A million little hits

Source: photolib.noaa.go

Somebody needs to do a study on the cumulative biochemical impact of constantly finding out you screwed up. I’m serious about this – especially for new mTBI survivors. And long-term survivors, as well.

See, here’s the thing – stress impacts thinking. Cortisol mucks with your thought process. Stress hormones block out complex reasoning abilities, in favor of pure fight-flight-freeze reactions. And the long-term effects of high levels of stress hormones do have a cognitive impact.

So, after you sustain a TBI, and you’re in that initial phase of cluelessness, where you are so positive that you’re fine and everyone else is screwed up… and you keep undertaking things that seem perfectly reasonable to you, but aren’t exactly good ideas… and you keep bumping up against your new limitations (I won’t say “newfound” because it takes a while to find them)… all the while, you’re getting hit with these little “micro-blasts” of stress. The plans you make don’t work out. The relationships you depend on start to erode. Your behavior becomes not only mysteriously different, but also uncontrollable and unmanageable, and every time you turn around, something else is getting screwed up. You weren’t expecting it at all. It’s a shock — to your self and to your system.

Lots of false starts, lots of botched attempts, lots of pissed off people… and all the while, the cumulative effect of your body’s stress response to these “micro-traumas” is building up. The really messed-up thing is, that when you’re freshly injured, the experiences you have can take on vast proportions, and every little thing can seem like a monumental event. Which makes your reaction to them that much more extreme — a lot more stress hormones get released into your system that might otherwise, if you had a sense of perspective that was proportional to the actual events of your life.

But no, when you’re freshly injured, EVERYTHING can seem like a

Big Deal.

Of course, you have no reason to clear out the biochemical sludge with something like exercise or mindfulness meditation or anything like that, because either your brain is telling you that it’s much more pleasant to sit around and watch television, and/or you’re so exhausted from the stresses of daily living that making additional efforts or changes is out of the question, and/or you’ve got a lot of pain, and/or you don’t have access to the equipment or a support system or good guidance for how to start with something like that.

You’re off in your own private Idaho — no, wait, your own private hell — of watching your life fall apart for no reason that you or anyone else can discern.

After all, it was just a little bump on the head, right?

People have been puzzling for some time about the connection between TBI and PTSD, as though they are two entirely different and distinct conditions. I can tell you from personal experience that traumatic brain injury, even mild head injury, can and does result in post-traumatic stress disorder. Because even though the build-up of stress hormones is gradual and incremental, it still happens. And unless and until you figure out a way to clear out the biochemical sludge of one alarming stress response (no matter how small) after another, you’re going to have a heck of a time clearing your mind to the degree you need to clear it.

Being a mild traumatic brain injury survivor (I’m actually thriving, not just surviving), and having experienced what my neuropsych has called a “phenomenal” recovery, I can personally attest to the importance of exercise and good nutrition in helping the brain recover. I can’t even begin to tell you how “gunked up” I was, when I first showed up for my neuropsych testing. I was a wreck. Just a walking series of screw-ups waiting to happen. I bounced from job to job, just dropped out of a couple, made really bad choices about my money and my career and my home and my relationship, and to those who were watching, I was indeed teetering on the brink.

Now, I’ve been extraordinarily blessed to have connected with a neuropsych who firmly believes (after 25 years of working in TBI rehabilitation and 30 years in neuroscience) that recovery is possible, even probable, and that there is hope of some kind for even the most intractable cases. But even they weren’t expecting me to do as well as I have.

Especially in the last year, I’ve made some pretty great progress, and it coincides with my starting to exercise each morning. I don’t do a lot, most days — just get my heart rate up for 15-20 minutes, then stretch, then do some light strengthening exercises. The main thing is that I get my heart and respiration rates up, and that I jump-start my system. This is something that anyone can do — and you don’t need special equipment to do it. We all have bodies, and most of us are able to exercise them enough to get our heart rate and breathing up.

This is key. I can’t say it enough — to help clear out the buildup of stress hormones in the body which can impair thinking and make the aftermath of an mTBI even more challenging than it is already, exercise helps like nothing else.

What’s more, it oxygenates the brain and it stimulates the parts of the brain that learn and heal. How amazing is that? Very, very cool. Even after a long period of difficulty, as the folks at the Concussion  Clinic at the University at Buffalo have found, regular exercise can clear away “stuck” difficulties of post-concussive syndrome. One of their study participants even got back to a way of being that was better than he was before his six concussions or so — according to his mother.

