NEWS FLASH: Brain injury in high-def with fiber tracking

Amazing – this could be the break we’ve been looking for, in getting people to take TBI/concussion seriously.

U. PITTSBURGH (US) — New imaging technology will allow doctors to clearly see for the first time neural connections broken by traumatic brain injury.

High definition fiber tracking reveals loss of fibers, or connections, on the injured right side (yellow) and the intact, undamaged left side (green). The patient was injured in an ATV accident and lost function in his left leg, arm, and hand. (Credit: Walt Schneider Laboratory)

“Until now, we have had no objective way of identifying how the injury damaged the patient’s brain tissue, predicting how the patient would fare, or planning rehabilitation to maximize the recovery.”

HDFT might be able to provide those answers, says co-senior author Walter Schneider, professor of psychology, who led the team that developed the technology.

Data from sophisticated MRI scanners is processed through computer algorithms to reveal the wiring of the brain in vivid detail and to pinpoint breaks in the cables, called fiber tracts. Each tract contains millions of neuronal connections.

“In our experiments, HDFT has been able to identify disruptions in neural pathways with a clarity that no other method can see,” Schneider says. “With it, we can virtually dissect 40 major fiber tracts in the brain to find damaged areas and quantify the proportion of fibers lost relative to the uninjured side of the brain or to the brains of healthy individuals. Now, we can clearly see breaks and identify which parts of the brain have lost connections.”

http://www.futurity.org/top-stories/brain-injury-in-high-def-with-fiber-tracking/

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The benefits of ignoring bad advice – part 2

I ran out of steam the other night before I could really go into the benefits of ignoring bad advice – medical and otherwise. But that’s good. I’m paying attention to my energy levels, and I went to bed earlier last night than I have done in months. I’m still tired, but at least I got some rest.

Anyway, when I think about bad advice, I’m probably a poster child for ignoring it. Not – mind you – because I just don’t feel like doing what others tell me to, but because I usually do exactly as others tell me, and then I find out all too quickly that they’re full of sh*t and I have to change my direction… or else. I’m willing to try just about anything, especially when it’s suggested by a qualified professional. I guess it’s just my luck that the things they suggest are often the worst possible things I could do – and I have to find out the hard way that they’re completely wrong in my case.

Take, for example, the years I spent in excruciating, crippling pain, about 20 years ago. I suddenly started having terrible pain in my joints. It truly sucked. I also had a small patch of rough skin on my face that got dark. I went to a doctor, and they told me they needed to do some tests. So, they did their tests, and they came back with a diagnosis that was a very serious, relatively unknown ailment that people didn’t know much about at the time. They told me that was the reason for the rash and the pain, and I should see another specialist to help me figure out this serious situation.

Long story short, I spent the next several years not only in excruciating pain, but also living a life that was just a shadow of what I could have been living. I went to plenty of specialists and followed their advice, was compliant with their orders… and my condition just got worse and worse and worse. Until finally I did something that was not in keeping with their instructions – I went outside and got some exercise. And I stretched. And the next day I felt remarkably better. I continued to get exercise, changed the shoes I was wearing from hard soles to soft, and I stretched. I also quit smoking and started eating better. And wonder of wonders, the pain abated.

I can’t say it’s gone away entirely, and some days it’s back with a vengeance, but I’m not living in constant debilitating pain, day in and day out, anymore.

And I seriously question if their diagnosis was correct to begin with.

Now I realize that there are some situations where you should definitely NOT disobey your doctor’s orders. But if you’ve followed their instructions and things just aren’t getting better, you owe it to yourself to try something different.

Likewise with work (or, should I say, over-work?) My current job, I see now — after a frenetic year — is a setup for overwork. The two people I report to are on opposite ends of the spectrum, and their boss is out in a completely different spectrum, period. They either want EVERYTHING DONE RIGHT NOW, or they just don’t care if/when things get done. If I follow either of their leads, I’m toast. Seriously. Even though one reports to the other, they don’t seem to have any interest in behaving as though there is a chain of command. It’s odd. Why would they complicate things like that? Chains of command make some things — like getting work done — so much easier. I guess it’s a case of the person in charge not wanting to be the heavy… or maybe the subordinate person threatened to quit, and they know where bodies are buried, so they have to be placated. Or maybe everyone is just weak? Who knows. Probably the latter. Ocam’s razor strikes again.

