Hyperreflexia, Memory, Neurological Disorders, Pain, Spasticity, Spinal Cord Injury, Writing

Top 5 Challenges in SCI Repair

Here are the top five challenges in the race for a cure for SCI:

  1. Post-injury survival – Keep nerve cells that survive the initial injury alive and healthy
  2. Regeneration and growth – Promote the re-growth of injured nerve cells and their fibers
  3. Axon pathfinding – Guide growing axons toward their normal targets (i.e., muscles or other neural tissues)
  4. Electrical conduction – Nerve cells must conduct electrical impulses with reliability and fidelity to carry information needed to execute complex tasks
  5. Synaptic connection –  Axons that reach their targets must connect and stabilize a line of communication

Progress: In my opinion, in more than 10 years in this field, I firmly believe that we’ve grown exponentially in terms of knowledge and application for milestones #1, 2,  3, and 4. And this is great news because this means that we are more than halfway toward fixing SCI. In fact, there are ongoing clinical trials in various parts of the globe investigating ways to increase the survival of nerve cells (a critical first step!), enhancing the growth of spared fibers, and guiding those axons toward their normal targets.

Next Steps: While less is known about how to promote re-connections between injured nerve cells and their targets (#5), we have a firm grasp on the molecular mechanisms involved in this challenge. We know that specific proteins interact in the growing nervous system (i.e., those that functioned when you were still in the womb, or just an infant) and that they turn-off, don’t work, or are non-existent in adulthood. So, in essence, we need to learn how to turn these switches back on, or replace them with functional ones. While no easy task, there are emerging tools to do this, including genetic therapies which has become a huge advancement and addition to our repair tool box.

What I expect: In the next few years, we will see some very big pushes on various research fronts in the SCI battle space. I think the biggest successes and those soonest to arrive will be in the form of new strategies designed to overcome many of the serious quality-of-life issues associated with SCI, including pain, reflex disorders, and poor autonomic function. Hang on; stay alert; stay hopeful!

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Academia, Existence, Missions, Philosophy, Problems to Solve, Prose, Storm, Thinking, Wisdom

A Day Off

I’ve slowed down my blogging to focus on priorities in my work schedule. I’m preparing to write a grant and rearing to dive into a new project. Also had a few projects end nicely with publishable results. So in all, April has been a perfect storm of activity.

I sit right in the middle of the eye of it right now.

Calm, but swirly, if I can call it that. That’s how I feel. Whew. Someone once said to me that “…in life, you’re either coming out of a storm, in a storm, or about to enter a storm.”

Brilliant. A bit cynical, but ingenious and true. So, I think I’m somewhere in the exiting part of it.

That in itself deserves a kind of celebration, a day off, and thank goodness I really did get a cold yesterday–had an extra, extra excuse to take a day off. A day off to think, to ponder, to reflect, to gather myself up again; gain those steely eyes and the rock solid determination to slap the next project in the face and find out what’s going on in this nasty disease we call neuropathic pain and spasticity.

My day off… I think I’ll take another one tomorrow. It’s Good Friday, for realz.

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Academia, Missions, Neurological Disorders, Pain, Problems to Solve, Spinal Cord Injury

Digging for treasure

I suppose it’s time to write something about my day. Just a quick note, a slice  of my 24 hours.

I’m now in the laboratory, sitting at my desk, thinking that I need to do more research. After my talk yesterday, I received a few questions and critiques regarding my next steps for my project.

The run down: I’ve built a firm foundation that I can rest my thoughts upon. The foundation are a series of papers I published that demonstrate a structural substrate, or medium, for the abnormal sensory sensations processed by the nervous system after injury (or disease).

Now that I’ve built this ‘floor’, I’ve been encouraged to explore targets that could test that foundation. Find the cracks, as it were. In order for me to do that, I have to go back to the drawing board; find out where there is a gap in my knowledge in my conceptual model.

To do this, I need to read. I need to read the plethora of literature regarding the possible mechanisms, or machinery, that may control what is happening inside the injured spinal nervous system. There is so much.

In the past, I’ve been able to focus my quest by the simple method of asking simple questions. So, now I will pose one as I dig into the netherworld of the internet databases, where decades of published work may reveal something useful for me.

I’m on a scavenger hunt, but I don’t know what I’m looking for. Not yet, anyway. How exciting….

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Academia, Coffee, Compassion, Missions, Neurological Disorders, Problems to Solve, Spinal Cord Injury, Writing

Steadfast, moving forward

I failed to meet my goal to maintain a posting frequency of one per day. I knew it was unrealistic given the workload I have in the lab. My well-being improves when I’m away from a computer as well (i.e., long-term desk work is bad for your health). Don’t get me wrong, I can be a prolific writer. I can dump my thoughts on a page and have you all read my freely associated mind boggles straight-up like a shot glass of 200 proof ethanol. Yes.

