“Oh, What’s Occurring?”

I am indebted to BBC Radio 1’s Scott Mills, for inventing this game, based on Nessa’s catchphrase from the beloved BBC sitcom, Gavin & Stacey.

In Scott’s game, a current event or star-du-jour that ought to be known to most Britons, is formulated as a question, which is then put to a “random sample” of 10 people on “Stupid Street” [a street right outside the London radio studio] by a BBC staffer. Let’s say, for instance, “Who’s Andy Murray?” The point of the game is not to guess the truth [the right answer]; but to guess the most frequent answer given by the 10-person sample on Stupid Street: also known as popular opinion.

Ponder the epistemological implications of this innocent little game for a moment. Since the truth about such objective, scientific matters as the human role in the rapidly melting polar ice caps [or whether Lili’s crippling condition, degenerative myelopathy, can be definitively diagnosed by a DNA test] is still being debated among the researchers themselves, it is tempting to default to the “received wisdom” of vox populi. Except we try to hedge our bets by avoiding the populi on Stupid Street. Our sources [we believe & hope] are reliable. They know whereof they speak. Nar’mean?

Because I’m a curmudgeon, I enjoy trolling the pages of the Science sections of the NYTimes & WaPost, not to mention my favorite discredited source BBC online news, for their uncritical, wildly-extrapolated-beyond-the-data, later retracted, proclamations on [not to put too fine a point on it] How To Avoid Death. Regular readers of this blog will know I prefer the wisdom of Epictetus & Marcus Aurelius on this subject: accept that you are going to die of something, sometime; and live each day as if it were your last on earth. This is not to be confused with fatalism or Nihilism. Nor is it a simple-minded call to Acceptance [an overhyped new form of psychotherapy]. It’s a call to Do Your Best and nil desperandum [pace Horace].

The non-Classical, dog-Latin variant of this last phrase, “nil desperandum illegitimi” [Don’t let the bastards get you down.”] is the take home message of the “Oh, What’s Occurring” game. Are others humiliating you with their ill-informed opinions about what’s wrong with you/your dog? Do they tell you “It’s a Judgement” [handed down by their otherwise loving God]? I have several patients coping with health issues, which their “God-fearing” co-workers blithely attribute to Retribution. I urge them [my patients, not their persecutors] to play “Oh, What’s Occurring?” by assuming their insensitive critics live on Stupid Street. I suggest that on the way to work, they try to predict what prejudiced opinions these quidnuncs are likely to voice. When they guess right, they can award themselves 100 Scott Mills points. Hurrah! It is actually quite an effective cortisol-buster, to predict correctly what slings & arrows will come your way today.

This week on Lili’s walks the denizens of Stupid Street have opined that she has hip dysplasia and needs aspirin [whereas increasing numbness is actually the problem]; that I am over-exerting her [whereas the recommended treatment is a daily long walk]; and that they saw on YouTube that you can fit a paralyzed dog with wheels [oh, Zeus, give me patience]. To which I hum the theme song to “Oh, What’s Occurring?” Right out loud.

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Filed under attribution theory, comic relief, Epictetus said..., stress and cortisol

Applied Stoicism (Or, Marky Mark Aurelius Was The Man, Man!)

In casting around for ways to cope with Lili’s heartbreaking Degenerative Myelopathy, both emotionally & practically, I recently reread the Meditations of Marcus Aurelius [written ca. 170-180 AD], which are timeless, or very timely. To quote him: “There is nothing new; all things are both familiar and short-lived.”

Inasmuch as Lili’s motto, in the face of rapidly progressing back-leg numbness, ataxia (drunken-sailor gait) & frequent collapses, seems to be: “Keep Calm & Carry On,” I would say she is more Aurelian than I am, at the moment.

For instance, she is my role model for this bit of advice: “Remember, too, on every occasion that leads thee to vexation to apply this principle:  not that this is a misfortune, but to bear it nobly is good fortune.”  I texted that one to my daughter at work, who immediately “got it,” and wrote back, “So, life is how you react.”

