Of pain and agitation and PTSD

I am really excited to report that my pain has subsided considerably. The inflamation across my iliac crest — the top of my pelvis at my lower back — has really gone down, to the point where it’s a little painful, but it’s more discomfort than pain, now.

Also my skin is not as sensitive to every contact, like it was. I still have my moments, when I start to sting and throb and my clothes hurt me, but when that starts to happen, I press the pressure point on my hand that I talked about in this post, and I take a few deep breaths to chill myself out and stimulat my vagus nerve, and I do a quick check-in with myself to see if I’m getting agitated about things.

Agitation really seems to get to me physically. Anxiety, too. When I’m worked up, everything feels more intense. So, calming my system down really seems to help matters.

Looking around, I found a June 2001 post from Science Blog that speaks to this. It’s ‘old news’ — over 7 years old — but it makes for good reading, and it really put things in perspective for me.


From Texas A&M University

Fear, anxiety affect pain

COLLEGE STATION, June 12 – Human emotion can be a powerful force, fueling everything from improbable sports championships to tragic acts of violence. Now there’s evidence showing how powerful human emotional states can be when it comes to determining a person’s ability to feel pain.

Texas A&M University psychologist Mary W. Meagher, who has conducted pain research for 16 years, says two emotional states – fear and anxiety – have profoundly different effects on a person’s ability to feel pain.

“Fear and anxiety have divergent effects on pain reactivity in humans: fear reduces pain, whereas anxiety has a sensitizing, or enhancing effect,” says Meagher, who holds joint appointments in clinical psychology and behavioral neuroscience.

Her conclusions are based on her and graduate student Jamie L. Rhudy’s recent work focusing on the role of human emotion on pain. Previous animal studies have suggested that fear inhibits pain and anxiety enhances it, but Meagher’s results support the view that emotional states influence human pain reactivity.

“From a clinical perspective, these data suggest that a patient anticipating an unpredictable threatening event will experience enhanced pain,” she says. “In contrast, a patient that has been exposed to a threatening event will experience a fear state that inhibits pain processing.”

Meagher believes previous conflicting reports of the effects of anxiety on human pain were due to a failure to properly distinguish between the emotional states of fear and anxiety.

Fear, Meagher explains, is an immediate alarm reaction to present threat, characterized by feelings to escape and accompanied by specific physiological changes. Anxiety, on the other hand, is a future-oriented emotion characterized by anticipation of potential threats.

Fear mobilizes a person to take action – the commonly known “fight or flight” response – but anxiety leads to scanning of the environment and body, resulting in increased sensory input, she says.

With these distinctions in mind, the conclusions make sense from an evolutionary point of view, Meagher notes.

Confronted with life-threatening situations, which would elicit fear, the body reacts by shutting off the pain response because feeling pain might get in the way of survival, she says. “Alternatively, during times of low threat – those times likely to produce a state of anxiety rather than fear – the chance of survival is increased if pain is enhanced so that behavioral responses can occur to minimize tissue damage,” Meagher explains.

Meagher’s work also shows that positive emotions can lead to pain reduction as long as a minimal level of arousal is reached, but negative emotions only lead to pain reduction when they are highly arousing. In fact, she says, negative emotions can actually facilitate pain if they are only low to moderately arousing.


This is consistent with my own experience — I can definitely confirm that in my own life, if I’m presented with a situation that involves a specific, verifiable threat, all my systems kick into action and I can actually perform at a higher level, than if I’m just rolling along in a relatively event-free, stress-free life. I can see better. I can hear better. I can interact with the world around me better. Fear actually forces me to focus — that is, if the fear relates to something that is real and significant.

Anxiety, on the other hand, throws me into a panic and sends me spiraling. I can totally see many examples in my life where non-specific threats “triggered” a hyper response to everything and anything around me. It makes me more sensitive, it makes me more jumpy, it makes me more pain-filled.

And thus the vicious cycle begins… because my hypersensitivity causes me to interact with the world poorly — it makes me sensitive to pain, it heightens my hearing, my eyesight, my sense of touch… everything. It makes me avoid situations I shouldn’t, it makes me choose to wear clothing that isn’t the most socially advantageous. (Note: Wearing a sweatshirt and jeans every time I go out in the world is not sending the best message — if anything, it sets me up to not be taken seriously by other people. In fact, I believe that a number of my interactive difficulties, from dealing with doctors to dealing other professionals/consultants, have been made more difficult because I chose to wear well-worn but comfortable clothing, rather than clothes that “sent the message” that I was someone to be taken seriously.) My tactile defensiveness makes me avoid human contact, from handshakes to hugs, which impedes me socially, as well. And it makes me more sensitive to light and sound, which causes me to unconsciously avoid situations that are bright and loud — which is where an awful lot of people hang out, and where an awful lot of deals are done.

But when the offshoots of my socially and physically impactful anxiety result in poor choices or actions that endanger my social standing, my employability, my ability to function in the world at large, it sets up conditions that produce fear. Existential crisis. Serious problems that endanger my job, my house, my family, my safety, my very life. And my sensitivites shut down — they swing to the opposite end of the spectrum. I don’t pick up on clues that people send me. I don’t notice things I should. I don’t realize that I’m falling behind in my work, or that there’s a traffic cop standing in the middle of an intersection ahead of me, waving their flashlight for me to stop. I kind of “click off” in some ways, becoming numb to the world around me, as I deal with my most pressing issue at the moment: I’m late for an appointment that will get me in trouble, or I’ve fallen behind in a task I was supposed to have done by tomorrow, or my back yard is so grown up, the ticks have started to come into the house.

