal bursts.

Sornette’s applied work highlights the cross-disciplinary relationship of the science of complexity and reminds us too that some part of our population suffers from extreme non-linearities in their day-to-day lives. And how more vivid can it be, as the picture above shows, than the fractal manifestation that is the migraine aura; when I first used to experience it, it would mark the beginning of hours of debilitation.

Meanwhile, news was reported a few weeks ago that untreatable epilepsy in children responded to a high-fat/low-carbohydrate diet. This is not particularly new. I notice now that Mark’s Daily Apple picked up a Science Daily report back in January to similar effect. Mark was also the original pointer to the picture above (thanks again Mark). So-called ketogenic diets have been known to be effective in treating even the worst sufferers from epilepsy as far back as the 1920s. And I even found a 1910 medical report quoted on a low-carb forum where a doctor had noted high levels of candy consumption among two chronic epileptic sufferers, one adult, one child, he’d been asked to treat. Drug therapies became preferred later because the higher-fat diets were found to be more difficult to follow, ostensibly for cultural reasons. Today there is a shortage of dieticians to help apply what you might call a clinical diet, where each gram of carbohydrate is very closely measured.

Well, it makes more and more sense to me that diet — and our modern carb-laden diet — has much more to answer for than we allow when we think that we are eating a “healthy mixed diet”. But it’s a struggle to remove easy grain-based carbs, and one has to wonder whether it is a sustainable option for the planet as a whole. Since I can afford it, I’m making the switch, but mainly because of the evidence that grains may play a role in activating cancer genes. I can’t ignore those pointers; I’m 43 and since January the oldest surviving member of my immediate family. Both my parents lived ostensibly healthy lives. That alone should predict that at least one would still be with us since my grandmother was alive just 7 years ago at 91.

Because of the complex, fast-moving chain of events that led to my brother’s death in January, it was hard for the surgeons to provide the family with a satisfactory narrative. I missed the chance to speak in person with the clinician; I was racing down the interstate in (melo)dramatic fashion in order to arrive before what turned out to be a technical pronouncement of death. My brother’s state on arrival in hospital the previous day was not materially different from when I arrived 10 minutes after the certification; he was on life-support simply for the purposes of organ-donation.

But that does not matter. What was described was a total neurological event — a seizure that affected all his vital functions. SUDEP — or sudden unexplained death in epilepsy — is what I understand it to have been, although that was not the word the doctor used. Or perhaps it was status epilepticus.

It’s ironic that neither SUDEP nor status epilepticus was something we knew about beforehand, or ever discussed as a possibility within our family. As I said, my brother’s principle pre-occupation in terms of epilepsy-related health (based on counselling I assume he received quite early on in his life) was that his long-term health would be compromised by the medicine he took rather than the diet he was exposed to. I think it made him fatalistic. I have no recollection that a low-carbohydrate diet would have improved his teenage outcomes, and it was something my mother would surely have responded to, had she known.

Later in life, my brother ate a standard North American diet, and there is no suggestion that this was a contributory factor to his SUDEP, but I have to wonder. Not least because the science of low-carb and the science of earthquakes both point to epilepsy from different perspectives. And scientists like Sornette and De Vany are using the same maths across these various domains.

Changing diet may not be a panacea, and I may already have sown the seeds of my own demise, but you don’t not pay into a pension scheme because you didn’t pay in before. That sort of fatalism does lead to literal and metaphorical penury. But above all else, these findings all suggest that a lot more critical reporting should be applied to questions of public health, preventative medicine, exercise, diet fads and even agricultural subsidy. That obviously ain’t happening at the moment. Indeed, the recent coverage of the ketogenic diet in the BBC/Lancet does not consider whether a lower carb diet contributes to a reduced risk of seizure more generally, and therefore might act to forestall a sufferer reaching the kind of tipping point that Sornette’s science is point toward. It is dealt with in the specific of untreatable epilepsy with no extrapolation that more general metabolic risk factors need to be considered or highlighted for all sufferers.

Well, when I asked in one of the leading cookery shops with a vast, if not complete, array of cookery titles if they had anything on the paleo diet, they had no clue what I was talking about, unsurprisingly. So there is much work to be done. That said, Nassim Taleb‘s advocacy in The Sunday Times the other day certainly has led to more Googling of “paleo diet” and other associated terms, from what I can see here, including searches for Prof De Vany.

Photo credit Auntie P @ Flickr (CC)

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The Economist this week has two stories back-to-back in its Science and Technology section on cognitive enhancement. Not surprisingly the first one, which is about the widespread use of cognition-enhancing drugs (such as Ritalin and Provigil) to help you pass exams or improve performance, and the expectation of more to come, has been given the greater attention by the wider press. It’s a scare story about competition and cheating and raises the possibility of the need to test students as potential drug cheats. But The Economist takes a controversial tack in its editorial, likening this to “harmless” coffee and arguing it is a good thing.