He’s very into noticing when humiliation gets up “thy” nose, and challenging it with Cognitive Reframing concerning Locus of Control: “But death certainly, and life, honour & dishonour, pain & pleasure, all these things equally happen to good men & bad, being things which make us neither better or worse.”  You’ve been dealt a rotten hand? Who cares if you deserved it, or if it was just random bad luck? Play the hand you’re dealt, and let the Greek chorus of kibitzers tend to their knitting (to mix a metaphor): “So much more respect have we to what our neighbor shall think of us than to what we shall think of ourselves,” observed the Philosopher King. And, yes, I agree with those who quibble, “Easy for you to say, Your Majesty. Noblesse oblige, and all that; but for us hoi-poloi, in high-density living situations, ‘one man’s ceiling is another man’s floor’ [as Rhymin’ Simon says].”

Speaking of the neighbors, we have gone out of our way [and comfort zone], to explain to ours, what’s up with Lili [not contagious, not painful, “not anyone’s fault”…unless you count her breeders, but let’s not dwell on that]. They have been, without exception, sympathetic and supportive…and grateful that their dogs have been spared Lili’s fate.

But, as Marky Mark would remind us, we’re all on Lili’s journey, even if we’re not as close to the other “shore,” as she is. Therefore, he counseled, “Thou will give thyself relief, if thou doest every act of thy life as if it were thy last.” Be like Lili: “Keep calm & carry on.”

 

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Filed under Epictetus said..., gets right up my nose, locus of control

Musta Bin Slipped a Mickey, So

As readers of the Oxford English Dictionary [or Google, even] will know, a “Mickey Finn” was a knock-you-for-a-loop potion, made by the addition of chloral hydrate to your already alcohol-based drink at the South Chicago saloon of one Michael [Mickey to his friends] Finn, more than a century ago. The better to bundle you off to the back room and relieve you of your valuables. When you came to in the ally, still dazed & confused, you were likely to be wondering, “Whatever was in that last drink I had?” To which your long-suffering Loved Ones, once they had scooped you up from the Drunk Tank at your local Cop Shop, would reply, “Only a guess, here; but I’m thinking it would have been alcohol.”

 

At which, your inner wolf would begin to howl: “Oh, the humiliation (of their false accusations)!” Not to mention, the pain & suffering of the drug’s after-effects, the intrusion of being man-handled by both barroom thieves & contemptuous cops. Worse still, if you really hadn’t drunk enough alcohol to account for the nausea & dizziness, and the amnesia for the night’s events, the fear that you were losing your marbles (not just your money) would have you raging.

Luckily for Chicagoans & [more commonly] out-of-town visitors, said Mickey Finn was arrested, convicted & jailed in 1903, leaving behind an eponymous, external locus of control, oft-invoked exculpatory explanation for apparent shenanigans. I like it much better than “The Devil made me do it,” as long-time readers of this blog will know. These days, the Mickey tends to range from (nefariously slipped) Rohypnol, to (self-administered) prescription sleep aids, such as Ambien. As in Old Chicago, though, skeptical First Responders’ first response is often, “So, how much did you have to drink?” [Then, as they are taught to do in First Responders’ class, they double the amount stipulated.]

But what if, like me, you are stone, cold sober; but you still feel like someone slipped you the Proverbial? Back in early June I placed my order for a replacement car for “Foxtrot,” my beloved [but increasingly unreliable, expensive-to-repair] Jeep turbo-diesel. With Lili in mind, I wanted something with ample head [ear] room, lower to the ground [for when she can’t leap anymore], but with enough traction to handle our Alpine road in foul weather. I chose a MINI Countryman All4, in Oxford Green with a black roof, which was going to take 8 weeks to build & ship down the Danube & across the Atlantic. I named it “Mickey,” because it was bigger than MINI & green [like the Emerald Isle, so].

I loved it on sight; and configured the back seat area as Pope-mobile for Lili [who still prefers to scramble into the trunk of our old Grand Cherokee & splay her ears like Yoda, since there is less headroom for her back there]. However, every time I drove it, even for a 15-minute run to the Safeway, I emerged like a drunken sailor, hardly more steady on my pins than poor Lili is these days! Highly motivated to understand, and manage, this situation-specific, inner-ear-on-the-Fritz problem, I began with my default setting: “Must be psychological.” Was this me vicariously “suffering” the early-stage symptoms of degenerative myelopathy [which my mother had & Lili has]? If so, why did the symptoms clear up so fast, after the ride? Was this the return of the bane on my youth, severe car-sickness? Then why did it only happen in the MINI [not in our wallow-y old Grand Cherokee, or in Chris’ sporty little Benz sedan]?  Aha! Maybe it was that obnoxious “new car smell,” I speculated; and thoroughly swabbed down the whole interior with boiling water. No joy. Then, 3 days in to my ambivalent ownership, I awoke with a vivid memory of Sean [our salesman] opening the “bonnet” to show me the battery and fluid reservoirs, and muttering under his breath, “It’s so slimy! I don’t know why they spray it with that protectant. It’s under the hood, after all.” So at 5 am that morning, there I was, swabbing the engine block with boiling water, until the sheen [and neuro-toxic goo] had disappeared.  As did my symptoms.

