The single most valuable lesson I learnt in my 18-year healing journey. 

 Without a doubt, this is the lesson I learnt when practicing to walk with a practice leg. After a full month of being completely paralyzed in the ICU and a further 2 months of being mostly bedridden, with brief jaunts in the wheelchair, the exhausting rehab work started in earnest.

 I had to coax my wasted and semi-paralyzed muscles into generating movement again. Even today (24 years later) I have vivid recollections of my body parts feeling as if they were glued to my bed; of the sheer amount of effort involved in moving any part of my body; of how utterly exhausting it was to move.

 The cold hard reality of what it would take to regain my body only really hit home during my first session with the occupational therapist (OT).

 “Place your open right hand palm downwards on the table”, Marinda, the OT, gently instructs me. She then immobilizes 3 of my fingers, “now, lift your pointing finger off the table surface 100 times”.

 Seems a simple enough ask. But no matter how relentlessly I engage what seems like 100% mental effort, with the sweat literally bursting out on my face, my finger remains glued to the table. Until finally . . . for a brief moment my finger comes unstuck.

 It takes way too much energy to hold up.

 Terrifying nausea starts gnawing at the pit of my stomach. My jumbled brain cannot make any sense of it, “if it takes this much effort to move a finger, how would I master walking?”

 Gym workouts are as demoralizing; memories of honing my once-powerful muscles into peak condition at the Sports Science Institute gym a few months previously are still fresh.

 Porcha, the beautiful bio, puts me through my paces. She deftly straps 200g weights to my wrists. I don’t have nearly enough strength in my hands to hold the weights. She asks me to position my arms at the sides of my wheelchair and then urges me to lift my arms away from the chair as far up as I could get to the horizontal.

 Despite my surging testosterone (trying to impress Porsha), huge mental drive and pounding heart, nothing much happens. My arms simply refuse to move beyond a 40 – 45° angle, even without the weights. It feels well neigh impossible to get any leverage whatsoever while sitting in a chair and struggling with exceptionally weak and semi-paralyzed core muscles.

 For the 1000th time, I visualize David, the drunk truck driver who put me in this place, in front of me and I imagine myself smashing his face in. The raw anger generated by these visualizations drives me through 30 more minutes of gym.

 “I simply have to get up out of this chair to get a decent workout”.

 It falls to Elmarie, the physiotherapist, to make this a reality. Or rather to foist another reality check upon me. Elmarie maneuvers my wheelchair to a table containing puzzle pieces. She instructs me, “Please stand up and build the puzzle without touching the table.”

 I gamely try to pick up a puzzle piece, but the moment I look at the puzzle I topple over and grab hold of the table with my other hand. Elmarie gently reminds me not to hold on. I try again, but I simply cannot concentrate on the puzzle AND balance at the same time.

My motivation starts to flag. The driving force that got me up to this point, my outrage at what David had done to me, starts turning on me. I can literally feel it sucking the life out of me.

I desperately need some fresh inspiration. It comes in the form of a challenge.

“If you work hard throughout July to build up enough strength and endurance to manage a practice leg, you can get going with walking training on 1 August”, Elmarie informs me.

This is exactly the tonic I need.

Despite being unable to grip elbow crutches, and with a left leg only able to stand for 180 seconds before collapsing in utter exhaustion by the time 1 August rolls around, Jan, my prosthetist promptly arrives with a bulky practice leg. Inflatable padding protects my stump from getting hurt by the hard shell of the practice leg, support straps keeps it fastened around my waist.

Finally, the moment of truth arrives. I stand at the end of the parallel bars contemplating taking my first step to ‘freedom’. My heart is beating furiously in my chest, my fight and flight response is spiking out of control.

“SNAP OUT OF IT”, I yell at myself, but to no avail. My fight and flight response simply must be brought under control. “But how??”

Laughter is the first thing that pops into my head. “See the funny side of your situation – here you are, 30 years old and you’re afraid of falling onto a carpeted floor. Who would ever have thought you would be in such a senseless situation one day?”
Seeing the funny side of my situation lets off enough pressure for me to take that first step.

As I expected, I immediately collapse in a heap. After more of the same I wrack my brain to think of similar situation I’d encountered before.

