The More You Know…

mbi-v2-1-gif

 

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I’ve started substitute teaching. You probably remember crusty, old geezers teaching your class when one of your teachers was gone. These fossils were fond of telling students that they don’t know what hard work is, that they had to recite the pledge of allegiance in Greek and had to learn math with an abacus.

 

Whatever the case, there was always the assumption that, like teaching vampires who only came out during the school day, subs didn’t have an everyday normal life; when the school day was over they’d retreat to the school basement to read the textbooks for enjoyment before using them as a bed to sleep on until they were called to action again.

 

My point is that, with a single day substitute, there isn’t really a chance to get to know the sub.

 

I typically sub at the school where I once taught and assisted librarily, so I know most of the teachers and they know of my condition. Given enough notice, I’ll offer to give a presentation to the kiddos about me. This way the teacher doesn’t have to prepare as much and the students get first-hand knowledge of why I am the way I am. I’ve posted a version of this presentation before (LINK), but it was a raggedy old PowerPoint.

 

AND THEN…last summer – I went to a writer’s conference to pitch my memoir. I wanted to stand out, so I put together a presentation. I had just given the students a crash course in PowerPoint presentations and Prezi, so I thought I’d give that a try. I didn’t get a book deal >:(, but my presentation was pretty sweet. Find it HERE

 

AND THEN…a new school year started and the sub jobs came pouring in. So far, I’ve presented to about 250 seventh graders, most of the eighth graders saw it last year.

 

AND THEN…my younger sister, a Latin teacher (She teaches Latin, she’s not a teacher who is Latin, no one is or really has been since the Roman empire), asked me to come talk to one of her classes. I thought that this nexus of presentation opportunities called for a revamped presentation.

 

AND THEN…I combined the raggedy PowerPoint with the fresh, shiny Prezi to create a PreziPoint (PowerPrezi?). The svelte can be viewed in all its smoothly transitioning glory HERE. Or, for your convenience, I’ve reproduced the presentation here in slideshow form.

 

AND THEN…actually, ‘AND THEN…’ doesn’t work here, but I’m nothing if not consistent, the frames with a 🌟 in the lower right corner were adapted from the original PowerPoint. This means that the ones without a star make up the original Prezi.

 

AND THEN… If you don’t notice, apart from the book excerpts, it rhymes! Isn’t that delicious?

 

AND THEN…FIN

 

AND THEN…@JarrettLWilson

 

A Picture is Worth a Thousand…Pictures…

All Done

All Done…or 93 pictures if you’re the GIF above. By that count, if a picture is truly worth 1,000 words, that GIF is a tidy package of 93,000 words. Add to that the words you’re reading, and you have the world’s longest blog post. Honestly, I almost could’ve written 93,000 words in the time it took to make this GIF.

While I explain what it is, I’ll explain how it was made. I have the MRI images for most of my scans, in total I found/used eight sets of scans. Then, I made some pictures with my webcam of my profile and the top of my freakishly large head. If my math is correct, that makes 8+1 = 9 sets of images. Each set has roughly 10 pictures – including multiples of the original and duplicates of the fading shots. The sequence of the scans is chronological (For instance, a scan from 2010 would come after a scan from 2009, a scan done in May of some year will come before a scan…scanned in September of that same year…And so on).

The images are labeled with the reason for and date of the scan. I’d only point out the first scan from May, 2009 showing a big blob of white stuff just below the very center of my brain profile and slightly off center looking at the top. It’s almost as if someone tried to white it out. Really, it’s blood, the doctor injects you with the air from inside a blacklight, then your blood glows white.

The magnetic manipulation of the various cells and particles that form a mass called “Jarrett” (Magnetic), and the clicking and knocking noises (Resonance) labored to produce the this Image a few days after the hemorrhage.

The magnets and sounds continued their unlikely coupling through my skull on August 15, 2016, one day before my appointment with my neurosurgeon (I verbally sparred with both the doctor’s office and the insurance company for a month and had to reschedule twice, but that’s a different story altogether).

On the last MRI image, notice all the white out has been removed. When looking down from the top of my head, the “cavern” that the cavernous malformation called home is still a dark hole. I can only speculate that this is why I forget stuff almost as quickly as it pops into my head, it gets sucked into this vortex of blackest black, of darkest dark, of ebon opacity, of obsidian obscurity, etc.

Anyway, this GIF sums up seven years of the physiological side of brain injury recovery. I’ll stop writing now as this post has now reached a staggering 93,443 words.