Hurrah! Not “all in my head.” Not “losing my marbles.” I had just been Slipped a Mickey by the MINI dealership. I wonder what’s in that spray.

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Filed under attribution theory, locus of control, vicarious trauma

Walk It Off

Well, now that the Olympics are upon us, this double-edged sword [have you been watching the Fencing? such histrionics! like an Italian opera!] of home-spun advice can be heard all over the shop. Remember back in the day, when a coach’s overheard gruff admonition to an injured-bird-like gymnast provided fodder for a series of SNL sketches, in which the putative “walk-off-able” injury morphed into the Knight-in-Denial scene from Monty Python & the Holy Grail?

On Day One, a BBC Soccer commentator Let The Phrase Begin, remarking of a [possibly histrionic] player, “Oh! He’s down! It looks like a nasty ankle injury! Well, no, actually, he’s walking it off, and he’s back in the match.” No Yellow Card was issued. Perhaps it was a case of Unconvincing Diving [a common occurrence in high-stakes matches]; or maybe it was a case of that well-known [at least Up North in England] medical condition, “Summat and Nowt.” [Translated in a previous Post, “Be Good…” as “Something and Nothing.”] Often, cases of Summat & Nowt respond well to “Walking It Off.”

 

The other day, my sister, a highly-placed Medical Librarian, forwarded me an article recommended by one of the vets attached to her Med School, entitled, “Managing Degenerative Myelopathy in Dogs: Ways of Slowing the Progress of This Debilitating Spinal Disease,” posted on September 4, 2008, by Dawn M. Smith.

Even though the alert reader will guess what’s coming, I’ll quote it, anyway. “Dogs with canine degenerative myelopathy benefit from controlled walking…in several ways. Allowing the dog to run around the property or in a dog park does not provide the same benefit, as the exercise is not consistent. A regular walk of a specific distance at a steady rate not only improves muscle tone, it improves brain function.”

I truly believe that Lili’s daily walk through the Smithsonian woods provides her both Physical & Occupational Therapy, during which she “gets smarter” about how to ambulate, despite her numb hind paws. So far, her leap into the Jeep-of-the-Day after a walk is noticeably stronger & more graceful than her initial load-up at our house.

As always, I am grateful to my sister for finding & sending me relevant research articles. In this case, my fear, that I might be inflicting pain & suffering on Lili by asking her, in effect, to “walk [her CDM] off,” was greatly diminished. Further, the humiliating dread, that a casual observer would think of me as that gruff [almost sadistic] gymnastics coach, denying or minimizing a real medical condition, as if it were only Summat & Nowt, has also been neutralized.

After all, we’re not Going for the Gold, here. The only goal is preserving Lili’s quality of life.

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Filed under attribution theory, power subtext, vicarious trauma, what's it all about?

Looking for The Beauty Part

This is the hardest post I’ve ever had to write for this blog. Last week’s power “outrage” had a couple of Beauty Parts. First, both daughters were in town, and [although it could have gone either way] we found the shared misery of our Second World [if not 3rd] existence bonded us together, rather than pulling us apart. Second, it gave me an alibi for postponing the disclosure of our sad news about Lili, whose DNA test for Degenerative Myelopathy came back positive.

If you’re not familiar with the disease [and we weren’t], a simplistic way of thinking about it is that it’s Multiple Sclerosis for dogs, with some important differences. Unlike human MS, whose etiology is still mysterious [maybe there’s a genetic component, maybe it’s stress-related, maybe it’s triggered by a virus…just follow the stories surrounding Jack Osbourne’s disclosure of his diagnosis], the dog version is 100% genetic. Both parent dogs have to be carriers of the gene, for it to be expressed in the offspring. Our pain & suffering-fueled angry thoughts have been [predictably] directed at Lili’s AKC-registered breeders, who “should have known better,” even though the genetic test for the disease was developed after Lili was born in 2004. Nowadays, though, any breeder who doesn’t test for DM is as unscrupulous as those who don’t test for hip dysplasia.