It falls on deaf ears here because this is a week when I did not drink or eat any coffee, milk, wheat product, potato, rice or any refined carbohydrate excepting that contained in one bar of 85% cocoa chocolate. I drank no alcohol either. I’ve been doing this as a stricter enforcement of a paleo-style diet to help regulate my weight, but above all else to enhance cognition, and for longer-term preventative health. As far as I’m aware, it is working. With one or two qualifications. Those qualifications being a coincident virus that caused a migraine which lasted longer than I’d normally expect, prompting a little hypochondria and Googling for ideas about nutritional deficiency — to no avail.

The paleo-style diet (or lifestyle) is hard to sustain and I can tell you that it has been a lot harder in the short run than popping a few pills. But my argument with The Economist‘s view is that the brain is a complex system: don’t mess with it if you don’t need to. My own experience seems to suggest that I’m a little insulin-resistant, with diabetes in the family, so a lower-carb diet is likely to be beneficial.

But the second story in The Economist pairing owes more to my approach than the pill-popping. This other story describing research that social position can be detrimental to cognition has received no mainstream attention elsewhere, as far as Google can tell us. It has been, thus far, editorially cold-shouldered, and subordinated, and yet by far and away it is the more interesting story for self-experimenters, self-improvers, collaborationists, diversity specialists, managers, teachers, coaches and parents.

Pamela Smith and colleagues from Radboud University Nijmegen suspected that a lack of social power might reduce someone’s ability to keep track of information and make plans to achieve goals in difficult and distracting circumstances. This seems like common sense, not least because I’ve seen a number of situations, for example, where even senior executives have lost confidence and status and then suffered a quite immediate impairment. I’ve even experienced it myself at significant moments. I once had to pitch for $30 million for a management buy-out having been booked into a shoddy lower-Manhattan hotel where the breakfast was served on paper plates. Not a good start to the day. The next day, for the next pitch, I moved to a different hotel and a waterside suite — ironically for much the same price.

The Economist says:-

To explore this theory, she (Dr Smith) carried out three tests. In the first, participants were divided at random into groups of superiors and subordinates. They were told that the superiors would direct and evaluate the subordinates and that this evaluation would determine the subordinates’ payment for the experiment. Superiors were paid a fixed amount. The subordinates were then divided into two further groups: powerless and empowered. A sense of powerlessness was instilled, the researchers hoped, by having participants write for several minutes about a time when they were powerless or by asking them to unscramble sets of words including “obey”, “subordinate” and so on to form sentences. The empowered, by contrast, were asked to write about when they had been on top, or to form sentences including “authority”, “dominate” and similar words.

Not much, you might say, to induce a sense of inferiority or superiority when compared with the real-life stress of a domineering boss or other confidence-draining circumstance, but nevertheless enough to make an impact on several cognitive tasks:-

In all three tests Dr Smith found that low-power participants made 2-5% more errors than their high-power counterparts. She argues that these results were not caused by the low-power volunteers being less motivated, as they had the same financial incentive as the high-power volunteers to do well. Instead, she suspects that those lacking in power suffered adverse cognitive effects from that very lack, and thus had difficulty maintaining their focus on the tasks.

A common problem in evaluating how well someone is doing relative to their ability is the often-mentioned fundamental attribution error: a pretty universal cognitive bias where we will tend to ascribe another‘s failure in a task to their personality rather than their circumstances — largely because we will probably have more data about their personality than the circumstances. Conversely, we judge our own failures more kindly because we know what extenuates them.

What Pamela Smith’s findings suggest is that when we are judging an individual for promotion, for example, it is quite possible that their performance will be transformed once they emerge from a subordinate position, and even more so if we have failed to motivate them properly. They may have been swimming hard against a tidal flow that we cannot see.

Of course, this applies from hiring manager to teacher, coach, and parent, and should require CEOs and other leaders to show a little more humility given the cognitive momentum their high status affords them.

While I love what the cognitive sciences are doing these days, I can’t help but be reminded of the existing literature on these matters. This one evokes the first record I ever owned: Hans Christian Anderson’s tale of The Ugly Duckling. And this YouTube rendering is not so different from the way I used to enjoy it nearly 40 years ago.

Take a look. And believe that you are a swan.

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I’ve been interested in the concept of athletic injury — why it happens and how to avoid it — since my early attempts at distance running went wrong. My failure to properly manage the progression from half- to full-marathon training scuppered my enjoyment at the full distance and cost me no small amount of time, money and pain at the physio clinic.

Last year I asked the London Marathon folks how many places they allocate each year, and how many drop out before the day, but answer came there none. Many runners, I’m sure, tough it out on inadequate training and recovery, just as I did in 2005, with a virus or other illness that seems marginal in the context of the joy of getting a place in this massive mobile folk festival, or the sense of obligation to one’s sponsors. The latter, of course, is very powerful.