I’ve been in more questionable situations than I care to think about, in no small part because I was shut down while I was dealing with some other crisis that took my mind off what was right in front of me. Or because I’d just come off a crisis I couldn’t deal with and that fried my system. I’ve gone walking in areas where there was active hunting going on, following deer paths on purpose, because I was more interested in getting in touch with nature than noticing the hunters around me. I’ve hung out with underground criminals who were obviously and openly checking out my various assets and having side discussions about me, when I was in a totally new area, having just moved there on my own and not having any real way to support myself and not having a clue, frankly, where my livelihood was going to be coming from. I’ve taken chances behind the wheelof my car that almost got everyone with me killed, when I was overwhelmed with coping with some really intense, deep-seated interpersonal issues that were more than I could handle.

And the aftermaths of these times resulted in more anxiety … and behaviors that made it all but impossible for me to deal effectively with the  demands of the world around me. I descended into intense pain. Or I started drinking heavily. Or I plunged head-long into a long period of over-work, in order to block out the drama, the pain, the trauma… the pain.

I think this business of psychogenic pain — that has both logistical and physical causes AND effects — is an area that should be examined more closely, especially by the mental health field. I think that the connection of emotions — fear and anxiety — and the physical results from them, can actually explain a fair amount of how TBI and PTSD can combine and worsen each other. And it could help explain additional sources of distress and trauma for people who are dealing with emotional issues… some of which won’t “budge” despite years of psychotherapy.

Therapists, in my experience, often focus so intently on the emotional root causes, the past events, the sources, of psychological issues, that they miss the physicality of the experiences they’re addressing. And in the process, they overlook both a contributing factor and a symptom of psychological distress and dysfunction. I suppose it’s to be expected, since psychotherapy is about the psychological side of life. But the more we learn about these things, the more closely connected we realize the mind, body, heart, and spirit are… and to discount any of them, in my mind, short-circuits the process of healing and recovery from the rough-and-tumble aspects of life.

I’m working with very limited time, here, so I don’t have all the hours in my day to devote to this study, but I hope someone else out there is looking at this. Or maybe they have, and I just don’t know about it.

One person who is looking at this, I believe, is Belleruth Naparstek, a psychotherapist who works with guided imagery to address effects of trauma and PTSD and other psychological dysfunctions. She’s got a website at http://www.healthjourneys.com/ where she not only has CDs and tapes and MP3s for sale, but she also includes research and articles about the use of guided imagery in healing.

I have friends who swear by her work, and I  myself have used her PTSD and Stress Hardiness Optimization and Panic/Anxiety guided imagery with some surprising results. I’ve never been much “into” guided meditations — people who try to “guide” me tend to irritate the sh*t out of me, and it often feels like this namby-pamby coddling pansy-ass touchy-feely crap that is one of the aspects of “new age healing” that just drives me nuts. Okay, so maybe I’m being harsh and it just goes to show I have plenty of healing to do, but I just hate feeling talked down to an patronized by people who are “more enlightened” than me. I usually feel condescended to ann treated like an infant.

Belleruth’s style, however, is not like that. She seems very down-to-earth to me — at least, in her CDs — and she’s very accessible and no-nonesense. She also strikes me as being very competent and intelligent, which helps. I hate it when dense people condescend to me. It makes me crazy and is a terrible distraction. Anyway, I’ve been very surprised by the effect her CDs have had on me — after being unable to shed a tear for many, many years, I’m actually able to cry. Okay, so I’m not very good at doing it around other people, and it stresses me out when they see me cry, but every now and then, I can really use a good breakdown in the privacy of my own home. And when I’ve listened to the imagery, I can sleep. This is big. I often fall asleep in the middle of the imagery, and then I wake up when it’s done. I suppose I may be getting some benefit while I’m sleeping, but the real boon is that I can sleep, at all. I went for years, after my last TBI in 2004, not being able to sleep through the night, waking up at 3 a.m. regularly, not being able to sleep on the weekends, not being able to really rest… which fried me even more after the fall and probably impeded my recovery terribly.

Anyway, to get back to the point of this post — in tracking the sources of my pain and finding out ways to deal with it, I have to look at the emotional aspects — the agitation and anxiety and fear pieces of the puzzle — and address them. When I address them, through deep breathing, monitoring and controlling my stress, and keeping myself relatively chilled out — or as chilled out as I can be — it helps me cut back on the pain. I also do things like cuss out people who make me angry, when I’m far from polite society — in the woods, or in my car (tho’ I have to be careful when I’m venting in my car)… write letters to the people who I feel have done me wrong, and then rip up the letters (never send them)… try to get more sleep, so I can deal with the physical issues that lead to the emotional ones that lead to the physical ones… and so on.

And I use the pain points on my hands to at least give myself a little immediate relief.

If you’re dealing with pain and you’re looking for ways to deal with it, I wish you the best of luck! Everyone is different, of course, but life is all about cause and effect. Even if what I use to cut my pain doesn’t work for you, if you engage in your own process and just keep trying, you may be able to find ways that you can use to address your own situation, and get more out of life, with each passing day.

Life can be wonderful, if we figure out how to let it be just that.

Medical Humanities has some interesting things to say

I came across this blog yesterday, and was encouraged to see someone talking about the latest reports out from the Institute of Medicine — one report about the length of residents hours at hospitals, and the other about the long-term effects of TBI in (Gulf War) veterans.

I’m glad there are other folks out there who are as interested as I am about these subjects. I know I’m not alone, but it often feels that way, give my limited range of motion.

What’s really exciting about the report about residents’ hours is that it puts out there in a very public way the shortcomings of an existing system. I have a relative who’s going through their residency right now, and I hear stories from them that sound like horrors — just the sleep deprivation alone makes me cringe. And expecting new doctors, who don’t have the wealth of experience behind them in their decision-making, to perform at peak on such little sleep… well, it troubles me. And it makes me want to avoid teaching hospitals with every fiber of my being.