Those who have read my “About a Bird” post will know that my mother got MS when she was 35 [and I was 10], so I had 25 years’ experience of watching how the progressive numbness of an individual’s [back] legs makes walking tricky, then difficult, and ultimately impossible. Lili is still at the “tricky” stage. She tends to “wipe out” on hardwood floors [especially when in hot pursuit of a cat], but still gallops on grass. The daily walk through the Smithsonian woods is both worrying and inspirational. On some mornings it takes 3 attempts for her to leap into the back of either of our 2 Jeeps; and the other day she landed in a disorganized heap on the grass verge as she jumped out of the car at the school. But [here’s one of the Beauty Parts] she has a “fan club” of laborers working on school renovations this summer; and when they expressed dismay at her fall, she pulled herself together and trotted off smartly towards the woods. So far, she seems to experience no humiliation when she loses her footing [unlike my late mother, and most of the MS patients I have known]. “She just gets on with it,” as the Brits say. That’s the Beauty Part.

The “I am your Pack Leader” power subtext has changed subtly on the cross-country trail. I let her set the pace, sometimes marching in place while she collects herself for the assault on the next steep hill. She often delights me by then going so fast that I have to double-time to keep up with her. Every day that she “makes it through” the woods and back to the car is a beautiful gift. I realize that I have to make contingency plans for the day that she can’t.

What is absolutely clear, at this point, is that [however tricky it is for her numb back paws to negotiate hidden roots & fallen branches, steep inclines & muddy patches] she is having the time of her life.

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Filed under born to run, leading a pack, power subtext

“Just Stop It!”

So said a young woman I see, to her obsessive-compulsive boyfriend, whose prolonged, ritual flicking on & off of a light switch was making them Late for a Thing they had planned to do. To her amazement & delight, he did stop it, at least long enough for them to get on with the day’s agenda. Who knew? 40 years of trying to effect changes of behavior through Socratic reasoning and other insight-oriented methods, and all along I could have done what your Dad [or at least mine] did: sonorously intone the command, “Knock it off!”

Trouble is, as parents & dog owners know, once the Commander has left premises, the proscribed behavior usually resumes.

The hard-to-extinguish behavior that I wish I could peremptorily curb [in myself & those intrusted to my care] is Black & White Thinking: the so-called Cognitive Error of perceiving everything in life as either All Good or All Bad.

Big fans of Stanford biologist Robert M. Sapolsky’s 1994 PopPsych bestseller, Why Zebras Don’t Get Ulcers, may quibble with my choice of animal metaphor, since his point is that wild beasts don’t overthink life’s adversities, therefore they produce fewer glucocorticoids, and suffer fewer stress-related illnesses. My rebuttal would be that this particular zebra is a captive of the Los Angeles Zoo [where we took his/her picture]; and if zebra-ear semiotics are anything like horses’, this one was signalling a situationally appropriate lack of joie de vivre.  “Okay, so I may be safe from drought, poachers, and my traditional predators; but, Poseidon! Is this enclosure ever bo-ring! Bring on the lions, already.”

Also, come on, how black & white can you get?

Remember the teenagers’ mantra of the 90s, “…but it’s all good”?  Usually uttered right after their disclosure of a Fairly Bad event or situation? How tempting it was to remark, “Surely, it’s not all good? Not 100% good?” Then, as now, there were also the drama queens, who at the first sign of adversity declared that a situation was “the worst!” Really? You can’t imagine an even more grim scenario? This one takes the cake?

One year when my girls were fairly young I gave up saying “Never” and “Always” for Lent: “You never clean your room!” became, “A lot of times, you don’t clean  your room.” [Far more accurate, and less humiliating for all concerned.] As gratifying as the ensuing Peace & Harmony was, it was difficult to sustain. We humans are wired to dichotomize: friend or foe? Am I the fairest of them all, or the ugliest? Do I feel “On top of the world,” or “like Hell”?

May I suggest 2 antidotes to Black & White Thinking? One, print & post this visual mnemonic of my LA zebra. Two, in response to adverse situations, try to Find the Beauty Part: the small, positive aspect that makes it “So it shouldn’t be a total loss.” This basic premise of Stoic philosophy helps counteract the “slings and arrows of outrageous fortune” [which want to get up our nose and produce rage & glucocorticoids].

