The Brain Sense - The Science of The Senses

CHAPTER 2

In from the Cold

Argentinean Andrea Salas isn’t just pretty. She’s flat-out gorgeous. Although
no relation to the fashion model of the same name, she’s even more beautiful,
in my opinion. The glow of a summer sunset streaks her cascade of
auburn hair. Her caramel colored skin is flawless. Usually, when she speaks, her
doe eyes dance with merriment.
But not today.
Today she is dredging up memories of her brush with death in Antarctica.
The deep waters of the world’s most extreme environment threatened to take her
life. If the sea didn’t, the cold surely would have.

ALL ABOARD FOR THE ANTARCTIC

November 23, 2007. Andrea’s ship, the Explorer, had been at sea for thirteen
of its scheduled eighteen days of sightseeing along the margins of Antarctica.
Andrea, age thirty-eight, was a veteran Antarctic guide, having served on two
previous voyages. This time, as one of sixty-four crew members, she was working
as assistant to the leader of the expedition team. She organized lectures, wet landings,
and recreational activities for the Explorer‘s ninety-one passengers, a sixteennation
aggregate of intrepid tourists who had opened their wallets wide for this,
the adventure trip of a lifetime.
The ship had departed from Ushuaia, Argentina, a town that fights a perpetual
feud with Chile’s Punta Arenas over which is the southernmost city in the
world. The itinerary called for a stop in the Falkland Islands—the Malvinas to
the Argentineans—and a visit to an abandoned whaling station in South Georgia.
From there, Andrea and her shipmates traveled to Elephant Island, famous as
the last refuge of the men of Shackleton’s Endurance Expedition of 1914–1916.
Shackleton failed to cross the Antarctic continent on foot as he had planned, and
he was forced to leave his men on Elephant Island while he piloted a single
lifeboat across eight hundred miles of open ocean to find help on South Georgia.
The landscapes of the islands were breathtaking, Andrea recalls. Wildlife is
scarce in this, the most inhospitable environment on earth, but the tourists marveled
at the albatrosses of Steeple Jason in the Falklands. They oohed and aahed
over the king penguin rookeries of South Georgia.
November is early for an Antarctic trip. The sun doesn’t rise in Antarctica
until September, and summer doesn’t arrive until January when the weather
warms to a balmy –15° to –35°C (–5° to –31°F). The weather was exceptionally
cold on this trip. Andrea kept her charges wrapped in layers of thermal underwear,
polar fleece, and waterproof jackets. Boots swaddled feet, while waders cocooned
passengers toes-to-chest for wet landings. The season and the cold brought
with them some disappointments for the passengers and crew of the Explorer. A
planned side trip to South Orkney Island had to be canceled because the seas
were beginning to crowd with icebergs.
It might have been a portent, but the Explorer steamed on.
On this Thursday night, Andrea left her cabin on the crew deck, below sea
level. There, while resting in bed, she could hear ice hitting the hull. She wasn’t
worried. The Explorer was built to handle icy seas. She headed to the bar to enjoy
a drink with fellow crew members and some passengers. The bar was warm;
the drinkers, convivial.

ABANDON SHIP!