In other news, I’ll just say that drinking coffee chronically and then stopping abruptly is dumb. I couldn’t keep my head above my shoulders for more than 20 minutes this weekend. I’m back though.

In the lab today…

I presented my research to about 20 of my peers, including the director of the research Center. I’m happy to report that I’m alive with my ego intact. I’m at peace with my ideas; the tearing and gnashing of my conceptual approach did not happen. So, now that I’ve got the proverbial green light to continue moving forward, I shall.  I’d like to thank my friend, mswestfall who authors the blog My Unplanned Life, for her moral support over the weekend.

Now, I’m moving forward with writing a cover letter to an editor of an academic journal. I’d like to submit my report for publication in this journal. It would be really kind of them to accept my work there, because that would get the word out about what I do in the lab. It’s such a pleasure when people hear what you have to say, understand it, and then somehow apply it. Feels good to know my thinking is relevant and useful and that people agree. We’ll see….

Steadfast

I had a thought about how I had become steadfast in my work. Not always like this; not really. When I was younger, just a few years ago, I used to become anxious that I wasn’t doing a good enough job. I’d work hard, then I’d feel that I had done, inadequately. That was what drove me. It was a feeling of fear or anxiety in my job.

No longer true. I’m more confident than before, hence, I feel more “free” to explore my ideas, and know that should I choose, I have the technical capability to execute. This is maturity, I think, and what a silly ladder we climb. I’m not even sure I need to consider this stuff anymore. Just go. Step. This is how I live now I suppose; within this routine of work, rest, work, and final rest. Bad things happen in my job, failure in an experiment, but I keep moving.

A lesson of wisdom, perhaps. I’m pedaling a bicycle, up and down, but the end result is forward motion. I know I’m moving forward, metaphorically, because I see the anchors and milestones behind me. Alas, as a scientist, as a human, I’m steadfast, moving forward.

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Academia, Hyperreflexia, Memory, Missions, Neurological Disorders, Pain, Problems to Solve, Spasticity, Spinal Cord Injury, Writing

Spinal cord memory: a next step forward?

I study spinal cord injury (SCI). It’s been a journey I’ve taken for myself these past many years, 8 or so. There are some ideas that don’t leave you; they get stuck up there in the dark crevices, like a bit of juice in a city gutter. It’s a mix of all stuff you’ve read, heard, or thought about.

Here I am. I need to start somewhere with this. But, this has been on my mind for 2-3 years…. trying to flesh it out.

The brain is a computer.

As a computer, the brain has the biological mechanisms for storing information. We call this memory. The idea that the brain is a memory machine is old, ancient, really. It’s part of our everyday understanding of what the brain does. It takes information, processes it, then stores it for recollection (remembering) later.

Now, what most people don’t know is that the spinal cord also “remembers”. The spinal cord also contains the same machinery that the brain has when it comes to forming and storing information (i.e., memories).

I’ve been exploring the idea that memory can go wrong.

‘Memory is linked to pain’ is well understood, if you think about it. Do you remember what it’s like to get a paper-cut? More interesting, do you remember what it’s like to be betrayed by a friend, or feel guilty, forms of emotional pain?

Inside the spinal cord are memory systems. Injury or disease, like SCI, can disrupt these systems, putting them into a kind of over-drive. The neurons no longer process and output electrical information normally. Turn on the radio, you hear music. Switch to a channel that has no information, or poorly received information, and you get static. That’s what we call neuropathic pain in the most basic sense: the absence of good information and amplify whatever noise is left.

Maybe, the same thing is happening there in the motor system, the machine parts that control movement. While some people with SCI don’t feel any ability to move, they are weak or even paralyzed; there are other individuals with SCI that have too much movement. Their muscles do not react voluntarily, moving or twitching on their own (some may call this “dystonia” or “myoclonus”). The intensity of these muscle contractions, or twitchings, could be of such great intensity that it’s actually painful or uncomfortable. There’s no relaxation posture or state of the muscle; it’s constantly active.

Here’s what I think is going wrong. Like the analogy I used for neuropathic pain (see above), the electrical activity in the neurons that control muscles is abnormally activated. They are over-excitable, as we like to say in the field.

Why are they over-excitable, which causes them to make muscles contract involuntarily, even painfully?

So many reasons. No laundry lists here. Here’s my take on it the problem….

The body is alive. It is constantly healing itself against insults the world throws at it. Your skin regenerates automatically when you cut yourself. When you break a bone, the doctor doesn’t “heal” you, your body does. All the doctor does is make sure your bones heal themselves, correctly.