It seems to me that one’s residency should be a time of over-rest, rather than under-rest. The brain needs rest and sustenance, when it’s dealing with a lot of input, stress, and new stimuli (even I know that)… so, why wouldn’t we do everything in our power to make sure our future doctors — whom we are entrusting with our lives and our futures — have ample access to hours off… and are not overloaded and/or receive extra help dealing with the additional stressors.

It strikes me that this might be a throwback to the practice of medicine during wartime — the Napoleonic Wars… the Civil War… when “modern” medicine (as I understand it) really got a foothold as an organized practice. It might be a relic of the times when a doctor had to be “on” at all hours because battle conditions required it. And there may be some elements of needing to prove oneself and one’s professional worth (again on the battlefield)… part of a primal sink-of-swim coming-of-age hazing process that cements the members of the profession in a special, unique, and exclusive club.

But these time-honored practices strike me as being closer akin to mind-control techniques used to break interrogants… using sleep deprivation to break down resistance to authority figures and make them more compliant (with the powers that govern the profession)… using trauma and compassion fatigue to reduce residents to walking profiles in PTSD, who are always on and are on constant alert, their limbic systems gradually frying and fusing, their amygdalas so overworked and overtaxed, that they cease to recognize anything that’s not AN EMERGENCY. I have had dealings with doctors who seemed like they were sleepwalking… only half present, when things were going okay… but who snapped into action and came alive when it was a life-and-death situation. One of them is one of the finest practitioners of their specialty, nationwide, and I would definitely want them in the ER, if I were ever there, teetering on the brink of oblivion. But when things are fine, and there isn’t an emergency, they practically fall asleep in front of you. That’s a little distressing, given that my life consists largely of non-emergencies… and I want to keep it that way.

Personally, I think the wartime medicine model leaves a lot to be desired. If doctors are conditioned to respond and function at peak only when there is an emergency, then what hope do we have of being able to live in a world of “boring” health and happiness? If our caregivers can respond effectively only when there is something horribly wrong, then it stands to reason that they can/will/must neglect the well-being of their charges, when things are going well… ultimately creating conditions that produce the circumstances that make them jump into action and charge forward… to aver the disaster that their inattention may have contributed to, in the first place.

Yes, it’s important to have doctors who can deal well with trauma. There are a lot of conditions in this world — even in relative safety — that resemble aspects of war, on some level. Serious car accidents… gang warfare… widespread domestic abuse and violent conflict. But what about practicing medicine in peacetime? What about dealing with patients who are NOT coming in from the battlefield and don’t need to be patched up quickly and sent back out? What about tending to the health of patients, instead of just managing their eventual deaths?

This is what excites me so much about the two reports from the IoM. They don’t only stand around wringing their hands — they make objective, well-researched observations and make substantive suggestions about what to do about it. They mirror my concerns about residents’ hours – and they do it with data and authority I either do not have or cannot convey. And they are pro-active. They don’t just talk about averting disaster. They talk about optimizing physician training and improving patient safety pro-actively. They don’t just say “Oh, how terrible that our vets get injured by blasts.” They don’t just dismiss “mild” TBI because there’s no penetrating wound. They really call out the long-term consequences of TBI in ways that make the data relevant not only to vets, but to others as well.

One example in particular, on pages 304-305 of the report on TBI talks about how job retention among soldiers who sustained TBI was worse among the older population, perhaps because the nature of their work involved more management and leadership — which can be more difficult to do, when your brain isn’t working quite like it used to. This is key for me, because I am in the over-34 age group, and my own job responsibilities tend to nudge me towards management and leadership positions, which I have instinctively avoided for years… without knowing quite why (until recently, when I started to realize the impact that my TBIs have had on me).

This is the kind of data that I can use personally, and I can refer others to, when they start to argue with me about what my instincts are telling me. See, I’m not wrong to be concerned about the potential impact that my impaired cognitive capacity may have on my job performance. I have difficulties communicating my experience verbally to others, and much that I do and experience is actually hidden behind a wall of socially acceptable practiced behavior (and if I do it right, nobody has any clue about my difficulties — that double-edged sword of high functionality). So, I get a lot of crap from people who try to “encourage” me to “get out of my comfort zone” without having any clue how disastrous that can truly be for me, given my limitations. But this report gives me peace of mind, that I’m not just shirking and slacking and avoiding being an adult. It recognizes that people like me, in my age group, have genuine issues taking on (and holding onto) jobs that require increased leadership/management responsibility.

Believe me, I don’t want to be underperforming. I want to push the envelope of my abilities as much as the next person — and as much as the people who love and care for me want to see me succeed and excel. But the impact of my TBIs cannot be understated. They may be mitigated, they may be compensated for. But they are still factors, and as a responsible adult, I need to be cognizant of the limits they may set on me and my abilities, so I don’t endanger the safety and well-being of others because of my cluelessness or my wanton drive to climb to the top.

I detest having these limits on me. But have them, I do. I hate struggling with things that others find easy, like engaging in conversation and maintaining my daily life. But I cannot escape the fact that I have to work a little (sometimes a lot) harder than I would like to. I cannot stand the thought that I am not fully aware of everything that’s wrong with me — especially in the moments that what’s wrong is keeping me from getting on with my life. But I can’t ignore the fact that I have holes in my memory and gaps in my knowledge that impair me in ways I don’t even know.

I just have to keep a level head, try to stay humble, and remember that no matter how irregularly my brain may be functioning, I still have a heart and a spirit and faith and love to guide me.

