I’m a rover, seldom sober.
(Age progression software, this is me in 10 years if I continue as a tree man…)
March 17 once again. For most, it is St. Patrick’s Day, the Irish homage to the juice of the barley and music of the fiddle. For myself, it is that too, of course, but it is also the start of my new fiscal year. Being born on St. Patrick’s Day is all it’s cracked up to be. It is time for the Guinness to flow. I am Irish on my mom’s side, by way of Newfoundland, the only true Irish colony.
It occurred to me several months ago that celebrating January 1st as the new year doesn’t really make any sense. What significance does that date have for me? I get a new day planner that I won’t use nearly enough, I get to chuck the Christmas tree out the door, and I’m left wondering what happened to all those “resolutions” from the previous January. And while all of this is happening, I’m nursing a hangover.
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January 1st is an arbitrary date for me. It doesn’t feel like the start of a new year, it just feels like – Tuesday. After pondering the issue for far too long, I decided that instead of calculating the new year the way that everybody else does, it makes far more sense for every individual to calculate the new year based on their birthday. Today, March 17, 2017, I turn 36, so today marks the beginning of my new fiscal year, Fiscal 36. For people who are actually born on January 1st, well, lucky you. Your day planner was custom made for you. The rest of us will just have to make do.
Ah, the start of a new year. A time to reflect on what was, and to draw plans for the future. Here are some of the things that I was up to in Fiscal 35:
I signed my first Apprentice – James
I had always looked forward to signing an apprentice but the timing and circumstances never seemed right. But last year, the stars aligned and James became the first apprentice at ConservaTree. Looking forward to a great season of climbing and trimming. Glad to have you aboard James!
EducatedClimber.com
Fiscal 35 saw me finally taking the steps to build an online arborist resource at EducatedClimber.com and quite frankly, I don’t know why it took me so long. As they say, the best time to plant a tree is 25 years ago, the second best time is now. I bought a GoPro camera and mounted it to my helmet, I got a Youtube account, and I started producing videos and articles and building an audience. This has now become my obsession. At any given time there are a hundred videos bouncing around in my head that need to be made yesterday. And I love that I have gotten back into writing. I always felt that I could write, but for many years after dropping out of university I just didn’t really have an excuse to do it. Look for big things on the site in Fiscal 36. I will continue to provide value for my audience, through producing content for my apprentice James. My apprentice provides context for everything that I do on the site. I am not interested in talking about all the latest gear, my focus is Back to Basics. Without a grounding in the basics, you do not have a framework from which to evaluate the latest and greatest gadgets and gizmos. My goal is to provide a solid foundation of basics for a total noob to absorb that will allow them to be productive on the jobsite from day 1. That is my mission.
Podcasts
I started listening to podcasts in 2013 with the Lew Rockwell show, but burning a couple episodes to a CD was just too tedious. But last year I switched trucks and my new beast (’97) had a brand new stereo with aux-in and a usb port. This finally made it feasible to listen to podcasts while driving, which was a game changer. I live out in the sticks, so pretty much wherever I go is a long drive. Now I actually look forward to long drives because of the information and stories that I get to absorb. These are my current favourites:
The Tim Ferriss Show
Deconstructing world-class performers. Really fascinating stuff from one of my favourite modern authors. He literally wrote the bible: The Four Hour Workweek. Love it.
Favourite episodes:
Arnold Schwarzenegger Part 1, Part 2
Pavel Tsatsouline
“The Iceman” Wim Hof
Sebastian Junger (former arborist)
Rick Rubin
Coach Christopher Sommer
Kevin Kelly Part 1, Part 2, Part 3
The James Altucher Show – Business and life lessons from my favourite blogger.
How I Built This – Entrepreneurial inspiration from NPR
You Are Not So Smart – it’s true, and I’m not either
Smart Passive Income – Pat Flynn is the best
Books
Here are some of the books that I enjoyed this past year:
Rich Dad, Poor Dad – Robert Kiyosaki
The E-myth Revisited – Michael Gerber
The 4 Hour Chef and Tools of Titans – Tim Ferriss
The War of Art – Steven Pressfield
Outliers – Malcolm Gladwell
Choose Yourself – James Altucher
A Drinking Life – Pete Hamill
Folks, This Ain’t Normal – Joel Salatin
How to Fail at Almost Everything and Still Win Big – Scott Adams
The Subtle Art of Not Giving a F*ck – Mark Manson
Year of the Squat
I started Fiscal 35 with big plans for lifting weights. My main focus was going to be squats. I have always hated barbell back squats, they throw my balance off and they just don’t feel right. Front squats and kettlebell squats feel fine, but back squats don’t seem to work for me. I had always read that back squats are supposed to work your glutes and hamstrings, but all I could ever feel working was the quads. Also, it was always difficult to keep my heels planted, it always felt more natural to roll forward onto the balls of my feet. Fiscal 35 was going to be the year that all of that changed.