But during all my middle-aged attempts at higher fitness, I think the most interesting concept I’ve come across appeared just the other day in the sports science newsletter Peak Performance:-

There is a price to be paid for developing specific robustness, and it goes some way to explaining how highly trained athletes can still be susceptible to injury. As training and strength progress we become increasingly adapted to the stimulus our body expects. However, high levels of adaptation to a familiar stress may conversely leave you potentially fragile to an unexpected stress. And as the highly adaptable and complex being that you are, it is often tiny unexpected stresses that may prove catastrophic. This is referred to as the robustness-fragility trade-off.

The concept is new to me, but presumably it will not be to those familiar with complex systems, be they biological or technological. I’m guessing here that it should also resonate in the workplace, school, the home and even the family. The more we become good at the specific skill, task, business or market orientation, the more vulnerable perhaps we are to some not entirely distant butterfly-wing flap – the tooth that cracks while biting on nothing more than a lettuce leaf.

Well, I’ve heard in business the suggestion that the big non-linearities are kind of unavoidable, and that their impact will be evenly distributed, so there is not much competitive advantage in laying down tools and tinkering in some other less defined direction, which is what the Peak Performance article advocates for physiological purposes.

I think they are telling us to do a bit more than just cross-training, the benefits of which are well-documented, but try and incorporate a range of movements into your life and workouts. For example, the article recommends introducing a “bandwidth of variability” in the way we run or exercise, and do things that challenge our coordination.

For runners (which is mostly where my interests lie) exercises like skipping and even hopscotch are recommended. It seems a far cry from what we conceive of as the serious business of piling on the miles.

Perhaps a bit more corporate hopscotch, and some of our currently endangered institutions might now be looking a little less vulnerable? But I doubt the stock analysts would be able to reduce it to a metric for discussion, so it is only through the wisdom of failure that most managers are likely to allocate any time or resources to such a pursuit.

The difficulty is that we prefer to focus on the task in hand and see ourselves progress directly at the sport or discipline in which we will be measured. The greater discipline required to step back and spend a little bit of time filling in the gaps seems to come at the cost of specific progress on that road to greater robustness in our chosen sport or business endeavour. That less-travelled training road is also likely to leave us feeling that we are falling behind our colleagues or competitors.

For example, if the choice exists between dropping some miles on the training path and some core stability training, the closer to an event the more likely that non sport-specific activity is going to be foregone if there is some other pressing work or family responsibility.

Very early readers of the Knackered Hack will recall my focus on rugby player Jonny Wilkinson‘s return to competitive sport, and his own comments on the mismanagement of his early training regime.

Up to now I have perhaps not had the strength to make these tough decisions because I always believed the toughest decision was to stay on the field and “tough it out” for an extra hour or so. The tough decisions for me now are about getting the most out of my training while still being able to rest and recuperate for the weekend’s game. I still train numerous times every day but I try now to train better and smarter, which does not necessarily always mean longer.

It is for this reason that, rather than focus on a specific event goal like the marathon, my training approach is now holistic, trying to put together some of the things I’ve learned over the past several years. This may mean a slower, more varied route to robustness. All that said, my opinion of my current regime is that it is still too monotonous. So, inspired by Peak Performance, I will be ringing the changes in the coming weeks with weights, tennis, badminton, skipping, basketball, and maybe even some hopscotch (corporate and otherwise).

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It had been my intention to take the blog on vacation with me to see what — in a very restrictive sense — ubiquitous computing might feel like. And to see whether a travelogue should ever form part of this miscellany. I bought a 3G dongle (not from a spam email…) and carried more digital and optical equipment than you can point a telescope at. The only things lacking were the skill to use it all and a guarantee of internet connection.

The immediate consequence of an absence of wireless reception beside the remote estuary where we perched for the duration of last week was that for the first little while there was not much to do but stand still. This was a good thing, but as the Knackered family has not stood still for well more than six months of rolling crisis, it was only natural that some of the tangled thoughts of grief found an opportunity to unwind and, for those few early days, occasionally overwhelm.

Cornwall April 2008 004

Road to Nancenoy

But the Cornish peninsula is nothing if not varied. And would a geographer pick an argument with me if I said it may be one of the most fractal landscapes on earth? — whether one is talking about the trees, the rugged coastline, the self-similarities of those flooded river-valley creeks, or the surf as the Gulf Stream makes landfall.

Cornwall April 2008 095

Kynance Cove

Within barely a few minutes’ drive the contrasts can be extraordinary. We’re quite happy with beaches out of season and in most weathers, and now — with the necessary neoprene — the option of body-boarding (and, someday soon, surfing) before supper presents itself.