Around midnight two passengers rushed into the bar, shouting, “There’s
water! There’s water!” Everyone ran from the bar, only to collide with the captain
who was ascending the stairs. “The captain told us water was coming in
through a hole,” Andrea says. She raced to her cabin, as did the others, pulling on
warm clothes and collecting her life jacket, while the captain announced from
the bridge that emergency evacuation was commencing. “This is not a drill!”
“We got to the muster stations almost immediately,” Andrea reports. Huddled
there in the dark and biting cold, passengers listened to reassurances from
the captain over the public address system. Attempts were underway to repair the
hull, but just in case, emergency rescue stations in Chile and Argentina had
been radioed, as had other ships in the area. Andrea joined her fellow crew members
in distributing hot drinks and hope while awaiting the order to abandon ship.
It wasn’t long before that order came. Repair attempts had failed, and seawater
was pouring in through a breach in the hull. Its cause? Probably impact with an
iceberg.
Now came the greatest challenge: Andrea and 153 others would have to
brave the turbulent Antarctic seas and the bitter cold in nothing more than small
lifeboats and Zodiacs, the inflatable rubber boats usually employed for tendering
to shore from the ship and sightseeing along rocky coasts and beaches. Andrea
hustled passengers into the emergency craft, making sure that each boat had
a crew member to handle the motor and steering.
She and two other crew members lowered one of the Zodiacs into the water
and scrambled aboard. Zodiacs are not lifeboats, but in Andrea’s opinion, they
represented a better choice for escape than did Explorer‘s aging orange lifeboats,
which were heavy, clumsy, and poorly powered, although provisioned with food
and water. The Zodiacs have powerful motors; they are light and are highly maneuverable.
Still, they are open, small, and cramped when holding more than
four or five people.
Andrea’s Zodiac maneuvered next to one of the crowded, heavy lifeboats,
transferring seven passengers into the rubber inflatable. When all the boats were
in the water, the crew lashed the lifeboats and Zodiacs together with ropes, using
the Zodiacs’ engines to keep the lifeboats from ramming into icebergs. The
passengers and crew of the Explorer had radios that allowed communication
among themselves but not with the outside world. They were alone and adrift in
the Antarctic seas.
The ten people on Andrea’s Zodiac crouched under blankets, settling in for
a long wait. Mostly they all stayed silent, the smell of apprehension heavy in the
air. “Those were the longest hours of my life,” Andrea says. The wind whizzed
past her ears. The cold crept through her seawater-soaked clothing to ice her bones.
In conditions like these, she discovered, waterproof jackets aren’t waterproof.
“My feet and hands were very cold,” she says. “I never feared death, but I did
fear that I might lose a hand, a finger, a foot. I don’t know how cold it has to be
to lose a part of your body, but I was afraid it would happen because I knew I
would not get any warmer.” She and her compatriots were stacked in the Zodiac
like cord wood. They had no way to move, no means of generating or sharing
heat. “I couldn’t feel my hands inside my gloves,” Andrea says. “My feet were
blocks of ice.”