I bought a set of weights and a barbell from a guy who didn’t use them anymore, 465 pounds worth. I built a squat rack out of two skids and some boards. I started doing back squats with maybe 100 pounds but it just didn’t feel right. So what I ended up doing was just focusing on bodyweight squats. I did a lot of bodyweight squats. I focused mentally on the back of my legs – the posterior chain as they call it. I just kept doing squats and after maybe a couple of months something changed. I no longer felt it in the front of my legs, I could now feel it in the back. The problem with squatting for me was not muscular, it was neuro. I needed to wear a new groove in my brain, a groove that would allow the action of standing up to come from the back instead of the front.
So, after saying all that, I still haven’t gone back to barbell back squats, but plans are in the works my friends. I have been studying the technique and will be getting back into it soon enough. This is the video that I have found most helpful:
I think it’s fair to say that Fiscal 36 will be the Year of the Squat, Take 2.
I found my album online
All the way back in 2003 I recorded an album at home on my computer called Waiting to Happen. A few months ago, a friend from way back sent me a link from the archives at CHRW radio, the campus radio station at the University of Western Ontario, and lo and behold, my album has been online this whole time. I had no idea. I wrote all the songs and played all the parts, audio quality is so-so, but it’s good for a laugh. All these years later, it remains, still Waiting to Happen.
Politics
Fiscal 35 was a year spent realizing that there is never a good enough reason to try to convince anyone else of your own political views. A bit of light reading about the Backfire Effect should be enough to convince us of that. My own beliefs about the values of personal liberty are evidently not shared by most. Most people, it would seem, have the desire to control everyone else. Not directly, of course, but they want to be able to choose which elected official will be in charge of controlling everyone else. Me, I just want to be left alone.
Further research: the Non-Aggression Principle (NAP)
Resolutions
1. Get up earlier
It seems that the only possible way to get any writing done in a house with 3 kids is to get up at an ungodly hour. For the past 5 or 6 weeks I have been trying to get up at 5:30 everyday, just so I can get some work done. I plan on making this a staple of my daily routine in Fiscal 36.
2. Daily Practice
After more than a year of experimenting, I am still in search of a short daily practice, along the lines of exercise/gratitude/journalling/meditating/writing, etc. etc. Fiscal 36 will be the year that I finally crack this nut. As Derek Sivers says, “If more information was the answer, then we’d all be billionaires with perfect abs”. Too true. See James Altucher for inspiration for a Daily Practice.
3. Drink less beer
I’m Irish. I like beer. I’m working on it. However, as old Abe said “It has been my experience that folks who have no vices have very few virtues.” Couldn’t agree more.
There you have it. Happy St. Paddy’s day, and, at least for me, the start of a new fiscal year. Slainte!
Climb High, Work Smart, Read More.
– TreeMuggs
Continue Reading: Zen and the Art of Tree Climbing
I would love to hear from you. Please send all comments/questions/hatemail to patrick@educatedclimber.com
Cognitive changes in amyotrophic lateral sclerosis
G.N. LEVITSKY1.2.3, V.M.GILOD4, R.V.CHUB2, O.S.LEVIN51- Russian Charity ALS Foundation, Moscow, 2- Real Health clinic, Moscow, 3- Medical Preventive Ambulatory № 51, Moscow, 4- Department of Psychiatry and Suicidology, City Hospital № 20, Moscow, 5- Department of Neurology of Russian Academy of Postgraduate Education
Age Progression Software
Introduction
Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease with impairment of central and peripheral motoneurons, which, according to modern views, is not restricted by suffering related with the locomotor system disorder, but can be also accompanied by cognitive impairments designated as frontotemporal disfunction (FTD). FTD at ALS can be represented by a number of malfunctions from mild cognitive abnormalities or behavioral disorders to deep dementia. Executive, speech, behavioral disfunctions or mixed syndromes can be usually observed within FTD. For FTD diagnostics, tests for speech fluency, optical-spatial praxis, tests for memory, scales for depression assessment, pseudobulbar emotional lability, as well as behavioral questionnaires are used, with the questionnaires being completed by caregivers of ALS patients (3). It was demonstrated that cognitive disorders at ALS are accompanied by decrease of the quality of life in case of the lack of behavioral disorders, and decrease of the lifespan of patients at presence of behavioral disfunctions (8). The follower of Charcot, Marie, was the first who described emotional lability at ALS, and ALS patients with irritability, delirium, hallucinations were described in some works published in the beginning of the twentieth century (6.10.21). In spite of this, until the beginning of current century, lecturers on neurology described ALS as a disease with intact cognitive functions.