Anyway, enough about them. I just have to follow my own lead, do what I feel is best, and trust that I know myself and my habits well enough to manage them properly. Of course, there’s always the chance of my “issues” showing up and getting in the way, but that’s nothing new. I just need to be aware of that and manage it.

But whatever I choose, in all things, I need to take care of myself. Make sure I get sufficient rest and exercise. Eat right. Don’t bombard my body with sugar and cheap carbs, and make sure I get away from the work, on a regular basis. Step outside. Get some fresh air. Stretch the gunk out of my bones and muscles. Do what makes me feel good and strong and keeps me going.

Just keep going. Take care of myself. Be smart. Keep going. So long as I do that, I have nothing to lose.

What if we all just… WERE?

Source: http://www.myspace.com/psychiatrypsucks

I had an interesting conversation with some acquaintances a few days back. For some reason, I ended up sitting at a table with a couple of folks who were lugging around diagnoses of ADD, like so much luggage they had to schlepp around an airport, in perpetual search of a flight that kept changing gates.

One of them embraced their ADD diagnosis with forced gusto, essentially turning the baggage into heavy Luis Vuitton satchels with special locks on all the latches. They proudly proclaimed that they were a “ready-shoot-aim” kind of person, who took things as they came… and proceeded to also comment that for all the balls they have in the air at any given time, they didn’t actually get much done.

Another of them sat silently as we discussed distractability and attention issues and what it’s like to live in today’s world. Not to be dragged down by any ADD/ADHD diagnostic belaborment, I proposed the idea that in today’s world, with all the things that are constantly thrown at us… if we have any interest at all in life, and if we are really invested in what happens to us and the world around us, we darned well sure are going to get “distracted” on a pretty regular basis.

I mean, if you give a damn about what’s going on around you, and if you have a deep and abiding interest in your surroundings, and your surroundings change and evolve, how can you not pay attention to shifting things?

“If you’re really, really alive,” I proposed, “you’re going to be prone to be distracted.”

The one with the “expensive luggage” just looked at me.

The quiet one got up and gave me the biggest hug I’ve gotten in a long time.

I think the quiet one would agree with me, when I loudly agree with Peter Breggin, who says “psychiatric diagnosing is a kind of spiritual profiling that can destroy lives and frequently does.

Check out his piece — it’s a wonderful read.

Yet more thoughts on TBI and mental illness

This morning (6/9/9), I took a gander at the ways people have been finding their ways to this blog since I first started it over a year ago.

  • 38 people got here by looking for info about TBI/brains and anger/rage
  • 86 got here just searching on tbi
  • 156 got here by searching for info on interviewing
  • 39 people got here by searching for brain info
  • 225 people found their ways here by searching on tbi and mental illness

Apparently, it’s something people are concerned about.

And so am I.

I’m worried. Really, really worried. Because this society seems all too eager to label people “mentally ill” when they really have logistical problems — it’s not necessarily that they aren’t thinking properly, ’cause of some inner psychological conflict going on — it’s that they can’t think properly, ’cause their brains have been rattled or somehow impacted.

And our society seems all too eager to prescribe medicines for psychological conditions — meds which may actually exacerbate the issues at hand.

For instance, as I understand it, the irritability and temper flares that come with TBI are often due to a “constant inner restlessness” that takes up residence in your head after a brain injury. That constant restlessness can be directly related to something called “tonic arousal” which (as I understand it) has to do with how awake your brain is. After TBI, certain functions slow down — processing slows down, connections that were once intact are now broken, so it takes the brain longer to sort things out. And with that slowness comes a decrease in tonic arousal… which also can lead to attention difficulties… which can feed into all sorts of problems that can make you nuts and drive you to distraction.

TBI >>> less tonic arousal >>> increased irritability >>> more meltdowns, rage, blow-ups, etc.