Why does this work? How does it work? There are lots of possible explanations, but at the core — for me — it’s about giving your body the ability to deal with the constant onslaught of surprise and alarm and reaction to situations which emerge (often blindsiding you) in situations where you thought you were fine. For me, it’s very much about giving your body the ability to return to balance, to homeostasis, so it can just get on with living life. It’s about clearing out the cortisol, the adrenaline, the noradrenaline, and the handful of other biochemical substances that our brains normally secrete in order to help us deal with emergencies. Humans don’t have the same ability as animals, to clear this stuff out. Rabbits and antelope will shiver violently and shake and run around to clear out their biochemical “load”, but humans just end up hanging onto it, for better or for worse.

But, you may say, having things turn out differently than you expected isn’t such a big deal. Why would that be so stressful?

Trust me, when you’ve sunk a whole lot of time and effort into something and your self-image and survival (i.e., job) depend on things going the way you planned… and then things turn out to be screwed up in a way you hadn’t anticipated, and everyone is all worked up and pissed off and gunning for you ’cause you wrecked things (again), it does produce an extreme reaction. Especially in someone who has to contend with the extreme emotions and volatility, uncontrollable anger, rage, inexplicable confusion, and all that crazy anxiety and agitation that go hand-in-hand with traumatic brain injury. Even folks with “mild” injuries have these kinds of issues, and it can exacerbate and compound matters to no end.

Ultimately, if it builds up enough (and let’s not forget the embarrassment and shame and confusion that can be socially isolating), it can all become utterly debilitating. Disabling. And all because our  bodies haven’t had a chance to recover adequately from all these little incremental alarms, shocks, and other reasons to get pumped full of adrenaline and cortisol.

So, it’s important to not gloss over the effect of those million little hits. Inside our bodies and inside our minds, they do add up. And as our bodies accumulate the sludge of fight-flight-freeze, our minds are affected. Fortunately, there is a way to deal with it — exercise. Vigorous to a degree that gets your heart and respiration rate up.

Don’t have access to a gym? So what? Take the stairs instead of the elevator. Don’t have a set of weights? Big deal. Carry around some heavy stuff in your home. Don’t have an exercise bike? Do some knee bends, jumping jacks, and run in place. Swing your arms around. Stretch and move. Just get going — enough to get your heart rate up and create a noticeable difference in your body.

Now, I’m not saying it can fix things overnight. It’s taken me a year of consistent effort and commitment to get to this point, and when I started out, it was about the last thing I wanted to “have” to do each morning. But I wasn’t making the kind of headway I wanted to in my recovery, and the doctors were starting to talk about putting me on meds for my attention and mood issues. Given the choice between pharmacopia and 15 minutes of exercise each morning, I went with the latter. I’ve done the drug thing before, and it just made my life that much worse. I can’t go back there again. I just can’t.

So, I started getting my butt out of bed, and am I ever glad I did. I’ve read about biochemical stresses and PTSD in the past, and I’ve read about how animals can clear out the “soup” but humans can’t. But until I started exercising and got clearer as a result, the full impact of what I’d read didn’t sink in.

Now it’s sunk in, and it makes total sense. TBI can very much lead to PTSD — by right of the constant barrage of surprise and alarm and shock (not to mention our tendency to over-react to the unexpected or unfortunate events in our lives) which bombards us with stress hormones that don’t automatically clear themselves out of our sensitive systems. Given that TBI survivors’ systems tend to be even more sensitive after our injuries, it’s all the more reason to get up and get moving.

If you’re still sitting down while reading this, please get up off your butt and move. Your brain — and your life — will thank you for it.

The biochemistry of beginning

Source: nasa1fan/MSFC

I’ve been giving a lot of thought, lately, to my suboptimal tendency to procrastinate. I think “procrastinate” is actually a euphemism — I don’t just put things off. I simply don’t do them.  I know there are things I need to get done. I know I need to do them. I know I need to do them sooner, rather than later.

I just don’t.

Until much later. When it’s almost too late. Then, on the verge of calamity, I throw myself into a full-on drive to make it happen. And I do. It’s very exciting, and when I’m done, it’s very gratifying. But it’s exhausting. And it’s no way to live.