It didn’t take long to recall my rock-climbing incidence 10 year previously. A frantic life and death situation that I only survived because I employed a straightforward, but extremely powerful tool to climb to safety. But, before I tell you about this tool, I will share another valuable lesson I learned from my rock-climbing incident. The ‘actual thing’ that switched my fight and flight response on was ‘giving thought’ to falling. Up to the point that I looked down, I was in complete control of my body, but the moment I ‘gave though’ to the 200m drop, my body instantaneously started trembling and the sweat literally burst out of my hands and my bare feet. I summed up my situation in one second flat.

“I can’t possibly hang on for more than 5 minutes in this precarious position before my hand muscles fatigue. If I want to get out of this alive I have to start climbing right now”. After another fraction of a second, a snap decision (I instinctively know this is my ONLY viable option). Don’t climb back down.

The very instant I made the decision to commit and focus 100% on CLIMBING, my fight and flight response instantly switched off. My body immediately stopped trembling, the sweat stopped pouring, an extreme awareness takes over, I observe myself climbing, I have zero thoughts in my head, I am fully aware of what I am doing, fully aware that any misstep means certain death.

I feel like Spiderman on speed as I scale that sheer rock face with speed and superhuman strength.

YES, this is exactly what I need to stop my fight and flight response dead in its tracts to enable me to keep my composure and WALK out of these parallel bars. The key is not to give my fight and flight response any more ‘encouragement’ by giving any thought to ‘not falling’. I discovered that despite my pitifully weak and entirely uncoordinated body, I only fell when I engaged any thought whatsoever about what I was doing; but when I stopped thinking entirely AND focussed 100% on walking, I succeeded. I used this strategy to walk all the way around the big physiotherapy room by the end of August.

Not thinking AT ALL, yet keeping a 100% single-minded focus on what I was doing (on my goal), was one of the most difficult things I have ever attempted, but it did teach me an unbelievably valuable lesson that I have since successfully employed on many occasions.

Practical stress management tips from a gold medal-winning Olympian.

Few occasions evoke greater performance anxiety than an Olympic final. Athletes must carefully manage their bodily stress reactivity to prevent them from succumbing to a nauseating mix of counterproductive bodily urges.

What are the tricks of the trade that enable athletes to produce gold medal-winning performances despite having to cope with overwhelming performance anxiety?

We were able to ascertain some of these trade secrets when we measured Abinath Bindra’s brain waves during shooting in the laboratory just a few months prior to him winning the gold medal in the 10m air-rifle shooting competition at the 2008 Olympics.

Abinath completed 60 shots (all bulls eyes) in 1h45 minutes in our lab, which is the number of shots and the time allotted in the knock-out stages of the competition. After each shot. Abhinav rated his shot as either ‘good’, or as ‘unstable’ or as ‘muscle tremor’. This enabled us to construct 3 grand average brainwave graphs – associated with ‘good’, ‘unstable’ and ‘muscle tremor shots, respectfully – of the state of Abinath’s brain during his 60 shots.

The differences in Abinath’s brainwaves during his good vs. unstable and muscle tremor shots were stark. During his good shots, Abinath displayed very low cortical activity throughout his brain, which showed that his cognitive processing of information (arriving from his body and from the environment) was kept to a bare minimum. Most fascinating of all was that this included the cognitive processing in his visual cortex. At first, it did not make sense that Abinath did not seem to cognitively engage with any visual input during his good shots.

After thinking about it for a bit, it started to make more and more sense. When we actively look at something our pupils dilate, and pupil dilation is mediated by the sympathetic nervous system (SNS). SNS activation is a big no-no when we need to remain as calm and composed as possible – it must be avoided at all costs.

Preventing SNS activation would be reason enough on its own for Abinath to not actively look at the target but maintain an open focus.

But there is another equally good reason for minimizing the visual input into the brain. This has to do with the sheer volume of neural information (including pre-processing) that reaches the brain via the two optic nerves. It has been estimated that the afferent nervous input from the 2 optic nerves is equal to the entire amount of efferent neural control that the brain has over the body.

To help us put this in perspective – if we compare the afferent information in the two optic nerves to balls being hit to the brain and we compare the brain response to bats that return each ball – the entire number of bats in the brain would be engaged in returning the balls arriving just from the two optic nerves.

Now add in the balls (information) arriving from the viscera to the brain, from the environment to the brain, from the ears to the brain, the muscles, the blood, the skin, proprioceptors, etc. If Abinath did not actively manage this information overload his brain would have been overwhelmed in a matter of milliseconds, his Fight and Flight response engaged, and the target missed.

Managing information overload is difficult enough in our daily lives but managing it during an Olympic final requires more than just quietening of the thoughts. In the next newsletter, I will explore another important ingredient that is required to deliver a gold medal-winning performance.

