Part IV: In which the brain adapts

HERE’S something nobody spells out before you go in for brain surgery: Recovery can take anywhere from six months to two years. Not to mention, forever.

Doctors probably don’t tell you that because patients would cancel their operations in hysterical droves. Surgeons would roll their eyes as gloomy brain surgery candidates screeched, “Wh-a-a-a-t? I’m much too important to be taken out of circulation for more than a long weekend! My perfect triplets are trying to make it onto Team Canada and urgently need my ceaseless hounding! I’m on tap to save Africa, Australia and the uglier parts of France! And, for the love of David Suzuki, who will turn my compost?”

Instead, along with a strong recommendation to remove the tumor, you are diplomatically told there are “certain risks associated with the surgery” and “possible after-effects.” Ignoring them, you blunder into the operating room, fingers crossed.

You’re relieved when you come out of surgery and discover you’re not dead. Soon afterward, you realize that (for example) your vision, your concentration, your ability to multi-task, and some of your memory are impaired. Then it dawns on you that if you don’t get better, you’ll spend the rest of your life getting stuck in snowbanks on the Handi-DART. That’s the point when you conclude that it’s time to stop coasting and take an active part in your own recovery.

The athletes and health nuts among you will see this as just another responsibility to perkily assume on the road to personal “wellness.” The slobs among you (hail, chums!) will be bewildered, thinking, “I’m used to my brain just doing all the work while I sit back and abuse it with alcohol, potato chips and reruns of King of Queens. How can I unlearn taking my central nervous system for granted?”

Boys and girls, it’s time to say howdy to your new buddy, Rehab.

For the brain, it appears, is not the frozen TV dinner we once thought it to be, with the immobile meat loaf firmly separate from the peas, the potatoes and the “Mom-style” apple pie. Actually, the apple pie can be thawed and used as a conduit for the peas, if required, and the meat loaf can cozy up to the taters. That’s the gist of what’s called “neuroplasticity”: The brain is not a rigid organ, full of hostile factions; rather, its various parts are surprisingly adaptable, even neighbourly. Given the guidance of speech therapists, occupational therapists and the like, a healthy brain can try and relearn old habits by rewiring itself to use different routes.

All you need is that shamefully under-rated virtue, patience. In the 2-1/2 months since my surgery to remove a benign brain tumor (don’t worry -- I’ll change topics next week), I’ve learned that rehabilitation after “neurological insults” is all about pacing. “Recovery is a process,” says the social worker assigned to me at my local hospital, a charming woman, well-equipped with tissues. “Rehab is lifelong learning…. Think of it as a work in progress.”

Ouch.

Getting better, then, is not a finite endeavor. That’s why there’s no easy answer when patients ask anxiously when they can expect to be “back to normal.” If the doctor or rehab experts give you a date, the social worker explains, you may see it as a deadline and get upset when you reach it and still have symptoms.

Instead, you are supposed to set aside your suddenly fond memories of how you used to be and concentrate on your new normal, improving that as much as you can. You do this by figuring out at what point in the day your eyesight, for instance, is strongest, and doing your reading or work at that time. Contrary to what we learn in almost every other aspect of life, pushing yourself too hard in neurological rehab is counterproductive.

Slow persistence, however, is fine. When you can’t remember the word for something, your friends (however irritated) aren’t supposed to help you. Even if it takes you 15 minutes to remember the name “Donald Sutherland,” or recall which of Queen Elizabeth’s sons was miserably married to Diana and now whinnies fondly at Camilla, the effort is worthwhile. You are training your brain to choose different routes to find the information that used to be readily available to you, and once a new route is in place it will be there next time you need to refer to that data. The name Donald Sutherland will instantly spring to mind, all because you wasted an agonizing quarter of an hour of your life muttering, “His son is on 24. His ex-wife is Tommy Douglas’s daughter. He used to go out with Jane Fonda. He starred with her in Klute. OMG, you nitwit -- you know this!”

“Rehab is all about using strategies,” says the social worker. And maybe you’ll triumph; maybe you won’t. “You know things have changed -- you don’t know where it’ll end up.”

Rather than focusing on your limitations and challenges, you’re supposed to track your gains, and keep a log of them.

Luckily, there are encouraging books around, like the bestseller The Brain That Changes Itself, by Canadian psychiatrist Norman Doidge (Penguin). Doidge is a compelling writer who is fascinated with this organ’s ability to shape-shift. In the book, he explains how experts once assumed that certain sections of the brain were responsible for key functions, and if they were injured, those functions would be impossible. But pioneers in neuroplasticity are figuring out how to train the brain to achieve some crucial functions (not necessarily perfectly) using the afore-mentioned alternate pathways. Amazing feats have been achieved for seriously debilitated people.

I’m progressing slowly through the book because the topic is complex, but it’s a cheerful story. The good news is that your brain’s abilities aren’t written in stone.

The bad news? You can’t send the thing out for service. Upgrades largely depend on you.

Comments

[Christina]

Thanks for writing about your brain tumour and recovery experience. I hope you can give us more updates as you go.

It's evident that the operation didn't impair your sense of humour!

Here's to neuroplasticity! Best wishes for a speedy journey down those neural pathways.