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Brain on Fire: A Q&A with Susannah Cahalan
Susannah Cahalan was just another ambitious New York kind of girl--a fast-rising cub reporter at the New York Post and fabulous gal about town--when something surprising happened. She lost her mind.
In her new book, BRAIN ON FIRE: MY MONTH OF MADNESS, Cahalan takes on a Herculean task that most journalists would not even think of trying -- she uses her reporting skills to chronicle a month of her life that she does not remember, a month where she changed physically, mentally and emotionally due to a rare brain disease. Here, Cahalan talks about the emotional aspects of reporting on your own medical case, what's missing from the current treatment of brain disorders and how her health is today.
Q: This book was an incredible undertaking. What inspired you to write your journey as a book?
Cahalan: My initial muse was really unromantic – it was the threat of making a deadline. My editor had heard about what happened to me through a colleague and assigned me less than a week to write about my experience. It was a nutty mission but it quenched my thirst to research and write more, and I thought the natural outgrowth of that would be in book form. It was only after my article was published that a real purpose emerged. I received hundreds of emails from people all over the world, telling me about their own stories and sharing their own hardships, and I realized that it was not only important for me (as a cathartic exercise) to write it, it was even more important for me to share it with as wide an audience as possible to get the word out about the disease and to give some support to those suffering from undiagnosed diseases.
Q: How difficult was it to delve into your own medical history?
Cahalan: My own medical history during my hospital stay was readily available to me through literally thousands of pages of medical records that outlined everything from my “bowel releasing” schedule to the minute details of my brain biopsy procedure. Other aspects, say of a visit that I took to a psychiatrist before my hospital stay, had to be tracked down with a little more elbow grease, which required a little use of my tabloid reporting skills that I learned at the New York Post. The hardest part, by far, however, had to do with what happened after the hospital, when medical records became less necessary and as I continued on in my recovery. That had less paperwork and more emotional elements to it, making it harder to write and report out.
Q: What did you learn about medicine and the brain? What surprised you the most?
Cahalan: Since I started at zero, only a basic understand of the body from high school biology and a few evolution classes at college, I learned a tremendous amount. There were so many surprising facts down this road that impressed me, which a more seasoned science practitioner would probably role her eyes at, but my most surprising finding was probably how little we really know about it all. I’d ask experts questions, straightforward cause and effect ones that I’d assume was obvious or dumb—and as I’d brace myself to be belittled—the expert would say, “We have no idea.” At first it was frustrating and then a bit disconcerting. But now I realize it’s exciting. The brain is the black box; the final frontier. We are only in the beginning stages of understanding how the brain and body works together and there’s so much left to figure out.
Q: What is missing from treating people with obvious brain disorders?
Cahalan: For me, I think that there’s a lot missing from the recovery or the post-diagnosis side of treating patients. Once the diagnosis is made, I feel that care drops off tremendously, even though it is precisely the time that a patient needs help the most, even if they are not verbalizing it. For me, recovery was the loneliest, most difficult part of it all and I feel we should be devoting a good deal of our efforts to helping people adjust to a new life with a different brain.
Q: Are you healthy now?
Cahalan: Yes, I believe I am healthy now. People ask me all the time if I’m back to 100% and I want to say yes, but I’ve found through this project that I’m not the best judge of my own condition. I believed I was 100% when I was far from it. Maybe that’s because I’m pigheaded, but I think we all have a blind spot that makes judging ourselves objectively really impossible. But that might be beside the point, if you did the blood work, the PET scans, and the MRIs (because I have had them done recently), yes, I would be healthy now.
Q: What do you hope that people take away from the book?
Cahalan: Be your own advocate. And if you can’t do it for yourself, make sure you have someone, family or a friend, who can do it for you. Get a second opinion from a different institution. On an entirely different note, I hope that readers walk away holding their loved ones a little tighter and feeling a sense of awe and respect for the incredible way our bodies can work and how devastating it can be when they fail.
Join Pulitzer Prize-winning reporter and best-selling author Charles Duhigg as he interviews Victoria Montgomery Brown, co-founder and CEO of Big Think, live at 1pm EDT tomorrow.