I tell you this so you know that the spinal cord does heal itself. We call this spontaneous regeneration. This happens all the time after SCI. For example, after the initial injury, a patient (or in my case, a rodent) undergoes a period of dramatically lost function, also known as spinal shockThis can be painful, uncomfortable (I’m using really weak adjectives, forgive me).

Overtime, however, the subject regains some function. This is due to two major things happening, we mostly think. First, balances of chemicals and electrical properties of the nervous system slowly return to a state where things that aren’t cut-off can function (albiet not 100%) and transmit information again. Second, those neuron that do survive and not directly injured by the SCI have an internal ability to spontaneously grow. Some types of cells are more capable than others, and certain chemicals need to be available, but generally, all neurons in the spinal cord have some capability, even in the adult, to grow or spontaneously regenerate.

Spontaneous regeneration, also known as reactive neuronal plasticity, appears to be a good thing. 

And it is. It’s the body’s self-healing process. But sometimes, it can go wrong. In my studies, I examine how the internal capability of neurons to spontaneously form new connections and regrow can lead to serious disorders after SCI. Using a broad brush explanation, for example, if a pain cell receives too many connections from the wrong place, then excess pain can be a result. The same is true for muscle function. If a cell receives too much information from a spontaneously regenerated nerve, then we might expect those muscles to have too much stimulation.

What bursts my mind is that this all happens internally, deep in the bowels of the spinal cord. Unlike a broken bone, in which a doctor can intervene by making a cast to hold the broken parts close together, allowing them to regenerate and heal back into the normal, original shape, we can’t do that with the broken spinal cord. Not yet.

It’s a musical orchestra in there….

There are many circuits that are impacted by SCI. We, as the research field, are struggling to dissect what wires go where. Let’s say…I take my laptop and throw it on the floor. It doesn’t break, not entirely, but the keyboard doesn’t work anymore. How do I know how to fix it, if I don’t know where all the wires are supposed to go?

I’m now looking at how my studies in neuropathic (nerve) pain are similar to what goes wrong in the motor system that leads to really annoying, painful, or uncomfortable problems. Many bodily systems require a huge orchestra of neurons working in concert with each other. I’m basically taking apart the orchestra, starting with the flute section.

Yes. Let’s play on.

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Academia, Career, Humor, Philosophy, Wisdom, Writing

No time to consider

It’s good I’m not a doctor, the kind with patients.

Why? I’m afraid to be proven wrong. I’d rather tell the truth as I see it. As a neuroscientist, I’m very good at observation and coming up with hypotheticals (so says me). But I shy away from most absolute statements without some argument or evidence to back it up. Without hard data, phrases like “maybe…” or “you got me, bud” seem to fit my style.

Can stethoscope-wielding doctors say stuff like this to their patients? That’d be borderline rude, I think. Let’s imagine for a moment….This is me as a clinician using the concept of you-got-me-bud:

“I don’t know.”

Seriously.

We’re different; scientists, I mean. We can say it like it is without repercussions (usually). Objective observation wins our day, and it’s even better when the results are unambiguous (a rare thing).

My graduate advisor a long time ago had told me that I’m allowed to make one assumption per experiment. This is what I do. I make one guess, and spend the rest of my time proving (or disproving) if I’m right.

“I don’t know, ” is the most powerful sentence a person can use. It’s requires humility. The second is, “I will do my best to find out,” which can be inspiring. True humility breeds inspiration.

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Academia, Career, Compassion, Faith, Pain, Philosophy, Spinal Cord Injury, Wisdom

Compassion in Science (about Pain)

I awoke to find my wife in pain. She had broken her wrist earlier in the month, and had just accidentally knocked her arm into the side of the door by the bathroom.

On top of this, she had a wisdom tooth removed by a dentist. The procedure had complications and the result was chronic inflammation and pain on the left side of her face. She now takes Vicodin, daily, wears a brace for her wrist, and has missed several days of work already.

We had a conversation this morning about her pain after she recovered from the smack with the door jam.

“I think I understand why people get depressed,” she said–“when they have chronic pain.”

“And for some people it doesn’t go away,” I replied.

“I know,” she said. “I’m okay.”

I felt better when she said she’d be fine. It would be a few weeks, but her injuries are minor and will heal completely. Soon, and truthfully, we will both forget a lot of the discomfort this brief experience into daily pain and the interruption it brings into our home.

This is why I write now, to remember–that what I do in the laboratory has greater importance, and is done in the awareness that I must approach this type of work diligently.

I know there are so many challenges ahead, including personal issues with this kind of work (I’ve talked about this in other posts); there is something else that pushes me. I’m not 100% entirely sure what that is. But nonetheless, I want to work with compassion in my SCI research. I truly do want to know that it goes beyond the paycheck, the tedious paperwork, the politics, and can make a difference–even just a small one.

This is something I’ll keep in mind today when I head into work. I’m not helpless here. I’ve got an idea.

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