And I have access to reports from the Institute of Medicine that give me hope.

Links to stories on TBI and vets

Many consequences seen with traumatic brain injury
Reuters India, India – 45 minutes ago
WASHINGTON (Reuters) – Traumatic brain injury may lead to an increased risk of developing symptoms like those of Alzheimer’s disease, Parkinson’s disease

Battlefield brain injuries bring long-term problems: US report
CBC.ca, Canada – 2 hours ago
Military personnel who suffered traumatic brain injuries from explosions on the battlefields of Iraq and Afghanistan are at risk for long-term conditions

Traumatic Brain Injuries Linked to Long-Term Health Issues for
Washington Post, United States – 3 hours ago
By Amanda Gardner THURSDAY, Dec. 4 (HealthDay News) — A new report provides evidence linking traumatic brain injury sustained by troops in combat in Iraq

Combat Head Injuries Tied to Depression, Dementia (Update1)
Bloomberg – 3 hours ago
By Alex Nussbaum Dec. 4 (Bloomberg) — US soldiers who suffer battlefield head injuries face higher risks of depression, dementia and stress disorders,

Brain-injured troops face unclear long-term risks
The Associated Press – 3 hours ago
WASHINGTON (AP) — Many of the thousands of troops who suffered traumatic brain injuries in Iraq and Afghanistan are at risk of long-term health problems

Panel Urges More Screening of Brain Injury in Troops
New York Times, United States – 6 hours ago
By BENEDICT CAREY A long-awaited government report is calling on the military to test all its new recruits for cognitive skills and then do large-scale

Troops with brain injuries face long-term health risks
San Diego Union Tribune, CA – 6 hours ago
By Rick Rogers The good news is that US troops are surviving battlefield blasts and returning home in unprecedented numbers. The bad news is that thousands

Long-term consequences from brain injury
WFIE-TV, IN – 1 hour ago
(NBC) – Soldiers who survive an explosion may still have battles to fight later in life, according to a new report from the Institute of Medicine.

Report: Mild TBI linked to multiple ailments
ArmyTimes.com, VA – 3 hours ago
By Kelly Kennedy – Staff writer A review of about 2000 studies reveals that service members with mild traumatic brain injuries — or concussions — are more

Brain-injured troops face unclear long-term risks
KSWT-TV, AZ – 5 hours ago
AP – December 4, 2008 12:14 PM ET WASHINGTON (AP) – A report headed up by a University of California, San Francisco doctor says many of the troops who

IOM Cites Poor Preparedness for Brain Injuries of Iraq and
MedPage Today, NJ – 6 hours ago
By John Gever, Senior Editor, MedPage Today WASHINGTON, Dec. 4 — The dramatic increase in brain injuries suffered by soldiers in Iraq and Afghanistan,

NHCNE leads ground breaking cooperative conference on
The Dolphin, CT – 14 hours ago
NEWPORT, RI – Civilian and military medical care givers from New England gathered for a first of its kind, cooperation conference addressing Psychological

Troops suffering brain injury face myriad possible health problems
The Canadian Press – 6 hours ago
Traumatic brain injuries have become the signature wound of the wars in Afghanistan and Iraq and troops who sustain them face a daunting array of potential

Report sees long-term problems for troops who suffer traumatic
Los Angeles Times, CA – 6 hours ago
Even mild brain injuries appear to be associated with problems such as seizures, aggression and dementia reminiscent of Alzheimer’s disease, according to

Traumatic Brain Injuries Linked to Long-Term Health Issues for Iraq Vets

Good news on the tbi news front – the Washington Post is running news of a new report on soldiers with tbi.

The 400-page printed report is forthcoming and will cost about $70 to purchase. You can read the full report online for free (tho’ you have to page through, one page at a time) at: http://www.nap.edu/catalog.php?record_id=12436#toc

While I am really, really happy that national attention is being drawn to this, what worries me is the thought that many tbi surviving vets may get dropped by the wayside and/or be underserved, because people keep repeating that old mantra about “every brain injury is different” and use that as an excuse not to fully engage in helping these wounded warriors heal.

It’s true — every brain is different, and hence every brain injury is different. But that can all too easily stop folks (especially bureaucratically bound professionals) from drawing conclusions and taking steps and reaching out to suggest new solutions to problems we tbi survivors face… just because (they insist) we’re all apparently so different from each other.

From the article at the Washington Post:

“The real bottom line significant finding is that there’s not a good human literature on the kinds of neurotrauma seen in Iraq and Afghanistan caused by blasts,” said Dr. George W. Rutherford, vice chair of the department of epidemiology and biostatistics at the University of California, San Francisco, School of Medicine. “The human literature is really about people who’ve had [brain injury] from car crashes or falling down stairs and, in the military, from shrapnel or gunshots. We’re all worried that blast neurotrauma hasn’t really made it into the human literature.”

This makes it difficult, if not impossible, to anticipate and hopefully mitigate the long-term consequences of such injuries, added Rutherford, who chaired the committee that wrote the report.

So, does this mean… because there’s not blast-related neurotrauma literature in abundance, there should be a bottleneck on looking for solutions and treatments and preventions for military personnel?

Because our Iraq/Afghanistan vets’ injuries are from a different source (and presumedly more severe or at least more severely unique) than your “standard issue” assaults, abuse, car crashes, falling down stairs, shrapnel, or gunshots, does this disqualify them from the benefits of the experiences of countless individuals who have experienced and survived tbi — albeit in a different form and from a different source?

Because there isn’t “good human literature” that’s germane to neuroblast specialization, must that prevent us from doing what we can to help these folks?

It’s a chilling thought, that people who are already disadvantaged by an injury that other people cannot see (and which may be in fact hidden from them because of cognitive issues), may continue to be under-served, because they are not your “run-of-the-mill” tbi survivors.