Case in point:

I have a number of things I need to do on a weekly/monthly basis:

  • Bag up the trash and take it to the transfer station.
  • Mow the lawn.
  • Order meds for my pet when they are running low, so they don’t get violently ill.
  • Pay certain bills, so the utilities stay on and I can still talk on my cell phone.
  • Etc.

My life is no different from others’ in these respects. Some things just need to be done, and nobody else is going to do it for me. I know I need to do these things. I understand the importance of doing them. Yet, week after week and month after month, I consistently don’t do them. It makes no logical sense. It’s counter-productive and problematic, and I each week/month I promise myself I’m going to do things differently the next time.

But I don’t. Once again I let things slide. The phone gets turned off. The pet needs to go on half-doses till the next order comes in. The trash sits in the garage, piled up in the garbage cans waiting for me to haul it away. And the lawn gets wild and high all over again.

Etc.

Then, when all seems just about lost, I kick into high gear, I set about doing the things I’m supposed to, and I do them extremely well, extremely efficiently, and with an ease that belies my days/weeks of procrastination and makes me look like a jerk/loser/slacker for not having just done it all up front, when things were still relatively normal.

I’ve spent a ton of time feeling bad about this tendency to allow myself to drift into the danger zone, trying to “whip myself into shape” and failing all over again. Not understanding why, not fathoming why I slack so terribly, when I know full well that I need to do this stuff, and I am perfectly capable of doing it. Does this, in fact, make me a total loser? Some might say yes, and I often agree.

But I’ve been giving this a lot of thought, lately, stepping back from the self-recrimination and agitation and anger (from myself and my spouse). And I think I’ve figured out why it is that A) I don’t do things right away, and B) why I can do all those things so very well, when I finally kick into gear.

Essentially, for me, it seems to boil down to an issue of Tonic Arousal

Tonic arousal refers to relatively slow changes of base-level arousal. For example, the daily cycle of sleep and wakefulness represent changes of tonic arousal. Stimulants (such as caffeine) or depressants (such as alcohol) also produce notable changes in tonic arousal — changes that may last several hours. The most important factor affecting tonic arousal is the diurnal cycle of wakefulness and sleep.

Tonic arousal is your general level of wakefulness. It affects attention, learning, and level of irritability. And it’s affected by sleep disruptions. Also, it’s very commonly affected by TBI. It’s related to brain stem formation and its connection to the frontal lobes, and given that the brain stem is so frequently damaged in TBI, tonic arousal issues often go hand-in-hand with head injury.

Now, there’s another aspect of arousal, called Phasic Arousal, which is defined as: “those transient states of arousal that are stimulated by significant environmental or internal events.” It’s that charge that you get out of something novel or something pressing, an alert or an alarm of some kind. If our lives are exciting (or even normal) we all go in and out of phasic arousal at least several times a day.

I (and many other people) tend to use phasic arousal to offset the dull effect of chronically low tonic arousal. We seek out excitement to perk ourselves up. We watch shows and videos that “bring us to life” with phasic arousal and get us out of our doldrums. We drink coffee and other concentrated caffeine drinks, we eat lots of “cheap” carbs and sweets, that get us going.

In addition to this, alarm coming from problems that emerge in my life can also have the same effect as a strong cup of coffee or an apple turnover. The sudden rush of stress hormones (as one of my friends once said) “is fun!” It feels good to be immediately alert and engaged. It feels good to be sharp. It also feels wonderful to have all that extraneous crap blocked out, and to be totally focused on only the main THREAT at hand. Being suddenly on alert over something I completely forgot to do, 10 minutes before the deadlines, brings me back “online” in a way that no caffeine or carbohydrate can.

That gets me started. It gets me to begin what I need to begin. It gets me to begin what I needed to have begun two weeks ago, but “never got around to it.” It overrides my procrastination, my anxiety, my fears, my phobias, and sets me in motion. When it works well, it puts me on the fast-track to success. Of course, it can also send me hurtling head-first into a great cosmic face-plant in the snowy slopes of life. But at least it gets me jump-started.

After giving this a lot of thought, and examining my behavior over the course of my lifetime (especially over the past years), I’ve come to the conclusion that I use the alarm states created by procrastination to perk myself up and get going on things that need to be done. Essentially, I use procrastination and the stress hormone biochemical cascade from the relative dangers of me not doing important tasks in a timely manner, to wake myself up and raise my overall arousal level.