This is all to say that my latest scans show no activity, and my recovery continues.

FIN (93,460 words if counting the number)

@JarrettLWilson (93,468)

Presenting – My…Presentation

I used to work at a middle school.

I’ve was employed there in some fashion for a number of years.

My first two years I taught 8th grade US history and coached boys’ athletics. The next year I taught 8th grade English and coached girls’ athletics.

At the end of that school year some blood vessels in my brain leaked like so much kiddie pool left to rot in the sun.

I taught 8th grade English for half of the next two school years. I came back the next school year as the assistant librarian and have filled that role for four years.

Assuming my math is correct (2+1+.5+.5+4), I’ve been working there for 21,554 years – this raises a few questions.

Firstly, I’m only 32 years old. Secondly, the school has only been there for 40ish years. Let’s round that figure down to eight school years.

I did so enjoy working with students. Thing is, I’m was’t like any of the other teachers/professionals in the school.

When I returned to teaching after the hemorrhage, I created a PowerPoint presentation about my condition to show to my class to prepare them for my uniqueness.

Recently, I had the opportunity to speak to the new seventh graders. I modified the presentation to fit my condition today. I thought I’d share it with you, the internet –

1

This is the title slide – note that it has the title written (in English, no less!) on it.

2

This slide is for a handout. The students were given the same graphic, but with blanks. In essence, they started with an empty brain and ended with a full one (symbolic, no?)

3

In the same fashion as the previous slide, the students filled in the blanks on the same graphic.

4

This slide is a pictorial representation (pictoriational?) of the functions of each lobe. For instance, the temporal lobe (orange) controls the instinct to swat things away from your ear (actually, that represents hearing), and the frontal lobe controls the confusion that comes from staring at gibberish on a sign post (actually, that represents planning).

5

Now we get to my contribution – you see, the seventh grade reading classes at the school where I work are covering non-fiction. They are reading Gifted Hands by Dr. Ben Carson – the brain surgeon that removed half of a girl’s brain. One of the teachers is a friend of mine and asked me to present my experience as a primer. The image in the slide is my brain (isn’t it beautiful?). The white dot in the middle is my cavernoma isn’t it (or rather, wasn’t it) ugly?

6

Not much to say about this slide that isn’t in the slide. I’ll just add that the symptoms listed are enough to get you a 20 minute helicopter ride.

7

Much like the image in the “My Brain Issues” slide – the head pictured is my head. My head is perfectly round and my brain has many different colors. I know what you’re thinking, “But Jarrett, there weren’t no color in the other image and your head ain’t perfectly round.”

I’ve a twofold reply to this comment. First of all, I was joking – that’s not my head. Secondly, you need to work on your grammar. Moving on, this one has info about the surgery. That fact weighed heavily in my decision to title the slide “The Surgery 9/2009.”

8

A few summers ago I went on a tour of a Nair factory – this happened to be the day that Gillette planned to sabotage the Nair factory. They set explosives…I’m tired of this explanation. It started off with promise, but now I hate it!

Truthfully, a few summers ago I wanted to see the scar, so I shaved my head.

9

This slide is linked to a file with moving pictures and sound! This “video” is about *drumroll* neuro-plasticity! A fancy term denoting the brain’s ability to form new connections.

10

This is a visual representation of how your brain thinks. For instance, you see a donut with your occipital lobe. That info shoots to your frontal lobe and activates your happy gland. Your happy gland shoots a message to your parietal lobe “GO GET THAT F’N DONUT!” Someone gets it before you can, so your temporal lobe tells you to break out your megaphone and shout obscenities at this person and threaten to call the police. This guy grabs a nearby napkin dispenser and wangs you in the Temple…

11

…That blow to the Temple gives you a TBI. Your brain rewires itself and finds an alternate route to your happy gland.

12

I included this slide to give the students an explanation as to why I sometimes shake when I speak and why I walk with a limp and hike up my left arm like so much Bob Dole. It also helps explain the little girl in the moving picture mentioned earlier. It also gave me a chance to…

Treating Hypertonicity with Pic

…mention the painful treatments. One thing I’ve learned from working in a middle school is that, as much as the kids want to be treated as adults, they still love to hear about people getting poked with needles and meeting a real life cyborg.

13

I like to pepper in some humor here and there to make sure the kids are awake. When this slide appears, it’s accompanied by a very loud, obnoxious laugh.