At least in your head, you could try to replace the [usually inaccurate] absolutes of “This is the best” or “This is the worst,” with the words of that modern-day Stoic philosopher, Larry David, “This is pretty, pretty, pretty good.”

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Filed under black and white thinking, Epictetus said..., semiotics

“hooked on the sound like it’s nicotine”

This apt metaphor comes from the current BBC Radio 1 hit, “Make Peace Not War” by the BritRap DJ, Skepta (known to his Nigerian-born parents as Joseph Junior Adenuga). I highly recommend its addition to your MP3 player, if only for the addictive hooky sample, “Everybody Dance, Now.”

As you may have guessed, the nicotine addict pictured above is not Skepta, but my own dear, long-since departed father (known to his Irish-born parents as “Red,” and to his shipmates as “Rosie”). Indeed, this picture comes from the official Naval book, U.S.S. WALKE, Korean Cruise, October 1950 to August 1951. What’s he like, eh? While everyone else in the book is pictured in uniform and smiling, the editors chose to let the Executive Officer’s inner wolf flag fly: “The Exec…If you felt you’d been [on deployment] too long, if you weren’t completely happy with your work, if you had any little problem at all, you just brought it in to this kindly old soul. He knew just how you felt.” [Note the use of the Poetic Speech function.]

A propos Memorial Day weekend, I will quote further from the book: “At 0740, June 12, 1951…a heavy explosion. In one stunning moment the full agony of war came home to us. In that moment 26 shipmates lost their lives and 40 more were wounded. Out of disaster came heroism and determination. The wounded were brought to safety and then we saved the ship. In the ordeal that followed a good ship became a great one…and the WALKE and the men who sailed her lived to fight again.”

One is tempted to say, “Put that in your pipe and smoke it, North Korea!” However, alas, it was Rosie, and many of his fellow Americans, who did the smoking; and this post is yet another attempt to understand why.

The research I will quote comes from an article in The New England Journal of Medicine, published on 17 June 2010: “Nicotine Addiction,” by Neal L. Benowitz, M.D. He begins with the usual grim statistics. “Cigarette smoking remains a leading cause of preventable disease and premature death in the United States and other countries. On average 435,000 people in the United States die prematurely from smoking-related diseases each year; smoking causes 1 in 5 deaths. The chance that a lifelong smoker will die prematurely from a complication of smoking is approximately 50%.”

So, what gives? Are all those smokers (including smart, brave, stoical Rosie) just Crazy Like a Fox? Maybe. “The pharmacologic reasons for nicotine use are enhancement of mood, either directly or through relief of withdrawal symptoms, and augmentation of mental and physical functions.” Wait, what? Don’t tell your “Kangaroo” [aka attention-challenged] children; but Benowitz cites lab animal & human research studies suggesting that nicotine improves concentration and adherence to task. The evidence is more compelling [and also ethically distressing] in the rat studies, since one would presume that the rats are responding only to the cholinergic effects of the nicotine, not to the learned social cues and expectations so exhaustively explored on MadMen.

To totally simplify his neuroscience-speak, the initial chemical effect of nicotine on the brain is to increase available dopamine [leading to a sense of calm well-being & “in-the-zone” mental/physical performance]. But soon the nicotinic acetylcholine receptors (known to their friends as nAChRs) become desensitized, “demanding” ever higher doses of nicotine, just to forestall (in rats) “anxiety-like behavior and the release of corticotrophic-releasing factor (CRF) in the central nucleus of the amygdala.” Aha! Our old nemesis, the howling wolf [amygdala, yah?] is flooded with toxic CRF, resulting in (unaccountable) fear (aka anxiety), and pain & suffering. No wonder those in nicotine withdrawal are so cranky!

Benowitz is not a big fan of [comparatively inefficient] nicotine-replacement delivery systems [such as gum or trans-dermal patches]. He believes in shielding the nAChRs from the depredations of nicotine in the first place. Short of psychosurgery or serendipitous Traumatic Brain Injury, however, no such nicotine-eluding technology yet exists.

Like a hooky song you can’t get out of your head, once you take “Nico” on board, you may have a “shipmate” for life.

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Filed under crazy like a fox, limbic system, stress and cortisol