Friday 10 October 2014

On rituals and familiarity

whee... anthropology post time. If you're looking for doggy things, move along.


Rituals are peculiar things. On the one hand, they can be extremely mundane. Brushing your teeth, for example, is a thing that, aside from a practical function, for many persons serve as the preparation for sleep, or relaxation, or make them ready for the start of their day. I'm oversimplifying, but yeah, brushing your teeth is pretty much as mundane as it gets, yet it can be considered a ritual. On the other hand, you get the large, society-organising, mind shifting, world altering rituals. This is the inauguration of a president, or the human sacrifice that marks the end of one era and the beginning of the next in many South American societies. The removal of a heart and the resulting death of a person is considered pretty foreign to our understanding of the world, and is seriously overdramatised and made into a spectacle by Hollywood (Indiana Jones and the Temple of Doom, anyone?).


Yet, just this morning, I attended such a ritual. It was a brain, and not a heart, but I feel like I'm splitting hairs in this case. Let me describe it to you:


Before the brain-ritual can begin, the ceremonial priests undergo extensive preparation. They are ritually clothed in garb that is never present outside of these rituals. The garb is loose, unflattering clothing that would be closest to sleepwear, and would accordingly be considered inappropriate to wear anywhere else. The garb is usually all of one colour, green, blue or white being typical, though brown is not unheard of. They cover their feet in special coverings in order to keep the outside world and all of its contaminating elements out of the ritual space, and also to keep the ritual space separate from the everyday, outside world. These are not shoes, and would not provide any protection to their feet from physical dangers like thorns or stones - they serve no purpose aside from maintaining and isolating the purity of the ritual space in this society. They also cover their heads in a similar manner to the way they cover their feet. This masks any hairstyle they may be wearing. In fact, the ceremonial garb seems to deliberately depersonalise the ceremonial priest - he or she is merely a symbol of being someone with the knowledge and necessary training to carry out this ritual, and his or her individuality is entirely irrelevant to the situation.


Once appropriately garbed and hooded, they proceed to clense their hands. They have special liquids that they apply and a strictly ritualised manner in which they apply this liquid. This is considered so important that even though the ritual is very harmful to their skin, over time resulting in very dry, cracked skin that can be fairly painful to live with, they do this every time and with great precision. Special circular motions and interlocking of finger digits are concluded by a long and careful rinsing process. Once done, these hands may now not touch anything in the ordinary, everyday world. They are carefully covered in purpose made gloves, gloves which are typically also worn only during rituals such as these.


I, as an observer occupying that peculiar space between a knowledgeable person and a layperson, was allowed to observe this process through a special screen. My knowledge comes from my experience as an anthropologist, but does not grant me the privileges of a fully fledged initiate into the ceremonial priesthood - something which takes roughly ten years to achieve, though initiates start practicing this ceremony from their second or third year. 


The priest enters the ceremonial area, and finds a human brain laid out on an altar for him. Priests are often male, though women are not excluded from becoming such priests. The brain has been carefully prepared by initiates. The skull was carefully sawed open, the brain stem severed, and the brain itself anointed, oiled and perfumed to make it into a ceremonial object. On special side-tables alongside the altar are various implements. A long bladed knife, various hooks and pins, and an assortment of what looks to be tweezers are laid out in neat rows. These implements, like the tables and altar, have all been ritually heated and anointed with alcoholic substances in preparation.


The brain is ritually sourced. Sometimes, a person willingly donates their body for this kind of ritual dismemberment. This is quite rare, though, and is socially a little frowned upon. More usually, the brain is taken from someone killed violently, often by the rapid impact of a big object to their body at high speed. This body is then not claimed or identified by anyone, which signals its availability for use in this ritual. Often, these bodies come from the least of society, the poorest, those with few social connections, people who will not be missed.