Disengaging from the busyness of life….

If, like me, you struggle to take your foot off the accelerator now is the time to start slowing down and to be kinder to your heart. My favourite time of the year has always been Christmas to New Year. It is a time of counting my blessings, of replenishing my heart and of recharging my batteries to meet the stressful challenges of the upcoming year.

Stressful challenges tend to take a heavy toll on our hearts. According to a 9 December 2020 News Release from the W.H.O:

“Heart disease has remained the leading cause of death at the global level for the last 20 years. However, it is now killing more people than ever before . . .”

This is no surprise as it is especially our hearts that take the brunt of all the stress generated in our bodies to survive in the circular economies (i.e., using recycled rather than raw materials) of today. It requires us to work ever longer hours for ever diminishing profit margins amidst ever greater competition for resources.

This vicious cycle is taking an extremely heavy toll on our hearts, because managing these punishing workloads requires excessive release of chemicals like adrenaline and cortisol into our bloodstreams.

You will never guess how scientists study heart failure in the laboratory.

Scientist mimic heart failure by injecting synthetic adrenaline into the bloodstream of laboratory rats! These so-called ‘heart failure models’ are then used to test heart medicines.

Therefore, by far the best thing you can do for your heart is to stop injecting adrenaline into your own bloodstream. Easy to manage while on holiday, but more challenging when confronted with endless deadlines and dwindling resources.

The best way to stop injecting adrenaline into your own bloodstream is by keeping your Mammalian brain calm. Our 2021 newsletters will kick off with a series on practical applications of mastering your Brain Reward System.

Wishing all of you a peaceful and joyful Festive Season filled with many blessings, serenity, and calmness.

Mastering your Sympathetic Nervous System
Before my life took on an entirely different trajectory post-accident I used to run/cycle in the mountains behind our home to control my excessive sympathetic nervous system (SNS) drive that ‘accumulated’ from managing the ‘weight of responsibility’ of obtaining my PhD. Indeed, hard exercise refreshed my body and cleared my head like nothing else, but, after I suffered brain and spinal cord injuries and lost my leg, I found that hard exercise robbed me of way too much energy.

I was thus desperate to find a more efficient way to regulate my sympathetic nerves and my heart rhythm. Though I understood very well from our StressEraser research just how powerful deep, slow breathing can be in calming the heart, I also realised that there is a deeper level that needs to be appreciated:

The breath is only effective when it aligns with the blood pressure (BP) rhythm
What this translates into is that the effective ‘ingredient’ underpinning Keeping Calm is the alignment of the heart rhythm with the BP rhythm. Given that the BP rhythm is under dominant SNS control, it necessitates that we must actively modulate the SNS drive, in addition to actively modulating the parasympathetic drive, in our bodies.

Cardiac Vagal Motoneurons
Restorative activities, such as deep breathing exercises, Mindfulness Meditation, Yoga, Qigong, etc. done in a quiet and secluded space, regenerates our bodies via our parasympathetic vagus nerve that originates in the cardiac vagal motoneurons in the Dorsal Motor Nucleus of the Vagus and in the Nucleus Ambiguus in the brainstem. It is possible to indirectly modulate these brainstem vagal nuclei via the Primate brain, more specifically via the ventromedial Prefrontal Cortex, but this more indirect modulation demands an appropriate brain state such as engendered by Mindfulness Meditation, Contemplative Meditation, Qigong, Yoga, etc. A more direct way to modulate cardiac vagal motoneurons is via the breath, i.e. via Primate brain ‘override of the spontaneous respiratory rhythm generated by our brainstem respiratory nuclei.

The 3 Groups of Nuclei controlling Respiration and the breathing circuitry
There are 3 groups of respiratory nuclei in the brainstem that control spontaneous breathing via neuronal circuitry that generates 1) inspiratory activity, 2) post-inspiratory activity and 3) expiratory activity. Note that the neuronal circuitry that generates expiration is passive during normal breathing, because our lungs are elastic and will deflate like a balloon once the inspiratory activity is ‘switched off’ by the post-inspiratory circuitry. Slowly adapting pulmonary stretch receptors in the lungs terminate inspiratory activity reflexively. This is known as the Hering-Breuer reflex that prevents over-inflation of the lungs. Our air-filled elastic lungs then deflate as we passively exhale. However, during speaking, exercise, stress, etc. expiratory activity is supported by expiratory muscles due to the increased respiratory drive accruing from the build-up of carbon dioxide.