It’s not very healthy, overall, but it works. And it works to my detriment, as often as not.

Below is a picture of what I tend to do. The red line represents the level I’d like to be at, to really feel like “myself” and be at my peak best (which I really need to feel like a real human being).  The brown line at the bottom represents my tonic arousal, or my general level of wakefulness and arousal. The blue line in the middle represents my phasic arousal — the intermittent, transient level of wakefulness and arousal that I experience in response to specific events/stimuli.

Here’s how this works:

I start out with a task (shown in the boring gray stars). My overall tonic arousal (shown at the bottom in brown)  is low, blah, and I’m just not feeling like doing much of anything. I’m not feeling very good about myself… not feeling like I’m “me”.

But stuff needs to get done. And all of a sudden, there’s an alarm(!) (shown in the yellow bursts) when I realize that if I don’t get going, I’m screwed. Body goes on alert. Stress hormones start to pump. And I kick into gear. My phasic arousal jumps way up, to about where I’d like to be all the time. All of a sudden, extraneous distractions like hunger and thirst and irritations from the neighbor’s barking dog are blocked out, and I’m fully focused on the task at hand. I’m ON, and I feel like myself, I feel capable, I feel competent. I feel human.

And I get the job done. Sometimes in record time.

However, after the alarm has passed, my phasic arousal starts to drop again, and I end up down where my basic tonic arousal is. Bummer. Eventually, another task shows up, which I don’t respond to very well, because my tonic and phasic arousal levels are way down.  I might also be pretty tired from the burst of energy — or, worse, my sleeping schedule might be totally hosed by my burst, and my overall arousal is lower than it could be.

Ack! It’s terrible. I feel awful. I feel blah. I don’t feel like myself. I feel boring and drab and useless. Until another crisis comes along. Then I feel great – energized, and useful and needed.

But the crisis takes it out of me, and I end up down again, before very long. Plus, the people around me who depend on me to be steady and consistent and reliable are starting to get a little peeved with me. If this happens enough, even if I eventually get my work/tasks/jobs done, the drama and delays and uncertainty that others feel at my erratic behavior takes a toll on my working (and living) relationships.

And so it goes… The rollercoaster of drama-fed effectiveness. It’s not the most efficient way of doing things, though it’s effective according to some criteria. People get tired of me not being as steady as I once was. And I find myself having to make up for past infractions on a regular basis – which is in itself a source of stress and focusing biochemical “pump”. Again, it helps focus me, but not forever. It wears me — and others — out. Worse-case, I set myself up for an anxiety attack or a full-blown panic attack. My autonomic nervous system can only take so much.

Like I said, it’s not rare for people to do this. Tons of people do it, according to my neuropsych. In fact, if you look around, you can probably find thousands of examples on large scales and small, of how people use this strategy — TBI or no. (I believe that PTSD sufferers and trauma survivors may be prone to this “strategy” since prolonged effects of trauma tend to dampen down the nervous system.)

But it’s no way to live. I need to do better. I want to do better.

Now that I’ve figured this out, I need to figure out a way to work around this. It’s no good for me to be on this perpetual roller coaster of drama/doldrums. It’s way too exhausting, and I don’t want to do it anymore. I need to develop tools to spot the danger zone ahead of time, before it starts to take too much out of me. I need to train myself to develop habits that keep me healthy and off that roller-coaster.

My primary purpose, these days, is twofold:

  1. Identify times and places where I am dull and low and not getting started on things, and I’m in danger of falling back on the “cheap” high of crisis to get me through life, and
  2. Find ways to avoid/address those scenarios in a proactive, productive way.

I need to watch out for the following things:

  • Being over-tired. That screws with your tonic arousal, especially. And when I am over-tired, I am even more prone to push myself and over-do my activity levels, just to feel human.
  • Dodging tasks without thinking about them, because I’m not taking the time to consider what I’m doing and why. Avoiding tasks for no apparent reason is a great way to get myself into trouble and get totally backed up — and stressed.
  • Diving head-first into things without stopping to think about them first. This is a great way to mess things up, and introduce even more phasic-arousal-producing “energy” that sends me up to a high, yes, but ultimately throws me even more out of whack.