COLD-SENSING

While Andrea waited for rescue, she felt overwhelmed by a paralyzing sense
of cold in every part of her body. What gave her that feeling? What was going on
in her nervous system to create that perception? The answer lies in tiny receptors
on the membranes of neuronal projections that lie close to the skin’s surface.
It’s long been known that touch neurons specialize. Some respond only to
pressure; some, only to light touch. Several subsets of neurons fire an impulse
when the ambient temperature rises. Others detect only a decline—or cooling.
(Any temperature lower than that of the human body, 37°C or 98.6°F, is “cold”
in the physiological sense.) One type of neuron fires at relatively warm temperatures,
15° to 4°C (59° to 39°F); yet another type activates at temperatures below
0°C (32°F).1 Still another kind generates an impulse only when cold is so
intense that it’s painful.
For a long time, no one understood what was going on in temperaturedetecting
neurons, but that changed in 2002 when several research teams delivered
up two prizes: receptors on nerve cell membranes that respond to coolfeeling
chemicals such as menthol; and cold-activated ion channels in cell
membranes. The receptors work just as taste and smell receptors do; after locking
onto a molecule of a cool-feeling chemical, they provoke some change in
the cell that, in turn, triggers a nerve impulse. The channels do precisely what
their name suggests. They either open in response to cold, allowing ions (charged
atoms or molecules) to flow into the cell,2 or they close to prevent them from
leaking out—maintaining the cell’s positive charge.3
The influx of positively charged sodium or calcium ions (or the maintenance
of a positive charge) causes electrical potentials to change across the outer membrane
of the neuron. That happens because a neuron at rest has a slightly negative
charge inside it, compared with a positive charge outside. When cold causes
an ion channel to open, sodium ions flow into the cell, thus changing the charge
along its membrane. For a tiny fraction of a second, the inside of the cell becomes
positive; the outside becomes negative. This reversal in one tiny area creates a
current that affects the membrane farther along. Channels there open, and sodium
flows into another section of the nerve fiber, then another, then another. That’s
how the impulse travels—eventually to the brain.
Receptors and ion channels can work alone or in concert, in the same cell
or in different cells. One receptor channel called TRPM8 has been studied extensively.
Also called CMR1 (cold and menthol receptor 1), it’s a major player
in detecting gentle cooling. Researchers at the University of California at San
Francisco found its genetic base when they isolated cold-sensitive, mentholsensitive
neurons from rats. They took the TRPM8 gene from those cells and
placed it into cultured neurons that were neither cold- nor menthol-sensitive.
The cells changed their function and became cold- and menthol-detecting neurons.
Why? Because the gene directed the construction of TRPM8 receptors on
the cell membrane.Another team of researchers that same year discovered how cells that have
TRPM8 receptors respond to temperatures in the 23°C to 10°C (73° to 50°F)
range. The calcium concentration increases inside the cell. This suggests that
TRPM8 is both a receptor and an ion channel.5 The scientists don’t know how
cold affects the channel, but they describe two possible mechanisms. Cold might
change the shape of the channel directly, or it might trigger the release of a chemical
(a “second messenger”) that, in turn, prompts TRPM8 to open.
Another possible mode of action has been explored by researchers in Spain.
They studied “voltage-gated” potassium channels in cell membranes. Neurons
insensitive to cold have them, but cold-sensitive neurons do not. The channels
function as “excitability brakes” during cooling in insensitive cells. They stop an
impulse from beginning. Cold-sensitive neurons lack such voltage gates, so temperature
changes can initiate an impulse in them. This relationship was established
when the Spanish team blocked the action of the voltage-gated potassium
channels in cold-insensitive neurons. About 60 percent of the neurons began
firing impulses in the cold.10
The human body can differentiate a temperature change as small as a single
degree Celsius, but only a few heat- or cold-sensitive ion channels like TRPM8
are known. How can relatively few cellular structures account for such a finely
tuned capacity? The answer may lie in the ability of the channels to shape-shift.
In cell cultures, channels that respond to increases in temperature are known to
rearrange themselves by combining with other channels within their same structural
“family” (not TRPMs but another category called TRPVs). The resulting
complexes demonstrate characteristics intermediate between those of the “parent”
forms. Research teams can measure the intermediate electrical charges and
ion-gating properties of these “hybrid” channels. This ability to shuffle and recombine
means that the number and variety of channel types are large. Although
channels that respond to decreases in temperature have not been researched, it’s
likely that they, too, combine with others to form intermediate types. Whether
such channel complexes act as functional temperature sensors in living organisms
remains unknown.11

RESCUE!

Andrea never gave a thought to her TRP receptors. She had survival on her
mind.

As the wee hours of the morning gave way to a (blessedly) clear dawn around
3 A.M. (nights deliver less than three hours of darkness at this latitude in November),
Andrea and nine others watched from the safety of their Zodiac as the Explorer
began to list starboard. The Explorer‘s engines had failed, perhaps swamped
by water. The boat careened drunkenly with the swirling currents, powerless and
empty after the captain was the last to abandon his post. Explorer drifted toward
seas increasingly jammed with icebergs, driven by a rising wind. Before it sank
at the end of the day, the Explorer would be completely surrounded by pack ice.
Andrea remembers the noise. “The sound of a ship when it is breaking and
about to sink is just like in the movies,” she says, her dark-chocolate eyes wide
with the memory. “I could hear pipes breaking.” The eerie creak of twisting
metal assaulted her ears unceasingly as what passes for an Antarctic dawn brightened
into morning.
And yet they waited for hours more, hoping against hope for a rescue they
could not be sure would come.
Then the Norwegian cruise ship, the Nornodge, topped the horizon. Rescue!
The Zodiacs raced toward the Nornodge, with the slower lifeboats trailing behind.
“We didn’t mind getting wet anymore,” Andrea says, her eyes brightening
now that she can report a happy ending. Miraculously, not a single person suffered
injury—not even frostbite. The Nornodge doctor offered treatment to the
rescued sailors—all 154 of them. Only two took advantage of the offer.
Andrea recalls how her sense of lethal cold disappeared when the rescue ship
arrived. “When I stood to look at the Nornodge, all the heat returned to my body,”
she says. “The hope I gained from seeing it sent a wave of warmth through me.
It was the excitement of feeling safe. Knowing that it was over, I didn’t feel cold
anymore.”