Executive disfunction at FTD is expressed in problems with planning, organization, generalization and placing of priorities along with disturbance of speech fluency (4). The syndrome of primarily progressing aphasia is expressed in dysnomia, phonematic paraphasia, grammatical mistakes, paragraphia, oral apraxia, stammering, dyslexia and dysgraphia (11). The syndrome of semantic dementia, more rare variant of FTD, is characterized with grammatically correct and rather fluent, but senseless speech with abnormality of the process of naming of known and famous people without disturbance of repetition and severe impairment of confrontation naming (15). The behavioral variant of FTD is characterized with changes of behavior according to the frontal type (apato-abulic syndrome or disinhibition), decrease of ability to critical analysis, impairment of expressive speech (11). A specific feature of FTD observed at magnetic-resonance imaging is primary atrophy of one of hemispheres of the brain, presence of which correlates with manifestation of one of clinical variants of FTD (13).
Molecular-genetic study in some cases can reveal hexanucleotide repetition in the gene С9orf72, the presence of which is connected with psychiatric symptoms and the behavioral variant of FTD (18).
The problem of neurophysiological examination at ALS is impossibility of performance of tests for speech fluency in case of some patients with severe bulbar impairments and unfeasibility of carrying out graphical tests by some patients at disorders of the dominant hand function. Recently, Edinburgh Cognitive and Behavioral ALS Screen has been elaborated (ECAS), which includes a non-specific scale with tests for memory and optical-spatial tests, specific scale for speech fluency and executive functions as well as a behavioral questionnaire completed by the ALS patient’s caregiver (2). It was demonstrated that at the behavioral variant of FTD, the assessment on the Frontal Systems Behavior Scale (FrSBe) does not correlate with the ALSFRS-R, a scale of ALS progression assessment, parameters of external respiration, age, gender of patients, at that predominance of bulbar debut is seen among ALS patients (19). At ALS, progressing and non-progressing forms of FTD are distinguished (23).
Based on the data of Rippon et al., the prevalence of FTD at ALS is about 31%; this being the case, 8% and 10% of patients respectively suffer from probable or possible dementia (16). Lately, the growing number of ALS patients and members of their families have been interested in the problem of cognitive disorders (22). It is suggested that inhibitors of reverse serotonin uptake may be effective at ALS with FTD (3).
In Russia, no studies of cognitive disorders at ALS have been previously performed.
This study objective is screening assessment of cognitive functions of ALS patients along with multiparameter evaluation of the emotional status and quality of life.
Materials and methods
The study was conducted at the basis of Moscow SBIPH MH № 144 (Head Physician A.A. Gurin, Candidate of Medical Sciences) and Clinical Diagnostic Center Real Health, LLC (Head Physician R.V.Chub, Candidate of Medical Sciences) from 2009 to 2014. 116 ALS patients at the age of 26-76 years old (63 men and 53 women, mean age 57.4±11.9 years old) were examined. The diagnosis was established according to the Revised El-Escorial Criteria taking in account the results of needle and stimulation myography and magnetic-resonance imaging of the brain and spinal cord (5). Neurophsychological examination included the assessment on the Montreal Scale of cognitive functions, Hamilton Depression Scale (HDS), CNS-LS (the scale for emotional lability assessment), ALSFRS-R (the scale for ALS progression evaluation), ALS-AQ40 (the scale for the quality of life assessment), the scale of frontotemporal dementia (6.7.9.12.14.17). The diagnosis of discirculatory encephalopathy was set for thirteen patients based on the clinical criteria and MRI data. At the moment of examination, 20 patients interrogated on the Montreal Scale were not able to speak, and 11 could not perform the graphic test. The diagnosis of frontotemporal dementia was established according to the criteria of D.Neary (15). In agreement with classification by A.Hudson in the modification by V.I.Skvortzova and G.N.Levitsky (2006), among the examined patients, 36 people had bulbar debut, 32 patients ‒ cervical debut, 8 patients ‒ thoracic and 8 patients ‒ diffuse debut with 32 patients having lumbar debut of ALS (1).