For the next hour or more, I truly lost track of time, the priest spoke a special language as he carefully cut the brain into ever smaller pieces, sometimes following along with the curved grey matter, at other times cutting through it. The special language is never spoken outside of the ritual context or the training therefore, lest it lose its power. It is made up of ancient languages of people that the priests consider their forebears, even though it is nearly impossible that they are actually genetically related to people who spoke those languages thousands of years ago. As he speaks, he names each piece of the brain with a word of power, that imbues that section with meaning and power that is only meaningful and powerful to the initiates of the priesthood, but that nonetheless leave the audience with a sense of awe and power.



The ritual is repeated, again and again, with no purpose outside of naming the parts and practicing the skills needed to perform the ritual itself. 



Finally, the ritual concludes with clapping of hands as a show of appreciation for the work done by the priest, and much admiration is expressed for the straightness of his cuts and his ability to remember and recite the ceremonial names of each part. 


What I was in fact watching was not some obscure tribal ritual, but a dissection of a brain by an anatomy expert. This ritual, that I have made seem somewhat strange, is in fact a perfectly ordinary teaching tool for making doctors and neuro-scientists - highly valued and powerful experts in their own context. 

Why did I make this seem so strange? Anthropology typically seeks to make the strange seem normal. In that way, it is a very powerful tool with which to fight prejudice (witchcraft is not foolish or superstition, in fact, it explains unfortunate events quite well, and even gives you some sense of control over them - see this PDF article by Evans Pritchard). But in an interesting twist of fighting prejudice, anthropology can also make the normal seem strange, by couching it in the narrative style usually reserved for practices we would find abnormal, worthy of condemnation. I'm not trying to say that dissections are worthy of condemnation, definitely not. I am trying to point out how very weird our medical science is. How very powerful our doctors and other medical people are, that they can take body parts from people and display them, anonymously and with great ceremony, to other experts. 

These body parts, depersonalised, unnamed, disconnected from a person, is entirely foreign to nearly anyone's experience after dying - most are carefully placed in caskets, celebrated and buried, with a marker indicating who they were and how long they lived. If the cadaver was donated, there may well be such a marker for the person, but donations are rare (and no wonder). Part of the reason for this rarity, is of course, a culturally-mediated conviction that bodies must be whole to be able to be resurrected upon the return of the messiah, but part of it is also that few people want to be made into such a specimen after death. Mostly, it's an unnamed and unclaimed corpse as a result of a road accident (which we have way too many of). The end of that corpse is being burned up with medical waste in a fire, or at best, remaining forever more in a jar of formaldehyde. 

Looking away from this spectacle once you've been invited in is frowned upon as unscientific (I am such a charlatan, this sort of thing makes me very queasy). Being a person of science makes you one of the most powerful people in today's world - like the priests of the Christian medieval world, they literally decide what is true and what is not, what can, and cannot, be known, or acted upon, or changed. 

I'm not trying to condemn. I'm trying to ask a question. Is this right? Is this fair? Is this, really, how we want to decide what is real, what is worth knowing and acting upon? 

Person whose brain I saw dissected today, I'll remember you. If nothing else, I can do that much. I'll remember you as a human, who lived, laughed, cried, spoke and made a difference to those around you. You were more than an amygdala oblongata and a pons, more valuable than a list of terms. Your contribution to medical science may be questionable, but I hope you teach students what they need to learn to practice medicine, and that in their practice they heal people.



Wednesday 8 October 2014

Chronic pain and what you can do about it.

It's one of those things that most doggy people will have to deal with eventually: chronic pain. Either from arthritis, or hip dysplasia, or simply weary old dog bodies, or, as is the case here, from an accident that left lasting damage.

Chronic pain in dogs, like in humans, can either be a constant factor or it can come and go, be better and worse over time. Sadly, just like in humans once again, there are things you can do to make it better, but rarely things you can do to fix it completely. You can manage it, though, and by taking an active role in pain management, you can improve your dogs quality of life quite a bit.