While blast trauma (and the ability to survive blasts) is a relatively recent phenomenon, in relation to the thousands of years people have gone to war, gotten hit on the head, fallen, been smashed and bashed around, and generally sustained brain traumas, the fact remains that head trauma and brain injury are NOT new to the overall human experience. Where human literature is missing, we DO have human experience. After all, the human race is still here.

Surely, there MUST be a way to employ what we DO know about tbi, surviving it, and recovering from it, to assist the folks who are coming back from one war, only to enter another, once they are back home and trying to find their feet again.

How I deal with the source(s) of my temper issues

Over Thanksgiving, I was telling someone for the first time about my mTBIs, and they asked how I figured out it was a neurological thing, and not just me having a bad day.

I rattled off “cognitive problems” and “memory issues” and “tinnitus” and “constant headaches” as examples. One of the folks who was traveling with me, who has known me for nearly 20 years said, once and for all, “Rage — it was the rage.”

I was abashed to admit it then, and I still am, but it’s true. The sudden violent rages – the yelling, smashing things, going off on people, becoming infuriated over very minor things, rolling along at a full boil, completely unable to stop my downward plunge into the blackest and most aggressive of moods… It’s always been rough for everyone — myself and everyone around me — to weather my tirades. But dealing with the aftermath — mending the broken ties, or having to say goodbye to people I hurt beyond repair, or having to look people in the face after I’d roasted them over the blazing fire of my temper — the aftermath has been at times even harder and more trying to deal with, than the events, themselves.

I can identify a number of sources of my temper flares:

  1. Fatigue – not getting enough sleep makes me think slower, and when I’m not processing quickly enough, my frustration level goes up, while my ability to monitor and manage myself goes down.
  2. Not eating properly – being hungry makes me mad quicker, and eating junk food stresses my body and makes me even more volatile than usual.
  3. Being/feeling alone – I feel assailed and overwhelmed and put-upon, when I’m alone (either for real, or perceived)… I often feel like I can’t keep up, and I’m going to pay for it.
  4. Not preparing adequately for stresses that I know are coming down the pike – not only does this open me up to the increased stress of the unfamiliar, but I also tend to beat myself up for not being better prepared, which just throws gas on the fire of my temper.
  5. Self-recrimination/blame – being hard on myself makes me even more aggressive and short-tempered with others, while cutting myself some slack eases my attitude towards others.

Ironically (or perhaps not), what is best for others, is when I take care of myself. When I’m in a good place and I’m happy with who I am and my place in the world, I tend to go easy on others, have patience, do well. But when I’m hard on myself, everyone around me pays – big time.

So, I:

  1. Make a point of getting enough sleep. Sometimes I work from home, so I can nap mid-day.
  2. Plan my meals and eat well-rounded meals and avoid junk food like the plague it is. I also stay away from sugar, which whacks me out.
  3. Reach out for help, either by contacting a friend/relative, or going online and either researching or participating in forums to help others and get help.
  4. Plan my days and weeks and months ahead of time. I can’t tell the future, but I do know that if I’ve got a lot of appointments in one week, I’m likely to be more tired along the way, so I try to schedule in some down-time. If I’m traveling or visiting family, I try to prepare myself mentally and emotionally for the trips. And if I have a busy week coming up, I try to “choreograph” my time as best I can, so I can dance my way through, instead of bumbling about, bumping into everything that gets in my way.
  5. Go easy on myself, make lists of things I do right, make lists of things I’m grateful for, remember how far I’ve come and how much I’ve accomplished in my life. Even if some of the things don’t seem like big deals to others, they may be to me, so I try to claim every small victory I can.

TBI and temper often go hand-in-hand, but if I know my stressors and I am aware of how my life is shaping up, I can often head off problems at the pass.

Most of all, I try to keep an open heart and a clear head and seek to help others whenever I can. Seeing that others have troubles, too, and seeing that I can help them, not only makes me feel grateful for all I have and makes me grateful for what I can do, but it also gets me out of my head… which can be a very dangerous place to be trapped.

Traumatic Brain Injury Clinic at Elmendorf AFB gives hope to wounded troops

Air Force Live has info on the new TBI clinic at Elmendorf. Check it out!

From the post:

TBI has become one of the most common injuries suffered by our troops during the Global War on Terrorism, with estimates at around 320,000 men and women returning from deployment with some form of TBI.

The patients I see commonly experience headaches, dizziness, cognitive decline, irritability and mood swings, difficulty with concentration, and other symptoms. These are often intertwined with symptoms of post-traumatic stress disorder, which further complicates the picture.

Fortunately, most patients make a full recovery within 3-to-6 months of the injury. I have seen some patients take up to a year to recover, with approximately 15% never fully returning to their pre-injury baseline. The good news is that even in the most severe cases some degree of recovery almost always occurs.

It’s great to see more attention being drawn to this issue, and it’s great to see our armed services starting to rally around this important cause.

EEGs show brain differences between poor and rich kids

News from UC Berkeley highlights recent research that seems pretty important to me…

University of California, Berkeley, researchers have shown for the first time that the brains of low-income children function differently from the brains of high-income kids.

In a study recently accepted for publication by the Journal of Cognitive Neuroscience, scientists at UC Berkeley’s Helen Wills Neuroscience Institute and the School of Public Health report that normal 9- and 10-year-olds differing only in socioeconomic status have detectable differences in the response of their prefrontal cortex, the part of the brain that is critical for problem solving and creativity.

You can read the entire article here.