Now, let’s say some doctor or psychiatrist gets hold of a TBI survivor and diagnoses them with some anxiety-related condition, or some other “psychological” dysfunction. Let’s say the attending caretaker prescribes one of those “downregulators” that slows down the processes that can feed into manic/anxiety type experiences. What do you get when you downregulate someone who’s already struggling to keep up? Decreased tonic arousal. Which can mean more irritability, more temper flares, more rage, more meltdowns… possibly increased violent acting out? Maybe?

Downregulating meds >>> even less tonic arousal >>> even more increased irritability >>> more and more and more meltdowns, rage, blow-ups, etc.

I’m not a doctor, but I don’t think you need to be one, to get this connection. Maybe not being a doctor helps you see it all the clearer, without the long-term effects of that sleep-deprived-traumatized-resident fog that lots of docs get hammered by when they first start practicing.

This really worries me — had I mentioned that?

And given how many people sustain TBIs each year, not to mention how many vets are returning from Iraq and Afghanistan with TBI’s and PTSD, etc., it really opens the door to a lot of crappy medicine and pain for the families and friends of the folks who have given their very brains in service to this country.

I think the only thing we can hope to do is educate people — not so much the doctors, because how many of them are listening? It’s about educating “the people” — the patients who look high and low for help (if they ever figure out that they need — and can get) help. Making sure people have access to truthful and accurate and independent information — and giving them easy and useful ways to wield that info as they defend themselves from the quacks of the world, not to mention Big Pharma.

Ultimately, it is up to each and every one of us to fend for ourselves, but a little help would be nice, now and then…

Prepping for my neuro visit tomorrow

I’ve got another neuro visit tomorrow — this one is finally a substantial one, when I’ll actually be reviewing the results of my MRI and my EEG. It’s been about a month since I got my MRI, and it’s been nearly 3 weeks since my EEG, and the suspense has been really intense at times.

In my more dramatic moments, part of me thinks, “Today is the last ‘normal’ day/week of my life.” And I get all worked up, thinking that these test results might come back with terrible news or some sign of a horrible condition/disease/tumor/whatever that will sideline me permanently — or at least turn my life into one big detour.

I worry that I won’t be fully functional anymore. That I’ll have to invest all this extra time and energy in overcoming a real issue that I’ve blissfully ignored for a long time. That I’ll be officially disabled. That I’ll be “less than human” and have to live a second-rate life as a result of what the pictures of my brain show.

I also worry that they won’t find anything at all… that I’ll turn out to be crazy and people will look at me like I’m just looking for attention… making things up… malingering… defrauding professional service providers.

Worst of all, I think, would be getting inconclusive results that will waylay my energy and keep me pre-occupied trying to track down the root cause of stuff that’s been getting in my way for a long time, but I’ve been able to brush off and minimize until the past year or so.

I’d almost rather get no results than inconclusive ones. But whatever happens, happens. And I’ll just deal with whatever comes up. I always do.

This waiting around for test results is really exhausting. Especially since I never got any medical attention for any of my multiple TBI’s, and I don’t have a lot of reliable medical records describing my symptoms and issues in medical jargon-y detail. I’ve never been able to articulate my issues to doctors with any level of accuracy, and most of the time, I’ve just given up and said, “Oh, forget it — it’s not that bad, really…” and went off to lick my wounds where I was safe and warm and able to tend to myself and my problems on my own terms.

I swear, this cognitive-challenge/communication-difficulty stuff just makes me nuts. I have a hell of a time articulating my issues out loud to doctors, who are all too often looking for medical data and/or some Latin-based vocabulary in order to properly assess my situation. I don’t know Latin, and I don’t have medical records that show evidence of my injuries. All I have is my life experience and a muddled, garbled mish-mash of out-loud observations that don’t come across right, when I’m talking to someone who doesn’t know me personally (and even if they do, can’t for the life of them imagine that I’ve actually been injured). Absent concrete data, I’m out of luck… so, I’ve been largely resigned over the years to just being out of luck.

