A Load of Old Cobblers

The severity of a Scoliosis curve is defined by referencing its "Cobb angle", so named for an early 20th century American orthopaedic surgeon named John Robert Cobb, whose childhood nickname was "Corn on the" (no it wasn't - that's silly - I made that up).

The Cobb angle measures the lateral curvature of the spine, which is to say the sideways curve.  A virtual line is drawn from the top of the first vertebrae that goes off piste and another line is drawn just below the last vertebrae that tilts at an angle.  Two more lines are drawn between them and the intersecting angle is - oh blow it, it's too confusing.  Time for a helpful diagram I think don't you?

Does this help?  Me neither. 

The thing is, even though this is the one and only measurement that is used for noting the severity and the change of scoliosis, it's not all that useful.

For one thing, the standard range of error is 5 degrees. 

This was a particularly startling and slightly discouraging piece of information to me.  I had been thrilled to find that my Cobb angle had gone from 41 degrees last September to 38 degrees this February.  I put it down to all the hard work and exercise I had done over the intervening months and now you tell me my Cobb angle might not have changed at all?

Apparently errors can be made when it is calculated by different people, on different machines, or even at different times of the day.  One person might have measured it from the x-ray itself and another from a computer screen.  I may have carried myself a teeny bit differently each scan, my body may have slouched a bit or showed the effects of the gravity at the end of a day instead of in the morning.  In other words, unless you can ensure that x-rays are taken at exactly the same time of day, by the same person at the same place, and measured by the same person in the same way, you can't possbily know if your Cobb angle has changed much at all.

And for another thing, scoliosis is a 3 dimensional condition and the Cobb angle is a 2 dimensional measurement.

I guess that should have really been the first thing because it makes the whole Cobb angle thing pretty much dead in the water.

So if the Cobb angle is a useless form of measurement, how on earth does one know how and if the condition has changed or worsened, and whether surgery is needed or not?

The Scoliosis SOS clinic staff were clear that the best form of measurement is a subjective one, based on the following:

• Quality of Life
• Posture
• Cosmetic Appearance
• Trunk Rotation (measured by a little device called the Scoliometre*)
• Lung Function
• Back Surface (measured with a Formetric Scan**)

* something that looks like it came in a box of Corn Flakes

**A radiation-free method whereby a 3D image is produced by the topography of a patient's back

Initially a Cobb angle might be useful in helping identify scoliosis, but it is entirely possible that someone might have a Cobb angle considered too small for surgery, but their pain is so excrutiating that treatment is urgent. 

So the real assessment derives from answering questions such as "Is your breathing better?"  "are you happier with your posture?"  "Has your pain been reduced?"

Surgery might be necessary for those who do not have the motivation to complete a daily exercise programme, or for those in imminent danger of having their heart squeezed or their lung punctured by a rotated rib for example, but even those with a Cobb angle measuring 90 degrees can avoid surgery and improve their condition purely with targeted, diligent exercise.

So rather than relying on a semi-annual round of x-rays as advised by the spine surgeon as a way to monitor my progress, it looks like I'm really better off becoming my own spine specialist and answering my own quality of life questions.

Weird Things that Cause Pain and Weird Things that Don't

In recent years I have been a bit bemused and downright confused about what was going on with my body.  Once I got a decent combination of medication for the nerve pain going I could give the little quirks more attention.

For instance, walking fast is much more comfortable than walking slow.  And window shopping is the absolute worst! This sounds ridiculous and doctor friends of mine look like I am, as P.G. Wodehouse might say "a bit touched".  I can only think that when I walk fast I carry myself better and when I walk slower I let my posture go a bit more, with weight shifting side to side. 

When I sing my left leg hurts.  P.G. Wodehouse would have another phrase for this sort of declaration: that I had been dropped on my head as a child.  I have never been told that I have and see no reason to cast shadow on my parents' child rearing ability.  My suggested reason for this daft sounding truth is that when I am at singing lessons or choir rehearsal I am so engaged in what I am trying to do with my voice that I stand rigidly, with hip flexors working harder than they need to.  At the absolute worst, my left leg goes numb and gets that pins and needles feeling.  All I have to do is sit down and 'break the spell' for it to feel better.  Another thing of course would be to relax my stance whilst lilting along, but I do not have enough singing talent to think of anything but getting the right note, word and sound.