And once I’ve identified these problem areas, I can do the following:

  • Get some sleep. Get to bed earlier than usual. And keep myself from staying up so late. If I’m overtired in the middle of the day on the weekends, I can stop doing what I’m doing and take a break. Or I can step away from what I’m doing, do some conscious relaxing for 15 minutes or so.
  • Stop and think about what I’m not doing — and why. I find that when I take a long look at what I’m avoiding, I can get past the unconscious avoidance tendency. A lot of times, I run away from doing things just because I don’t feel like I have the energy to do them.
  • Get some energy. For real. Going for a brisk walk, doing some jumping jacks, or even some stretching, often does wonders for me. A small cup of coffee can help, too, but I have to be careful I don’t drink it too late in the day (never after 3 p.m.), or it will screw up my sleep schedule.
  • Steer clear of cheap and easy energy. Stay away from the vending machine at work. Stay away from the snacks and treats and cheap carbs that spike my energy, but then let me down terribly afterwards.
  • Stop and think about what I’m about to do. Pause for a moment to make sure it makes sense. And be open to the idea of not doing it at all. Not everything I feel compelled to do — like go to the library and check out more books before I’ve finished reading the ones I already have — makes sense. I have to really check myself at times, and when I do, I rarely regret it.

It’s all a process of course. It’s a never-ending exploration of what works and what doesn’t. I keep learning, all the time, about my limits and capabilities, which can be as discouraging as it is encouraging. The important thing is that I don’t quit, that I don’t give up on myself, and that I keep refining my approach.

It’s also important that I understand there is a physiological/neurological basis for these kinds of behaviors, and what I’m doing is actually an ingenious short-term solution for potentially debilitating levels of low tonic arousal. It’s not a character defect or a sign that there is something desperately wrong with me. Ultimately, it’s me trying to take care of myself and feel like a real person again. But I have to understand the limitations of the overall approach, and use it judiciously so I don’t overtax my system and do more harm than good.

Obviously, nobody’s perfect. But if I keep paying attention to myself, I can teach myself to be more effective at being the person I am meant to be.

Connections between pain and PTSD

The past couple of weeks have been crazy for me, and it’s taken somewhat of a toll. I’ve been busy with work, busy with other activities, busy, busy, and more busy. I also did some traveling for about a week to out-of-state relatives, for a big family get-together. In and of itself, it was a great time. But the change in my schedule, the long hours of driving — over 30 hours, all told, in the car — not being able to get enough sleep, and the change in food choices (how do they eat that stuff?) all threw me off, big-time.

I managed to keep it together and not completely blow-out/melt down during the trip, or immediately afterwards, which often happens when I travel to this particular branch of the family tree. But the past few weeks have been packed full of crazy-busy-ness that I now realize has been a pretty concerted effort to dull the pain of the trip.

I’m not talking about emotional pain… though it’s never easy to spend time as an outsider, when everyone else is connecting and having a wonderful time being together — I’m the oddest bird in the family, and between my difficulties in keeping up with what’s going on around me and my narrow and intense interests that aren’t run-of-the-mill, people often don’t know what to do with me.

What I’m talking about is physical pain.

Yes, physical pain — the kind that burns, that aches, that throbs, that stings. The kind that makes my clothing hurt me, that rakes my legs when my pants rub against them… the kind that makes me jump whenever someone touches me… the kind that sends a shock wave of smacking ache to the marrow of my bones when my spouse puts their hand on my forearm… the kind that keeps me from sleeping, because I can’t stand the feel of sheets on me, but I also can’t stand the feel of air-conditioning blowing across my skin… the kind htat gets worse when I am stressed or tired or upset or all of the above… the kind that I often don’t even know is there until someone makes contact with me, and I jump, and they feel like they’ve done something to hurt me. They have. They didn’t mean to, and they would never do it on purpose. But they hurt me.

It’s not just the emotional pain of family visits that gest me. It’s the physical pain, as well.

Here’s the deal — for as long as I can remember, I have had issues with a whole slew of sensory problems, the most disruptive of which was body-wide pain. I can remember, ever since I was a little kid, feeling like I was being hit, when people would just reach out to touch me in very innocent, social, appropriate ways. I would shrink back from them, and they would often take offense or get angry with me for “rejecting” them. It sorta kinda messes with your head, when the people who love you the most cause you intense pain when they try to show their affection for you. And it tends to muck up your relationship with them, when you can’t accept their (appropriate) affection, but they don’t understand why.