With that in mind, here is a list of things you can do to help manage pain:

1. See your vet.

Dogs are stoic creatures, and especially old dogs often have their quiet, reserved habits attributed to being old, in stead of to being in pain. This puts the onus on us to make sure what we're seeing is in fact old dog (or calm dog) behaviour, and not behaviour that signals "I'm in pain". It's like the vet joke about tooth and gum disease in dogs - the main symptom is none at all.

In Talos's case, times when she is in more pain are marked by her disappearing for stretches of time. Not exactly the easiest marker to spot, since she alternates being out of sight with being on my lap, very close to me. She also sleeps more, is less playful, and is much quieter. Our vet (and other professionals) recommended we keep a journal, this has been absolutely crucial in figuring out a pain scale, with which I can assess when we're at crisis level and need to go see the vet, when I can just medicate at home, and when she's sore, but it's not yet time to medicate.

When you suspect you're dealing with pain, go see your vet.

2. Medication

This is, for many reasons, a tricky one. You don't want to dope your dog. Many painkillers over time cause liver damage, or stomach upset. That said, having a supply of non-steroidal anti-inflammatory medications (or whatever is most relevant to your dogs type of pain) that your dog both tolerates well, and is effective, is worth its weight in gold. Some dogs will need a pill every day, especially if they have the kind of chronic pain that stays constant throughout. Others, like Talos, will need a pill during a bad spell.

We use Rimadyl  - not necessarily the best choice. But, since we only need it infrequently, it is readily available and reasonably inexpensive, Talos tolerates it well and it relieves her pain, this is our choice. It is well worth reading your medication's information leaflet. Here is the one for Rimadyl:
https://www.rimadyl.com/other-links

3. Exercise

It may sound weird to recommend exercise for pain, since usually the advice is to rest. However, especially joint pain from joints that are surrounded by muscle can be kept at bay by having exactly those muscles strong and capable of supporting the joint. This is not as easy as it sounds, however, given that your pooch is likely to be compensating for pain by avoiding the use of that (or those) joints. Also, given that your dog is in pain, and that your dog is compensating for this in various ways, the injury risk is actually quite high. If you have one available, I encourage you too consult with a doggy physiotherapist or other doggy exercise specialist to help you make, stick to and frequently evaluate an exercise plan. We have a three pronged approach, using swimming, slow, controlled leash walks, and specific exercises that if you blink, you'd think are tricks.

For swimming, we go to a fantastic hydrotherapy place where we both swim in the conventional way (into the pool you go, little pug) and walk in an underwater treadmill. As a first line of defense against muscle atrophy, this is perfect. Her weight is supported, so she can safely use the full range of motion in her limbs against a resisting force (water) that really gets those muscles working. Swimming works all her muscles, especially the core (they actually have to use their core muscles to keep their bums from sinking - good swimmers have good core muscle strength, and one of the things that makes many pugs such poor swimmers are just plain old weak muscles).  In both cases, the dogs are closely supervised and their progress is tracked and recorded.

At first, Talos did not swim very well. She's gotten much better, considerably less splashing!

Slow, controlled leash walks we do in the neighbourhood in the mornings. 30 minutes of slow, close heelwork. It can be very boring, but it can also be a lot of fun if you put some energy into it. We criss cross the roads, turning every which way, weaving around decorative lawn boulders, turning both with us in sync, or with me and dog turning in opposite directions. I add in spins (see below) and various sits/downs/stands. I heel with her on the left and right of me. Generally, I do my best to keep her engaged and happy, and generally, I succeed. Half her breakfast she earns on these walks. The benefit of slow walking is that it makes them use all four of their limbs more evenly than they do if they're at a faster pace, plus it encourages good use of the entire range of motion available to them. It really builds muscle and muscle control where those have been lost. In the interest of full disclosure, this is also the thing we cut out when Talos is having a more sore period.