Cornwall April 2008 092

Kynance Cove

In true amateur form, much of our expedition was inspired by reading Simon Barnes’ book, How to be a Bad Birdwatcher. And with a much diminished self-consciousness, this point-and-shoot ethos carried us through birdwatching itself, astronomy, body-boarding, rowing our own boat up the muddy creek (with paddles, thankfully), and much lower-maintenance-than-usual holiday gastronomy (pasties and fish pies from Gear Farm in St Martin).

Cornwall April 2008 131

Nancenoy

Cornwall April 2008 116

Serpentine rock at Kynance (on the Lizard peninsula)

Helford-Aerial

Helford River

Stonechat

Stonechat

Photo credits: stonechat, Andrew Pescod; aerial view of Helford River, Google ;the rest, Knackered Hack

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bike psyche

02Apr08

Great Britain again dominated the World Track Cycling Championship at the Manchester Velodrome this weekend. I watched only briefly, taking a break from the Twitter stream to see an interview with team psychologist Steve Peters.

Peters is something of a phenomenon, if not a genius; Undergraduate Dean of Sheffield University, much in demand in a variety of UK sports, he’s a sometime visitor to the England rugby training camp here at the Sports Training Village in Bath — which, by the way, seemed to be a secret he did not want told on national TV.

Vicky Pendleton and Shanaze Reade

But most interestingly, perhaps, he is a former forensic psychologist, who spent many years working in Rampton Secure Hospital, exemplifying our own belief here at Knackered Towers that the study of that which is broken yields useful lessons if you want to succeed.

If that were not enough, the unassuming Dr Peters is a highly competitive Masters M50 sprint champion (that’s running fast for old folks). His training regimen, discussed here, would likely pass muster with that most eminent of critical thinkers on all things sporty, Professor Art de Vany. It’s very unorthodox.

Now, recently I’ve been tempted to comment on Reuters’ CEO Tom Glocer’s blog, but held back. Tom was talking about national character, negativity and optimism. If I understood his point correctly, he was saying that if only you think positively, good things will follow (that was the post title in any event). He referred to the need for an optimistic outlook, drawing on the athletic coach and the self-talking salesman as examples.

You can’t really argue with that. Except that, as Ed Smith painted in his book, the truth is a lot less certain and requires a more subjunctive qualification: think positively and good things might happen. The corollary being, think negatively and it ain’t gonna happen, not now, not never. And that’s more my own experience; as Woody Allen would have it, 80 pct of life is about turning up.

But, in my own corporate experience, positivity and negativity tend to be understood in very binary terms. And because of that, useful information about how products could be improved (or an organization better configured) does not flow freely up the ranks. With tools like wikis, of course, it now flows much more freely across reporting lines, if managers take the step to encourage their use. And it flows pretty freely among the folks who stand outside the office smoking, but let’s not go there.

Returning to individual and team confidence, what Peters had to say was quite brief but highly nuanced. What was clear was that positive thinking, and the psychological tools needed to create it, were not straightforward: they were specific to the individual, but also situational depending on the person, whether a team was involved, the type of event, the coach, championship and location. What mattered was educating athletes into how their minds worked, what trigger points led to negative emotions, and how those could be turned around.

Vicky Pendleton, the diminutive and self-confessed “girly girl” who won two gold medals and a silver over the weekend, had lacked confidence, according to Peters, when he started working with her. But he described how she had been able to train herself to turn her mood around within 10 minutes of a setback.

Peters explained how large events, such as the Olympics, create a huge range of distractions (from transport to security) each of which will affect each athlete differently, and for which all need to be prepared if they are to secure their own best chance of success.

What makes sport an interesting crucible through which to understand performance these days is that there is just so much of it, it is so professional, and there is so much research (physiological, neurological, psychological) . And it produces characters like Peters, Martin O’Neil and Ed Smith.

Sportsmen and women are dealing with the most intense of situations in which their vulnerabilities are very public, even on a day-to-day basis in training. They have a lot of complex information to understand, and failure to self-manage can quickly lead to injury, loss of form, loss of a place on the team, loss of funding, denial of access to quality coaching, etc. And that ignores the consequence of a random fall or illness at a critical moment in a training schedule. This cascade gathers its own momentum because at each stage the athlete finds him or herself increasingly isolated, so the reversal becomes commensurately difficult to effect.

It should not be forgotten, and if you have ever trained really hard you will know, that resulting sharp mood swings can affect motivations and relationships outside of the sport as the body and mind adapt and recover from the process of extreme exertion. Indeed, a protracted bad mood is a sign of over-training syndrome which is very hard to pinpoint in oneself until it’s too late, and takes a surprisingly long time to recover from.

There don’t seem to be enough Steve Peters to go round sport, let alone international business. I wonder how we should go about making more?

Photo: British Cycling

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