To tell the truth, I didn’t even understand why. It’s hard to explain, unless you’ve been there, but the experience of painful touch is such a visceral, physical thing, it sometimes doesn’t translate into words. It’s just there. You can’t describe it, you can’t even really pinpoint it. Sometimes you have no idea it’s there, until someone makes contact with you. Then, all you know is, it hurts, and you pull away to avoid it, so you can just get on with your life.

And you do things to avoid/mitigate it. You steer clear of expressive people. You avoid demonstrative friends. You always keep more than arms’ length away from other people, just in case they reach out to you. You spend time with people who either don’t like you or couldn’t care less about you, because the chances of them touching you is small to none — and it’s easier to be around those types of people, than the friendly ones who like to make contact.

These things are done on a subconscious, instinctive level, and sometimes they don’t even register with you when you’re doing them. Like pulling away from people when they come close. Like shrinking back from a hug someone is trying to give you. Like jerking away quickly when someone touches you accidentally.

And depending on how sudden or shocking the pain is, it can trigger a whole cascade of other sensations/symptoms/reactions that look a whole lot like PTSD.

Over at Helpguide.org, I found this list of symptoms

Re-experiencing the traumatic event

  • Intrusive, upsetting memories of the event — memories of past painful contact tend to show up suddenly
  • Flashbacks (acting or feeling like the event is happening again) — yes, it does feel like it’s happening all over again
  • Nightmares (either of the event or of other frightening things) — sometimes nightmares do follow an extremely painful episode, tho’ that’s rare
  • Feelings of intense distress when reminded of the trauma — yes, it is intensely distressing to be reminded of it, it just sends me in a downward spiral
  • Intense physical reactions to reminders of the event (e.g. pounding heart, rapid breathing, nausea, muscle tension, sweating) — my heart sometimes starts pounding, I tense up, and I feel sick to my stomach, when people touch me, sometimes

PTSD symptoms of avoidance and emotional numbing

  • Avoiding activities, places, thoughts, or feelings that remind you of the trauma — I tend to avoid physical human contact of any kind; women frighten me, because they tend to be so tactile, and it’s literally too painful at times, to interact with them
  • Inability to remember important aspects of the trauma — I tend to block out the particulars of painful experiences. All I know is, it’s hurt me before, like it’s doing now
  • Loss of interest in activities and life in general — Why should I get involved, if it’s just going to hurt like the dickens?
  • Feeling detached from others and emotionally numb — Oh, yes… ’nuff said.
  • Sense of a limited future (you don’t expect to live a normal life span, get married, have a career) — how precisely am I supposed to live fully, if the experience of basic human interactions promises me pain?

PTSD symptoms of increased arousal

  • Difficulty falling or staying asleep — could have something to do with my insomnia?
  • Irritability or outbursts of anger — yet one more contributing factor
  • Difficulty concentrating — it’s tough to concentrate, when you’re on high alert. Especially if you’re working with tactile people.
  • Hypervigilance (on constant “red alert”) — someone might be approaching…
  • Feeling jumpy and easily startled — but of course

Other common symptoms of post-traumatic stress disorder

  • Anger and irritability — not being able to establish comfortable human contact makes me nuts and pisses me off
  • Guilt, shame, or self-blame — why can’t I just be normal like everyone else and tolerate a hand on my shoulder?
  • Substance abuse — been there. Thank heavens that’s behind me.
  • Depression and hopelessness — my occasional visitors
  • Suicidal thoughts and feelings — once upon a time, occasional visitors. Now, very rarely.
  • Feeling alienated and alone — not just feeling… BEING alienated and alone
  • Feelings of mistrust and betrayal — it’s hard to not feel that way, when everyone around you might possibly cause you pain
  • Headaches, stomach problems, chest pain — the first two, yes. The third, not so much

So there we have it — PTSD arising from chronic body-wide pain. Painful touch. There’s even a word for it — Allodynia (meaning “other pain”) — a painful response to a usually non-painful (innocuous) stimulus. I haven’t been formally diagnosed. That would require that I talk about it to my doctor. And talking about it out loud to anyone has never really been an option for me, except for with my last therapist who is long gone by now. It’s just too painful. Emotionally and physically.

I’d rather keep my own counsel and just live my life. Pain-free. Alone, but pain-free.