The statistical processing was performed using the software packages BIOSTAT (Hungary, 1998). Besides, U-criterion of Mann-Whitney, chi-square criterion and Spearman correlation analysis were used. Differences were considered significant at р<0.05.
Results
Cognitive disorders (CD) were revealed in 47 ALS patients (40.5%), 27 women and 20 men at the age from 44 to 76 years old (mean age 64.5±7.7 years old). Patients with CD were reliably older than patients without CD (52.5±12.1 years old, р=0.0001). Progression of ALS in patients with CD was reliably faster (13.5±9.3 and 10.4±9.1 scores a month on the ALSFRS-R scale, р=0.033). The number of patients with bulbar debut in the group with CD was slightly more (19/28 and 16/53, х2=2.8; р=0.093), at the level of a tendency. In the group without CD, patients with lumbar debut dominated reliably (839 and 2445, х2=3.94; р=0.047). Among patients with bulbar debut, the number of women was significantly higher (2736 and 944, х2=7.63;р=0.005), however, the rate of progression did not differ between men and women (13.6±9.4 and 9.48±7.3 scores a month on the ALSFRS-R scale, p=0.106). The average score on the Montreal Scale in the group of patients with CD was reliably lower than in the group of patients without CD (21.7±4.4 and 28.1±1.4, р=0.0001).
The average score on the HDS in the group of patients with CD amounted to 11.4±6.5, and in the group of patients without CD to 11±6.8 (no differences were revealed). The average score on the Montreal Scale did not correlate with the mean score on the Hamilton scale either in the group as a whole (r=-0.066; p=0.5), or in the group with CD (r=-0.05; p=0.7), or in the group without CD (r=-0.2; p=0.8). The average score on the positive spectrum of the emotional lability scale amounted to 12±5.8 in the group with CD and 11±7.4 in the group without CD (no differences were revealed). The average score on the negative spectrum of the emotional lability scale was 12.9±6.6 in the group with CD and 12.8±5.5 in the group without CD (no differences were revealed). The average score on the subscale of emotional condition of the quality of life scale ALS-AQ40 in the group with CD equaled to 40.9±20.4, and in the group without CD-31.7±20.1 (no differences were revealed, р=0.204). The average total result on the scale of quality of life in the group with CD amounted to 182.6±84.2, and in the group without CD – 183.5±99.5.
Table 1 contains correlation coefficients of parameters of different scales of emotional condition and general quality of life. Table 1. Correlation of parameters of different scales of emotional condition and quality of life in ALS patients with CD and without CD
ALS patients without CD
| HDS | CNS-LS (П) | CNS-LS (Н) | ES | GQL | |
| HDS | - | r=0.48 p=0.02 | r=0.7 p=0.0001 | r=0.45 p=0.031 | r=0.54 p=0.008 |
| CNS-LS (П) | - | - | - | r=0.168 p=0.43 | r=0.2 p=0.3 |
| CNS-LS (Н) | - | - | -- | r=0.23 p=0.25 | r=0.4 p=0.054 |
| ES | - | - | - | - | r=0.83 p=0.0001 |
| GQL | - | - | - | - |
ALS patients with CD
| HDS | CNS-LS (П) | CNS-LS (Н) | ES | GQL | |
| HDS | - | r=0.43 p=0.062 | r=0.48 p=0.037 | r=0.45 p=0.053 | r=0.35 p=0.13 |
| CNS-LS (П) | - | - | - | r=0.36 p=0.119 | r=0.45 p=0.052 |
| CNS-LS (Н) | - | - | - | r=0.6 p=0.008 | r=0.52 p=0.022 |
| ES | - | - | - | - | r=0.78 p=0.0001 |
| GQL | - | - | - | - | - |
Table 1 shows that in ALS patients without CD parameters of the Hamilton scale correlate with parameters of positive and negative spectrum of the emotional lability scale, subscale of emotional condition ALS0-AQ40 and general quality of life. The last two parameters correlate with each other. The positive spectrum of the emotional lability scale does not correlate with the general quality of life, with the negative spectrum demonstrating correlation.