The Brain Sense - The Science of The Senses

CHAPTER 1

Life Without Touch

In many ways, Chuck Aoki is a typical teenager. At seventeen, he’s an avid athlete.
His Minnesota Timberwolves basketball team won the national junior
championship in 2008. He plays rugby competitively, too. Tennis and baseball
are his recreational sports. He likes the history and English courses in his
Minneapolis high school, and he is confident that he did well on his SATs, although
he hasn’t received his scores yet. He likes Taco Bell food. He finds girls
confusing. “Women dance around the bushes. Men get straight to the point,” he
says.1 He and his friends like to ride the bus to downtown Minneapolis to go to
a movie, eat at a restaurant, or hang out at the mall. He’s lined up a summer job
as a human resources assistant for the Minnesota Twins baseball team, a perfect
situation for him since he loves sports. Chuck hopes to go to college on a basket -
ball scholarship. He will major in psychology or sports management.
But for all that, Chuck Aoki isn’t a typical teenager. He was born with no
sense of touch in his arms, hands, legs, and feet. With a few spots as exceptions,
he feels in his limbs neither heat nor cold nor contact nor pressure nor vibration
nor pain, although he experiences normal sensation in his head and trunk. His
legs were repeatedly damaged in childhood when he walked, ran, and played
baseball. His joints have disintegrated and his bones are crumbling. He’s fulltime
in a wheelchair now; his athletic teams are wheelchair basketball and quadriplegic
rugby. He’s lost eight of his fingers down to the first joint. Text messaging
on his cell phone produces bleeding sores on what’s left of his thumbs. Buttoning
a shirt is impossible. Cutting lettuce for tacos or taking a pizza from the oven
poses a serious risk.
Chuck was born with an extremely rare, inherited disorder called hereditary
sensory and autonomic neuropathy (HSAN) type 2. This is his story as he shared
it with me in a sidewalk café one sunny afternoon. It’s also the story of his mother,
Jennifer Nelson. She’s a librarian for the Minneapolis public library system and
the proudest mom I’ve ever met.