Richard Feynman once asked a silly question. Two MIT students just answered it.
Here's a fun experiment to try. Go to your pantry and see if you have a box of spaghetti. If you do, take out a noodle. Grab both ends of it and bend it until it breaks in half. How many pieces did it break into? If you got two large pieces and at least one small piece you're not alone.
But science loves a good challenge<p>The mystery remained unsolved until 2005, when French scientists <a href="http://www.lmm.jussieu.fr/~audoly/" target="_blank">Basile Audoly</a> and <a href="http://www.lmm.jussieu.fr/~neukirch/" target="_blank">Sebastien Neukirch </a>won an <a href="https://www.improbable.com/ig/" target="_blank">Ig Nobel Prize</a>, an award given to scientists for real work which is of a less serious nature than the discoveries that win Nobel prizes, for finally determining why this happens. <a href="http://www.lmm.jussieu.fr/spaghetti/audoly_neukirch_fragmentation.pdf" target="_blank">Their paper describing the effect is wonderfully funny to read</a>, as it takes such a banal issue so seriously. </p><p>They demonstrated that when a rod is bent past a certain point, such as when spaghetti is snapped in half by bending it at the ends, a "snapback effect" is created. This causes energy to reverberate from the initial break to other parts of the rod, often leading to a second break elsewhere.</p><p>While this settled the issue of <em>why </em>spaghetti noodles break into three or more pieces, it didn't establish if they always had to break this way. The question of if the snapback could be regulated remained unsettled.</p>
Physicists, being themselves, immediately wanted to try and break pasta into two pieces using this info<p><a href="https://roheiss.wordpress.com/fun/" target="_blank">Ronald Heisser</a> and <a href="https://math.mit.edu/directory/profile.php?pid=1787" target="_blank">Vishal Patil</a>, two graduate students currently at Cornell and MIT respectively, read about Feynman's night of noodle snapping in class and were inspired to try and find what could be done to make sure the pasta always broke in two.</p><p><a href="http://news.mit.edu/2018/mit-mathematicians-solve-age-old-spaghetti-mystery-0813" target="_blank">By placing the noodles in a special machine</a> built for the task and recording the bending with a high-powered camera, the young scientists were able to observe in extreme detail exactly what each change in their snapping method did to the pasta. After breaking more than 500 noodles, they found the solution.</p>
The apparatus the MIT researchers built specifically for the task of snapping hundreds of spaghetti sticks.
(Courtesy of the researchers)
What possible application could this have?<p>The snapback effect is not limited to uncooked pasta noodles and can be applied to rods of all sorts. The discovery of how to cleanly break them in two could be applied to future engineering projects.</p><p>Likewise, knowing how things fragment and fail is always handy to know when you're trying to build things. Carbon Nanotubes, <a href="https://bigthink.com/ideafeed/carbon-nanotube-space-elevator" target="_self">super strong cylinders often hailed as the building material of the future</a>, are also rods which can be better understood thanks to this odd experiment.</p><p>Sometimes big discoveries can be inspired by silly questions. If it hadn't been for Richard Feynman bending noodles seventy years ago, we wouldn't know what we know now about how energy is dispersed through rods and how to control their fracturing. While not all silly questions will lead to such a significant discovery, they can all help us learn.</p>
A study looks at the performance benefits delivered by asthma drugs when they're taken by athletes who don't have asthma.
- One on hand, the most common health condition among Olympic athletes is asthma. On the other, asthmatic athletes regularly outperform their non-asthmatic counterparts.
- A new study assesses the performance-enhancement effects of asthma medication for non-asthmatics.
- The analysis looks at the effects of both allowed and banned asthma medications.