Personally, I’m not sure why this is so surprising to people. We’ve known for years that trauma causes changes to the brain — both chemically and cognitively and physically. And poverty contributes to trauma. Of course, there may be a chicken-or-the-egg connection — which comes first, the poverty or the impaired brain function? — but at least someone is getting tangible measurements about the interplay between socioeconomic status and cognitive functioning.

This puts a new spin on haves and have-nots.

Better today… of pain and ptsd

Well, I got to bed by 10:00 last night, and I was able to sleep through till 6:30 or so, which is an improvement over what I’d been able to do over the last weeks.

I’ve been kept up by anxiety over what my neuropsych evaluation is going to reveal — that’s coming up this week — me being terribly afraid that I had given wrong information or I just couldn’t think my way through certain things… I’ve been second-guessing myself for days and days, wondering if I answered as accurately as possible… of if maybe I’m more crazy than head-injured… or that my head injuries have led to some sort of mental illness that’s invisible to me because of my anosognosia… or maybe I’m just on this wild goose-chase that will end up being all for nothing.

I try to be level-headed and logical about this and remind myself that my neurpsych has been doing this for many years, and they have certainly seen worse cases than me. But still, not being able to be a full participant in the process and being a subject of examination and enquiry… well, that makes me uncomfortable, and even if I do trust the doctor. I just don’t know what to expect, and I cannot manage my wild rang of emotions, if I don’t know what I’m managing for.

Fortunately, I do feel better this a.m. — not so much pain, not so much tenderness. I got a bit of a massage yesterday p.m., and it really, really helped. Even if it was painful at times — I don’t care. Short-term pain for long-term benefits. I’ll take the pain in the short-term, if it will help me feel this much better in the a.m.

I still have discomfort when I move – especially in my hips and lower back. And my elbows are still sore. And my thighs are still tender. But I can push up my sleeves, so they’re not chafing my wrists, and my body isn’t screaming so loud I can’t hear myself think.

I tried the Arnica yesterday. i can’t say I noticed an immediate effect, but I’m going to keep trying it — 4 tablets dissolved under my tongue 4 times a day, for a few days. I’m going to take it again after I finish my cup of coffee. (I’ve heard that you have to be careful taking homeopathic remedies when you’re eating or drinking. It’s my understanding that the remedy needs to be the only think you can taste… or I could be wrong.) I’m not off caffeine entirely — that would be too much. But I am cutting back. I only had one cup yesterday, which I think helped me sleep.

This arnica experiment is definitely going to be totally screwed up by my other changes I’m making. In a “real” test, the only thing I would change would be taking the arnica, not getting more sleep or changing my diet or getting more exercise. But dude, I’m in pain, and I need it to stop, so I can get on with my life.

Thinking about the role that pain has played in my life, I think there’s a definite trauma aspect to it. I have friends who specialize in treating trauma, both in medical and psychological environments, and they talk a lot about it. They also love to tell me I’m a “trauma survivor” — having had a whole bunch of accidents that left me progressively more impaired, as the years went on, along with the social, interpersonal, and physical after-effects of my impairments that haven’t helped me get by in the world.

And since I have a history of trauma — physical, as well as psychological — I have to admit I do show signs of PTSD.

Over at Wikipedia — http://en.wikipedia.org/wiki/Posttraumatic_stress_disorder — I found this (note: my comments are in italics):

The diagnostic criteria for PTSD, per the Diagnostic and Statistical Manual of Mental Disorders IV (Text Revision) (DSM-IV-TR), may be summarized as:[1]

A. Exposure to a traumatic event – multiple head injuries over the years, along with other accidents and fights/clashes with people that threatened my safety
B. Persistent reexperience (e.g. flashbacks, nightmares) – I’ve had lots of them over the years… where do I begin?
C. Persistent avoidance of stimuli associated with the trauma (e.g. inability to talk about things even related to the experience, avoidance of things and discussions that trigger flashbacks and reexperiencing symptoms fear of losing control) – some things I just will not talk about… you can pump me for details till the cows come home, but I’m not talking about certain things that have happened to me, unless I can know that it’s not going to ruin my life, if I do
D. Persistent symptoms of increased arousal (e.g. difficulty falling or staying asleep, anger and hypervigilance) – well, yuh, I’ve had more restless nights and being jolted awake at 3 a.m. with my heart racing and my body soaked in sweat… than I care to think about
E. Duration of symptoms more than 1 month – try months and months… sometimes years later, after the initial event is over
F. Significant impairment in social, occupational, or other important areas of functioning (e.g. problems with work and relationships.) – just ask my friends, family, and co-workers… just ask my 17 former employers

Notably, criterion A (the “stressor”) consists of two parts, both of which must apply for a diagnosis of PTSD. The first (A1) requires that “the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others.” The second (A2) requires that “the person’s response involved intense fear, helplessness, or horror.” The DSM-IV-TR criterion differs substantially from the previous DSM-III-R stressor criterion, which specified the traumatic event should be of a type that would cause “significant symptoms of distress in almost anyone,” and that the event was “outside the range of usual human experience.” Since the introduction of DSM-IV, the number of possible PTSD traumas has increased and one study suggests that the increase is around 50%.[48] Various scales exist to measure the severity and frequency of PTSD symptoms.[49][50]

Now, this is all pretty thick stuff for me to get into. Personally, I don’t feel like I can take on much more to process, other than just dealing with my own pain… but I have to say, the pain is worse, when I’m feeling the after-effects of some past trauma. When I’m dealing with people who have really physically hurt me in the past — like adults who used to really knock me around — or I’m interacting with people whom I have hurt in the past because of my bad behavior and poor social integration.