GROWING UP

“You young mothers. You worry too much,” the pediatrician told Jennifer
when Chuck was a baby. The infant was teething. He’d chewed his fingers to raw
and bleeding pulps.
“Is that normal?” Jennifer asked. The doctor wrote a prescription for anti -
biotics. The baby had an ear infection, he said.
Throughout infancy, Chuck cried intensely and interminably. Only full body
contact, his tiny trunk held tight against his mother’s skin, could console him.
“Is that normal?” Jennifer asked. The doctor wrote more prescriptions for more
antibiotics to treat more ear infections.
Chuck walked at nine months, but he walked on his knees. “Is that normal?”
Jennifer asked. More antibiotics. Babies get lots of ear infections.
But by the time Chuck celebrated his first birthday, the fact that something
was wrong could no longer be blamed on ear infections. The tentative diagnosis
of HSAN type 2 came when a neurologist examined a sensory nerve taken from
the boy’s foot. The fiber was smaller than it should have been, and it lacked the
dozens of tiny, hairlike projections usually seen on nerves. The fiber also lacked
the myelin sheath that surrounds, protects, and insulates normal nerves. In the
absence of myelin, nerve impulses could not travel along Chuck’s sensory nerves.
The baby’s motor nerves were normal, so his brain could direct his limbs to move,
but his sensory nerves were nonfunctional. He could feel nothing past his shoulders
and his hips.
Chuck was eighteen months old. None of the doctors knew how to treat his
condition; they’d never seen anything like it before. The only model came from
diabetic neuropathy, which shares some common features with the inherited neuropathies.
Diabetic neuropathy compromises blood flow, leading to infections
and the “spontaneous amputations” that have robbed Chuck of his fingers, one by
one, over the years. Chuck also developed Charcot joints, in which inflammation
and loss of healthy bone lead to the overgrowth of abnormal bone tissue, fragmentation,
and instability. Why? Because when he walked, he felt the ground
only from his hips. He had no feedback to tell him how much force he was exerting
with the muscles of his legs and feet, so he stomped too hard. Similarly, when
using his hands, his sensation begins at his shoulders. He pushes too hard when
he uses a computer, plays video games, or holds a spoon. As a result, his hands
constantly bleed and callus. His mother debrides and bandages his wounds daily.
As a small child, he could grasp with his palm but he never learned to make
the finely controlled, pinching movements needed to pick up small objects. Because
he felt no pain, everyday activities were hazardous. “We pursued a strategy
of avoidance,” Jennifer says. The hot water temperature was lowered so that
Chuck would not burn himself. Jennifer was ever vigilant, keeping the boy away
from flames, sharp objects, and hot surfaces.
Jennifer recalls a family vacation to Oregon when Chuck was seven. “We
played on the beach all day,” Jennifer says, “and that evening Chuck’s left knee
was swollen to the size of a grapefruit.” The child had been seeing a rheumatologist,
and Jennifer suspected a flare-up. She called the doctor and asked what
to do; the family was planning to take a train home the next day. In the absence
of an open wound, infection, or any obvious break, the doctor advised merely
watching the situation and keeping the boy off the leg as much as possible on the
journey home.
Back in Minneapolis, Chuck went for x-rays. Nothing showed up. He went
for an MRI. Nothing appeared wrong except for the persistent inflammation, so
Jennifer continued icing and wrapping the joint. Weeks passed with no sign of
improvement, so the rheumatologist consulted a specialist radiologist. The radiologist
examined the images and found a shadow that previous examiners had
missed. An orthopedist then decided to open the leg surgically. He found a fracture
of the femur, the large bone of the thigh. “Chuck had been walking around
for six weeks on a broken leg,” Jennifer says. He was home from school for eight
weeks. He had a cast on for twelve weeks. Soon after the cast was removed, he
broke his ankle, so he had to be in another cast. He couldn’t use crutches because
he couldn’t coordinate the alternating right- and left-arm actions that crutches
require.
When Chuck was nine, doctors discovered that the earlier fracture of the left
femur had destroyed most of the bone’s growth plate. Subsequent surgery closed
the entire growth plate in his right leg and what remained of the growth plate in
his left leg to prevent unequal limb growth. “A limb length discrepancy would
be dangerous on a daily basis,” Jennifer says, “getting in and out of the shower
and that kind of thing.” After that, he snapped his anterior cruciate ligament
(ACL). “We don’t know how he did it. We didn’t repair it. What would be the
point?” asks Jennifer. “His feet are flat, his ankles have sunk into his heels, and
both of his feet are deformed,” she says. Chuck has been using a wheelchair
full-time since he was twelve.

DIAGNOSING HSAN

Throughout Chuck’s childhood, his parents remained uncertain about their
son’s diagnosis. They took the boy to the Mayo Clinic when he was nine in hopes
of getting a definitive answer. A precise diagnosis was important, Jennifer explains,
because it would help the family plan for Chuck’s health and care as he grew.
His neuropathy was obvious, but the autonomic part of the HSAN description
was not. The autonomic nervous system controls those bodily functions outside
conscious control. It regulates heart rate, blood pressure, intestinal action, and
glandular function. In all those ways, Chuck appeared normal. Did he really
have HSAN? If so, was it really type 2? There are several kinds, each with its own
symptoms, course, and prognosis.
To look for the autonomic component of the diagnosis, doctors at the Mayo
Clinic did a sweat study on Chuck. “They put him on a little gurney, sprinkled
him with powder, and put him into a makeshift, plastic covered oven, and heated
the space up,” Jennifer explains. “Then they charted where his body turned
purple, which is where he sweated. He doesn’t sweat from his fingertips and he
doesn’t sweat below his knees. There was the autonomic part of his neuropathy
that we hadn’t known about.” The HSAN type 2 diagnosis was confirmed.
The broad category of all hereditary sensory neuropathies (HSNs) includes
as few as four and as many as six disorders, depending on which classification
system is used. All types are genetic, and all involve loss of feeling in the hands
and feet. One HSN that is more common and better known that Chuck’s dis -
order is familial dysautonomia (FD, HSAN type 3, or Riley-Day syndrome). Children
with FD often experience feeding difficulties and fail to produce tears when
they cry. Other symptoms may include lung dysfunctions, cardiac irregularities,
poor growth, and scoliosis. Children with FD are most often born to parents of
Eastern European Jewish heritage, with an incidence of one in every 3,600 live
births.2 Genetic tests are used to diagnose FD but not the other HSAN types.
Chuck’s HSAN type 2 is inherited as an autosomal recessive. That means
both Jennifer and her husband, Andy, carry the gene on chromosome 12. Their
chance of having a child with the disorder is one in four. (Chuck’s younger
brother, Henry, is unaffected.) Although the inheritance pattern is understood,
the reasons why symptoms vary among individuals are not. Some babies with
HSAN type 2 feed poorly, exhibit poor muscle tone, and can’t maintain body
temperature. Chuck had none of those symptoms, but like most others with the
disorder, he suffered numerous fractures of hands, feet, and legs, as well as Charcot
joints. Also like most others with the condition, Chuck’s muscular strength
is normal.