Being alone not only keeps me out of arms’ reach (literally) from people who may hurt me, but it also keeps emotional upheaval at a minimum. It’s hard to get worked into a state, when you don’t have much contact with people who affect you emotionally. I can block out all the politics and social drama pretty well. But the emotional connections I have with people… well, they’re trickier. So, I steer clear of them, by and large. And I steer clear of emotionally charged subjects with people — like avoiding talking about my chronic pain issues with my doctor.

It’s wild, how emotional distress can heighten physical pain. Emotional pain sets off an alarm state with me, and that alarm state unleases a whole avalanche of stress hormones and hypersensitive biochemical agents into my system. And the buildup of all the stuff that gets “stuck” in my system does not help me. Not one bit.

Over at Healthjourneys.com, Belleruth Naparstek quotes from her book Invisible Heroes and describes it well:

Chronic Pain Conditions
This constant activation of the alarm state leads to an accumulation of metabolic waste products in the muscle fibers, and the release of kinins and other chemical pain generators in the tissue, resulting in myofascial pain and the appearance of those seemingly intractable chronic conditions such as fibromyalgia, chronic fatigue, irritable bowel syndrome, chronic headache, TMJ and more.

And because these conditions are generated in the brain stem and the motor reflex centers in the spinal column, and routed through a perturbed, automatic, arousal circuitry, peripheral forms of treatment provide only temporary relief.  Constantly activated by everyday sensory cues, normal muscle movement and spontaneous memories, symptoms grow and become more and more entrenched over time.  In other words, this is one nasty gift from the kindled feedback loop that, if not interrupted, will just keep on giving.

Our epidemiology research has already shown us an astounding percentage of people with baffling chronic pain conditions and “functional” diseases that have no obvious causes, who have been found to have prior histories of severe trauma.  Probably if we could tease out the subset of traumatized people who experienced substantial dissociation during their trauma, and a truncated freeze response in the midst of it, we might find closer to one hundred percent suffering from posttraumatic stress.  Unfortunately for them, they are often assumed to be malingering or engaged in attention-seeking behavior for neurotic reasons, instead of suffering from a very serious, self perpetuating condition with a potentially worsening trajectory.

Included in this group of maligned and misunderstood patients would be scores of people suffering from pelvic and low back pain, orofacial and myofascial pain, genito-urinary and abdominal pain; interstitial cystitis; and the previously mentioned headache, fibromyalgia (FM), chronic fatigue syndrome (CFS), and reflex sympathetic dystrophy (RSD); irritable bowel syndrome (IBS), inflammatory bowel disorder (IBD), multiple chemical sensitivity (MCS) and migraine.

And there it is — in part, anyway. The post over at Belleruth Naparstek’s blog asks Is There a Connection Between Fibromyalgia and Traumatic Stress? but it’s not just about Fibro, to me. It’s about the “and more” she mentions. It’s about the “whole lot more”.

So, what the hell can I do about this? I’m of the mind that the best reason to talk about anything difficult, is to figure out what to do about it to make it better. To reduce the quotient of human suffering in the world. That includes my suffering (I’m in the world, after all). What can I do about this pain business?

Well, first, I need to get back on my schedule. I need to get back to my sleeping routine, which I’ve been doing pretty well with. I need to get back to eating the right kinds of foods at the right times of day — and I’ve been doing that pretty well, too. I also need to exercise and do other things that will enable me to discharge some of the built-up stress from the trip. I tried explaining to my new therapist how disruptive that sort of travel is to me, but they didn’t seem to “get” the intensity of it, so I’m not getting much support there. Screw it. I’ll support myself. I’ve been having a lot of good long cries, in the privacy of my own company, over the past few days, and that seems to be helping me. I also need to get back to my regular work schedule and just get some stuff done. Being productive has a way of chilling me out nicely, so I’ll do that.

And drink plenty of water. Take some Advil before I go to sleep. Listen to the Healing Trauma CD from Belleruth Naparstek to deal with the PTSD. Have a good cry. And another. And another. And make sure I let loose in my own company, away from others who neither understand nor want to understand just how hard things are for me… and end up minimizing and negating and invalidating my feelings about what I really go through, and tell me I’m fine and I don’t have a problem and I shouldn’t worry about this stuff,  just because they either don’t have the emotional resources to hang with me, or they’d be too traumatized, themselves, if they knew what it’s really like to live in this body.

Most of all, I need to keep it simple. Count my blessings. Remember just much good there is, along with the bad. And remember, tomorrow is another day, and all things considered, I’m pretty lucky to be alive.