15

I don’t really do any of these anymore, but I mention it because I did it for so long, and it drives home the point that I’ve had a long road.

16

In my mind, all of these will someday be replaced with “Painfully normal”. For purposes of this presentation, it gives the students an idea of what to expect when they see me.

17

It can be difficult to work around young people with my disabilities. Instead of hiding or pretending that I’m no different, I encourage the students to come talk to me if they have a question. I want to think that I’m an ambassador for the disabled. Hopefully, these students will apply what I’ve tried to teach them to others with disabilities.

I included the last bullet because I’ve had some students speak very loudly and very slowly to me. You see, they have to tell me their student ID number to check out a book. In previous years, a student or two would speak to me as if I was unable to type and listen at the same time.

18

I’m a pretty smart dude and I can be pretty creative, but I didn’t discover any of this and I didn’t make this sh*t up.

If there’s one thing I learned in college, it’s that Keystone Light is super cheap and tastes like weedkiller. If there’s a second thing I learned in college, it’s that plagiarism is bad (I remember a syllabus that said there’s a special place in hell for those that plagiarize).

We try to instill that fear into the students, so I model the proper citing of sources.

FIN

@JarrettLWilson

Yad Sdrawkcab and The “Science” of Numoronology

This magic science employs elements of algebra, geometry, voodoo, music, lighting & poultry
Numeronology Logo with Border
This magic science employs elements of algebra, geometry, voodoo, music, lighting & poultry

A few weeks ago, everything got turned around on me. Literally. On Saturday, October 12th, a day that will live in ymafni, almost every piece of clothing I ventured to dawn came out backwards.

Let’s break this down so it kinda seems scientifical. Backwards day was October 12, 2013. My surgery was the third day of September, in that foul year of our Lord, 2009.

According to this website, 1501 days elapsed between those dates. Significance? 15+0+1=16. The 16th letter of our alphabet is ‘p’.  ‘P’ rhymes with, and is the first letter of ‘pee’ – which is what I must do now…

I’m back, moving on – ‘p’ is also the first letter of the word ‘polar’. In this case, polar has a dual meaning. On the one hand, it’s getting cold outside. We often use said word to denote extreme cold. On the other hand, polar is often placed in front of opposite to suggest something is out of order.

This brings us back to my clothes inversion excursion (exversion?). Anyway, the details are thus –

1# ecnatsnI – As per my usual Friday routine, I put gym shorts on under my pants. At some point that I don’t recall, I decided to put the shorts on both backwards AND inside out.

2# ecnatsnI  – I changed clothes after working out. Did I put the shirt on backwards? Yeppers. Did I fix the shirt to walk my dog? No.

3# ecnatsnI – I took the shirt mentioned in 2# ecnatsnI off after walking said dog and, being so unadorned, I deemed it uncouth to greet the visitor so gently rapping on my chamber door. Away to my dresser I flew like a turtle and grabbed a shirt. I carefully inspected the inside of the collar for the tag, swearing that, henceforth, I shall put my clothes on correctly.

Despite my oath, the damn shirt ended up going on backwards – I blame Fruit of the Loom (this blog brought to you by Hanes “You can’t put our shirts on backwards, we won’t explain how this is possible, you just can’t.”).

Continuing with our / numerilogical/historical/chronological(I will call this new “science” numoronology – notice the five letters after ‘nu’), the square root of 16 (being the sum of 15+0+1) is four. I took the square root because only “squares” where their clothes backwards.

Four is significant because that is the number of botox injections I got in my foot for the last treatment.

I’ve tried with little success to describe the pain that comes from injections in the foot – I’ll give it another shot. To experience this very unpleasant…uhh…experience follow this four step process –

1. Get a long, sharp object (i.e. a needle)

2. Take off your shoe

3. Take off your sock

4. Take the needle from step one and impale the bottom of your exposed for with it four f*cking times!

Please forgive my lack of creativity with that description. You see, I can think of no feeling, painful or otherwise, that compares to a needle stick (nay, four needle sticks) in the bottom of the foot.

However, the pain is worth it after the botox starts to work its magic on my toe flexors.

Listen, after my hemorrhage/surgery, some wires done got crossed and now my toes think my brain wants them to curl all the time.

My brain my or may not be sending a signal to curl so vigorously, but my toes are hearing “CURL, DAMMIT! CURL UNTIL YOUR TOES POINT BACKWARDS!”