Sometimes walking in flats hurts more than in heels.  And I can still wear these!  (as long as I don't walk a marathon of course)

Of course the pain medication has produced a few quirks of its own. 

My balance is way off what it was (which wasn't great!).  I get little jolts of nerves in my fingers at times, which makes my fingers and hands shaky, and sometimes it feels like there are small electric pulses zapping through me.  As a result my eye-hand coordination gets impacted: when I throw or catch I sometimes misjudge and suddenly send something off in a trajectory not predicted by myself or the person at the receiving end.  My throat gets extremely dry.  Weight gain is another side effect that I am trying to fight against.  But the worst is that I always feel like I am working in a mental fog, and am constantly trying very hard to remain focused and not get distracted.  Being a writer and editor seems to have been a very poor choice of career for someone with her head operating in a cloud, but it's a bit late for that now.  So please forgive any mispeellinng, repetitive word choice or repetitive word choice.

week 3

It's week three at the Scoliosis SOS clinic (http://www.scoliosissos.com/)and there are definitely changes felt.

We lost two of our group, one who was only doing 2 weeks and the other who will do her second 2 weeks at a later time.  We have added four, one who is only doing 2 weeks, with the others now completing  their 4 week program after a gap when they did their home program in between.  I am curious as to whether there is greater benefit in doing the 4 weeks in a row or taking a break in between.  The physios. say that it takes 6 weeks of work to change a muscle - how many hours a day constitutes "work" in that instance?  No one knows either answer.

I felt very achy the second weekend, so was quite happy to relax, do a few stretches, walk for an hour, and converse for 48 (not quite but it felt like it!)  Monday I was very stiff at the beginning, but slowly felt a bit looser during the day.  I walked for an hour afterwards and that seemed to settled a few remaining kinks.

We are working hard, with more exercises than stretches filling our days.  We move swiftly from exercise to exercise as we know the set-up and waste little time, which of course means we are working harder.  On the one hand there is more quiet huffing and puffing of exertion filling the silence, and on the other hand the room breaks into frequent chatter, teasing and laughter, as we are all more familiar with everyone and the way things run. 

On nice days several of us eat our lunch together in one of the little nearby parks, along with everyone else in London.  The minute the sun comes out, the Brits. escape outdoors and there is barely a scrap of green grass that isn't covered with pale bodies (or burned red ones, if the sun was out yesterday too).  I have found a small church (St.Olave - Hart Street) that offers free lunchtime concerts twice a week, so when the weather was cold and wet I slipped off to sit in an ecclesiastical sanctuary and listen to a piano-accompanied soprano singing Benjamin Britten, or a young and passionate pianist channeling Beethoven.  I had to escape before the encore to get back, but it was worth it.  With the body working so hard all day, it's nice to let it rest and allow the brain and other senses some freedom.


From here you can barely hear
the building site noise next door

A rare escapee from London's Great Fire of 1666



I was confused about the Norwegian flag,
until I realized that st. Olave (or Olaf)
was (or presumably still is) the patron saint of Norway

I am starting to feel muscles I've never felt before: one up by my left shoulder blade that I can feel move while doing my rotational breathing, another at the base of my lower right spine when I lie over the large ball and kick my right knee into the ball's side.  At the end of traction exercises, I feel almost faint, and quite dizzy when I get up, but a rub of the lower back and then a "prayer stretch" with rotational breathing fixes me right up. Two of our crew have missed days due to pulling some muscle or working a little past their comfort zone, but I am lucky to be able to work at maximum every day and still be able to walk a fair pace in the evenings.

I had felt rather proud of being fairly flexible when we started, thanks to Martha, Nancy, Shauna and Anita back home, but I am now able to put my head to my knees, both sitting and standing.  I can't get my legs apart enough to do the splits, but I can now sit and lean my forearms on the ground with my legs out in a V.  I have the most flexible calves in the class.  "Look Ma, I'm a success!"