When I think back on being a kid, I remember a lot of pain, both from internal sources and from without. My pain issues date back to fairly early childhood – I was not a very limber kid, and I had a lot of difficulty doing things that other kids could just do, like touching toes and climbing and jumping and doing cartwheels and such. I had a lot of trouble with my balance, and I couldn’t do a somersault until I was about 5 or 6. I can’t remember exactly how old I was, but I do remember the day I did my first “real” somersault — I didn’t fall off to the side, but was actually able to just roll right over and keep my balance. When I tried to stretch and extend, like other kids could, it was very painful for me. But I kept trying, and I just forced myself to stretch and extend… until the pain was too much, and I had to stop… which was usually far short of where I wanted to be.

I wanted so much to participate, to take part, to be a part of what was going on. I hated being on the outside, not able to do what other kids could as easily as they could, so I pushed myself — very hard. There was a lot of pain, but that was just the price I paid for being able to be a part of what was going on.

The other source of pain was from the outside. I was raised by parents who didn’t know how to relate to me. I tended to get over-stressed and over-extended with all the stimuli going on around me (including the pain), and they tended to discipline me. Grab me. Jerk me around. Take hold of my arms and pull me to where I was supposed to be. It was excruciating, and it was shocking. My memories of childhood are full of instances where my mom would grab me out of the blue — I wasn’t following what was going on, and I didn’t understand what she wanted me to do, so she would yell and/or grab me and pull/push me to where I was supposed to be. With my sensitivities, it was like just being pounded out of the blue, time and time again. I could never prepare for it, I could never brace for it. And I didn’t really “get” why it was happening, a lot of the time.

I wasn’t able to explain my “bad” behavior to them, and they didn’t seem much interested in finding out if I was having problems, or if I was just a bad kid who needed discipline. I think, because of their religious orientation and the role that my very religious grandparents had in our lives, they “went with” the religious explanation that I was a “sinner” and that “sin” or the “devil” had taken hold in my life, so I needed to be disciplined to stop my acting out.

So, they did. I got called a lot of names, when I was little, because I couldn’t keep up cognitively or physically — spaz, space cadet, bugger, doofus, spastic… that was my dad. My mom preferred to call me pathetic or disgusting or asinine (asinine was her favorite). I was actually shielded from their wrath a lot, because I didn’t understand till I was 7 or 8 or 9 (?) that they were actually talking to/about me. I thought they were just saying what they were saying into the blue. It didn’t occur to me, till I had been in school for a few years, and other kids were calling me names, that my mom and dad were calling me names, too.

Actually, come to think of it, it didn’t occur to me that my mom was calling me names, till a few years ago. Somehow, being mistreated by my mother is a lot harder to take than being mistreated by my dad.

Even when they showed affection, my family’s hugs and touches were extremely painful. My family — for whatever reason — loves to give big, hard hugs, and it hurts like crazy when they do! I don’t know what it is that makes them think it’s okay to just throw their arms around someone and squeeze so hard… or maybe they can’t really feel it, themselves, so they have to have hard hugs and forceful contact, to even tell someone is there. My grandparents were hard huggers, and my mom was/is, too. She loves to reach out and grab people as a sign of affection, which is a double-whammy — I don’t want to shut her out, but I cannot take the force of her contact. Just over Thanksgiving, she was walking by me, and she reached out and grabbed my arm as a sign of affection. And when I was getting ready to drive home, with the weather being as rainy as it was, she got scared for my safety and she just threw herself at me and hugged me really hard, which really hurt.

I still haven’t figured out how to tell people that when they touch me, sometimes it feels like they’re pounding on me. It’s embarrassing, it’s troubling, and I dread people knowing just how much pain they’ve caused me. Being in pain is bad enough, but then “spreading it around” by telling others about it — and telling them there’s nothing they can really do, but keep their distance — is just awful. I’ve done it before, and it’s awful. Awful to be pushed out to the margins. Awful to be forced to push people away. Awful to have to hold them at arm’s length and never let them close, without pain.

Thinking about growing up in constant pain, raised by people who repeatedly hurt me terribly, is definitely not easy to take. I have to tell myself my parents weren’t fully aware of the effect that their behavior was having on me, and that if they’d known what it was like for me when they grabbed me or hugged me, they would not have done it. I have to tell myself that they had no idea, that they were innocent. Believing that my parents would intentionally harm me, is more than I can process right now.

But it’s probably worsening my pain, to hold back from that belief. Now that I’ve been away from them for a whole day, I’m starting to relax, and I’m starting to be able to adddress my pain. I think when I was in the midst of it all, I was so shut down that even if I’d been in terrible pain — which I may have been — I wasn’t aware of it. I was up in my head. I was too busy talking. I was too busy trying to stay out of arm’s reach of both my parents.

I rarely notice until days after the fact, but when I am in the midst of family at holiday/Thanksgiving time, I hold as still as possible for long periods of time — both as an attempt to not draw attention to myself, and to keep myself from acting out when I get stressed. When I’m stressed, my brain stops working really fluidly, and I end up needing to take more time to explain myself. But when things are all wild and woolly, like at my parents’ place at Thanksgiving, I don’t have the time to fully explain myself, and I end up hurting people’s feelings from a poorly told joke, or an attempt to josh around with others, and then I start flashing back to all the other times I said/did things that people took the wrong way.

Yes, I hold very, very still during the holidays… both for my own protection and that of others.

And it probably doesn’t help my pain — because of my rigidity and my disconnection from my body.

And it doesn’t help my PTSD. Because I go back to that place where I’m on auto-pilot, where I’m just keeping my head down and keeping moving, where I’m just doing what’s in front of me, and not aware of whether or not I’m hungry or tired or anxious or stressed. And when I’m not aware, when I’m just soldiering through (as I do so well!), I tend to push myself even harder — do more stuff, take on more tasks, be more manic, be more forceful, be harder on myself and add more things to my to-do list — and that cuts in on my sleep, it cuts in on my rest, it cuts in on my physical well-being.