Ok, let’s recap. I started by mentioning yad sdrawkcab (backwards day) and finished with curling toes. numoronology is a truly dizzying, convoluted science.

FIN

@JarrettLWilson

Oh yeah, in observance of NaNoWriMo, I don’t plan to blog for the month of November – toodles!

Medical Vernacular Spectacular!

Part of having a condition like mine is learning a lot of big words. I like big words and I like to write silly poems – seems reasonable to assume that I would double like a poem about big words. I haven’t written the poem yet, but I’m sure I’ll like like it. To that end, I’ll quit introducing and start writing the poem you’re about to read. One last note – I’m going to stick to a simple AABBCC rhyme scheme – Shakespeare I amn’t. I’m going to italicize the terms to set them apart.

The medical field uses words that are big and complex,

For instance, raising you for at the able is called dorsiflex(ion) :).

The above word is one of the many that end with I-O-N,

Proprioception is a word that I use often;

It’s a big word for knowing where your limbs are in space.

Circumduction is another I-O-N, it affects walking pace.

When the knee doesn’t want to bend, the leg swings;

If I’m not careful, I’ll start to kick things.

Yet another I-O-N is ambulation;

Or you could say “walking”, if you value concision

Walking is made more difficult by the symptoms of spasticity.

Incontinence is when you have trouble going pee-pee,

“Pee-pee” is a silly word for releasing fluid that is pent.

The fancy term for pooping is “bowel movement”.

There is also a tube for moving pee-pee and other fluids hither and thither,

The fancy word for this tube is catheter.

There’s an intrathecal catheter delivering medicine to my spine ,

The catheter carries medicine from a baclofen pump to help me feel fine.

At first, the needle caused my spine to leak,

But thanks to a blood patch twas fixed in about a week.

To get the blood for the blood patch, the nurses set a Mid line,

The needle went so deep into my arm, I felt like dying.

Medtronic is the company that makes my pump.

Ataxia, or loss of balance, makes it difficult to jump.

Seeing two of something is called double vision or diplopia.

Seeing two of something is called double vision or diplopia.

Dysphagia is one of the fanciest medical terms I know,

It’s easier just to say “it’s hard to swallow”.

Let’s not forget the word for constant muscle contraction,

Hypertonicity is the word given to this action

I owe this list of words to the Pons region of the brainstem,

Without having a major hemorrhage there. I wouldn’t have learned them

This concludes the list

Did you get the gist?

I know I left some off, but I’m happy with this list, short as it may be. I think I explained the meaning of the words pretty well, but here’s a list with definitions just in case –

Dorsiflexion: This is when a door opens – I jest. Quite simply, it’s bending your ankle so that your foot/toes goes up

Proprioception: Obviously this describes a professional at “priocepting”, and as we all know (right?), prioception is the ability to perceive of a Toyota Prius. Actually, it’s your perception of the relative position of some body part.

Circumduction: The Romans came up with this one. Circ is Latin for “Pringles” (they’ve been around for a while). Um is Latin (and every other language ever for “WTF?”). Duction translates to “talking with one’s mouth full”. In essence, when in Rome, it’s not cool to talk with a mouth full of Pringles. Truthfully, it’s when the leg swings outward because the knee won’t bend enough to clear the ground.

Ambulation: Walking

Spasticity: Tremors caused by constant muscle activity

Incontinence: When you’re not on a continent. Examples – swimming in the ocean, flying on a plane or exploring outer space. A less awesome and more truer answer is when you can’t pee

Bowel movement: Pooping (heh, poop)

Catheter: This one was adequately covered above – it’s just a tube

Baclofen pump: A hockey puck shaped machine that delivers sweet, sweet baclofen (muscle relaxer) to the spine

Blood patch: The use of blood to patch a leak in the spine. I asked them if they could just use tape. They laughed derisively and said we could, but then we won’t get to set a…

…Mid line; thereby IMPALING my right bicep to harvest blood from a deep vein

Medtronic: A science fictiony name for a company that makes baclofen pumps

Ataxia: The IRS’s answer to whether or not there’s a tax for some object. E.g. “Is there a tax for asking stupid questions?” IRS reply: “A tax, yeah.” That, or loss of balance.

Diplopia: This one means double vision, I don’t get it. When I think of the word “plop” I think of poop splashing into the toilet.

Dysphagia: Saying disparaging remarks to some named “Phagia” – she(?) will punch you in the throat and make it difficult to swallow.

Hypertonicity: Similar to “spasticity” – constant muscle contractions.