WADA uncertainty<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yMzUzNzU0OS9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYxMDc4NjUwN30.fFTvRR0yJDLtFhaYiixh5Fa7NK1t1T4CzUM0Yh6KYiA/img.jpg?width=980" id="01b1b" class="rm-shortcode" data-rm-shortcode-id="2fd91a47d91e4d5083449b258a2fd63f" data-rm-shortcode-name="rebelmouse-image" alt="urine sample for drug test" />
Image source: joel bubble ben/Shutterstock<p>When inhaled β-agonists first came out just before the 1972 Olympics, they were immediately banned altogether by the WADA as possible doping substances. Over the years, the WADA has reexamined their use and refined the organization's stance, evidence of the thorniness of finding an equitable position regarding their use. As of January 2020, only three β-agonists are allowed — salbutamol, formoterol, and salmeterol —and only in inhaled form. Oral consumption appears to have a greater effect on performance.</p>
The study<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yMzUzNzU0Ny9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTY1MTIzMDQyMX0.Gk4v-7PCA7NohvJjw12L15p7SumPCY0tLdsSlMrLlGs/img.jpg?width=980" id="d3141" class="rm-shortcode" data-rm-shortcode-id="ebe7b30a315aeffcb4fe739095cf0767" data-rm-shortcode-name="rebelmouse-image" alt="runner at starting position on track" />
Image source: MinDof/Shutterstock<p>Of primary interest to the authors of the study is confirming and measuring the performance improvement to be gained from β-agonists when they're ingested by athletes who don't have asthma.</p><p>The researchers performed a meta-analysis of 34 existing studies documenting 44 randomized trials reporting on 472 participants. The pool of individuals included was broad, encompassing both untrained and elite athletes. In addition, lab tests, as opposed to actual competitions, tracked performance. The authors of the study therefore recommend taking its conclusions with just a grain of salt.</p><p>The effects of both WADA-banned and approved β-agonists were assessed.</p>
Approved β-agonists and non-asthmatic athletes<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yMzUzNzU1MC9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYxMzkxODk0M30.3RssFwk_tWkHRkEl_tIee02rdq2tLuAePifnngqcIr8/img.jpg?width=980" id="39a99" class="rm-shortcode" data-rm-shortcode-id="b1fe4a580c6d4f8a0fd021d7d6570e2a" data-rm-shortcode-name="rebelmouse-image" alt="vaulter clearing pole" />
Image source: Andrey Yurlov/Shutterstock<p>What the meta-analysis showed is that the currently approved β-agonists didn't significantly improve athletic performance among those without asthma — what very slight benefit they <em>may</em> produce is just enough to prompt the study's authors to write that "it is still uncertain whether approved doses improve anaerobic performance." They note that the tiny effect did increase slightly over multiple weeks of β-agonist intake.</p>
Banned β-agonist and non-asthmatic athletes<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yMzUzNzU1Mi9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYzNjI3ODU5Mn0.vyoxSE5EYjPGc2ZEbBN8d5F79nSEIiC6TUzTt0ycVqc/img.jpg?width=980" id="de095" class="rm-shortcode" data-rm-shortcode-id="02fdd42dfda8e3665a7b547bb88007ef" data-rm-shortcode-name="rebelmouse-image" alt="swimmer mid stroke" />
Image source: Nejron Photo/Shutterstock<p>The study found that for athletes without asthma, however, the use of currently banned β-agonists did indeed result in enhanced performance. The authors write, "Our meta-analysis shows that β2-agonists improve anaerobic performance by 5%, an improvement that would change the outcome of most athletic competitions."</p><p>That 5 percent is an average: 70-meter sprint performance was improved by 3 percent, while strength performance, MVC (maximal voluntary contraction), was improved by 6 percent.</p><p>The analysis also revealed that different results were produced by different methods of ingestion. The percentages cited above were seen when a β-agonist was ingested orally. The effect was less pronounced when the banned substances were inhaled.</p><p>Given the difference between the results for allowed and banned β-agonists, the study's conclusions suggest that the WADA has it about right, at least in terms of selection of allowable β-agonists, as well as the allowable dosage method.</p>
Takeaway<p>The study, say its authors, "should be of interest to WADA and anyone who is interested in equal opportunities in competitive sports." Its results clearly support vigilance, with the report concluding: "The use of β2-agonists in athletes should be regulated and limited to those with an asthma diagnosis documented with objective tests."</p>
Certain water beetles can escape from frogs after being consumed.
- A Japanese scientist shows that some beetles can wiggle out of frog's butts after being eaten whole.
- The research suggests the beetle can get out in as little as 7 minutes.
- Most of the beetles swallowed in the experiment survived with no complications after being excreted.