The inspiratory circuitry decreases the vagal nerve activity to our hearts via inhibition of the cardiac vagal motoneurons in the brainstem, to thereby increase the heart rate. Once the inspiratory circuitry is disengaged this so-called vagal break is removed. This then switches the vagal drive to the heart back on to actively slow the heart rate down. Some of the fit young athletes (18-20-year olds) I have tested dropped their heart rates by more than 40 beats a minute with one deep slow out-breath!

I typically do my 10 sec deep breathing exercises just after midday to resynchronise my heart-brain-body loop. Note that this is a form of physical activity that necessitates your complete focus and engagement. Start by taking a sharpish 3 second in-breath followed by a 1 second post inspiratory lag, before taking an active and prolonged out-breath over 6 seconds. It is best to time your 10 sec breaths to be most effective. The gold standard is to take 60 breaths over 10 mins; but taking a minimum of 30 breaths over 5 minutes will also be heart healthy and improve your performance!

Follow your heart, but only if you know who is leading who.

If your Fight and Flight response is activated for whatever reason, you can kiss modulating your cardiac vagal motoneurons via your Primate brain – whether indirectly by engaging the appropriate brain state or more directly via breathing – goodbye. Powerful as the out-breath is in calming our hearts, the breath becomes part of the problem when our innate Fight and Flight responses highjacks our breathing rhythms & breathing aligned heart rhythms. As we saw above, the BP rhythm is a 10 second rhythm, which is noticeably slower than our ~4 second spontaneous breathing rhythms and much slower than our panicked 2-3 sec breathing rhythms. By training our Mammalian brain and bodies to align our heart rhythms directly with our innate 10 second BP rhythm, it is possible to remain composed even during high pressure situations.

Whenever the weight of responsibility bearing down on you becomes too great a burden, then take active steps to ensure that your heart stays closely aligned with your 10 second BP rhythm. But whatever you do – if your heart does become aligned with your flighty breathing rhythm when you are under pressure – DO NOT follow it there.

Spring Special for the months of August/September: Book now for a 2-session Zoom workshop with Dr Laurie on aligning your heart with your 10 sec BP rhythm for R950. Normally valued at R1250.

Bearing up under the weight of responsibility
When I first heard the term ‘the weight of responsibility’ it immediately struck a chord. Responsibility is indeed a crushing weight, the handling of which needs our constant attention. Like the body builder who gradually adds more and more weights to build the size and strength his/her muscles, the more we are exposed to handling the weight of responsibility the ‘stronger’ our ‘weight’ bearing abilities become. Not that the ‘heaviness’ itself ever goes away. No, it is ongoing, and it is relentless and the sooner we learn to bear up under the ‘heaviness’ associated with responsibility the better it will be for our health, wellbeing and our performance.

In my own case, when the StressEraser project finally got the nod, I committed to it wholeheartedly, despite my anxious heart telling me that this was a bridge too far. There were many similarities to walking out of the parallel bars upon first learning to walk with my peg leg. The game-changing difference between my futile attempts at mastering walking with the peg leg while I was at the same time trying not to fall – as compared to having a single-minded focus on walking – similarly applied. I had to step beyond my Performance-Arousal tipping point, trust my body and not think of falling by keeping my focus on my single-minded goal to measure the effects that deep breathing has on the neurobiology of performance. How exactly I was going to go about doing this was the unknow that kept me awake at night.

The importance of having a single-minded goal
The big difference between my anxious heart telling me to find an alternate career, after I had seemingly made no noticeable headway for 7 years following my accident, and my anxious heart telling me not to take on the StressEraser project was my single-minded goal of wanting to understand how breathing impacted the physiology of performance. Keeping this single-minded goal ‘alive’ in my brain allowed me to ‘look beyond’ my current stress levels to where I wanted to be. As I fine-tuned the research protocol and Gabriell took over from Diane and the equipment arrived from the UK and pilot testing started, my nerves started to settle.

After the data collection was finished, we had to analyse and interpret the data. This was a labour-intensive and stress provoking process that took us a good 2 years to fully come to grips with before we were able to write the first paper. Prof Wayne Derman, who originally obtained the funding for the StressEraser project, mentored us in this process. Given the novelty of the research our first paper spent 2 years in the review process before it was finally accepted for publication. Next on the agenda was Gaby’s PhD thesis and then on to publishing further papers. This project ended up spanning a total of 9 years, but it was well worth the time, effort and expense. Not only did Gaby graduate with her PhD and the 5 StressEraser papers are still highly cited today, it also enabled me to forge a research niche for myself.