Oh, well… what’s next? Life is waiting…

But tomorrow, I will actually be having a discussion with a doctor about real, honest-to-goodness medical test results. Imagine that. I am really looking forward to it. I’m looking forward to it so much that I’ve been studying up on MRI’s and EEG’s and learning to recognize what they show.

I found a couple of great sites for learning about them — with plenty of pictures, which I desperately need.

There’s the section on Electroencephalography and Evoked Potentials followed by their Electroencephalography Atlas over at Medline. I have been studying the page on Normal Awake EEG
so I know what I’m looking at, when the doctor shows me what’s going on with me. I’m studying the normal EEG, as well as other types, so I can tell the difference — if there is any — between what my EEG looks like and what a normal one would look like.

Normal Awake EEG - A 10-second segment showing a well-formed and well-regulated alpha rhythm at 9 Hz.

Normal Awake EEG : A 10-second segment showing a well-formed and well-regulated alpha rhythm at 9 Hz.

I’ve also been studying MRI’s over at Harvard’s Whole Brain Atlas, which shows what a normal MRI looks like — with the different slices — so that when I look at my own MRI, I can see if/how it differs from how it “should” look.

The Whole Brain Atlas

They have MRI slices from different scenarios —

  • Normal Brain
  • Cerebrovascular Disease (stroke or “brain attack”)
  • Neoplastic Disease (brain tumor)
  • Degenerative Disease
  • Inflammatory or Infectious Disease

And you can look at the slices from different angles, which is way cool!

I’ve been studying the normal brain MRI slices, so I am better able to understand what — if anything — is wrong with my gourd.

Now, on a wireless or dialup connection, the images load a little slowly, but on broadband/cable modem, they’re speedy.

Okay, so I know I’m a bit of a nerd/geek, but this just fascinates me. I’m also studying EEG electrode placement patterns, so when I look at my own EEG, if there is any abnormal activity, I can see what area of my brain it takes place in.

Electrodes are placed on 10-20 different areas of the scalp, and they’re lettered/numbered by position. F means Frontal Lobe, T means Temporal Lobe, O means Occipital Lobe, P means Parietal Lobe, and combinations of them mean the electrodes are getting data from more than one lobe. The numbers are odd on the left side of the head and are even on the right side. Here’s an image I’ve been studying:

eeg electrode placement - click to enlarge

I think it’s fascinating. And I have a lot to learn. I think I’ll get myself a balloon and blow it up, then write all the electrode numbers on the balloon with a permanent marker, so I have a 3D version of the placement to take with me to the doctor. I’ll let the air out of the balloon, so I can take it with me easily and then blow it up at the doctor’s office so I can see what’s up, when they start talking about the different readings of my brain.

Of course, this may be moot, if my EEG comes back perfectly normal, but in case it doesn’t, I would like to understand where/how/why things are ‘off’ with me… what it means… and if/how any of my prior TBIs have specifically impacted certain parts of my brain.

This stuff just fascinates me. It’s a lot to take in, and it can actually be pretty serious, but for now I’m going to entertain myself… not to mention distract myself from all the different scenarios my broken brain is coming up with.

Sometimes the inside of my head is a scary place to be.

TBI and Mental Illness

I found an interesting post over at Lawyers Attorneys: Brain Injury and Schizophrenia: How to Deal

For victims of a traumatic brain injury (TBI) and their families, side effects such as bipolar disorder and memory loss are tragic, but well known and well understood. But in the last decades, scientists have begun to study another serious side effect of brain damage that may go undetected: schizophrenia.

What is Schizophrenia?

Schizophrenia (Greek for “shattered mind”) is a psychotic disorder that affects behavior, mood and thinking. The term was originally coined as “the schizophrenias” because of the wide variety of symptoms characterizing the condition. A misperception that all schizophrenics hear voices is actually untrue. It is a symptom in some suffering from schizophrenia but not all. Psychologists break symptoms of schizophrenia into three categories:

. Positive symptoms are behaviors that are not present in normal individuals. Other symptoms include hearing things, delusional though as well as sporadic thought.

