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BABY, IT ' S COLD OUTSIDE
Mary G. Barry, MD
Louisville Medicine Editor editor @ glms. org
I
’ ve been reading about brain plasticity, and how to preserve it. According to researchers at Mass General and Northeastern University, as described by Dr. Lisa Feldman Barrett in the New Year’ s Eve New York Times, this requires“ the yuck factor.” Dr. Barrett, the Distinguished Professor of Psychology at Northeastern and author of a forthcoming book about emotions and the brain, quoted the U. S. Marine motto,“ Pain is weakness leaving the body.”
In her article about“ Superagers,” she reported that the most brilliant and liveliest 88-year-olds have been lifelong fitness buffs who don’ t just stroll, but regularly exert near-maximum effort in exercise, both mental and physical. Functional MR imaging showed that crucial regions of their brains were indistinguishable from those of young adults. These regions in the brain cortex that she called“ hub regions” were thicker than in those of similar age who had lost mental and physical capacity: the thicker that cortex, the better the person performed on tests of memory and attention. Those with thinner, more atrophied cortical regions did worse.
How to get“ thick in the head?” Dr. Barrett said, work hard at something.“ Many labs have observed that these critical brain regions show increased activity when we perform difficult tasks, whether the effort is physical or mental.” However, when activity in these parts of the cortex increases, people also report that“ they feel bad in the moment.” The old adage,“ No pain no gain,” applies fully here; to keep our brains smart and supple we have to push hard, to work at something till it hurts, till we are used up, till we are worn out. No lollygaggers need apply.
She pointed out that this does not mean just doing the Sunday crossword puzzle. She means doing something intellectually challenging, regularly, with more intensive exercise like interval training, not strolling around the block with the dog. I’ ve also been reading Seveneves, by Neal Stephenson, who has written many long and highly imaginative science fiction / techie novels( vacation over, so I still haven’ t finished it). This one actually qualifies for the Barrett Yuck Factor intellectual division, since the author indulges in long aerospace engineering treatises on orbital mechanics, asteroid mining and unimaginable interplanetary distances. Later, he explores genetics and epigenetics in great detail, and I cannot but wonder what I will have to comprehend and absorb during the last third of the book.
His space travelers who die are kept on the ISS in the deep freezer; reading this while at 38,000 feet over the North Atlantic, where the outside temperature is-50 C, definitely induces severe internal shivering. Yet, freezing each other on purpose to save a life – and a brain – is something humans do every day. Ever since the groundbreaking research in
Toronto from Dr. W. G.“ Bill” Bigelow et al, beginning in 1946( he points out that he was inspired by an episode of frostbite), we have cooled the human heart for open heart surgery. We have done enough studies on cooling the whole person after cardiac arrest to recommend it strongly, even for out of hospital cardiac arrest, spurred by stories of miraculous survival when children are pulled from frozen ponds and awaken mentally intact over the next 24 hours. In the Jan. 2016 issue of Resuscitation, Dr. Daniel Howes and multiple other authors reported on the Canadian guidelines for the use of targeted temperature management( TTM) also known as therapeutic hypothermia. This was the report of a large working group that issued a joint statement from the Canadian Critical Care society, the Canadian Neurocritical Care Society and the Canadian Critical Care Trials Group.
They reviewed all available evidence, reviewing some original research and all articles since 2002, relating to the preservation of brain and bodily function by intentional immediate freezing of the patient. They then issued recommendations for the safe and effective use of TTM. The strongest recommendations rested on what we Americans call " Level A evidence." Any evidence they felt not quite so worthy was given a suggestion for treatment as opposed
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