Pons: Latin for bridge due to its position between the cerebellum and the cerebrum on the brainstem (that sounded pretty scientifical, eh?)

Hemorrhage: Internal bleeding, which, when paired with the term above, can create everything above that. Basically, it’s at the bottom of everything (symbolic, no?)

FIN

@JarrettLWilson

Presenting – My…Presentation

I work at a middle school.

I’ve been employed there in some fashion for a number of years.

My first two years I taught 8th grade US history and coached boys’ athletics. The next year I taught 8th grade English and coached girls’ athletics.

At the end of that school year some blood vessels in my brain leaked like so much kiddie pool left to rot in the sun.

I taught 8th grade English for half of the next two school years. I came back the next school year as the assistant librarian and have filled that role for going on three years now.

Assuming my math is correct (2+1+.5+.5+3), I’ve been working there for 21,553 years – this raises a few questions.

Firstly, I’m only 32 years old. Secondly, the school has only been there for 40ish years. Let’s round that figure down to eight school years.

I do so enjoy working there and continuing to work with students. Thing is, I’m not like any of the other teachers/professionals in the school.

When I returned to teaching after the hemorrhage, I created a PowerPoint presentation about my condition to show to my class to prepare them for my uniqueness.

Recently, I had the opportunity to speak to the new seventh graders. I modified the presentation to fit my condition today. I thought I’d share it with you, the internet –

1

This is the title slide – note that it has the title written (in English, no less!) on it.

2

This slide is for a handout. The students were given the same graphic, but with blanks. In essence, they started with an empty brain and ended with a full one (symbolic, no?)

3

In the same fashion as the previous slide, the students filled in the blanks on the same graphic.

4

This slide is a pictorial representation (pictoriational?) of the functions of each lobe. For instance, the temporal lobe (orange) controls the instinct to swat things away from your ear (actually, that represents hearing), and the frontal lobe controls the confusion that comes from staring at gibberish on a sign post (actually, that represents planning).

5

Now we get to my contribution – you see, the seventh grade reading classes at the school where I work are covering non-fiction. They are reading Gifted Hands by Dr. Ben Carson – the brain surgeon that removed half of a girl’s brain. One of the teachers is a friend of mine and asked me to present my experience as a primer. The image in the slide is my brain (isn’t it beautiful?). The white dot in the middle is my cavernoma isn’t it (or rather, wasn’t it) ugly?

6

Not much to say about this slide that isn’t in the slide. I’ll just add that the symptoms listed are enough to get you a 20 minute helicopter ride.

7

Much like the image in the “My Brain Issues” slide – the head pictured is my head. My head is perfectly round and my brain has many different colors. I know what you’re thinking, “But Jarrett, there weren’t no color in the other image and your head ain’t perfectly round.”

I’ve a twofold reply to this comment. First of all, I was joking – that’s not my head. Secondly, you need to work on your grammar. Moving on, this one has info about the surgery. That fact weighed heavily in my decision to title the slide “The Surgery 9/2009.”

8

A few summers ago I went on a tour of a Nair factory – this happened to be the day that Gillette planned to sabotage the Nair factory. They set explosives…I’m tired of this explanation. It started off with promise, but now I hate it!

Truthfully, a few summers ago I wanted to see the scar, so I shaved my head.

9

This slide is linked to a file with moving pictures and sound! This “video” is about *drumroll* neuro-plasticity! A fancy term denoting the brain’s ability to form new connections.

10

This is a visual representation of how your brain thinks. For instance, you see a donut with your occipital lobe. That info shoots to your frontal lobe and activates your happy gland. Your happy gland shoots a message to your parietal lobe “GO GET THAT F’N DONUT!” Someone gets it before you can, so your temporal lobe tells you to break out your megaphone and shout obscenities at this person and threaten to call the police. This guy dressed a nearby napkin dispenser and wangs you in the Temple…

11

…That blow to the Temple gives you a TBI. Your brain rewires itself and finds an alternate route to your happy gland.

12

I included this slide to give the students an explanation as to why I sometimes shake when I speak and why I walk with a limp and hike up my left arm like so much Bob Dole. It also helps explain the little girl in the moving picture mentioned earlier. It also gave me a chance to…

14

…mention the painful treatments. One thing I’ve learned from working in a middle school is that, as much as the kids want to be treated as adults, they still love to hear about people getting poked with needles and meeting a real life cyborg.