. Negative symptoms are symptoms showing loss of normal abilities. They include loss of ability to show or feel emotion, lack of motivation and trouble with speaking.

. Neurocognitive defects are problems with brain function in areas such as memory, problem-solving, attention and social functioning.

Schizophrenia Related to Brain Injury in Patients

Scientists have established that psychiatric conditions such as bipolar and anxiety disorders are more common in patients who have suffered from traumatic brain injuries. Schizophrenia itself has been associated with individuals who have previously suffered brain damage regardless of family history. But it is only since the early 1990s that researchers have begun to explore in depth that connection between brain damage caused by traumatic brain injury and schizophrenia.

Schizophrenia and Brain Injury: Recent Studies

. Among the findings of those studies:

. TBI-associated schizophrenia is true schizophrenia, not another disorder with similar symptoms, according to a 2001 study by Columbia University. Schizophrenia and TBI are now being associated as hand-in-hand illnesses, one usually occurs in the victim of the other.

. Another study in the same year at the University of New South Wales in Australia discovered that TBI patients with schizophrenia-like psychosis had more widespread brain damage and cognitive impairment than TBI patients without psychosis. It also suggested that a family history of schizophrenia and the severity of the brain damage sustained during TBI increased the risk of schizophrenia.

. Scientists at the Hawaii State Hospital found in 2002 that it took an average of four to five years after a traumatic brain injury for psychosis to manifest, with most cases arriving within two years. Psychosis may be the result of trauma and blunt force to temporal and frontal lobes, for which researchers are attempting to determine.

While the complex nature of schizophrenia makes its cause unclear, as the last study suggests, there is evidence to believe that brain injury directly causes schizophrenia, by damaging the areas of the brain that control higher functions. There is also evidence that a traumatic brain injury may cause psychosis indirectly. Scientists believe that schizophrenia is caused by a combination of genetic susceptibility to the disease and an emotionally or physically traumatic experience that triggers this susceptibility. Researchers are finding that TBI and the trauma that can occur can actually trigger schizophrenia.

Many physicians know a traumatic brain injur may cause neurocognitive disorders such as trouble with speech, and psychiatric problems like bipolar disorder, but not all are aware of the growing evidence linking schizophrenia with brain damage. It is imperative that after a TBI accident, that a victim consult a psychiatrist to ensure that they return to normal behavior. In addition, brain injury patients and their families should consult an experienced brain injury attorney as they seek to recover costs for expenses such as lost wages, current medical costs and future medical care.

A couple of things came to mind when I read this:

  • Okay, so does it mean I’m going to lose my mind, because I sustained a TBI? Am I headed for a psychotic break?
  • If head-injured folks are given proper treatment, rest, nutrition, and time to heal after their injury, will that help prevent a later development of mental illness?
  • How is that these symptoms are ascribed to schizophrenia:

. Positive symptoms are behaviors that are not present in normal individuals. Other symptoms include hearing things, delusional though as well as sporadic thought.

. Negative symptoms are symptoms showing loss of normal abilities. They include loss of ability to show or feel emotion, lack of motivation and trouble with speaking.

. Neurocognitive defects are problems with brain function in areas such as memory, problem-solving, attention and social functioning.

I don’t know nearly enough about schizophrenia, but it seems to me that calling a neuro-physical condition a psychological one not only makes it difficult to properly diagnose, but also makes it difficult, even dangerous, to treat. Approaching an actual physical condition (or a neurological one) with a psychological approach might actually do more harm than good — convincing the specialist and the patient that there’s something wrong with them rather than something wrong with their bodily system.

Might this not actually make matters worse? I think psychotherapists and psychiatrists really need to think this through — familiarize themselves with TBI and its effects and realize what neuro-physical issues might truly come up along the way that mask themselves as psychological issues, and realize that they might be barking up the wrong tree.

Misdiagnosing TBI as schizophrenia or some other psychological disorder is dangerous, not only for the patient but also for the clinician, and it makes both parties chase the wrong ghosts. Not good for anyone involved.

(Note: I have more thoughts on this at this post – More thoughts on Brain Injury and Mental Illness)

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