The StressEraser research taught me a whole lot. Not only was deep, slow HRV paced breathing very effective in managing anticipatory anxiety, it also had a significant positive effect on cognitive performance and on subjective relaxation ratings. I found out that the primary reason why deep, slow breathing works so well is because the heart follows the breath. Note it is not the heart rate that follows the breath, rather it is the heart rhythm that follows the breathing rhythm. This is so, because your heart rate speeds up as you breathe in and your heart rate slows down as you breathe out. A fast, shallow breathing rate leads to a fast but ineffectual heart rhythm. Ineffectual in that a fast heart rhythm panics the brain. In contrast, slowing your breathing rate down to 6 breaths per min brings another rhythm into play – the alignment of your heart rhythm with your blood pressure rhythm.

Coherence in our 3 internal bodily rhythms
What this translates into is that the heart is not following the breath as such, rather it is following the Primate brain, because it is your Primate brain that sets the deep, slow breathing rhythm. Furthermore, the Primate brain is now also aligning with the Mammalian brain, which then leads to coherence of these 3 bodily rhythms. These 3 bodily rhythms cycle at around 10 seconds, therefore in order to synch these 3 bodily rhythms we have to increase the force and length (to about 3-4 seconds) of our in-breath and slow our out-breath to about 6-7 secs so that our combined in-and out-breath is about 10 seconds long. The feedback that your Primate brain and your Mammalian brain gets from a heart rate that rises and falls according to the aligned 6 breaths a minute rhythm is serene and as such is restorative in nature.

Why does the 6 breaths a minute work so well, and why for instance does 10 breaths a minute or 3 breaths a minute not work? This is because your blood pressure (BP) feedback loop operates on a 10 second rhythm. Unlike your breathing rhythm and your heart rhythm, your BP rhythm cannot be overridden by your Primate brain. It operates on this 10 second rhythm – regardless of Primate brain interference – to allow your blood pressure to be stable over the long term, despite wide short-term fluctuations each time your heart beats or you have an emotional response. 

Note that your BP rhythm is independent on your BP, i.e. no matter how high or low your BP is, it still operates via a 10 second feedback loop. Say for example your BP drops, your BP feedback loop corrects this as follows: 1) baroreceptors inside your arteries fire that 2) sends a message to your brainstem, 3) different sets of nuclei in your brainstem will interpret and 4) relay the signal to your blood vessels to constrict them 5) and to your heart to speed your heart up to 6) thereby increasing your BP. This whole feedback loop has built-in delays so that it ends up taking ~10 second in duration. This feedback loop keeps cycling and manifests as a 10 sec BP rhythm.

Engaging in 5 minutes of deep, slow breathing just prior to a stressful meeting, an exam or a sporting event will thus help you to be calmer and more focused, and positively impact your reaction time and your performance. This occurs because your heart–brain-body loop becomes highly synchronised after about 5 minutes of 10 sec breathing. This enables your Primate brain to switch to a state of heightened awareness instead of engaging in over-thinking and in overriding of your Mammalian brain. Keeping in mind that your Primate brain is the one that instructs your Mammalian brain that then executes whatever thoughts you have in your Primate brain. Hence the importance of thought control.

If this is done correctly, the feedback from your coherent 10 second heart rhythm to your Primate brain and your Mammalian brain will indicate that all is well in your body & environment and there is thus no need to activate excessive bodily resources to cope with potential challenges. This is the perfect time to be following your heart because you know it is your Primate brain setting the rhythm of your heart, rather than a stressor. Needless to say, following your heart when your heart is reacting to a stressor will lead to panic. Do not follow it there!

Powerful as deep, slow breathing is in calming your heart, clearly there is a deeper level that needs to be appreciated. The breath itself is only effective when it aligns with your BP rhythm, meaning it is the alignment of the heart rhythm with the BP rhythm that is the effective ingredient underpinning keeping calm. Our BP rhythms are under dominant Sympathetic Nervous System (SNS) control, which necessitates working with the SNS in addition to the parasympathetic vagal nerve. Previously I took to running/cycling in the mountains to modulate my excess SNS drive to manage the ‘weight of responsibility’ of working towards my PhD. Indeed, exercise refreshed my body and cleared my head like nothing else, but now that exercise robbed me of what little energy I had, I was desperate to find a more efficient way to regulate my sympathetic nerves and my heart rhythm.            

Part 4 to follow.