13

I like to pepper in some humor here and there to make sure the kids are awake. When this slide appears, it’s accompanied by a very loud, obnoxious laugh.

15

I don’t really do any of these anymore, but I mention it because I did it for so long, and it drives home the point that I’ve had a long road.

16

In my mind, all of these will someday be replaced with “Painfully normal”. For purposes of this presentation, it gives the students an idea of what to expect when they see me.

17

It can be difficult to work around young people with my disabilities. Instead of hiding or pretending that I’m no different, I encourage the students to come talk to me if they have a question. I want to think that I’m an ambassador for the disabled. Hopefully, these students will apply what I’ve tried to teach them to others with disabilities.

I included the last bullet because I’ve had some students speak very loudly and very slowly to me. You see, they have to tell me their student ID number to check out a book. In previous years, a student or two would speak to me as if I was unable to type and listen at the same time.

18

I’m a pretty smart dude and I can be pretty creative, but I didn’t discover any of this and I didn’t make this sh*t up.

If there’s one thing I learned in college, it’s that Keystone Light is super cheap and tastes like weedkiller. If there’s a second thing I learned in college, it’s that plagiarism is bad (I remember a syllabus that said there’s a special place in hell for those that plagiarize).

We try to instill that fear into the students, so I model the proper citing of sources.

FIN

@JarrettLWilson

On a More Seriouser Note

The following is an article I wrote to submit to magazines – unfortunately, People turned me down.

My previous entry about botox generated a buzz on the Bookface and it weren’t even scholarly. This one is more informativer and could prove to be more helpfuler.

Be warned, this article is long and boring.

 

To Botox or not to Botox?

 Wouldn’t it be nice if there was a catch-all medication for the symptoms that occur after a brain injury or stroke? Alas, the symptoms and deficits left in the wake of such an event are so varied that such a medication would have to address thousands of symptoms. One such symptom that I continue to experience, resulting from a hemorrhage and surgery back in 2009, is spasticity, or “motor dysfunction arising from upper motor neuron lesions… significantly interfer(ing) with body image, balance and gait.”*

A common treatment for spasticity is botulinum toxin. This treatment involves vials of this toxic substance and several needles. I won’t sugarcoat it, you become a human pin cushion; I’ve had to endure as many as 15 injections in my left leg (yes, that includes my foot) and left arm.

I continue to endure this treatment because, for me, it works. However, there are some shortcomings to this treatment – that is to say, there are areas where botulinum toxin falls short; this has been my experience and the research backs me up. Before I discuss the strengths and weaknesses of botulinum toxin, I’ll tell you more about the general applications of botulinum toxin.

General Information

The consensus according to the medical literature is that botulinum toxin does work, the degree to which it helps varies depending on: 1. Where it’s injected, 2. The dose, and 3. Active vs. Passive outcomes (more on this later). Concerning the injection location, studies are divided into upper limb outcomes and lower limb outcomes. Much of the current research looks at the effect of botulinum toxin in the upper limbs (elbow, wrist, finger flexors, etc.). What little research there is for lower limb outcomes shows an improvement in gait, speed, stride length and standing posture.* Dosing is pretty straightforward – a bigger dose produces better results. With a higher dose comes the question of side effects. I’ve not experienced any of these, but it’s possible for 1. The botulinum toxin to seep onto surrounding muscle – causing them to become weaker, 2. A muscle to receive too much botulinum toxin, making it difficult to use; thereby stifling any therapeutic advantage, and 3. Building an immunity to botulinum toxin.** Moreover, a higher dose does not increase the duration of the results; there doesn’t appear to be any correlation between the amount of medicine and the length of time that spasticity symptoms subside.***

Passive vs. Active Outcomes

Improvement is not easy to define. Outcomes are often classified as “active” or “passive”. Active improvements refer to a measurable change in some activity (a timed walk, putting on a shirt, etc.). Passive improvements report changes in spasticity symptoms at rest. The former are measured by a therapist or doctor using one of various tests of function; the latter can be observed and reported by a therapist or doctor, but are more often expressed by the patients,*** or caregivers.**

As previously noted, treatment is divided into two zones: 1. Upper limb, and 2. Lower limb. This being the case, the results of botulinum toxin treatment fall into four categories: 1. Upper limb active outcomes (functional improvements, such as getting dressed faster or completing household chores more quickly), 2. Upper limb passive outcomes (relief from the spasticity symptoms, etc.), 3. Lower limb active outcomes (stride length, speed, standing posture, etc.), and 4. Lower limb passive outcomes (relief from spasticity in the lower limbs).

