Move on or move out

I recall from my old biology days that the one differentiating factor between plants and animals is that animals have the ability to move. Over the years I’ve come to respect that movement not only reflects life but is also life enhancing. An animal that is wounded disengages from life and seeks a quiet place free of disturbance where the need or expectation to move is minimized – the wounded lion seeks a dark cave in which to rest, recover and regain its strength. Paralleling this ‘sickness behavior’ is a change in the metabolism of the animal – it moves into a catabolic state in which it breaks down its own protein, passes less urine, sodium levels drop and potassium levels rise in the blood. This well recognized post- traumatic metabolic state also occurs following surgery. Additionally sickness behavior also occurs in extreme negative psychological states (which may also be post-traumatic) and are similarly mediated in part by the inflammatory mediators.

Remarkably, as the healing phase begins, the metabolism changes to anabolic – protein begins to be synthesized, sodium levels rise and potassium levels return to normal. It’s at about this point that the animal begins to take an interest again in the surroundings. In the human animal we are familiar with the ‘positive lipstick sign’ – women patients put on lipstick before the morning ward-round. This usually occurs on about the third day following surgery when healing is well underway.

Several years ago I researched and wrote an article describing how movement maintains health. I uncovered much evidence to show that enhanced neuro-muscular activity promotes cellular function and accelerates healing. Conversely, states of immobility which result from either physical impairment and/or compromised psychological states such as depression, either prolong illnesses or in certain cases even precipitate them. Consequently one of the critical factors in my clinical approach has been the drive to early mobilization of my patients. I’m known as the surgeon with the ‘steel fists in velvet gloves’. Obviously one needs to respect those patients who require the extra day or two to emerge from the phase of sickness behavior, but thereafter it’s all go. We set an important goal for our spinal patients – to mobilize them so that they can climb the one flight of stairs and get to the coffee shop!

Indeed in my own personal life I have always been active in some form of motor activity (generally I was my own motor!). In the early days this was intuitive. Only later when insight was gained, did I ensure that activities were sustained.

Unfortunately, the nature of my work involves treating and rehabilitating those who have suffered permanent neurological loss such as paraplegia and quadriplegia. But even in these unfortunate individuals, the maintenance of all the movement that they have needs to be promoted and sustained. I recall a quadriplegic patient of mine whose only movement remaining in his limbs was pronation of his left hand. Confined to a wheelchair, we managed to create an attachment to his left hand whereby he was able to punch the keys on a keypad. The result was that he was able to run his company – with just the pronation of his left hand. Unfortunately he had developed a spinal cord cyst just above the level of the cord trans-section (he had dived into a shallow lake at a family barbeque and broken his neck). The cyst put pressure on the remaining healthy spinal cord with the result that he lost his one movement – pronation of the hand. If permanently lost he would lose all independence. I was however able to insert a small silicon drain into the cyst and thereby regain the function in his hand. On one occasion the tube blocked and function was lost. But on inserting a second tube, function was again regained. He remained very active in the face of his affliction for several years. Towards the end of last year he once again lost function but sadly this was not due to a blocked tube. Spinal function had deteriorated to the next level and he had subsequently lost all function in his limbs. This was likely to be permanent. It was extremely difficult to break the devastating news to the patient. He died two weeks later from respiritory failure. I truly believe that without that vital function, he had thrown in the towel. For not only had he lost the vital limb function, he had lost a major part of his engagement with the world – and that had included vocal interaction, facial expression as well as all the associated cognitive and emotional function. 

With some spare time on my hands recently, I decided to engage again with some physics topics. I have always had this interest in physics. Unfortunately my latter day interaction with the subject has developed a snag – my mathematical knowledge has become dangerously rusty since the many lives that separate me from my old university physics and mathematics days. Nevertheless I decided to re-engage with Special and General Relativity (ala Einstein!). A tall undertaking indeed. Knowing what I was in for, I initially did several online courses to bring my maths up to speed and proceeded with Relativity. Things were going quite well until the three and a half hour mark. Anything that was unclear in the formulae was quickly resolved when the corresponding graph was introduced. I’ve generally been strong on graphs. But suddenly without warning the dude substituted a new set of symbols and formula ... and I was sunk! Anger welled up. How could the bugger do this to me? Anyway there’s a reason for me telling you all this.

One of the components in General Relativity really tweaked me. It goes like this (I kid you not): That which moves further, ages less! Suddenly I reflected upon this thing called movement and how I have encouraged and coerced all and sundry (myself included) to move and be active and would you believe it, the Old Man (i.e. Einstein) had already developed a physics formula for it!

Being the curious guy that I am, I began to reflect on people and the amount of distance that they cover in life. Obviously one moves to cover distance. But there are other ways of covering bigger distances. Well it became obvious that the individuals that cover the greatest distances are people that do a lot of travelling. The proposed hypothesis was therefore to select individuals that cover a lot of distance in their lives and see if the figures indicate a significant increase in longevity. Appropriately therefore I selected airline pilots as the sample and studied their longevity. Bingo! A study performed by the US Federal Aviation Administration in 1995 indicated that in a sample of 1494 pilots that retired at the age of 60 years, there was an increased average longevity relative to age and sex matched non-aviation individuals, by 5 years. Agreed it’s not that dramatic, but still somewhat interesting.

In essence then what is the take home message from this lengthy meander? I guess it’s really to engage life with all that you’ve got. Embrace it and make it better than it was before you engaged with it. But above all be curious and laugh a lot – where there’s movement, there’s life and where there’s life, there’s hope.

Copyright reserved - Ian Weinberg 2018