I don't know if I have lost any weight but I do feel a bit more toned.  And if I am heavier due to muscle, which is heavier than fat, then that is just fine by me!

A Tale of Two Cities

I generally walk through the City at one point or another of my daily commute.  The City of London is not to be confused with the city of London.  The city of London actually contains the City of London, which is usually just called "the City".  It is almost precisely one square kilometre of what was the original city bounds and which remained so for centuries after it was first settled by the Romans in the 1st Century AD. It wasn't until after the Middle Ages that the city grew into the surrounding areas, but the original City was and still is a separate city with its own mayor and ceremonial customs quite apart from what we commonly call the city of London.

Got that?  Good! Going on.....

"The City" also references the financial services industry, as this was and still is where many head offices in the international banking industry reside.  When someone says they work "in the City" it usually means they are connected to the financial industry and they may not actually work in the City.

Well done!  You are much cleverer than I am.  It took me ages to understand the idiosyncrasies of the City in the city.  Like why there was a Lord Mayor's parade starring someone who was not the person I had always seen identified as the mayor of London (as opposed to the mayor of the City of London).  I learned to look out for the capital letter "C" in the word "city".  If it was a large C then I slowly learned which one was being referenced.

The City of London is a fascinating place these days, given that the meltdown in the British economy over the last few years was to a fairly large extent due to the unrestrained activities in which the banks ran rampant.  The City has historically given a lot of rein to the banking industry and still does. In fact, one of the largest unrestrained tax havens in the world is the City of London.

When you mention the words "tax haven" I instantly think of Swiss Bank accounts or the Cayman Islands.  Those tax laws are not designed for the benefit of the average Swiss or Caymanians, but for those wealthy people and corporations that are in a position to make use of them in order to avoid the tax rules in their own countries. This results in one set of rules for a rich elite and another for the rest of us.

Over severeal centuries, sovereigns and governments have sought loans from the City of London in exchange for privileges and freedoms from rules and laws to which the rest of Britain has to deal with.  The City has an enormous cash reserve that has built up over the last thousand years or so, which is very useful in buying off dissent. The Freedom of Information Act ensures most of this is invisible, as the Act applies solely to City functions such as local or police authority.  The cash assets are beyond all scrutiny. 

As noted in an atrticle in the New Statesman:
"By the 1980s, the City was at the centre of a great, secretive financial web cast across the globe, each of whose sections - the individual havens - trapped passing money and business from nearby jurisdictions and fed them up to the City: just as a spider catches insects. So, a complex cross-border merger involving a US multinational might, say, route a lot of the transaction through Caribbean havens, whose British firms will then send much of the heavy lifting work, and profits, up to the City."

The article goes on to describe the inner part of the web being a collection of islands: Jersey, Guernsey and the Isle of Man.  The next ring includes British territories like Burmuda and the Cayman Islands (I knew they were involved somehow!) Then there are those places with looser connections, like Mauritius, Hong Kong and the Bahamas.

The point to be made is "Thus, the role of the City of London Corporation as a municipal authority is its least important attribute. This is a hugely resourced international offshore lobbying group pushing for international financial deregulation, tax-cutting and tax havenry around the world."

Pretty strong sentiments. Is it accurate?  A best selling book called "Treasure Islands" by Nicholas Shaxon indicates it is. ( http://www.treasureislands.org/the-book/ ) 

Every morning the underground disgorges a river of black and grey suits that swarms down the streets of cafes and coffee shops.  There's a temporary lull and then it moves again, to Tesco Express checkouts, and HSBC bank machines and pubs that promote real ales or food deals or screens devoted to rugby and football. And then at 5pm or so, the river flows back to the underground stations and the train stations, with slow eddies outside of pubs for a pint or two.

My work was always in the West End,and never in the City, so this time provides me with a new sense of this most ancient part of  London.  In the West End there are circuses and squares and Malls, but in the City there is directness to the language of places.  There is a large monument marking the spot where the great fire of London took place in 1666.  It is called the Monument.  There is a tube station nearby, called Monument station.  There is another station right by the Bank of England.  It is called Bank station. 

The only time I have ever seen it quiet in the day time (and this place is dead quiet at night) was on the bank holiday Monday.  It was like a ghost town - I could walk right down the middle of Fenchurch street.