Upper Limb Outcomes

There is no shortage of data available that focuses on upper limb responses to botulinum toxin treatment. Although they all have different results, there are a few constants –

1. More botulinum toxin = better results

2. More botulinum toxin ≠ Longer duration of results

3. Despite the outcome of any functional measurement, patients report being more comfortable

4. Combining therapies (electronic stimulation, physical therapy, wrapping, etc.) will produce better outcomes, both in terms of active and passive.

Active outcomes are a mixed bag. A report analyzing data from several studies of botulinum toxin treatments for both upper and lower limbs found “no significant functional improvement” in five out of ten studies. Eight out of the ten reported “significant reduction” in symptoms related to spasticity; four of those eight specifically mention an increased range of movement in the fingers, wrist and/or elbow.*

A first-hand study found similar results; including, “significant reduction in spasticity at the wrist and fingers with a greater range of passive movement at the wrist and less finger curl at rest.”***

These findings suggest that botulinum toxin may not help much in terms of functional activities (i.e. getting dressed), but there’s a pretty good chance that these injections will relieve some of the passive symptoms of spasticity.

Interestingly, some patients reported and were observed to have a better walking pattern due to upper limb injections. It is believed that this unintended effect was the result of “better walking symmetry.”***

My Upper Limb Experience

When I started getting botulinum toxin injections, a small part of me hoped that the injections would completely restore my dexterity and coordination, or at least make my left arm more useful. I did get a little more use out of it, but at the time, the improvement was not enough to justify continued treatment.

I have since continued with upper limb treatment with the understanding that my arm won’t be lot more useful, but I will get some relief from spasticity. My experience with lower limb injections has been more successful from a functional standpoint.

Most of my injections go to my left leg. My doctor will often inject what is needed in my leg first, then whatever is left goes to my arm. Therefore, most of the experience I will relate will be with the leg.

Lower Limb Outcomes

Published research for lower limb botulinum toxin injections are generally positive. In an article from Neurology, researchers pooled data from multiple studies and found that injections in the hamstring and calf were effective in improving gait.**

With lower limb results, passive outcomes often lead to active outcomes. For instance,

“While correlation has been observed between muscle tone reduction and gait parameters, significant improvements have also been reported for walking speed, stride length and premature activity of soleus muscle after injection.”*

Studies that report the effects of lower limb outcomes tend to focus on issues associated with spasticity below the knee.

In the case of the thigh, studies have found some improvement in functional outcomes with hamstring injections and adductor injections.**

Most of the research regarding botulinum toxin in the lower limbs focuses on injections in the gastrocnemius (calf). One study in particular reported “Improved gait over 1 to 3 months.”** Other studies document similar results. Specifically, a study of 12 patients with spastic calf muscles showed improvement in “Velocity, stride length and stance symmetry.”***

My Lower Limb Experience

Spasticity in my left leg makes it difficult for me to walk. Without the injections, it’s difficult for me to raise my foot (ankle dorsiflexion), causing my foot to drag. In terms of function, the injections help smooth my gait by making it easier to lift my foot. Spasticity also causes the toes on my left foot to constantly curl, making them sore. I get relief from this discomfort, (note: to relieve spasticity in the toe flexors, I have to get shots in the bottom of my foot – painful, yes. Worth it? Absolutely.)

I can’t offer much information regarding injections into the hamstring. Although I have gotten them in very small doses, my doctor typically advises me to inject more into the calf muscle. The problem with the hamstring is that, if injected with too much botulinum toxin, the hamstring will be too weak for standing and walking.

I like benchmarks to measure improvement. At the end of last year I decided to time myself as I walked the perimeter of my apartment complex (roughly 1/4 mile) – my time shows an improvement when within the window of botulinum toxin’s greatest effect (10 days to two months after injection). As of this writing, my last botulinum toxin treatment was Thursday 1/03. My average time on the walks before then is 8:10. The average time for walks from the two months after the injections is 7:56. Not only do I move a bit quicker, but I feel like I’m walking much more smoothly. Both of these are due to increased dorsiflexion in my ankle – I don’t drag my foot as much.

Closing Thoughts

Like with any treatment, it’s always better to be informed and aware of what to expect. That is especially the case with a treatment like this one. Most people don’t enjoy getting one shot, let alone a dozen or more.

