2022 Year in Review

The good, the bad, and plans and worries for 2023

Thanks for reading the 59th edition of my newsletter. This newsletter tracks my work on lumbar nerve root syndromes aka sciatica.

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Happy new year! Let’s look back at the third year of this newsletter.

The good

• Rob and I published our book Cauda Equina Syndrome, The Clinician’s Guide, which has sold well and received really good feedback.
  
  I’m very satisfied with the book because I think we achieved a very specific and ambitious goal, which was to make it useful, singular and interesting to read. This is in contrast to so many clinicial books which are theoretical, generic, and boring. What’s more, a lot of the feedback we’ve got for the book confirms that we achieved this: people frequently say there’s just nothing else like our book out there, and that includes other stuff on red flags and CES.
  
  Another big step forward I’ve made with this book is that it is an actual book, printed and bound and existing in the real world with a lovely cover. This was a lot of work compared to my previous book which was really just a pdf. It took a long time to find out how to make a paperback of reasonable quality without it costing an arm and a leg to print. Now that I know how to do this, it should be a lot less work next time.

  

  Readers’ CES books from around the world

• The most popular email this year was the print-it-yourself sciatica zine. It was fun to make this (at least, after a few inevitable ‘forgot to click save and lost everything’ episodes) and I think it’s something genuinely different and interesting. The zine format is a good way to do what I enjoy and am good at: distilling a lot of research into something quite straightforward, without losing any nuance, and without being too serious about it. The second zine, on assessment, I priced at five dollars - it sold very well.

  

• Another popular email was ‘On Being Wrong’ - it’s encouraging to know that I can write about stuff that isn’t sciatica and people still like it!

• More of you keep subscribing! Happily, this is without me having to do too much self-promotion on twitter etc. - so, thank you if you’ve shared and recommended it this year.

  

  Subscriber growth since day 0. The decrease in subscribers was me removing inactive email addresses.

The bad

• This year, no email reached the dizzy heights of what I now think of as the ‘classic’ posts of 2020 and 2021!

  
  I don’t feel too bad about this though, as it’s pretty much a result of having far less time to spend writing, now that we have two children. The time I do have, I have to spend on stuff that will more directly generate income, which isn’t newsletters, sadly. So there have been fewer really high quality emails this year.
  
  

• The CES book sold well, but it didn’t sell as quickly as my first sciatica book. I put this down to a few factors: 1) it’s a slightly more niche topic; 2) we published it at the height of the cost of living crisis in the UK; 3) I didn’t have time to dedicate to promotions and podcasts etc.; and 4) we haven’t made an ebook version yet, which means once you include postage and packaging the paperback costs about thirty pounds (we can’t make it cheaper due to the printing cost). We’re aiming for the ebook to be out in the Spring and we can price this lower.
  

• I didn’t achieve last year’s goal of re-publishing my sciatica book. I took it off the market over a year ago, I think, with the aim of re-writing it, re-illustrating it, and making it available in paperback. I’m pleased to say I have done much of this work… practically every paragraph, maybe every sentence, I’ve improved in some way, and 80% of the illustrations too.
  
  But I don’t feel too bad that I haven’t quite finished yet, because the main reason is that I’ve been collaborating in this work with the amazing Annina Schmid - and although collaboration takes longer, it has improved the book substantially.
  
  [As a reminder, if you did buy the original version of this book I will be emailing you when the re-write is out to let you know of significant changes, major and minor - none of that ‘you have to buy the second edition to find out what’s changed’ malarkey!]

Life news, and what’s next in 2023

Of course the biggest thing to happen in 2023 was the birth of our second child, baby Eve. She’s just over two months old now. She has had some quite serious health problems which we’re still trying to get to the bottom of (I’m writing this from her hospital room). I feel so fortunate to have Eve in my life. She’s lying next to me wiggling away as I type this.

You might know that we live in Houston at the moment, where my wife has recently finished a postdoc. We’re staying in Houston for the time being as she has been offered a position to continue at the same place, and we like it here. It’s ridiculously hot and humid and much uglier than our previous home in Michigan, but apart from that life in Houston is very good, and it’s a good place to raise a family!

So what’s next for the sciatica newsletter, and my work on sciatica more generally?

1. Re-publish my previous book on mechanisms of sciatica and disc herniation.

2. Publish the ebook of the CES book.

3. Publish another zine or two.

4. Encourage other clinicians to write. With a few important exceptions, clinical writing has now become polarised between twitter threads and doorstop textbooks. Both great, but severely limited. There is so much tacit knowledge out there we need to unlock, which means writing proper stuff! I want to help people do this. (I have some ideas about how… Do get in touch if you’re interested).

After those four things… I have to think very carefully.

One of my big goals with the newsletter has long been to write a book on the treatment/management of sciatica. When I started out, this was realistic. And indeed, I did write two other books! Now, however, this is a lot less realistic. We have two young children, which means it’s nearly impossible to put in the sustained time and focus required to research and write a high quality book.

It’s a shame because I have so many great ideas! And I think the book does need to exist, too.

I don’t want all this to sound too final - there’s lots of interesting and important work to be done to help clinicians and theur patients with sciatica. I just need to think hard about whether a book is the right thing to do, for me. And if it is, how do I make it work with my other responsibilities?

Do let me know your thoughts and impressions of what I’m saying here - I’m curious.

Well that’s it. Here’s to another year of learning, writing and drawing! Til next time,

Tom