And I have pain. Lots of it. Tearing, ripping, screaming, shooting, chafing, burning, crazy-making pain.

So, in a way, the pain is like my barometer for how I’m doing, stress-wise. It tells me if old stuff is coming up that’s making me do things and make choices that aren’t healthy. It tells me if I’m falling back on old patterns, letting my fears and anxieties and old hurts stop me from living my life. It tells me if I’m tired — and it tells me that I’ve let myself get over-fatigued and ill-nourished.

It’s an objective measurement of how I’m doing psychologically and physically. And it gives me a great “excuse” (in my mind, when a simple reason won’t suffice) to step back and cut out all the shit I’ve got on my plate… focus in, take care of basics, talk over my issues with my therapist, and make sure I get plenty of rest. It tells me, loud and clear and in no uncertain terms, that I’m totally f’ed up, and I need to stop doing what I’ve been doing, and just take a break. Take care of myself. Have a long, hot shower. Take care of myself. Now.

Unless I do, I’m going to stay in pain. That’s just the way it is. And it’s my choice.

In a way, pain is my friend — but only because it’s my mortal enemy.

When they think your TBI is PTSD

I just checked my blog stats, and somebody came over to this site while Googling for info on soldiers and PTSD.

I want to quickly put in a word for military folks who are seeking help for post-combat/deployment issues, who may be headed down the PTSD treatment road, but may miss TBI treatment in the process.

I started professional counseling about six months ago for “coping issues” that I couldn’t get my head around. Everything in life had just gotten so difficult, and I couldn’t understand why I kept running into dead ends with jobs and relationships and why I couldn’t seem to advance in life. All my peers have “moved on” and “grown up” — many of them now with grandkids and advanced careers, long-term homeownership, and all the accoutrements of adult life… while I languished in a no-man’s-land of false starts, scattered ideas, and a long line of failed or aborted attempts at living a normal life.

Now, don’t get me wrong — on the surface, my life looks like it’s highly advanced. I’ve got a great home, a wonderful marriage, and two cars in the garage. My resume looks fabulous, and I’ve got a lot of respect from folks. But my external circumstances don’t match my internal state… and they haven’t for a long time. Nobody really knows just how deep the self-doubt, anxiety, self-criticism, abysmally low self-esteem, and constant invisible struggle really goes.

Except me. And I don’t breathe a word of it to anyone. Not if I can help it.

So, when my health and career and personal life all started to tank in a very big way, this past year, I sought professional help. The counselor I found is highly experienced, compassionate, insightful, kind, caring, and very adept at what they do. But I found myself over time feeling as though they were looking for some sort of horrific trauma in my past that would cause me to lose big chunks of my memory, be uncertain around people, and erode my emotional and behavioral (and cognitive) foundation.

I got the distinct impression they were looking for emotional trauma. Abuse. Neglect. Some sort of terrible thing(s) others did/do to me that cause me to have PTSD. Or some life-threatening event that brought on PTSD.

We had talked about post-traumatic stress a good deal, and both of us accepted that it could have a part in my difficulties. But no matter how closely I looked at my life, I couldn’t for the life of me find THE Event(s) that had wrecked me for “normal” life.

It just didn’t make any sense to me. And when I dug deep and did my own research and realized that sustaining a traumatic brain injury at the age of 8 (and possibly other times), as well as another TBI three years ago, did actually fill in a huge, gaping missing piece of the puzzle.

It’s not that my counselor was incapable or incompetent. They were just looking for the wrong thing in the wrong place. They’re a wonderful resource for me, and I really value their input, but in the case of TBI, I had to come up with my own diagnosis.

This article was very helpful:

Concerns grow about war veterans’ misdiagnoses – Brain injuries can defy easy detection” – I passed it along to my counselor, and they found it very helpful… as well as a bit disconcerting.

And the blog “A Soldier’s Mind” has some more info.

If you’re in the same boat I am/was, you may need to do your own research & preliminary diagnosis, too. After all, TBI tends to make it very difficult for people to tell what’s going on inside our heads — and it can make it tough for us to figure that out, too. Doing research online is a great way to make a start.

I’m finding that TBI is not particularly well-known in the psychotherapeutic community — I have a bunch of friends and associates who are therapists, and when I’ve talked about TBI, I’ve gotten blank stares. That’s not entirely their fault. They aren’t always trained to look for physical ailments, which are the domain of medical doctors. If anything, they’re taught to look away, in terms of medical issues — liability issues, I suppose. Unfortunately, there seem to be a lot of highly trained individuals who simply don’t have the kind of physiological orientation that treats cognitive-behavioral symptoms as possible neuro-physiological phenomena. They are accustomed to looking at emotionally traumatic life experiences as the root of PTSD problems. They’re looking for the right thing… but they’re looking in the wrong place.

I really want to devote a fair amount of time and energy on this site to explaining to psychotherapeutic professionals the personal realities of living with TBI, as it relates to trauma. There are different aspects of the condition that both mask post-traumatic stress and exacerbate it. TBI adds another wrinkle to the whole scene that complicates matters and requires greater sensitivity to our situation.

When I informed my counselor about my TBI, they seemed a bit concerned that I wouldn’t need their help anymore… or that I’d terminate my sessions with them. They seemed to think that TBI work would replace the cognitive-behavioral work I was doing with them. But in fact, the TBI aspect makes it even more important to do cognitive-behavioral counseling. It doesn’t make counselors superfluous. If anything, it makes them all the more essential.

Other posts about PTSD:

Better today… of pain and ptsd

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