It is debatable how much more function you might gain, but both research and I agree that you will get some relief – worth a try while we wait for a treatment that covers every symptom of stroke/ brain injury.

*Ozcakir, S., & Koncuy, S. (2007). Botulinum Toxin in Poststroke Spasticity. Clinical Medicine & Research, 5(2), 132-138.

**Simpson, D. M., Gracies, J., & Graham, H. K. (2008). Assessment: Botulinum Neurotoxin for the treatment of spasticity (an evidence-based review): Report of the therapeutics and technology assessment subcommittee of the american academy of neurology. Neurology, 70(19), 1691-1698. Retrieved from http://www.neurology.org/content/70/19/1691.full.html

***Smith, S. J., Ellis, E., White, S., & Moore, A. P. (2000). A double-blind placebo study of botulinum toxin in upper limb spasticity after stroke or head injury. Clinical Rehabilitation, 14(5), 6-13. Retrieved from http://cre.sagepub.com/

Still here

Well, I haven’t posted in a while, not because I’m lazy, but because I have been ” busy”, but definitely not because I’m lazy *shakes head profusely*. Because it’s been so long, I have changed the background to a new spiffier design (you’re welcome).

Since I don’t have all day and I am very “busy” I will fill you in over the next few days over what has happened since my last post.

So what category should we choose today, Alex? How about we talk about the therapy for 10. I say 10 because that is the number of shots I got for my last Botox treatment. Four in my arm and six in my leg on the left side. Aside from the very unpleasant experience of the shots, there have been several very good outcomes –
1. My doctor prescribed more physical therapy which I hadn’t done for four months or so, it felt good to get back on that horse.
2. The tone on my left side, including my left elbow, my left ring finger and my left pinky have gotten significantly better. My left ankle seems to have benefited, but my toes still curl quite a bit and I still have a tremor.
3. I have no fear of improperly packaged food items because I’ve been pumped so full of botulism that I am probably immune by this time.
4. Mathematically, I have learned that one shot sucks times one; and 10 shots are 10 times worse. I think I should get math certification based on that simple formula. Think of it like this, if a toffee fudge blizzard is awesome, 10 toffee fudge blizzards would be 10x as awesome. There, I have applied it and taught it, SBEC are you listening? Also, here is a science lesson – if one toffee fudge blizzard gives you brain freeze, 10 toffee fudge blizzards will gives you brain freeze 10 times worse, assuming the rate of consumption is constant.

Therapy itself has been a boon for me, both mentally and physically. Instead of goals like walking and sitting up straight, I’ve moved up to goals like running and typing faster than a snail. While I haven’t reached these yet (snails type fast!), I feel myself getting stronger and stronger, I might even turn green soon. My PT sessions consist mostly of stretches and walking for two purposes –
1. Get the strength/balance to run.
2. Stop left leg circumduction (prevent the foreskin from falling off my leg) .

Actually, circumduction = swinging my left leg outward, rather than bending my knee; this problem along with knee hyperextension has led to the need for a knee brace. I haven’t gotten it yet, but I have high hopes. Apparently, Sherman is a geographical oddity as concerns knee braces, one week from everywhere. I have learned patience from this process, but when it comes to things that might fix me, I want it NOW!

Occupational therapy consists of regaining my former strength/coordination in my left arm and improving my penmanship so my writing doesn’t look like it was done by a drunken three year old.

I feel lucky with my team of therapists, they seem genuinely concerned with helping me reach my goals AND ensure my success in the classroom, they also give me candy!

I can’t think of anything else to report about therapy at this time, so I’m going to sign off, ciao!

@JarrettLWilson

Holding Nothing

I am sitting at Panera bread right now, where I’ve had several delusions of normalcy. Yesterday, my physical therapist took me off the cane, so when I am just standing or sitting I tend to forget my deficits without the cane to remind me.

Anyway, my left leg twitches, and my left arm hangs as if I’m holding something (but I don’t hold stuff in my left hand unless I want to drop it). I’ve asked several people if they would just cut off my left side, I’ve even offered cash! Alas, no takers, my left leg lives to twitch another day and my left arm continues to hold nothing.

Quinn and I went to a pumpkin patch outside Chandler, Ok Saturday. We both had a good time. Q got to ride a pony and pet lots of animals. There was a corn maze that could’ve been very traumatic for some kids had I not had the cane. My left arm up carrying nothing, my short, punctuated steps, I looked like a zombie! I refrained from eating brains though (Ryan’s looked tasty).

Hands hurt,see ya!