In ALS patients with CD, parameters of the Hamilton scale also correlate with the positive and negative spectrum of the emotional lability scale, but do not correlate with the general quality of life, which might represent the main difference between the groups. The positive spectrum of the emotional lability scale, as in the group of patients without CD, does not correlate, and negative one correlates with the general quality of life. The emotional state correlates with the general quality of life.
In 41 patients, FTD was detected (the average log-rank 1.47 [1.92; 1.26]), reaching the level of dementia in 4.2% of cases (the average log-rank -0.4 [1.07; -3.09]).
The quality analysis of FTD assessed on the Montreal Scale demonstrated that decrease of auditory-verbal memory was documented in 34 patients (72.3%), at that, the reaction to hinting was preserved only in 23 patients (48.9%), decrease of phonetic activity was detected in 25 patients (53.1%), neurodynamic disorders occurred in 10 patients (21.2%), disorders of generalization ‒ in 4 patients (8.5%), paragraphia ‒ in 3 patients (6.3%), 2 patients failed to name the current date (4.2%).
Optical-spatial disorders (temporal) were seen in 17 patients (36%), in 15 cases they were accompanied by the decrease of auditory-verbal memory, phonetic activity or impairments of neurodynamics (frontal). Abnormalities of verbal counting were not observed in the patients. In 8 cases, disorders of repetition of sentences and numbers were revealed, false recognition / naming was registered in 1 case.
Thus, in 23 patients (48.9%), frontotemporal (mixed, executive and verbal) disorders, in 16 patients (34%) – frontal (executive), in 2 patients – temporal (isolated optical-spatial) (4.2%), and in 2 the most severe patients – isolated behavioral disorders (4.2%) were observed. No patients with isolated verbal impairments were revealed.
Discussion
In this study of cognitive abnormalities at ALS, the first one in the Russian Federation, it has been established that the percentage of patients with cognitive impairments is 35.3% (at exclusion from the analysis of patients with discirculatory encephalopathy, presented in the group of ALS patients without CD in the number of 5, and in the group with CD - 8). It approximately corresponds to the international data – 31%. In the study of Van der Hulst et al., in 38 ALS patients without dementia, the executive type of the disorder was revealed in 56.8%, in 24.3 % of cases the executive-verbal variant was detected, and in 18.9% of cases ‒ the verbal variant. In one patient (2.7%), the isolated behavioral variant was registered. Differences in representation of FTD variants in the abovementioned and present studies can be explained by the significantly lesser volume and the lack of representability of the sample of patients from Scotland or population-related genetic differences; in our work, isolated speech disorders were absent (20). We have established the connection of FTD with the age and progression of ALS as well as bulbar debut (as a tendency), which correlates only partly with data of foreign experts (19, 23).
We have demonstrated that at lumbar debut of ALS, FTD are much more rarely. The comparison of parameters of different scales of emotional condition and the quality of life allows coming to the conclusion that the presence of CD did not influence the emotional state, level of emotional lability and general quality of life in the study group. The multiparameter correlation analysis performed in the current study indicates that the emotional state of ALS patients renders no influence on the revealed patterns of CD and vice versa. It makes doubtful the suggestion that inhibitors of reverse serotonin uptake may be effective at ALS with FTD (3). The lack of correlation of the mean score on the HDS with general parameter of the quality of life in patients with CD may be connected with decrease of ability to critical analysis in these patients. Figure 1 depicts similar optical-spatial disorders in ALS patients with depression and discirculatory encephalopathy or without them.
Single observations in dynamics have been performed. Figure 2 contains the Montreal test in the course of treatment with cholinolytics for correction of salivation and after their withdrawal. Improvement of drawing of the watch and elimination of mistakes in writing can be observed. During the course of treatment with galantamine, akatinol memantine and their combination, some positive dynamics was detected in ALS patients with FTD. Unfortunately, the small number of observations hampers making a statistically confirmed conclusion about the efficacy of these drugs.
References
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