THE BRAIN WITHOUT TOUCH

As for what happens in the brain when touch signals fail to enter it, Jennifer
and Chuck’s doctors can only speculate. The somatosensory (“body sense”) region
of the cerebral cortex lies in the parietal lobe at the top of the brain, near
the crown of the head. Adjacent to it and forward from it, in the frontal lobe, lies
the primary motor cortex, where voluntary actions are triggered. These two long,
skinny areas lie sandwiched together, and their nerve fibers are organized in descending
rows, like twins lined up side by side. Each nerve and each small area
is dedicated to a particular body part—forming side-by-side regions for feeling
and movement in the left arm, the right leg, and so on. But the two parallel rows
are not identical. In the motor cortex, the amount of “processing power” devoted
to a body part varies with the precision of the movements that body part can
make. So, for example, the fingers get more space in the motor cortex than the
toes do. In the somatosensory cortex, the allocation of space depends on the body
part’s sensitivity to heat, cold, pressure, vibration, contact, or pain. Thus, the fingertips
and lips get a disproportionate share of the somatosensory cortex. The
back gets short shrift.
This basic anatomy suggests (but by no means proves) that Chuck’s somato -
sensory cortex may have allocated space differently from the way it is allocated
in other children. Receiving no sensory impulses from his limbs, the parts of his
somatosensory cortex that would have processed touch information from arms,
leg, hands, and feet probably failed to develop. Did the sensory nerves from his
head and trunk take over the brain’s spare “real estate”? There’s no way to know,
but it’s possible. It’s possible, also, that his motor cortex is organized differently,
although what happens to the motor cortex if it fails to receive somatosensory
feedback is unknown. Still, we can make some guesses in Chuck’s case. Athletes
who practice their sport and attain a high level of mastery probably devote larger
areas of the motor cortex to the body parts they use most. I suspect Chuck’s practice
of basketball skills and his mastery of his sport have modified his motor cortex
and probably his cerebellum as well—for that’s where movements that are
practiced enough to become automatic are coordinated.

LIVING TO THE FULLEST

Although the brain can reorganize itself to some extent to meet the demands
of its owner’s life, major brain regions maintain their own specialized functions.
As one expert put it, a brain region steals from its next-door neighbor, not the
whole town. So Chuck’s brain regions for hearing, vision, and the other senses
probably aren’t any different from anyone else’s. But what he’s learned to do with
his senses is another matter. Chuck says that he relies on vision to manage daily
living. He dribbles a basketball expertly (an action some doctors think he should
be unable to perform), using his peripheral vision to judge where the ball is and
how forcibly he is propelling it. When playing video games, he holds the controller
in front of his eyes and peers over the top to see the screen. He’s learning
to drive a hand-controlled car. He says he uses his peripheral vision to determine
where his hands are on the steering wheel, brake, and throttle.
Chuck’s vision, strength, and motivation have helped him achieve in sports.
He recently started playing wheelchair rugby on an adult team sponsored by the
Courage Center in Minneapolis. He’s getting good at it. He practiced with the
U.S. Paralympics team in 2008. “Maybe I can get named to the USQRA [United
States Quad Rugby Association] team. . . . That would be a step toward a world
championship team or the Paralympics team,” he says.
As for touch, “It’s not all it’s cracked up to be,” Chuck jokes, then adds more
seriously, “I’ve never had it, so I’ve adapted, and I don’t really get what I’m missing.
. . . It’s not like it has negatively affected me in any really serious way.”
“He thrives in his life,” Jennifer says. “It is fun to watch him.”