 I walked that day from the clinic to Leicester Square, about an hour. The first half was so quiet - shops closed, pubs silent, roads still.  But as soon as I got near Covent Garden I could see and hear a swell of crowds, mostly tourists, and my brisk walk bacame a crawl.  It told my what I knew in my heart, the City is for the business of business and not a lot else.

As long as the City is allowed to conduct itself they way it has for centuries, there will be crowds of tourists mavelling at its sites, and immigrants attracted to its reputation.  And money flowing in for the benefit of who knows who?

Curvature of the Breath - Rotational Breathing

I have been introduced to a new form of mental torture:  Rotational Breathing.

The first instruction given to me was to direct my breath into the so quaintly called "collapsed side".  Easier said than done my friend.  It takes a large amount of mental effort to move air into a specific part of the body. It made me go cross-eyed standing there and focusing on getting air moving down past the lungs and off to the right, expanding the ribcage on my compressed side. 

Next I was told to try to keep the breath in that place for as long as possible while exhaling slowly.  I found employing a 'ssss' sound helped make my out breath last longer. I try to imagine my right side is the bottom of a full balloon that I am slowly emptying from the top.

Okay, fine and dandy.  Got it.  That was in week 1 and I got rather complacent about the whole breathing thing.

Then came week 2 and the rotational part.  As air is being exhaled, I am to direct it up and around my left ribcage, while still keeping air expanded in my right side.  I find it a bit like patting your head and rubbing your tummy at the same time. the image that helped was to think of the air going up one of those long, narrow curved stairways you find in ancient cathedrals and castles.

The idea of rotational breathing is to expand the part of the ribcage that has shortened and dipped and misshapened, and to try to shift the other side of the ribcage into a more 'normal' position.  At the moment the ribs on my left side are rotated around, resulting in a raised bit on the left side of my back, which I'd rather not say is a 'hump' but it is, so there you are. 

To help me get the hang of it, one of the physios. would grasp my back on my left side as I breathed in to my right side, then they'd press hard and up as if pushing my ribs forward and up around to where they should be, in the front of my body, while I let out my long sibilant exhalation.  I closed my eyes to try and imagine what I hoped was going on with my breath, moving around and upward with each long exhalation. 

I invariably find myself unconsciously shifting my jaw to the right everytime I breath in, as if in sympathy and as if it would help!  Nice to think the rest of my body is emapthetic.

What with breathing into my compressed side, and this new rotational breathing, as well as abdominal breathing for singing, side breathing for yoga and pilates, and my daily keigels, I am left quite breathless!

Moon over London

All is calm All is Bright!

The 5 Stages: #3 - Bargaining

Bargaining with yourself is a losing operation.  for starters, I never believe myself.

If I give up eating out, I would be able to afford a trip to theatre?  Please.  Like I can't figure out a way to do both!

So if I laze around watching TV every evening because my back doesn't hurt doing that, it means my back is going to be fine doing that forever, right?  Not so right.  The last thing a back with scoliosis needs is lazing around.  It might end up with permanent lazing, which may sound like a holiday but it is not for me!  My clinic term includes a few teenagers who are still growing. They get a bit distracted by the others, or their hair, or something.  And they get bored doing repetition after repetition of exercises that require real effort.  What I can't do but want to is sit them down and lovingly say "Suck it up!" 

Even with less active work taking place, I see them standing a little straighter after only two weeks.  Their bodies are still so young and their muscles so pliable that changes happen quickly.  For the rest of us dealing with bodies that have had decades of weakened muscles and overstretched muscles and bendy bones, it requires much more effort to make changes.

So it's no good asking "Why me?", because "Why not me?" 

And before I get on that road of 'if I do this, then maybe this will happen', I have to stop myself and remember that all the really wonderful things that have happened to me (other than being born when, where and to whom, which was just luck) happened because I got into the trenches and slogged it out. 

You can only successfully bargain with someone who is in a position to provide what you want.  And with scoliosis, the only one that can do that is me. And I know that I must drive a hard bargain to get something of real value - a body that works for as well and as long as possible.