Lastly, the 'tricks' we do. Some of these are stretches. Leg tucked up against her body, in full extension forward, down and back. A 'bow' stretch. A 'reach up as high as you can' stretch, for her core. We do some balance work, on a balance ball or, at hydrotherapy, on a boogie board in the pool. Both of those she enjoys. We do 'doggy pushups' sit-down-sit-down-sit-down repeat (if they keep their bum stable, this exercises their forelegs). You can do 'doggy butt-ups' too, bow-down-bow-down-bow repeat, but we're still learning bow, so we're not there yet. Give paw is a great way to get your dog weight shifting, as long as you include all four paws. Our front-right paw is super good at targeting all sorts of things... our front left paw is getting there (my girl is rather right-pawed). Our back paws... yeah. Once she realises they exist and can move independently we'll get to working on her picking them up. Lastly, we do slow, controlled spins. 'Sit pretty' or 'beg' (whatever you call the meerkat sit, where they sit on their haunches) is another really great core muscle workout, but we cannot do this one. These things are done under the recommendation of a physio - I am not suggesting a workout for anyone else.

4. Alternative therapies

We make use of a few alternative therapies to help with pain. I say 'alternative' therapy in the sense that some vets (or doctors) would only consider medication or surgery true therapies. Many of these have good research backing up their efficacy, some have hearsay only. But heck, my dog is sore, if it actually helps, onwards!

Massage, cold laser, acupuncture, chiropractics, and hot and cold therapies are what is available in our area. We have good experience with all of them aside from chiropractics, which I have not yet been able to overcome my skepticism of and actually try. A lot of research shows chiropractics does more harm than good, especially over time, and there is little support for their 'alignment' ideas of bodies, but I have to immediately veto this with the hundreds upon hundreds of dogs who have  gotten help from chiropractors. Massage is something you can learn to do at home, it stimulates blood flow and makes everything loose. Cold laser helps with pain. Acupuncture (or more accurately, dry needle, my skepticism is with me always) has seriously helped us. Talos lies down on the mat, and relaxes as the needles go in. Afterwards, there's a spring in her step and a lightness to her bearing that we only see otherwise on really good days. She's also more active, and the improvement lasts for a few days at least.

Talos at the vet, getting acupuncture. 
Hot and cold is another thing we do nearly daily. An ice pack in the morning, a hot pack in the evening. They numb pain, stimulate blood flow, and are easy to do (and can do no harm).

5. Supplements

This is another grey area. We give a joint supplement, chondroitin, glucosamine, MSM. Research here is dodgy. Some say it works, others say under double blind tests no difference can be seen in comparison with a placebo. We take this supplement because our specialists say we should, and I have not seen a difference on it (but maybe there would be one if I stopped it and found out). I've put our older dog on this same supplement, hoping that it might help with arthritis down the line  -  she currently has no issues. I am not ashamed to say that while I try my best to research these things, I also succumb to my fair share of 'try and hope'.

Another supplement often recommended is coconut oil  -  it has anti-inflammatory properties and is good for the skin/coat. And it feels nice. And tastes nice. Much love for coconut oil here.

 Spirulina has shown some promise as an alternative protein and as a supplement too.

Then there's the great mess of quackery that is also variously expensive, like 'stempets' (which we're finishing a bottle of, because some people swear it's miraculous... I've seen none of that, but I've also seen none of the bad side effects other people have ... and there's perhaps some case to be made for cyanobacteria as a supplement ... maybe). Of these, there are hundreds. I'm trying to keep an open mind. So many of my doggy friends have had results with some of these, but if you look online, so many have had bad side effects... most therapy people have some types that they prefer. That's probably the place to start.

There's also joint soup, which is rich in glucosamine/chondroitin too:
http://www.cookevet.com/2012/02/10/make-your-own-glucosaminechondroitin-tendonligament-soup-for-dogs-cats-people/

All that said, a good multi-vitamin, the best diet you can manage (which is probably not for sale at your vet's office... just saying) and nutritious treats (not the flour-and-flavourant biscuits that some people seem to think is a good idea, and probably not spray cheese or peanut butter either) will all make a difference to quality of life, if not to pain management directly.