Touch the Pain Away
 
Mothers and infants know what the rest of us may forget—a tender touch
takes some of the pain away. A pediatrics team in Boston divided mothers
and their newborn infants into two groups. Half of the mothers held their
babies in whole-body, skin-to-skin contact while a physician performed the
standard heel-stick procedure to draw blood samples from the infants. The
other half of the babies were wrapped in receiving blankets and placed in
bassinets while the blood was drawn. Babies in contact with their mothers
grimaced 65 percent less than the bassinet-held babies did, and their crying
time was a whopping 82 percent less. The held babies did not experience
the same rise in heart rate as the control babies did. The researchers concluded
that skin-to-skin contact reduces both stress and pain for infants.

How Successful People Manage Their Time

I want to give you a revelation in life. You might need to take a pen, write this down and put this on the wall in front of your table. It is this.

Each of us has 24 hours a day.

Yes, 24 hours. Whether you are a toilet cleaner or a CEO of a listed company, you have 24 hours a day. Donald Trump, Bill Gates, Warren Buffet and my favorite motivational speaker, Adam Khoo has 24 hours a day.

How do you think they manage to do so many great things within 24 hours a day, while some of us complain that we do not have time?

There are 3 ways you can do the same if you follow act upon these principles.

1. Analyze Your Lifestyle

Everyone lives differently and only you, yourself know what kind of lifestyle that suits you best. Also, each people manage their time differently based on the nature of their lifestyle.

Analyzing your lifestyle simply means living your life circumspectly. What does it mean to live circumspectly?

It means you are cautious, pay close attention and carefully evaluate your schedule. In order to save time, you must first know how to lose it.

Having a full time job from 9am - 6:30pm during the weekdays, I still have to find the best resources to post on my Excellence Blog. Not only that, I need to attend cell group, conduct bible study, attend leaders meeting every Tuesday and fellowship with the people around me.

That's not all. During the weekend, I spend most of my time doing my Internet marketing projects.

My schedule may not be as busy as some of you who are reading my blog but I can assure you this is not what an ordinary person can or is willing to do.

So my point is not trying to tell you how busy I am but to share with you what kind of lifestyle I have and how I managed to do so many things in a week.

I've seen people keep complaining that they have not time to do this and that but they have time to watch TV, upload photos to Facebook or Friendster and going for movies.

So examine your lifestyle and you will be able to know how you can slot in time to do much more.

"The unexamined life is not worth living." - Aristotle.

2. Utilize The Present

"I'll do it later!" and "I'll wait for the right time to do it". This is the number killer that people do not take action. It is not that they do not have the desire to take action but they keep procrastinating. This should not be the path for you and me.

If there is a better time to certain things, it should be right now. Adam Khoo said that the reason why he is so successful is not because he was more gifted or more talented than others. It is his ability to take action now that makes all the difference.

While others procrastinate and spending time to analyse the business model, he simply took action.

So friends, make the most out of every opportunity you have.

3. Prioritize What's Important

I have a lady friend of mine is not doing very well with her health recently. I asked her why she never make an appointment to meet the doctor up and she told me that she does not have time.

She has been very busy with her day job and part time accounting work. By the time she reaches home in the evening, she will be dead tired to do anything else.

I then asked, "Why don't you take half a day off from your work and go to see the doctor?"

"I am so busy with my work and my supervisor keep giving me work to do. It is just never ending"

"Well, you need to know your priority. If your health is not even helping you, what else can you do?"

She went silent for a short while and said, "Alright Rahul, I'll make an appointment next week".

Sometimes, you need to know what is important and what is not, so that you can plan your time accordingly. Do what is important first and the ones that are of lesser importance later.